How Late Is Too Late for a Baby How Late Is a Baby Alowed to Be in the Mom

How Long Tin can You Wait to Accept a Baby?

Deep anxiety about the ability to accept children afterward in life plagues many women. But the decline in fertility over the form of a woman's 30s has been oversold. Here'south what the statistics actually tell united states of america—and what they don't.

Geof Kern

Editor's Note: Read more than stories in our series about women and political ability.

In the tentative, post-9/eleven spring of 2002, I was, at 30, in the midst of extricating myself from my first marriage. My husband and I had met in graduate school merely couldn't find two academic jobs in the same place, and then we spent the three years of our marriage living in different states. After I accepted a tenure-track position in California and he turned down a postdoctoral research position nearby—the chore wasn't adept plenty, he said—it seemed clear that our living situation was not going to change.

I put off telling my parents about the carve up for weeks, hesitant to disappoint them. When I finally bankrupt the news, they were, to my relief, supportive and understanding. And then my mother said, "Take you read Time magazine this week? I know you lot want to have kids."

Fourth dimension'south cover that week had a infant on it. "Listen to a successful woman hash out her failure to comport a child, and the grief comes in layers of bitterness and regret," the story within began. A generation of women who had waited to start a family was showtime to grapple with that decision, and one media outlet afterwards some other was wringing its hands nearly the steep decline in women'south fertility with age: "When It's Besides Belatedly to Have a Babe," lamented the U.Thousand.'southward Observer; "Babe Panic," New York magazine announced on its cover.

The panic stemmed from the April 2002 publication of Sylvia Ann Hewlett'south headline-grabbing book, Creating a Life, which counseled that women should have their children while they're immature or risk having none at all. Within corporate America, 42 percentage of the professional women interviewed by Hewlett had no children at age 40, and most said they securely regretted it. Just as you plan for a corner function, Hewlett advised her readers, yous should program for grandchildren.

The previous fall, an ad campaign sponsored past the American Society for Reproductive Medicine (ASRM) had warned, "Advancing age decreases your ability to accept children." One advertisement was illustrated with a babe canteen shaped like an hourglass that was—just to make the point glaringly obvious—running out of milk. Female fertility, the group announced, begins to decline at 27. "Should you have your babe now?" asked Newsweek in response.

For me, that was no longer a viable option.

I had always wanted children. Even when I was busy with my postdoctoral inquiry, I volunteered to babysit a friend's preschooler. I frequently passed the time in airports by chatting upwardly frazzled mothers and babbling toddlers—a 2-yr-old, quite to my surprise, once crawled into my lap. At a wedding I attended in my late 20s, I played with the groom's preschool-historic period nephews, frequently on the flooring, during the entire rehearsal and most of the reception. ("Exercise you lot fart?" ane of them asked me in an overly loud phonation during the rehearsal. "Everyone does," I replied solemnly, every bit his grandfather laughed quietly in the next pew.)

But, all of a sudden unmarried at 30, I seemed destined to remain childless until at least my mid-30s, and perhaps always. Flying to a friend's wedding in May 2002, I finally forced myself to read the Time article. Information technology upset me and so much that I began doubting my divorce for the get-go time. "And God, what if I want to take ii?," I wrote in my periodical as the cold plane sped over the Rockies. "First at 35, and if you wait until the kid is 2 to effort, more than probable you have the second at 38 or 39. If at all." To reassure myself near the divorce, I wrote, "Nothing I did would have changed the situation." I underlined that.

I was lucky: within a few years, I married again, and this time the lucifer was much ameliorate. Only my new husband and I seemed to face up frightening odds against having children. Well-nigh books and Web sites I read said that one in 3 women ages 35 to 39 would non go pregnant within a year of starting to try. The beginning page of the ASRM'due south 2003 guide for patients noted that women in their late 30s had a xxx percent chance of remaining childless altogether. The guide also included statistics that I'd seen repeated in many other places: a woman'south adventure of pregnancy was 20 percent each month at age thirty, dwindling to v percent by age 40.

Every time I read these statistics, my stomach dropped like a stone, heavy and foreboding. Had I already missed my adventure to exist a mother?

