Women can have it all—depending on how you define it. Love? Sure. Career? No problem. Children? Well, you’ll have to plan accordingly. This last checked box is where it gets a little more complicated.
Over the past several decades, women have continued to delay pregnancy for a number of reasons. For one, social trends now favor women who bear children later in life, enabling them to achieve a satisfying career, a happy relationship, and a more mature, educated perspective going into motherhood than they would have had otherwise.
This social trend can bring biological complications along with its message of empowerment. As increasing numbers of women are seeking pregnancy in their late-30s and early to mid-40s, a significant number of these women are seeking infertility treatment as well.
Although there is a very well demonstrated decline in women’s fertility due to age, many healthcare providers still don’t address preparation for a delayed pregnancy. This creates problems for many women—it’s important to know the effects of aging on fertility so you can make plans to accommodate. If you plan properly, you can have children later in life.
The Myth of Eternal Youth
Many women, after years of trying not to get pregnant, face infertility when it’s finally time to become a mother. It’s easy to avoid considering fertility issues until you are seriously thinking about having kids. By then, however, it could already be a serious issue. Don’t be fooled by the youthful face staring back at you in the mirror—if you want to wait, plan ahead. The time is now.
Compared to other major organ systems, the female reproductive system ages to the point of failure at a relatively young age. The American Society for Reproductive Medicine describes how age is associated with declined fertility: “Although the average age of menopause is 51, peak efficiency in the female reproductive system occurs in the early 20s with a steady decline after. There is a gradual loss of fertility as a function of female age, with the rate of decline in fertility becoming more dramatic after the age of 35.”
This decline in fertility occurs in spite of the fact that women generally maintain regular, ovulatory menstrual cycles into their 50s. The ASRM goes on to say that a healthy 30-year-old woman has a 20 percent chance of getting pregnant in a given month. Ten years later, that same woman at age 40 has just a five percent chance of pregnancy.
The reason is pretty straightforward. A woman is born with all the eggs she will have in her lifetime. Over time that supply declines and the eggs become less-than-optimal for a healthy pregnancy, giving an increased chance of complications, should a pregnancy be realized.
Preparing for the Future
So how can you prepare for later-in-life pregnancies if you’re already in what science regards as a less-than-optimal biological state?
>> Fertility Tests. Having a fertility test done can gauge how many eggs you still have available. The best tests are an ultrasound to count the number of follicles in your ovaries and a blood test to check your hormone levels at certain points in your cycle. (These tests are typically covered by insurance, but check with your provider to be sure.) The ultrasound and blood test can’t guarantee that you’re fertile—too many other factors come into play—but they can tell you how loudly your clock is ticking and whether you need to consider speeding up your schedule.
>> Practice Safe Sex. It might be counterintuitive to think that condoms would come up in a conversation about getting pregnant, but safe sex can be a crucial factor in your future ability to have kids. STDs like gonorrhea or chlamydia could be in your system without causing symptoms. If left untreated, these diseases can lead to a serious condition called pelvic inflammatory disease, which can scar the fallopian tubes and cause infertility. So get tested regularly, and make sure your partners do as well.
>>Take Your Vitamins. “Every woman of reproductive age—even if you’re not actively trying to get pregnant—should take a multivitamin containing folic acid,” says Jorge Chavarro, MD, an instructor at Harvard Medical School and coauthor of The Fertility Diet. According to Chavarro, folic acid appears to improve fertility by stimulating ovulation and giving an embryo essential proteins needed for survival. His research also found that women who took iron supplements were 40 percent less likely to have fertility problems, so look for a vitamin with at least 40 mg of iron and 400 mcg of folic acid, and get in the habit of taking it every morning.
>>Cut Back on Alcohol and Caffeine. Some studies show that having one to five alcoholic drinks per week can drop your chances of conceiving that month by as much as 50 percent. While other studies have found little connection between moderate drinking and fertility, the point is that sobriety certainly couldn’t hurt, and might help. And while you’re at it, cut back on mornings with five cups of coffee. Though there is no real consensus, some studies suggest that consuming more than 300 milligrams of caffeine a day (about two eight-ounce cups of regular coffee) may increase your risk of endometriosis or fallopian tube problems.
>>Eliminate Cigarettes. If higher rates of lung cancer and breast cancer haven’t made you swear off smoking, consider this: The ASRM estimates that cigarettes are linked to 13 percent of infertility cases. Tobacco messes with your fertility in all kinds of ways. It makes your eggs deteriorate faster than they naturally would, increases your risk of early miscarriage and ectopic pregnancy (a dangerous condition in which the egg implants in your fallopian tubes or ovaries instead of your uterus), and can hasten menopause by up to four years. Plus, if you wind up needing in vitro fertilization (IVF), smoking will reduce your chances of success by 34 percent. The encouraging news is that once you do quit smoking your fertility level will return to normal in about a year. (Considering that it takes the average smoker two to four tries before quitting for good, you should start trying to kick the habit well before that.) While you’re at it, recruit your partner, parents, and friends to quit with you: A recent study in Tobacco Control found that women who were exposed to secondhand smoke six or more hours a day as adults were 36 percent more likely to have trouble getting pregnant.
