When You're Not Expecting

Exploring the emotional aspects of women's reproductive health

Eventual Moms-To-Be: Heads Up!

Those 40-something Hollywood moms can be misleading

How many of us really know how our age affects our fertility? Judging from a recent study, we shouldn't be bursting with confidence.

Sure, our doctors and ob-gyns have probably cautioned us in general about keeping healthy: avoiding too much weight gain, stopping smoking, being careful about STDs and STIs, getting exercise, eating nutritiously, preventing unplanned pregnancies—we all know the drill. But have any of those doctors asked us about the age at which we may decide to try to become pregnant? Not very likely and, if the question is raised, many of us would feel that we have plenty of time (and plenty of plans to pursue) before stopping birth control. And, frankly, our lives may have revolved for so many years around birth control of one kind or another that actually trying to become pregnant may feel like it is light years away.

But, should we look more carefully at those light years? A knowledgeable physician would offer a resounding "Yes!" And we, watching all the famous Hollywood new moms in their 40s, may have been telling ourselves that we don't need to be in any hurry. After all, many of us are looking and feeling younger than our chronological ages. And with exercise, help from a dermatologist or plastic surgeon, and careful use of makeup, we are pleased that we can slow the hands of time with a youthful appearance.

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But, here's the deal. Many of those Hollywood 40-something moms cuddling newborns have not shared the more private details of their efforts to conceive: hormone treatments, in vitro fertilization, use of donor eggs or donor embryos. And the couples who have used a surrogate to carry their baby/ies are so blissful at the healthy births that they focus on the bliss of parenthood rather than dwelling on the anxiety of finding and working with a surrogate. Few of those moms need to count their pennies the way most of us would need to do when seeking help with our infertility (which is covered by health insurance in only a small number of states).

And, then, there are some "eventual moms-to-be" who protect themselves against the emotional sadness of infertility by looking at adoption as another path to parenthood. But here again, being informed is important. There are very few healthy Caucasian babies available for adoption in the U.S., so prospective parents are being encouraged to consider children of color, sibling groups, special needs children and older children. As far as international adoptions go, some countries and agencies have restrictions on parental age, marital status and length of marriage, criminal history, health factors (including obesity), and/or work status (e.g. requiring one parent to be at home full time). So, attractive as domestic or international adoption may seem in the abstract, the specifics require patience and fortitude (which may be especially difficult as we grow older without yet having become a parent).

So what is the concern around women being uninformed about age and conception? A new fertility awareness survey's results were presented at the American Society of Reproductive Medicine's recent annual meeting. The poll of 1,000 women ages 25 to 35 who had talked to doctors about fertility found that fewer than 50 percent of participants could correctly answer seven out of ten basic questions. Women were wrong most often about how long it takes to get pregnant and about how much fertility declines at various ages. The facts? At age 30, a healthy woman has about a 20 percent chance of conceiving per month and by the time she reaches 40, her odds drop to about 5 percent. Yet the women surveyed thought that a 30-year-old woman would have a 70 percent chance of conceiving and that a 40-year-old's chances could approach 60 percent! They also believed that a 20-year-old woman might get pregnant in less than two months of unprotected sex, rather than the five months that is the average.

We are now suffering the effects of not being proactive about understanding our bodies and the way age affects our reproductive capacities. Many fertility specialists bemoan the fact that many women seek their services only when they reach age 40, by which time the biological clock will be ticking very loudly and their reproductive options are increasingly limited.

With infertility as a condition that affects some 7.3 million women in the US (this is 12 percent of the population of child-bearing age) or about one in eight couples, understanding the fertility facts of Bio 101 is important for all couples. Statistically all women should know that after age 35 their fertility plummets, their chances of genetic abnormalities in pregnancies rise, and the number of pregnancy losses increase. So the take away message for all women is to begin conversations with our ob-gyns no later than our late 20s to be fully educated about any conditions we might have that could compromise our fertility (e.g. endometriosis, diabetes, hypertension, weight extremes, polycystic ovarian syndrome, irregular periods). Then that conversation should move in the direction of when (or whether) you might feel ready to consider parenthood. Better to educate yourself about your fertility early than to face the stunning news that conception will require expensive, time consuming, energy depleting and anxiety producing fertility treatment. Begin these conversations early!

Connie Shapiro, Ph.D., is a professor of family studies at the University of Illinois at Urbana-Champaign and author of When You're Not Expecting: An Infertility Survival Guide.

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