As a psychology researcher who'd published articles in scientific journals, some covered in the popular press, I knew that many scientific findings differ significantly from what the public hears virtually them. Before long subsequently my second wedding, I decided to get to the source: I scoured medical-research databases, and speedily learned that the statistics on women'southward historic period and fertility—used by many to make decisions about relationships, careers, and when to accept children—were 1 of the more spectacular examples of the mainstream media's failure to correctly written report on and interpret scientific research.

The widely cited statistic that 1 in 3 women ages 35 to 39 will not exist pregnant after a twelvemonth of trying, for instance, is based on an article published in 2004 in the periodical Human being Reproduction. Rarely mentioned is the source of the information: French nativity records from 1670 to 1830. The chance of remaining childless—30 pct—was also calculated based on historical populations.

In other words, millions of women are existence told when to get meaning based on statistics from a time before electricity, antibiotics, or fertility treatment. Most people assume these numbers are based on big, well-conducted studies of modern women, only they are not. When I mention this to friends and assembly, by far the most common reaction is: "No … No mode. Really?"

Surprisingly few well-designed studies of female age and natural fertility include women born in the 20th century—simply those that do tend to pigment a more than optimistic moving-picture show. One study, published in Obstetrics & Gynecology in 2004 and headed by David Dunson (now of Duke University), examined the chances of pregnancy among 770 European women. It found that with sexual practice at least twice a week, 82 percent of 35-to-39-yr-former women conceive within a year, compared with 86 percent of 27-to-34-year-olds. (The fertility of women in their belatedly 20s and early 30s was almost identical—news in and of itself.) Another study, released this March in Fertility and Sterility and led by Kenneth Rothman of Boston Academy, followed 2,820 Danish women every bit they tried to get significant. Amidst women having sex during their fertile times, 78 percentage of 35-to-xl-yr-olds got pregnant within a year, compared with 84 percentage of 20-to-34-year-olds. A study headed by Anne Steiner, an associate professor at the University of North Carolina School of Medicine, the results of which were presented in June, constitute that amongst 38- and 39-year-olds who had been pregnant before, 80 percent of white women of normal weight got meaning naturally within six months (although that pct was lower among other races and amid the overweight). "In our information, we're not seeing huge drops until age forty," she told me.

Even some studies based on historical nascence records are more than optimistic than what the press commonly reports: One found that, in the days before nascency control, 89 percent of 38-year-quondam women were still fertile. Another concluded that the typical woman was able to get meaning until somewhere betwixt ages 40 and 45. Withal these more encouraging numbers are rarely mentioned—none of these figures announced in the American Guild for Reproductive Medicine's 2008 commission opinion on female age and fertility, which instead relies on the most-ominous historical data.

In brusk, the "baby panic"—which has by no means abated since information technology hit me personally—is based largely on questionable data. We've rearranged our lives, worried incessantly, and forgone countless career opportunities based on a few statistics most women who resided in thatched-roof huts and never saw a lightbulb. In Dunson's study of modern women, the departure in pregnancy rates at age 28 versus 37 is only nigh 4 percentage points. Fertility does decrease with age, just the decline is not steep enough to keep the vast bulk of women in their belatedly 30s from having a kid. And that, after all, is the whole point.

I am now the mother of 3 children, all built-in after I turned 35. My oldest started kindergarten on my 40th birthday; my youngest was built-in v months later. All were conceived naturally inside a few months. The toddler in my lap at the airport is now mine.

Instead of worrying about my fertility, I now worry nigh paying for child care and getting three children to bed on time. These are adept bug to have.

