In Depth: Fertility after 40

November 02, 2017 06:36 PM

More than six million women in this country suffer infertility. That means they're unable to get pregnant after one year of trying or six months if they're older than 35.

As more women delay pregnancy, infertility rates for women over 35 are on the rise. The Centers for Disease Control finds about 20 percent of women in this country have their first child after age 35. About a third of couples in this age group have fertility problems.

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I've been hearing from many of these women. They tell me their doctors didn't tell them or didn't do a good job of alerting them to the risk of infertility as they put off pregnancy.

"I just figured, you know, it would happen," explained Christine Reeves Van Ullen.

She always wanted children, but the man who captured her heart arrived later in life. A second marriage for both, she was 36 when they walked down the aisle.

She says she had no clue pregnancy might not be so easy.

Reeves Van Ullen and Michelle Smith-Carrigan don't know each other, but they're sisters in the journey to have children after age 35. Both say they were blindsided by their inability to conceive.

"The fact that we couldn't have children to start sharing our life and our love was devastating," admitted Smith-Carrigan.

"As women get older, it's harder and harder to get their own eggs and the data is pretty clear that those eggs are not as good," explained Dr. Kevin Kiley, chair OB/GYN at Albany Medical Center. 

Women are born with all the eggs they will ever have. As we age, the ovaries' ability to release them decreases and the remaining eggs are generally not as healthy.

Older women are more likely to have health conditions that cause fertility problems and more likely to have a miscarriage.

"I think fertility declines noticeably at 38, 39," pointed out fertility specialist, Dr. Michael Grossman.

He says a 47-year-old woman was the oldest patient he treated who conceived with her own egg and there's literature regarding a 48-year-old. He's clear though, they're the exception.

"With their own eggs, what I typically say is at age 40 for a woman, for a couple with no fertility difficulties, they'll conceive about five-percent per month. For a woman who's 45, again no fertility difficulties -- it's just about zero," he explained.

WEB EXTRA: Dr. Michael Grossman discusses fertility in men after age 40

"When I was 38-ish, I stopped taking the pill and it was just like, 'You know, it'll happen,'" recalled Smith-Carrigan.

She and her husband, Mark, are puppeteers. Their lives are surrounded by children -- just not children born of their union.

By the time Smith-Carrigan was 42, they tried pretty much everything except IVF or donor eggs -- cost prohibitive for them. So they fostered two young boys who they've now adopted.

"I feel very full and I'm very happy. I love them more than anything, but there is still a little piece of me that would like to see a little me or a little Mark, my husband, running around and what that would have been like," noted Smith-Carrigan.

She shares her story, hoping other women realize that time is not on their side when it comes to fertility. She wishes she'd known that.

With news stories about older moms - especially celebrities - she never realized most of them are using assisted reproductive techniques and most probably, donor eggs from younger women.

"Donor eggs will be the most cost-effective, time-effective, hope-effective, energy-effective way to conceive," pointed out Dr. Grossman.

"I was thinking, 'Well if we have to use a sperm donor, I'm fine with that,'" acknowledged Reeves Van Ullen.

However, the thought of a donor egg rocked her. She feared she wouldn't feel like it was her baby. Then, a friend shared a life-changing observation.

"'It will be your blood running through that baby,'" recalled Reeves Van Ullen. "I said, 'Okay, I can do this then.'"

That was 22 years ago and now delights in her son who looks like his dad and his half-brother from her husband's first marriage.

"If I can help one woman understand and know that egg donation is probably the way you're going to go," noted Reeves Van Ullen.

We all know women who become pregnant over age 40 without medical intervention, but the fact is their numbers are very small and the risk of birth defects rises – which is why so many of these women turn to donor eggs.

Dr. Kiley counsels women considering pregnancy at any age to stay in good shape and maintain their health to carry a baby to term.

"Even in a 55-year-old, you can substitute the hormones that make the uterus receptive to an oocyte and once the pregnancy gets going, it's self-sustaining," he explained.

Women can freeze their eggs before age 35, but there's no guarantee that will lead to pregnancy and it's cost prohibitive for many.

That brings us back to the importance of frank fertility discussions between patient and doctor early in a woman's life - because time is the enemy of fertility.

"It's too easy to think, 'I have regular periods, I'm in good health.' And it may not be as easy as they expect to conceive when the time is right for them," explained Grossman.

A test that estimates how many eggs a woman has remaining appears not to be worth the money. A study funded by the National Institutes of Health and released earlier this month says the tests do not appear to predict short-term chances of conception in women with no history of infertility.

The study appears in the Journal of the American Medical Association.

More information:

National Institutes of Health: Ovarian reserve tests fail to predict fertility, NIH-funded study suggests


Benita Zahn

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