This is Part II in a Special TBTAM Post Series. Links to the next post in the series are at then end of this post.
In my recent post “How to Get Pregnant” I compared the reproductive workings of the female body to Windows Explorer. However, I neglected to tell you that there is no fix for the Year 35 Bug. The biological time clock that begins to ring softly at 35, scream loudly at 40, and like a wind-up alarm, grind to a halt somewhere around 45.
Now, I see two kinds of women in my practice – those who hear the alarm and those who hear it, but turn on the snooze button. The former are, more often than not, single, and the latter, married. Interesting paradox, isn’t it? Needless to say, I handle each group of women a little differently.
The married woman with all the time in the world
I for one am not going to try to talk anyone into having kids who doesn’t want them. But most of my married patients know that they want a family, and the majority of these are blithely going about their childless existence as if they have forever. As their gynecologist, I feel it is my duty to make sure that they understand the facts as I know them, as opposed to their own vague notions, and advise that they consider these facts as they plan their families. (This is in contrast to their mothers, who just want those grandbabies.)
First, I ask them to do the math with me, considering how many children they wish to have and when they want to start. (You would be surprised how many women think that between the ages of 35 and 40, they can get pregnant, carry to term, and breast feed 3 children spaced 2 years apart.)
Then, I sit them down and show them the data.
I find that visually representing it conveys the message best. And that message is, simply – you don’t have as much time as you think. Because, like it or not, female fertility declines with age, as a result of decreased number of eggs from the ovary. Additionally, the incidence of miscarriage increases with age, because older eggs are more likely to divide abnormally.
That’s it. The visuals speak for themselves. I give them a copy to take home and share with their husband. (Poor guy – He has no idea what he is in for tonight when he walks through the door…)
I tell them the bottom line is this: If you and your partner are sure you want to have a family, then the younger you are, the better your odds of conceiving. If you have other factors that might impact fertility (fibroids, endometriosis, menstrual irregularities), don’t add older age into the mix. Start as soon as you are ready and able.
I sometimes tell them my own story. That I began my marriage unsure as to whether I even wanted children. That I began my family at 35 and had my second child at 40. And that my biggest regret is that I am now too old to have a third.
More than one patient has become pregnant within the year after this discussion. But most simply take the information into consideration, which is all that I really want them to do. Their lives are their own, after all. And I am not their mother.
The Single Female who knows better
Now, I am not cruel. I do not show the graphs above to my single patient who is over 35 and with no current prospects, and who is concerned about whether she will ever have children of her own. These women do not need me to rub their faces in their predicament.
With them, I take exactly the opposite approach. (It’s all in the spin, you see…) I tell them that at age 35, the odds are still with them. I tell them that I had no trouble getting pregnant at 35, and again at 40 (although I did have one miscarriage in between), and that they should not give up hope of having their own children.
I also talk to them about oocyte freezing (still considered experimental, but now available in New York), and about freezing embryos if they are willing to use donor sperm and are unwilling to risk an experimental procedure. Some may wish to consider single parenting, and these I refer to support groups like Single Mothers by Choice. None of these is an easy choice, and I do my darned best to be non-directive, non-judgemental and supportive to these women.
What I really want to do is find them a nice man to settle down with. I admit, I have set up at least one patient – it didn’t work. Maybe I should hook up with a sports medicine doc, and we could run a dating service out of our offices…
The Lesbian (You thought I’d forgotten about you, didn’t you?)
Lesbian women have the same wake-up time as straight women. However, in this one area they have a few more options. Of course, they always need a sperm donor. But that means that freezing embryos may not be as big an issue for them. And here’s the best part – If they are lucky enough to have a partner who is younger, they can just ignore the alarm, roll over in bed, and say “Honey – It’s up to you. I’m sleeping in”.
If you want more information about age and fertility, you can order this this this booklet from the American Society for Reproductive Medicine. They also have this booklet about assisted reproductive technologies.
Category: Second Opinions
From Ro: Or you can do what I did…marry a man with four children! No morning sickness or stretch marks!
If I could only find a man worth settling down with. Humph.