All the same the memory of my abject terror about historic period-related infertility still lingers. Every time I tried to get pregnant, I was consumed by anxiety that my age meant doom. I was not solitary. Women on Internet bulletin boards write of scaling back their careers or having fewer children than they'd like to, because they can't carry the idea of trying to get pregnant subsequently 35. Those who have already passed the dreaded birthday enquire for tips on how to stay calm when trying to get significant, constantly worrying—just as I did—that they volition never have a child. "I'1000 scared considering I am 35 and everyone keeps reminding me that my 'clock is ticking.' My grandmother even reminded me of this at my hymeneals reception," one newly wife wrote to me afterward reading my 2012 advice book, The Impatient Woman's Guide to Getting Pregnant, based in role on my ain experience. It'due south not only grandmothers sounding this annotation. "What scientific discipline tells us about the aging parental body should alarm u.s.a. more it does," wrote the journalist Judith Shulevitz in a New Republic cover story tardily last year that focused, laser-like, on the downsides of delayed parenthood.

How did the infant panic happen in the first place? And why hasn't there been more public pushback from fertility experts?

One possibility is the "availability heuristic": when making judgments, people rely on what'southward correct in front of them. Fertility doctors see the effects of historic period on the success rate of fertility treatment every solar day. That's particularly true for in vitro fertilization, which relies on the extraction of a big number of eggs from the ovaries, because some eggs are lost at every stage of the difficult process. Younger women's ovaries answer better to the drugs used to extract the eggs, and younger women's eggs are more likely to exist chromosomally normal. As a upshot, younger women's IVF success rates are indeed much higher—about 42 percent of those younger than 35 will give nascence to a live babe subsequently ane IVF cycle, versus 27 pct for those ages 35 to 40, and just 12 percent for those ages 41 to 42. Many studies have examined how IVF success declines with age, and these statistics are cited in many research manufactures and online forums.

Yet only about ane pct of babies born each year in the U.South. are a result of IVF, and nearly of their mothers used the technique not because of their age, but to overcome blocked fallopian tubes, male infertility, or other issues: virtually 80 percent of IVF patients are 40 or younger. And the IVF statistics tell us very little most natural conception, which requires simply 1 egg rather than a dozen or more, amongst other differences.

Studies of natural formulation are surprisingly difficult to behave—that's 1 reason both IVF statistics and historical records play an outsize role in fertility reporting. Modern birth records are uninformative, considering about women take their children in their 20s then use nascence control or sterilization surgery to forestall pregnancy during their 30s and 40s. Studies asking couples how long it took them to conceive or how long they have been trying to get significant are equally unreliable as human memory. And finding and studying women who are trying to get pregnant is challenging, every bit there's such a narrow window between when they start trying and when some will succeed.

Millions of women are beingness told when to get meaning based on statistics from a time before electricity, antibiotics, or fertility handling.

Another problem looms even larger: women who are actively trying to get pregnant at historic period 35 or after might be less fertile than the boilerplate over-35 adult female. Some highly fertile women volition get pregnant accidentally when they are younger, and others will become meaning quickly whenever they try, completing their families at a younger age. Those who are left are, unduly, the less fertile. Thus, "the observed lower fertility rates amidst older women presumably overestimate the upshot of biological crumbling," says Dr. Allen Wilcox, who leads the Reproductive Epidemiology Group at the National Found of Ecology Wellness Sciences. "If we're overestimating the biological decline of fertility with historic period, this will only be good news to women who have been most fastidious in their birth-control utilise, and may be more fertile at older ages, on average, than our data would lead them to expect."

These modern-24-hour interval research problems help explain why historical data from an age before birth control are so tempting. Notwithstanding, the downsides of a historical approach are numerous. Avant-garde medical care, antibiotics, and fifty-fifty a reliable food supply were unavailable hundreds of years ago. And the decline in fertility in the historical data may as well stem from older couples' having sex less ofttimes than younger ones. Less-frequent sexual activity might have been especially likely if couples had been married for a long fourth dimension, or had many children, or both. (Having more children of grade makes information technology more difficult to fit in sex, and some couples surely realized—eureka!—that they could avoid having another mouth to feed by scaling back their nocturnal activities.) Some historical studies effort to control for these issues in various means—such every bit looking simply at only-married couples—but many of the same problems remain.

