Age and fertility: The pros and cons of waiting to have children
Many women choose to wait to have children for a variety of reasons. You might want to set aside time for higher education and career placement and/or advancement. You might want to achieve more financial security. You might want to travel or live life a bit untethered for a while longer. You might not have a choice.
While older women can have healthy, successful pregnancies, there are risks to waiting. First, it can be more difficult to get pregnant. Second, increased maternal age sometimes comes with its own set of pregnancy problems. But there are some benefits to waiting, too. Often women who are older are in a better place financially. And there’s merit in achieving certain personal goals and crossing items off your bucket list before becoming a mother — those life experiences can inform your parenting while also boosting your confidence. Here we discuss how and why age affects fertility, and we weigh the benefits and risks.
How age and fertility are related
According to The American College of Obstetricians and Gynecologists (ACOG), a woman’s peak fertility begins in her late teen years and continues until her late 20s. Fertility begins to decline around age 30. By age 45, conception for many women is unlikely.
Why? You begin with 6 to 7 million eggs while you’re still in your mother’s womb. That number drops to 1 to 2 million at birth. Once puberty hits, you have about 300,000 to 500,000 eggs remaining, with about 1,000 eggs dying every month. In your lifetime, you will release about 500 eggs from your ovaries. Your body can’t make new eggs, so once they’re gone, they’re gone.
Older moms (and dads): A trend
According to the CDC, the average age of a woman’s first birth has risen considerably over the past four decades, and the trend is not slowing down. The most recent data shows birth rates are declining for women 15 to 34, rates are mostly unchanged for women 35 to 39, and they are rising for women 40 to 44.
The same holds true for men. A 2017 study analyzing the age of fathers over four decades showed a mean paternal age increase from 27.4 to 30.9 years.
Should you wait to get pregnant?
Risks of waiting
As you age, it can be more difficult to get pregnant. According to ACOG, healthy women who are in their early 20s to 30s have a one in four chance of getting pregnant in any given menstrual cycle. By age 40, that number is reduced to one in 10.
Age also contributes to health problems throughout pregnancy, in part because older women simply tend to have more health issues — for example, high blood pressure can increase the risk of preeclampsia. Miscarriage and stillbirths are more common in women 35 and older, as is the risk of birth defects, particularly Down syndrome. Studies have also shown that the prevalence of depression in women who have recently given birth becomes significantly greater as they age.
According to ACOG, women are also more likely have multiples (e.g., twins, triplets) as they age. While this may be a joyful surprise, it does come with an increased risk of preterm labor.
For men, studies (limited compared to those of women) have shown that the quality of a man’s semen declines with age, which can affect fertility. And while increased paternal age has been correlated with increased health issues for the child, more research on this is needed.
Benefits of waiting
While many studies focus on negative outcomes with advanced maternal age, a 2017 German study showed that there are now benefits to waiting compared to in decades past. This is largely due to socioeconomic and demographic changes.
Today older women tend to have achieved a higher level of education, and they’re having fewer children. This means more financial security and resources within the family unit. The study also shows that children with older parents often have higher cognitive scores. In addition, the longer you wait to have a child, the more opportunities they will have to take advantage of new societal developments in everything from medical advances to learning approaches. Finally, the study shows that older women tend to feel more prepared for motherhood, resulting in less stress and increased happiness.
The ABCs of IVF
ACOG states that no medical technique can guarantee fertility. That said, in vitro fertilization (IVF) can help couples have children later in life.
IVF begins by extracting eggs from a woman’s ovaries and fertilizing them with a man’s sperm in a laboratory. If the fertilization process is successful, embryos grow. These embryos are then transferred to the woman’s uterus.
One of the great things about IVF is that donors can be used for the eggs, sperm, embryos and/or in the form of a surrogate if needed. However, rates of success vary greatly depending on many factors. Also keep in mind that the procedures are time-consuming and invasive, and the cost can be prohibitive.
If you’re not quite ready for pregnancy but want to preserve your eggs, you may consider talking to your ob-gyn about oocyte cryopreservation, more commonly referred to as “freezing your eggs.” You can freeze unfertilized eggs or embryos (fertilized eggs), meaning you don’t immediately need sperm. This procedure is often recommended for women undergoing cancer treatment that may affect their fertility. However, it’s important to note that success rates following unfertilized egg preservation are low. According to a study published in the April 2017 issue of Human Reproduction, women 37 or 42 years old would have to freeze 20 and 61 oocytes, respectively, to achieve a 75% chance of having at least one live birth.
Deciding when to have a baby is deeply personal, with many factors in play, so talk to your ob-gyn if you have any concerns. According to ACOG, infertility evaluations are suggested for women older than 35 who have not gotten pregnant after six months of trying. And if you’re older than 40, ACOG recommends speaking with your doctor before trying. If you’re comfortable doing so, talking with family members and friends who have had kids at different ages can also give you insight into parenting risks and rewards in every age bracket. Just be mindful that the reasons for when women get pregnant are multilayered and sometimes not by choice. Thankfully, no matter your childbearing age, you can find support.
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Goldman, R. H., Racowsky, C., Farland, L. V., Munné, S., Ribustello, L., Fox, J. H. (2017, April). Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients. Human Reproduction, 32(4), 853-859. https://academic.oup.com/humrep/article/32/4/853/2968357
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