Motherhood postponed? Be aware of the risks

February 15, 2000
Web posted at: 8:04 AM EST (1304 GMT)

In this story: As age rises, fertility drops Beyond fertility RELATEDS

(WebMD) -- Kathe Lieber spent much of her 30s building her writing and editing business and traveling. It wasn't until she was approaching her fortieth birthday that she truly felt ready for motherhood. "At that point, I'd done all of the things I wanted to do, except have a child."

While she was slightly concerned about the health implications of postponing pregnancy, her doctor offered some reassuring words: "She told me that my age didn't put me at any higher-than-average risk of complications because I was an extremely healthy person." Nine months later, she gave birth to a healthy baby girl.

Lieber's decision to postpone having children is representative of a growing number of women in the U.S.: According to the National Center for Health Statistics (NCHS), the number of women giving birth in their 40s jumped by more than 50 percent between 1976 and 1996. What these statistics don't hint at, however, is the number of women in their 40s who weren't able to get pregnant.

It's a scenario that Mark Perloe, M.D., director of reproductive endocrinology, infertility and in vitro fertilization at the Atlanta Medical Center, has seen played out in his office time and time again.

"I find it frustrating that many women delay childbearing until after age 40, thinking that it's a realistic possibility to start their families at that point," he says. Perloe blames the media for glorifying the image of the older mother and playing up reproductive advances that allow some women to give birth during their late 40s and even into their 50s. "We hear stories about women who are successful in having babies later in life - the 54-year-old who gives birth to triplets - with the implication that it's OK to wait. But we don't hear about the women in their forties who aren't successful and that there's a serious possibility that waiting will jeopardize their fertility."

Although Perloe's statements sound strong, they are based on research, and the majority of fertility experts would agree that women need to know that there can be a price to be paid for postponing motherhood.

As age rises, fertility drops

Unlike men, who have the ability to manufacture sperm throughout their lives, women are born with all of their eggs. The quality of these eggs deteriorates over time, which can lead to fertility problems and an increased rate of pregnancy loss. According to Perloe, one-half of a woman's eggs will be chromosomally abnormal by the time she reaches age 40 -- a noteworthy increase over just five years earlier, when only one-third of her eggs are abnormal.

There are other factors, too, that can speed up the ticking of the fertility clock, Perloe adds: A woman is more likely to go through menopause early (the average age of menopause is around age 50) if she smokes, if her mother smoked during her pregnancy with her, if she has only one ovary, or if the women in her family tend to go through menopause early.

Perloe suggests that women who are 35 or older who are thinking of postponing pregnancy have an evaluation of ovarian reserve (done with a blood test) to "guesstimate" her current fertility to give her an idea of her reproductive age. "Some 35-year-olds are actually 42-years when it comes to reproductive function," he says.

Beyond fertility

Fertility isn't the only factor a 35-plus women needs to consider:

A study reported in the December 1998 issue of Obstetrics and Gynecology found that women over the age of 44 are 7.5 times as likely to require a cesarean delivery as younger women. All that said, there are plenty of women who do manage to have healthy babies during their forties. "For the large majority of women, having a baby in the late 30s or early 40s is safe and uncomplicated," says Dr. John R. Sussman, co-author of The Unofficial Guide to Having A Baby. "What's also important is deciding when it's right for a woman and her partner to bring a new life into their lives."

© 2000 Healtheon/WebMD. All rights reserved.

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RELATEDS AT :

Detecting defects
Pregnancy after 35

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RELATED SITES:

American Academy of Obstetricians and Gynecologists
American Society for Reproductive Medicine

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