Ouch, did this ever hit home. Tick tock, tick tock…
my clock stopped too early. Wish somebody tested my hormones when I first started complaining of 2- and 3- months delays. Maybe then I still ovulated ocasionally and could do artificial insemination. Then maybe not. Felt bitter and angry about it for a while – enough to lash out in some angry post on the internet (without names, of course, I was angry with the whole practice of NOT testing hormones of women with menstrual problems, not with a specific doctor), now starting to realize that I could’ve insisted on the test myself and that maybe it wouldn’t make any difference anyway. I don’t think any woman can think she has all the time in the world. Nobody knows when her time is going to run out.
You are great for trying to help single women. If any of my doctors thought of setting me up with somebody when I was still fertile.
Only after my third child (at 37), did I learn that my mother had entered menopause at 36. I am profoundly grateful for my sheer, dumb luck. My point is–I had no idea that I should be asking about my mother’s reproductive history. I’m sure I’m not the only woman in that boat.
I had no menstrual irregularities or anatomical problems, yet needed to use Clomid and HCG midcycle at age 30 after three years of letting nature take her course (no hurry on my part there). Miscarried at 12 weeks, pregnant on next go around (with drugs), pregnant again at 33, first cycle with drugs.
Too crazed for third that close, so asked my infertility doctor/friend if I coould wait–he said yes–at that time–14 years ago–data wasn’t so clear (but I was infertile to start with!)
So despite Pergonal and ultimately GIFT, no third baby. (Age 38-40).
Obviously, could have pursued adoption if we’d truly wanted a bigger family–
Moral: Listen to the good doctor gals.
But Good Doctor–you need to be up front with your single gals, not tailor your remarks to what you think they want to hear. I do wonder if my friend/infertility doctor decided my lack of desire to have somebody in diapers for six years straight was stronger than my desire for a larger family.
I have to thank you for one single line: “I for one am not going to try to talk anyone into having kids who doesn’t want them.”
I’ve never had kids, never wanted ’em. Not wanted to be pregnant, or adopt, or step-parent. Kids for me are a non-issue like mountain climbing is a non-issue, maybe more so. The amount of time various OB/GYNs have spent trying to convince me that 1) I *do* want kids, I just need to grow up or marry someone else, or 2) I’ll change my mind, or 3) I need to see a psychiatrist is truly depressing.
Now all I need is somebody that’ll tie my tubes or do Essure so I can get off this blinking Pill.
At 23 I haven’t thought about children much, let alone marriage. I’ve had two great relationships, but they have always been second to my work and schooling as an architect.
Reading your blog was an interesting reminder that if having children is something I would like to do, maybe it’s not a good idea to completely opt for work over dating.
As much as I love my work, the idea of settling down is sounding more and more appealing. I don’t feel as young, naive and ridiculous to want children before thirty.
Well said, Jo!
I thought we were supposed to have choices, so why do people look at me strange for not marrying or having children?
Mary, age 48
It’s a little late for this but what is not widely known is there is a male biological clock that women should know more about. Who is going to tell you where to look for the scientific research about the what goes on with sperm? No one you have to do your own research. Here is a little bit in my paper on the father’s age as a risk factor….http://ebdblog.com/paternalage/Because I was unlucky in this regard I want to warn people and suggest that men freeze semen in their 20s and early 30s for any fathering of babies past the age of 35ish.
I wish my (NYC) gyn had given me those to charts. Instead, I ended up at an RE and had a baby at 42 after IVF#3.
You know i am begining to think that my biological clock is ticking way way too fast. I am only 22 all i can think about is if i am infertil now or might be why wait till 26 or 27 to find that out. Beacuse i have a screwd up period as it is and i really really hope that i never am infertil. It would kill me. I feel like my body is just screaming for the next stage of my life to begin but how can i afford going to IVF everytime it dosen’t work.Better yet the first time how can i afford that? I don’t even know how long it would take me to save $10,000 or more. I feel like i’m so ready to do but not one person is going to understand why i am doing it, or even help with financing it in the first place. I feel kind of like i’m 30 in a 22 year old body. and all i’ve had is bad relationships so i keep thinking what if it’s all going to be the same ever…. single….. time….
