This is Part II in a Special TBTAM Post Series. Links to the next post in the series are at then end of this post.
In my recent post “How to Get Pregnant” I compared the reproductive workings of the female body to Windows Explorer. However, I neglected to tell you that there is no fix for the Year 35 Bug. The biological time clock that begins to ring softly at 35, scream loudly at 40, and like a wind-up alarm, grind to a halt somewhere around 45.
Now, I see two kinds of women in my practice – those who hear the alarm and those who hear it, but turn on the snooze button. The former are, more often than not, single, and the latter, married. Interesting paradox, isn’t it? Needless to say, I handle each group of women a little differently.
The married woman with all the time in the world
I for one am not going to try to talk anyone into having kids who doesn’t want them. But most of my married patients know that they want a family, and the majority of these are blithely going about their childless existence as if they have forever. As their gynecologist, I feel it is my duty to make sure that they understand the facts as I know them, as opposed to their own vague notions, and advise that they consider these facts as they plan their families. (This is in contrast to their mothers, who just want those grandbabies.)
First, I ask them to do the math with me, considering how many children they wish to have and when they want to start. (You would be surprised how many women think that between the ages of 35 and 40, they can get pregnant, carry to term, and breast feed 3 children spaced 2 years apart.)
Then, I sit them down and show them the data.
I find that visually representing it conveys the message best. And that message is, simply – you don’t have as much time as you think. Because, like it or not, female fertility declines with age, as a result of decreased number of eggs from the ovary. Additionally, the incidence of miscarriage increases with age, because older eggs are more likely to divide abnormally.
That’s it. The visuals speak for themselves. I give them a copy to take home and share with their husband. (Poor guy – He has no idea what he is in for tonight when he walks through the door…)
I tell them the bottom line is this: If you and your partner are sure you want to have a family, then the younger you are, the better your odds of conceiving. If you have other factors that might impact fertility (fibroids, endometriosis, menstrual irregularities), don’t add older age into the mix. Start as soon as you are ready and able.
I sometimes tell them my own story. That I began my marriage unsure as to whether I even wanted children. That I began my family at 35 and had my second child at 40. And that my biggest regret is that I am now too old to have a third.
More than one patient has become pregnant within the year after this discussion. But most simply take the information into consideration, which is all that I really want them to do. Their lives are their own, after all. And I am not their mother.
The Single Female who knows better
Now, I am not cruel. I do not show the graphs above to my single patient who is over 35 and with no current prospects, and who is concerned about whether she will ever have children of her own. These women do not need me to rub their faces in their predicament.
With them, I take exactly the opposite approach. (It’s all in the spin, you see…) I tell them that at age 35, the odds are still with them. I tell them that I had no trouble getting pregnant at 35, and again at 40 (although I did have one miscarriage in between), and that they should not give up hope of having their own children.
I also talk to them about oocyte freezing (still considered experimental, but now available in New York), and about freezing embryos if they are willing to use donor sperm and are unwilling to risk an experimental procedure. Some may wish to consider single parenting, and these I refer to support groups like Single Mothers by Choice. None of these is an easy choice, and I do my darned best to be non-directive, non-judgemental and supportive to these women.
What I really want to do is find them a nice man to settle down with. I admit, I have set up at least one patient – it didn’t work. Maybe I should hook up with a sports medicine doc, and we could run a dating service out of our offices…
The Lesbian (You thought I’d forgotten about you, didn’t you?)
Lesbian women have the same wake-up time as straight women. However, in this one area they have a few more options. Of course, they always need a sperm donor. But that means that freezing embryos may not be as big an issue for them. And here’s the best part – If they are lucky enough to have a partner who is younger, they can just ignore the alarm, roll over in bed, and say “Honey – It’s up to you. I’m sleeping in”.
If you want more information about age and fertility, you can order this this this booklet from the American Society for Reproductive Medicine. They also have this booklet about assisted reproductive technologies.
Part III: The Male Factor
Category: Second Opinions
My patients who have decided to have children almost invariably ask me, “What should I do to get pregnant?” What books should they read? How do they take their basal body temperature? Should they use an ovulation predictor test?
I practice medicine, cook and wax prolific in New York City. You can call me Peggy. Or Dr P. Just don't call me late for dinner.
