By Gina DiPietro, Novant Health Healthy Headlines
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Women are having children later than previous generations, but that won’t deter a family member – or total stranger – from asking, “So, when are you going to have kids?”
Maybe you’re trying to get pregnant, haven’t found “the one” or have other goals you’d like to accomplish first.
Financial reasons rank among the top reasons Americans are delaying parenthood, according to a national study of women who want kids eventually. Of those surveyed, more than half wanted more money in savings or a higher salary before starting a family. Many others said they were prioritizing more time for travel.
Dr. Joseph Stringfellow
Women should feel empowered to wait until they’re ready. In many ways, the thinking on having children later has shifted along with people’s behavior, said Dr. Joseph Stringfellow, an ob-gyn at Novant Health City Lake OB/GYN – Thomasville.
But if you’d like to get pregnant one day – is there anything you should do now? And what options exist for women who still aren’t sure? Here are the basics of babies after 35.
How does age impact fertility?
A woman is born with all the eggs she will have in her lifetime. With age, eggs begin to gradually decline in number and quality, said Dr. Tom Valaoras of Novant Health Valaoras & Lewis OB/GYN in Winston-Salem.
“This decline begins to accelerate around age 35 to 40, but it’s not a definitive rule. There is a hereditary component to fertility, as well,” Valaoras said. “I don’t really get too concerned until around 40. But with patients in their early 30s who are asking, ‘When should we try to conceive?’ I’ll say, ‘When you’re ready emotionally and economically, but as you get past 35, it could be harder to conceive.”
Dr. Thomas Valaoras
Older pregnant women also have a higher risk for preeclampsia – high blood pressure and protein in the urine during pregnancy – gestational diabetes and hypertension as a result of their age.
“We tend to observe them more closely during pregnancy,” Valaoras said. “We do fetal monitoring. In the third trimester, we do it twice a week. And then, we typically try to deliver those patients by their due date.”
Waiting to have children can also increase the chances of having a pregnancy with a genetic abnormality, he added, such as Down syndrome.
“There’s also a greater risk of miscarriage,” Valaoras said. “The underlying risk for younger women is 10 to 20%, but it can go up to upwards of 40 or 50% for women who are older.”
35 isn’t a “magic number”
Since the quantity and quality of eggs begins to decrease around 35, it’s considered a milestone in women’s fertility. In health care, the phrase “advanced maternal age” is often used.
If you’re thinking, “I’m 34. That’s it. I only have one year left, and that’s it for me,” Stringfellow said you’re not alone. But that’s simply not the case.
“It’s not like you turn 35 and there’s a quick, rapid progression in loss of fertility. It’s more complex than naming a specific age threshold,” he said. “Historically, academic bodies began to assign that ‘advanced’ language since there are changes in a person’s physiology around that age. Yes, those changes can impact how easy or difficult it might be to conceive, but it’s not always that simple or universally applicable.”
The bottom line: There’s no magic number. Most healthy women who get pregnant after 35 and even into their 40s can have healthy babies.
“As obstetricians and gynecologists, we are more aware of how to care for these pregnancies,” Stringfellow said. “And they’re not as high risk as we once thought. So, there is a biological clock, so to speak, but it’s not as demanding as people may think.”
He continued, “So there’s no need to rush. Creating a deadline for yourself can create added stress, which could actually be more harmful to a pregnancy than waiting until you’re comfortable.”
Small steps to take now
In the meantime, women can focus on optimizing their health before (or during) pregnancy. “The things that help a person have a healthy pregnancy are the same things that keep us healthy generally,” Stringfellow said.
He suggested:
1. Diet and exercise. Exercise regularly and eat a healthy, diverse diet that is rich in nutrients.
2. Take folic acid. Proper vitamin supplementation makes the biggest difference as we get older, Stringfellow said, and that’s especially true with folic acid. He encourages all women to add a folic acid supplement to their daily routine.
“Folic acid is important for all pregnancies, but even more important for women who are waiting later to have kids as it can help prevent neurological disorders or developmental problems,” he said.
3. Reduce stress. Whether it’s physical or psychological, Stringfellow said stress can impact reproductive health on a number of different levels.
“That’s not to say it will prolong your fertile years, but can it improve your chances of having a healthy pregnancy? I’d say so,” he said.
4. Have the ‘right’ pieces in place. In an ideal world, any woman who plans on having children will have the resources they need, Stringfellow said. “That’s not to say that everyone needs the same resources, or that they have to be a certain income level or anything, but make sure you have a support system with people you trust.”
“I think it’s also important for women to know that options exist, especially if they’re at an age where that might pose some challenges,” he added.
Consider a fertility workup
Freezing eggs is one way to preserve the number and quality of eggs that you currently have. Doctors may recommend a fertility workup first.
“If a patient is concerned about her fertility, we might start with an evaluation – a fertility workup – and find out about ovarian function and how regular her menstrual cycles are,” Valaoras said.
The basic workup involves a complete medical history and can involve blood work, he said. If a spouse or male partner is involved, it can also involve a semen analysis.
It may also include an HSG (hysterosalpingography) test, which is an X-ray test involving injected dye that outlines the shape of the uterus and shows if the fallopian tubes are open or blocked. “If you suspect endometriosis (an often-painful condition in which the uterine lining grows outside the uterus), we might pursue that,” Valaoras said.
If your ob-gyn hasn’t approached the conversation, patients are encouraged to ask for one.
“We can’t accurately predict how many years of fertility someone has left, but a fertility workup will help us understand how active someone’s ovarian reserve is,” Stringfellow said. “For people who are on the lower end, that’s OK. It gives us more information to determine what someone’s next steps might be.”
Preserving your eggs
The next step might be freezing eggs. If that’s the case, your ob-gyn can refer you to a specialist. Valaoras gave the hypothetical example of a 38-year-old single woman who’s pretty sure she wants to have a child at some point. She may or may not have a spouse or partner at that future date, but freezing her eggs now is sort of an insurance policy.
In a case like this, Valaoras typically makes a referral to a fertility specialist.
“So, if that same patient gets to be 42 and decides she’s ready, we retrieve those frozen eggs,” he said. “And those aren’t 42-year-old eggs. They’re the age the woman was when they were first frozen. Further, we can do genetic testing on those eggs to find out which are the ‘good ones’ and which aren’t.”
Benefits to waiting
Some studies will tell you there are benefits to waiting. Take this one, which found women who have children after age 33 are more likely to live longer.
“As to why, it’s not entirely clear, but I think it comes down to better mental health,” Stringfellow said. “People who wait may be more likely to be in a stable relationship, have a better support system or less stress. They’re also more likely to be financially stable, so all of that likely contributes to better health from a psychological standpoint.”
“The studies are really interesting,” he added. “And maybe they can even alleviate some concerns about waiting too long. Just know your ob-gyn is always there to listen, offer support and help you weigh your options.”
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