A woman’s attitudes about education, career and child-bearing are often at odds today with biological realities.
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Women who were part of the Baby Boom generation formed a vanguard in American society. Access to reliable birth control courtesy of “the pill” made it possible to plan the number of children in a family while expanding roles for women opened up new career opportunities. The children of the Baby Boomers, Generation X, entered this brave new world with unprecedented access to educational and employment opportunities plus an extensive array of reliable birth control choices. Yet fast-paced social changes are muddying the playing field as marriage and childbearing are increasingly delayed.
In 1970 the average age of a woman’s first birth was 21.5 years. By 2000 that average had jumped to 25. Today, many women delay marriage, childbearing or both until well into their 30s.
Such long delays are not without risk. Although fertility doesn’t drop off dramatically until after age 37, a recent study of 800 couples concluded that fertility begins to decline after age 27, much sooner than the early 30s as women had previously believed.
Infertility is a widespread problem, affecting approximately 15 percent of Americans of reproductive age, an estimated six million people.
As assisted reproduction techniques are becoming increasingly sophisticated, it’s tempting to count on these high-tech options. But couples need to be aware that assisted reproduction is expensive, often physically difficult, and fraught with disappointment if attempts are not successful. Although assisted reproduction often results in a much-wanted pregnancy, women need to be aware that there are many low-tech lifestyle approaches that can increase fertility.
When couples are evaluated for fertility problems, results show that in 40 percent of cases infertility can be traced to the woman, in 40 percent of cases, to the man, and in 20 percent of cases the problems are either shared or can’t be explained. Some fertility problems are beyond the control of the individual; others can be changed by personal choices.
Age is the most crucial factor influencing fertility and one that affects all women. Research shows that the decline in fertility that starts in the late 20s begins to accelerate during the 30s. By age 35, 25 percent of women will need to use assisted reproduction to become pregnant. By age 40 that number jumps to 50 percent and by 45, to 90 percent.
Social reality for women often doesn’t mesh well with this biological timetable. Clearly, for women who feel they have a choice, the odds of a successful pregnancy increase if you avoid waiting too long.
Oral contraceptives were once suspected of causing fertility problems. But a large study of 8,497 planned pregnancies found that rather than impeding conception, being a former pill user may actually help. Women who had taken oral contraceptives for more than five years were more likely to become pregnant in the 12 months after stopping the pill than women who had not used the pill but were also trying to conceive.
An Australian study found that women who had taken the pill for a number of years had a lower rate of age-related miscarriage (7 percent) when they did become pregnant compared with women who had not used the pill (28 percent).
Smoking can lower a woman’s chance of becoming pregnant by 30 percent. It affects both the number of eggs produced and the quality of eggs. And the more a woman smokes, the harder it is for her to get pregnant.
Weight can affect fertility at extremes of both under- and overweight. Women who diet or exercise excessively may lose so much weight that they no longer menstruate regularly. Women who are seriously overweight also have problems becoming pregnant as well as more complications associated with pregnancy and delivery when they do conceive.
Untreated sexually transmitted diseases (STDs) such as chlamydia and gonorrhea can make women infertile. Scarring of the fallopian tubes or low-grade infections, both of which can result from STDs, can make it difficult either to conceive or to sustain a pregnancy.
For some, pregnancy occurs within a short time of having unprotected sex; for other couples conception can be frustratingly elusive. Women can take comfort in the fact that when infertility occurs, there are an ever-increasing number of high-tech options to help conceive a child. Just as important, and far more accessible, are the low-tech, lifestyle steps women can take to maximize their chances of having a healthy baby.
Fertility a Weighty Issue
Women who are at extremes of weight, either very underweight or obese, have more difficulty becoming pregnant than women of normal weight.
An Australian study of 3,500 women who received assisted reproduction services found that the pregnancy rate for very obese women was only half that of women of moderate weight. Women in the underweight group were also less likely to become pregnant than moderate weight women.
Menstrual disturbances, lack of ovulation and abnormalities in the lining of the uterus were all factors affecting fertility for women at extremes of weight.
[SOURCE: “Being Underweight or Overweight Reduces Probability of Pregnancy,” Obesity, Fitness and Wellness Week, December 23, 2000]
Assisted Reproduction
Options Continue To Grow
When couples are unable to become pregnant via intercourse, they have a growing list of assisted reproduction options available to them.
· In vitro fertilization has been used since the late 1970s. New drugs now make it possible to induce ovulation even in women who have stopped producing eggs.
· Women can also use donor eggs or donor embryos.
