The Scenario: “Your friend” wants children someday, but she’s in her mid-30s and still going on Tinder dates. As she left-swipes all the bros holding dead fish who list “beer” as an interest, she wonders: How worried should she be about her biological clock? Is there an age when, medically speaking, one should give up on getting pregnant? And how many years does she have left to make things happen?
The Reality: Fertility starts to decline in a woman’s mid-30s, but age does not significantly hurt reproductive success rates until 40, studies have found.
“At the age of 40, risks to the mother start to increase, and the odds of a healthy pregnancy start to fall,” says Edward Marut, a Yale-educated physician with the Fertility Centers of Illinois. However, “If a woman is otherwise healthy, there is no reason not to keep trying until 44 or 45, when the odds of getting pregnant and having a healthy baby start approaching zero. Over 45, [it] is probably a waste of time in terms of getting pregnant, and an unnecessary risk to the woman if not healthy.”
Male fertility is also a factor, if your friend envisions herself trying to procreate with a man her age. As men grow older, sperm shape and motility tend to deteriorate and carry a higher risk of genetic defect, according to the American Society for Reproductive Medicine's patient guide. But the effects of age aren’t as harsh and men face no deadline like menopause. Some in their 70s have fathered children with younger partners.
Brian Levine, a reproductive endocrinology and infertility specialist at the Colorado Center for Reproductive Medicine, says that women probably won’t be able to produce viable eggs past age 46, “but that doesn’t mean they can’t get pregnant.”
Levine says women can carry donor eggs up to their mid-50s. Even after menopause, a healthy woman is still capable of carrying a baby to term. The rate at which transfers of fresh donor embryos lead to live births does not change much with age, according to the Centers for Disease Control’s 2015 summary of fertility treatment data. The success rate stays at around 60 percent for women younger than 30 and older than 47.
This option is not cheap. One cycle of in vitro treatment with donor eggs costs around $30,000. Health insurance rarely covers it. For women older than 54, any pregnancy is too taxing, particularly on the cardiovascular system, Levine says. “The body goes through a lot,” he says, “both during pregnancy and through giving birth.”
Your friend is certainly not alone in her concerns. In case you have never before read a news story about millennials: Young people are putting off marriage and children for longer these days.
In 1975, 67 percent of Americans aged 25 to 35 had reached three milestones: moving out of the home of their parent(s), marrying and living with a child, according to a report from the US Census Bureau. In 2016, just 32 percent of people in the same age bracket could check all three of those boxes.
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The mean age of a first-time mother in the US rose from 21.4 years in 1970 to 25.8 years in 2012. This drop was partially fueled by a sharp decrease in teen pregnancy, but there were also declines in the birthrates of women in their 20s, as more women dedicate those years to work and school. (Sadly, parenthood still stagnates mothers’ careers in ways that rarely impact fathers.)
In 1976, the percentage of women aged 20 to 24 who had at least one child was 31. In 2014, for that same age bracket, it had dropped to 25, according to that Census Bureau report. Over the same time span, the percentage of women 25 to 29 with one kid dropped from 69 to 59 percent. And for women 30 to 34, the percentage with at least one kid decreased from 84 to 71.
Putting off motherhood can be lucrative: Each year of delayed maternity adds a 10 percent increase in earnings over a woman’s career and a 3 percent spike in her average wage across her work life, according to a 2005 study from the University of Virginia’s Department of Economics. That’s enticing for a generation that has never known financial stability and is also less likely than those born earlier to say that having children is important (and also must have avocado toast).
But amidst all the anxiety about age, people can overlook other factors that complicate pregnancies, Marut says. Women at any age with chronic medical problems—like obesity, diabetes, hypertension, kidney or heart disease, or neurologic issues—“should be evaluated appropriately before even trying to conceive,” he says. Such a medical background probably won’t likely diminish fertility but can make pregnancy riskier. He adds, “A healthy 40-something has a better outlook than an unhealthy 30-something.”
The Worst That Can Happen: Some risks are just correlated with maternal age. To 20-year-old mothers, Down syndrome and other chromatic abnormalities are very rare, according to the ASRM patient guide. Those risks increase each year. By age 49, the risk of Down syndrome balloons to one in eleven and a risk of general chromosomal abnormalities to one in eight. Still, another way to look at that is that more than 87 percent of those fetuses are perfectly healthy—and these days a blood test can be administered to identify chromosomal abnormalities early in a pregnancy.
The risk of miscarriage also increases with age. There’s a 10 percent chance until age 30 and the risk budges upwards from there, according to the ASRM, reaching a 34 percent chance for pregnant women 40 to 44 and increasing to more than half of pregnancies for those older than 45. New data and improvements in obstetric medicine may revise these statistics, but age will always be a factor.
What Will Probably Happen: We can’t make any predictions about your friend’s outlook for finding a partner, but if she’s under 40 and wants to get pregnant, she can probably get pregnant. A 2013 Boston University of Danish women found that those aged 20 to 34 conceived within their first year of trying in 84 percent of cases. Those aged 35 to 40 had a success rate of 78 percent. Not a huge difference.
What to Tell Your Friend: Older age is and always will be associated with declining fertility and increased risks for the mother and child, but her chances of conceiving do not drop significantly until 40. And a healthy pregnancy is still possible for a few years after that. Then, in vitro fertilization with donor eggs can keep open the prospect of giving birth—for a cost. It gets more complicated from here on out, it’s not until the mid-50s that she ages out of all her options.
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