How does age affect fertility?

A few weeks ago, I was out to dinner with 5 of my girlfriends, and the topic of age and fertility came up. All of us had our first born when we were above the average age of first time mothers in the US, and we all experienced difficulties when trying to get pregnant.

In the US, the average age of a mother’s first birth has increased from 21.4 to 26.3 years of age between 1970 and 2014. When I think about what my life was like at age 21.4 versus 26.3 versus when I gave birth to my first child at 29.8, I find that the reasons for delaying having kids apply to me and many of the women I know. Reasons for the increased occurrence of older maternal ages include increased access to better contraceptive options, later marriage, second marriage, and greater opportunities for education and career advancement. College educated women have higher rates of first birth rates in their 30s, and surveys have shown that women desire stability in their career, finances, personal goals, and marriage prior to planning pregnancy.

One of my friends has 1 child, but wants more. She had a miscarriage several years ago when trying for a second child, and has not been able to get pregnant since. She’s losing hope that her son will have a sibling. My heart broke when she mentioned that she wished someone had warned her that she may have more difficulties getting pregnant if she waited until she was older to start a family. She’s an amazing person with a very successful career, and has no doubt made and will continue to make a world of difference in the lives of many people. As women, do we really have to decide between a successful career and having children? Being a mother of 3 daughters, I sure hope not, and in terms of having this discussion with them when they’re older, I’m honestly not sure what is best. At the time of my life when I was making big career decisions, I was told that a woman can’t have both a career and a family because it’s not possible. This may have been one of the biggest reasons I decided not to go to medical school. I did not think that I would be able to have kids and be a doctor. I ended up still having a busy career, and even returned to medicine later in life to become a Physician Assistant (PA) after having my 2 older daughters, but I do wonder what my life would be like if I had gone to medical school when I was in my 20s. Is ignorance bliss or should our daughters be able to make their own informed decisions? From what perspective should we give? I don’t think that there is a right answer because everyone is so different. Fortunately, I have a little bit of time to figure things out with my girls, but from the medical perspective, this is what we know:

Women in their late 20s are almost half as fertile as women in their early 20s. In addition, older and younger women are at risk for the same pregnancy complications, but older women are at increased risk for some of these problems. There is an increased rate of miscarriage in older women probably due to a decline in egg quality. Changes in hormonal and uterine function may contribute.

Pregnancy complications that occur more often in women of advanced maternal age include ectopic pregnancy, some congenital anomalies (i.e. down syndrome), fetal chromosomal abnormalities, placenta previa, preeclampsia, gestational diabetes, cesarean delivery, postpartum hemorrhage, hysterectomy, thrombosis, preterm birth, low birth rate (LBW), perinatal mortality, and maternal death. Advanced maternal age may also increase risk of still birth, autism spectrum disorders, and twin pregnancy. Interestingly, when compared to singleton pregnancies, outcomes in older women are as good or better than in younger women.

On the other hand, maternal age has been found to be related to improved immunization rates, language development, frequency of unintentional injuries and social development in children up to age 5.

At Layla, we hope to make getting pregnant easier, less time consuming, more convenient, and effortless in order to save you time and reduce the stress that can be experienced with trying to conceive regardless of your goals or what is going on in your life.

Reference

Fretts RC. Effects of advanced maternal age on pregnancy. Wilkins-Haug L, Simpson LL, and Eckler K, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on August 25, 2019.)