· A man with a low sperm count can have sperm cells taken from a testicle and injected directly into an egg’s cytoplasm.
· In a procedure known as cytoplasmic transfer, scientists can remove the cytoplasm from the egg of a healthy younger woman (leaving the DNA behind) and inject it into the egg of an older woman to improve its quality.
· Scientists have discovered how to harvest and freeze eggs when a woman is young and keep them frozen until she is ready to use them.
[SOURCE: “How Old Is Too Old To Have a Baby?” Discover, April 2000]
Supplements Can
Increase Sperm Count
Men whose fertility is compromised by a low sperm count can increase sperm numbers more than 70 percent by taking folic acid and zinc supplements for six months.
Dutch researchers found the supplements boosted the sperm count in fertile men as well as in those with fertility problems.
[SOURCE: “Sperm Booster,” Community Pharmacy, October 7, 2003]
Balancing Pregnancy
and Contraception
A woman who is sexually active between the ages of 20 and 45 and plans to have two children will spend 20 years of her life trying to avoid becoming pregnant. Women use a variety of birth control methods over those two decades, including oral contraceptives, diaphragm, IUD, condoms and tubal ligation, the choice of many women after they’ve completed their planned childbearing.
[SOURCE: Cicely Marston and John Cleland, “Relationship Between Contraception and Abortion: A Review of the Literature,” International Family Planning Perspectives, March 2003]
Older Women More
Likely To Miscarry
The chance of miscarriage increases with age, according to a Danish study of 500,000 women. At age 35 about 20 percent of pregnancies will end in miscarriage. By age 42 more than 50 percent of women who are pregnant will miscarry.
The high failure rate of pregnancy in older women stems from the fact that older eggs are more susceptible to genetic damage.
[SOURCE: Kristyn Kusek, “Will You Still Be Fertile In 5 Years?” Parenting, February 1. 2003]
Smoking Harms Fertility,
Pregnancy and Baby
Quitting smoking is one of the most important decisions a woman can make if she’s planning to become pregnant. Women who smoke take 30 percent longer to become pregnant than women who don’t smoke. And when they become pregnant, smokers are more likely to either miscarry or to give birth prematurely.
A Dutch study found that one in four women smokers continued to smoke throughout pregnancy. Two thirds of those who quit while pregnant took up smoking again within two months of giving birth.
Although most women knew that smoking impaired fertility, few were aware that smoking raised the risk of an infant being born with a clubfoot and a higher risk of illness in the early years. Smoking in the presence of a baby also increases the risk of sudden infant death syndrome.
[SOURCE: T.J.Prins and C.Honing, “Planning to Become a Mom?” Tobacco Control, March 2002]
REFERENCES:
“Annual Summary of Statistics on U.S. Birthrate, Infant Mortality in 2001 Released,” Medical Letter on the CDC & FDA, February 9, 2003.
“Being Underweight or Overweight Reduces Possibility of Pregnancy,” Obesity, Fitness and Wellness Week, December 23, 2000.
Jacob Brody et al, “Reproductive Longevity and Increased Life Expectancy,” Age and Ageing, January 2000.
John Caldwell and Thomas Schindlmayr, “Expolanations of the Fertility Crisis in Modern Societies,” Population Studies, November 2003.
“Even Second-Hand Smoke Impairs Fertility,” Better Nutrition, December 2000.
Brian Good, “Easy Potency Test,” Men’s Health, March 2002.
Mark Henderson, “Baby Hunger: The Clock Starts Ticking at 27,” The Times, April 30, 2002.
Fristyn Kusek, “Will You Still Be Fertile in 5 Years?” Parenting, February 1, 2003.
Pial Ganguli, “Long-Term Pill Use – Does Not Hinder Planned Conception,” Practice Nurse, November 8, 2002.
“Lower Fertility and Increased Risk of Miscarriage,” Contemporary OB/GYN, December 2000.
Jon Marcus, “Too Thin To Be Fertile,” Times Higher Education Supplement, June 14, 2002.
Judith Newman, “How Old Is Too Old To Have a Baby?” Discover, April 2000.
Suzanne Stipe Persaud, “It’s Not Just About Age,” Fit Pregnancy, August-Sept. 2003.
T.J. Prins, “Planning to Become a Mom?” Tobacco Control, March 2002.
“Test Aims to Help Couples,” MMR, March 24, 2003.
“When Fertility Tests Can Deceive,” Pulse, April 28, 2003.
Allen J. Wilcox, “The Timing of the Fertile Window in the Menstrual Cycle,” JAMA, January 17, 2001.