>>Freeze Your Eggs. By storing your eggs, you may be able to use them for treatment in the future. You may want to talk to your clinic about freezing your eggs if you are concerned about your fertility declining as you get older and are not currently in a position to have a child, or if you are facing major medical treatment (like radiation or chemo) that may affect your fertility. To help boost egg production, fertility drugs are used to stimulate the follicles (which contain the eggs). By stimulating the follicles, they hope to be able to harvest more than one egg in a given menstrual cycle. After the eggs are retrieved, they are placed in storage in liquid nitrogen.
All these suggestions may seem daunting, but if you just break them down and take it one step at a time, you’ll be able to do it, plus you’ll feel good knowing that you’re ensuring the viability of your future family.
Essential Eating Tips for Pregnancy after 35
Nutrition is always a key part of being healthy, but it is especially important during pregnancy when that nutrition is fueling a new life growing inside the mother. To get a nutritionist’s perspective on how a 35-plus first-time mom should eat, we turned to Michele McRae, CN, the senior director of research, formulation, and quality with Rainbow Light Nutritional Systems.
NS: How can a woman over 35 maintain a healthy pregnancy once pregnant?
MM: In the past 20 years the number of first-time moms over the age of 35 has increased by 64 percent, accounting for more than 675,000 of the babies born each year. Many of these pregnancies are planned, with a priority placed on prenatal care. And while there are defined risks involved with 35-plus pregnancies, many healthcare professionals today gauge these risks by the woman’s health, rather than her age.
The 35-plus mom tends to be well-educated, financially stable, and to have medical coverage and an established physician. They are also generally well-informed and proactive about their healthcare plan. However, she may also feel under pressure to conceive because she feels her “clock is ticking,” while at the same time feeling stressed and tired because she is managing multiple priorities.
Nutrition is a very important aspect of a woman’s life when she is planning to conceive, during her pregnancy, while nursing, and beyond. Good nutrition is necessary for hormonal balance, which supports fertility and the ability to conceive. And, while a healthy whole foods diet will provide a strong foundation for a healthy pregnancy, healthcare professionals do recommend that women begin to take a quality prenatal vitamin as soon as they decide they want to become pregnant. If a woman can build her nutrient stores before pregnancy, she may be able to reduce certain risks and protect not only her baby’s health but her own wellness and vitality. A growing baby receives preferential treatment during pregnancy, taking nutrition from the mother as it grows and develops. This can lead to nutrient deficiencies for pregnant women that can negatively impact their health.
NS: What types of risks are associated with pregnancy over 35?
MM: Moms who are 35 and over may be twice as likely to develop high blood pressure—a precursor to preeclampsia—during pregnancy. This age group is also at higher risk for gestational diabetes, low birth-weight babies, birth defects like Down’s syndrome, miscarriage, and placental issues like placental abruption and placenta previa.
Compared to pregnancies earlier in life, 35-plus moms may experience more discomfort sooner. This can take the form of swelling, heartburn, back pain, varicose veins, nausea, and fatigue.
NS: What types of food or meals are beneficial to getting pregnant or maintaining a healthy pregnancy?
MM: Foods like leafy greens, orange juice, dried beans and peas, meat, fish, eggs, and dairy are rich in folic acid, choline, and B-complex vitamins. These nutrients are essential to support the baby’s brain, spine, and nervous system development, and also promote mom’s health and daily energy. An enhanced form of B12 called methylcobalamin really helps with daily fatigue and anemia. B12-rich foods include fish and shellfish (which should be avoided during pregnancy), meat, eggs, and dairy. If one is vegan or vegetarian there may be additional risk of a B12 deficiency.
Iron protects against iron-deficiency anemia. Iron-containing foods include red meat, poultry, shellfish, spinach, legumes, dried fruits, and nuts.
Vitamin C and chromium are important to support healthy blood sugar levels. Lutein—found in dark, leafy greens; egg yolks; and fruits—supports baby’s vision health. New research with lutein shows promising benefits for cognitive health with fetal brain development. Choline is very important for healthy neurosynaptic mapping in baby’s brain for enhanced cognition later in life. Pregnancy changes choline metabolism, increasing the need for choline. Calcium, minerals, trace minerals, and vitamin D are important for both mom and baby’s skeletal health, bone strength, and immunity. Fortified milk and yogurt can be an excellent source of calcium; broccoli and dark, leafy greens are great dairy-free options. Adequate vitamin D potencies may be harder to obtain from animal-derived food sources on a daily basis, so supplementing with vitamin D is a good idea.
The omega-3 fatty acid DHA is known to benefit baby’s brain development and cognitive function and should be consumed during pregnancy and while nursing. Tuna, eggs, and salmon are good food sources, but many women try to avoid eating fish during pregnancy due to potential heavy metals present in the fish. DHA supplements that have been molecularly distilled are a great alternative.
NS: What’s an ideal amount of weight to gain during pregnancy?
MM: During the first trimester, mom doesn’t need any extra calories, but as she moves into the second trimester, women of healthy weight should be getting about 300 extra calories per day. In the third trimester, calorie intake should increase by 500 calories per day. The overall recommended weight gain during pregnancy for women of normal weight is 25–35 pounds.