“What I wish I had known about age and fertility”

Talking with more than a thousand single women over the years at Choice Mom networking events, a prevailing reality and regret expressed by many is that it is more difficult to conceive than many anticipated. They wished they had known more about the relationship between age and fertility. One 2013 journal article in “Human Reproduction” illuminates what we tend to find out later in the game.

Thanks to Alice Ruby, executive director of The Sperm Bank of California, for sending this journal article to me in her continuing efforts to help Choice Moms become better informed about fertility and age. This will be a focal point of education in the upcoming Choice Mom E-Guide to Fertility.

“Age Shock: Misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40.”  (published in Human Reproduction, Vol. 28, No. 2, p 350-356, 2013, by K. MacDougall, Y. Beyene, and R.D. Nachtigall)

Q: What do older women understand of the relationship between age and fertility prior and subsequent to delivering their first child?

Survey conversations with 61 women who delivered their first child after the age of 40 using IVF — the majority of them with a post-graduate education and media family income above $150,000 — included these primary results:

  • 30 percent expected their fertility to decline gradually until menopause at around 50 years
  • 31 percent reported that they expected to get pregnant without difficulty at the age of 40
  • 28 percent cited incorrect information from friends or their doctors or misleading media reports of pregnancies in older celebrity women as reinforcing notions that older women can easily become pregnant. Said one 42-year-old: “Of course I’m not old. Everyone’s having babies at 42.”
  • A few women were skeptical of medical statistics and believed that their own situations were unique. Said one married woman: “We just thought it was scare tactics to make you have kids young and thought it would be just fine.”
  • While the chance of a live birth after a cycle of IVF plummets from 40 percent at age 35 to 4 percent after age 42 (SART, 2009), the rapidity of this fertility decline is not appreciated by most non-infertility-specialist physicians, the general public, or men and women who are delaying childbearing.
  • 44 percent reported being ‘shocked’ and ‘alarmed’ to discover that their understanding of the rapidity of age-related reproductive decline was inaccurate.
  • Compounding the dismay at learning statistics from fertility specialists, 52 percent found that even IVF would offer them limited chance for success. Said one, “I think I had a very naive notion [that] with the various reproduction technologies you could have a baby no matter what. That was what was really sobering.”
  • In retrospect, their belated recognition of the effect of age on fertility led 72 percent of the woman to state that they felt ‘lucky’ or ‘had beaten the odds’ in successfully conceiving after IVF. 
  • The median number of IVF cycles required that led to success for this pool of 61 women was two. The survey did not include women who did not succeed at IVF.

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