The best way to appraise fertility might be to measure "cycle viability," or the chance of getting pregnant if a couple has sex on the most fertile day of the adult female's bike. Studies based on cycle viability use a prospective rather than retrospective pattern—monitoring couples as they attempt to get pregnant instead of asking couples to think how long it took them to get pregnant or how long they tried. Cycle-viability studies also eliminate the need to account for older couples' less active sex lives. David Dunson'due south analysis revealed that intercourse 2 days before ovulation resulted in pregnancy 29 pct of the time for 35-to-39-twelvemonth-one-time women, compared with about 42 per centum for 27-to-29-year-olds. So, by this measure out, fertility falls past about a tertiary from a woman'southward late 20s to her belatedly 30s. However, a 35-to-39-twelvemonth-old'south fertility two days before ovulation was the aforementioned as a 19-to-26-year-old'due south fertility three days before ovulation: according to Dunson's data, older couples who time sex just one day meliorate than younger ones will effectively eliminate the historic period divergence.

Don't these numbers contradict the statistics y'all sometimes see in the popular press that merely 20 percent of 30-year-former women and 5 percent of forty-twelvemonth-onetime women get meaning per wheel? They exercise, but no journal commodity I could locate contained these numbers, and none of the experts I contacted could tell me what data fix they were based on. The American Society for Reproductive Medicine'due south guide provides no commendation for these statistics; when I contacted the clan's press office request where they came from, a representative said they were simplified for a popular audition, and did not provide a specific citation.

Dunson, a biostatistics professor, idea the lower numbers might exist averages beyond many cycles rather than the chances of getting meaning during the starting time wheel of trying. More women volition become meaning during the beginning cycle than in each subsequent one because the virtually fertile will conceive quickly, and those left will take lower fertility on average.

Most fertility problems are not the event of female historic period. Blocked tubes and endometriosis (a status in which the cells lining the uterus also grow outside it) strike both younger and older women. Almost half of infertility problems trace back to the man, and these seem to be more mutual amid older men, although research suggests that men's fertility declines simply gradually with historic period.

Fertility problems unrelated to female age may besides explain why, in many studies, fertility at older ages is considerably higher among women who have been pregnant before. Among couples who haven't had an accidental pregnancy—who, every bit Dr. Steiner put it, "have never had an 'oops' "—sperm issues and blocked tubes may exist more likely. Thus, the data from women who already have a child may requite a more than accurate picture of the fertility decline due to "ovarian aging." In Kenneth Rothman's study of the Danish women, amongst those who'd given nativity at to the lowest degree once previously, the chance of getting pregnant at age 40 was similar to that at age 20.

Older women'south fears, of course, extend across the ability to get pregnant. The rates of miscarriages and birth defects rise with age, and worries over both have been well ventilated in the popular press. But how much do these risks actually rise? Many miscarriage statistics come up from—y'all guessed it—women who undergo IVF or other fertility treatment, who may have a higher miscarriage hazard regardless of age. Yet, the National Vital Statistics Reports, which draw information from the full general population, find that 15 percent of women ages xx to 34, 27 percentage of women 35 to 39, and 26 percentage of women 40 to 44 written report having had a miscarriage. These increases are hardly insignificant, and the true charge per unit of miscarriages is higher, since many miscarriages occur extremely early on in a pregnancy—before a missed period or pregnancy test. Notwithstanding information technology should be noted that even for older women, the likelihood of a pregnancy's continuing is nearly iii times that of having a known miscarriage.

What about birth defects? The risk of chromosomal abnormalities such equally Down's syndrome does ascension with a woman's age—such abnormalities are the source of many of those very early on, undetected miscarriages. However, the probability of having a child with a chromosomal abnormality remains extremely low. Even at early on fetal testing (known equally chorionic villus sampling), 99 percent of fetuses are chromosomally normal among 35-year-old pregnant women, and 97 percent among xl-year-olds. At 45, when near women can no longer go pregnant, 87 percent of fetuses are still normal. (Many of those that are not will later exist miscarried.) In the near future, fetal genetic testing will exist done with a simple blood examination, making information technology even easier than it is today for women to go early information about possible genetic bug.

Westwardhat does all this mean for a woman trying to decide when to take children? More specifically, how long can she safely wait?