Don’t get me wrong i’d love to be in a relationship but only if it’s really worth the trouble it causes. I’d rather be single, have two children before my grandmother passes and have as much as a stable job as i can. Like they say you are never ready for kids….. But i know i am. I would like any tips from any of you single mothers out there who have advice about having an IVF Pregnancy especialy if you had one yourself. Thanks for listening. Here’s my e-mail: darrkkitty25@hotmail.com.
Heather:
Why not see your doctor and talk to him/her about your fears? And why your cycles are “screwed up”? While premature ovarian failure is always a possibility, it is rare.
It seems you are anxious for motherhood to begin, but don’t let anxiety drive the process. Not to mention your desire for a stable job would be encumbered by those 2 kids you want.
Take your time.
Good Luck.
Have two children at 29 years old and 32 years old. Had this really firm construct in my head that I had to get all the kids out by 35 years old. The advanced maternal age thing really bothered me.
In any event I have spent the last 2 years now being obsessed in wanting another child but also equally divided that I would now be forty on delivery. Now I used to really think that that was old!! Now that I am getting to that age, I am reconsidering.
Does not help that I have returned to a residency and the Head Obstetric Anesthesiologist just professed in a room with all my much younger peers that having kids over 35 years old was just plain foolish. Relieved to see that an OB/ Gyn had a child at forty- that has helped lift my spirits- Thanks.
However in spite of all the negative comments and judgements I also understand the nature of regret. Few people regret going for things that they really want in life.
Wish me luck on having another!
I have just turned 35 and found out i am pregnant to someone who i went out with for 8weeks.I got pregnant after having sex once unprotected! I am in a dilemna, i want children, but not to this guy….do i chance, that it will happen again so easily in a few years or not?
Anonymous –
A very difficult situation you find yourself in. All I can advise is that you discuss this with your doctor and others who know you and support you. The information in the graph is there to inform your decision, but ultimately it is yours to make. Good luck.
Just a little levity on the subject – http://www.webdonuts.com/2009/06/the-little-addition/
I read through this post and wanted to get your views on unexplained infertility. My husband and I have been trying for over 1.5 yrs. We have gone through all the tests and have been assured that we are both fine. Despite that, nothing has changed for us. I will be 33 soon and it is hard to relax and enjoy the process. What percent goes through these unexplained troubles and is there hope?
Anonymous –
I’m sorry to hear you’ve been unsuccessful to date on getting pregnant. About 1/4 of infertile couples have unexplained fertility, so you are not alone.
I don’t know where you’ve been getting care or what tests you’ve had done, but consider getting another opinion at a top notch fertility center to be sure you’ve exhausted all diagnostic possibilities And just because your infertility is unexplained does not mean you can’t be offered treatment options to try, which can include clomid, IUI and IVF. And it does not mean that you won’t eventually get pregnant on your own (as about 10% of couples in your situation do in a period of 12 months even with no treatment).
Best of luck to you.
Peggy
Thanks for the response Dr. P. I just moved to the NYC area two weeks back and am in the process of setting up appointments with ob-gyns. If you know of a good fertility specialist (center or person) that I could reach out to, do let me know. I have included my e-mail in the text field. I have my periods regular as clockwork and also have got the HSG test done. My husband has had his semen test. Anything else we need to test?
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Hi Dr. P,
As I mentioned to you earlier – we have been trying for more than a year and a half and nothing seems to work out. I have made an appointment with a fertility specialist later this month. In the meantime, I wanted to write and ask your opinion on accupuncture to improve fertility. Has it shown to help those who have no problems but yet find it hard to get pregnant? Thanks!
Unless you count my patient who just past her due date and went to accupuncture to induce her labor and ruptured her membranes on the table, making me wonder where the accupuncturist put that needle!
In general, I see no harm in women trying accupunture, provided it is done by a licensed provider using proper technique. But the data are mixed as to its results for almost everything, and Ive yet to see much to convince me of its value beyond placebo.
Best of luck to you!
Peggy
Hi again Dr. P,
Based on your suggestion I did go and see a fertility specialist at WC. However, after learning more about how time consuming different processes are, I want to move to a place closer to my work place/home (they are both 5 mins from each other) as I might be required to go multiple days/times etc. I am not sure who to ask – so thought I’d post the question to you once again. Would you happen to know of a good fertility center/person that is close to downtown manhattan (financial district) or westside midtown? Please do let me know. Thank you so much for your help!!