This question tin't be answered with absolutely certainty, for two big reasons. First, while the information on natural fertility among mod women are proliferating, they are still sparse. Collectively, the 3 mod studies by Dunson, Rothman, and Steiner included only most 400 women 35 or older, and they might not be representative of all such women trying to conceive.

2nd, statistics, of grade, can tell us merely almost probabilities and averages—they offer no guarantees to whatever item person. "Even if nosotros had good estimates for the average biological decline in fertility with age, that is yet of relatively limited use to individuals, given the large range of fertility found in good for you women," says Allen Wilcox of the NIH.

So what is a woman—and her partner—to exercise?

The data, imperfect equally they are, advise two conclusions. No. 1: fertility declines with age. No. 2, and much more relevant: the vast majority of women in their late 30s will be able to get pregnant on their own. The lesser line for women, in my view, is: program to accept your last kid by the time you lot turn 40. Beyond that, you're rolling the dice, though they may still come up upwards in your favor. "Fertility is relatively stable until the belatedly 30s, with the inflection bespeak somewhere around 38 or 39," Steiner told me. "Women in their early 30s tin call back about years, but in their late 30s, they need to be thinking about months." That's as well why many experts advise that women older than 35 should encounter a fertility specialist if they haven't conceived later vi months—particularly if it's been six months of sex during fertile times.

There is no single best time to have a kid. Some women and couples will discover that starting—and finishing—their families in their 20s is what's best for them, all things considered. They just shouldn't let alarmist rhetoric push them to become parents earlier they're set. Having children at a young age slightly lowers the risks of infertility and chromosomal abnormalities, and moderately lowers the adventure of miscarriage. Just it also carries costs for relationships and careers. Literally: an assay past one economist found that, on boilerplate, every year a woman postpones having children leads to a 10 percent increment in career earnings.

For women who aren't gear up for children in their early on 30s just are still worried about waiting, new technologies—admitting imperfect ones—offer a third option. Some women choose to freeze their eggs, having a fertility doctor extract eggs when they are still young (say, early 30s) and cryogenically preserve them. So, if they oasis't had children by their self-imposed deadline, they can thaw the eggs, fertilize them, and implant the embryos using IVF. Considering the eggs volition be younger, success rates are theoretically higher. The downsides are the expense—perhaps $10,000 for the egg freezing and an average of more than $12,000 per cycle for IVF—and having to use IVF to become meaning. Women who already have a partner tin, alternatively, freeze embryos, a more mutual procedure that also uses IVF technology.

At home, couples should recognize that having sexual activity at the most fertile time of the cycle matters enormously, potentially making the divergence between an easy conception in the bedroom and expensive fertility treatment in a clinic. Rothman's study institute that timing sex around ovulation narrowed the fertility gap between younger and older women. Women older than 35 who want to get pregnant should consider recapturing the glory of their xx‑something sex lives, or learning to predict ovulation past charting their cycles or using a fertility monitor.

I wish I had known all this back in the spring of 2002, when the media coverage of age and infertility was deafening. I did, though, find some relief from the smart women of Sabbatum Night Live.

"According to author Sylvia Hewlett, career women shouldn't wait to take babies, considering our fertility takes a steep driblet-off after age 27," Tina Fey said during a "Weekend Update" sketch. "And Sylvia's correct; I definitely should have had a baby when I was 27, living in Chicago over a biker bar, pulling down a cool $12,000 a yr. That would take worked out great." Rachel Dratch said, "Yeah. Sylvia, um, cheers for reminding me that I have to hurry up and have a baby. Uh, me and my four cats will get right on that."

"My neighbor has this adorable, cute little Chinese baby that speaks Italian," noted Amy Poehler. "And so, you know, I'll simply buy one of those." Maya Rudolph rounded out the rant: "Aye, Sylvia, perhaps your next book should tell men our age to terminate playing K Theft Auto Iii and holding out for the chick from Alias." ("Yous're not gonna get the chick from Allonym," Fey brash.)

Xi years afterward, these four women have eight children among them, all simply 1 born when they were older than 35. It's good to exist right.

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Source: https://www.theatlantic.com/magazine/archive/2013/07/how-long-can-you-wait-to-have-a-baby/309374/

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