‘INFERTILITY time-bomb warning”; “infertility on the rise”; “women can’t ‘have it all'” – the news can make grim reading forwomen in their thirties who have not yet started a family. This week, the fertility specialist Lord Winston declared that youngerwomen should be encouraged to take time out of their careers to have children, to avoid the heartache of leaving it too late.
Yet the facts belie this dismal picture. The truth is that for a woman in her late thirties who wants to have a baby, the odds are still in her favour. The number of babies born to women over 35 has doubled in the past decade. A new book, Conception and Pregnancy over 35, seeks to cater for this growing constituency. Professor Lesley Regan, head of obstetrics and gynaecology at St Mary’s Hospital, Imperial College, London, writes in the foreword that “conceiving in the late thirties will probably, but not necessarily, take a bit longer” and that “most couples are successful eventually”. But why does it take longer? And is there anything you can do to speed things up?
1How likely am I to experience problems conceiving?
Women over 35 experience a decline in fertility as a result of a decrease in the number and health of their eggs, an increasing likelihood of medical problems such as diabetes and hypertension, and less frequent sex. They may also experience unrecognised miscarriages as a result of chromosomal problems. Also, ageing affects the uterus by, for example, increasing the chance of fibroids (growths of fibrous tissue), making it more difficult for fertilised eggs to implant.
According to Dr Laura Goetzl, an American specialist in high- risk pregnancy and the principal author of Conception and Pregnancy over 35, that does not mean you should assume the worse.
While you may have a longer conception time, “it is best to assume that you will become pregnant within a year or so and confidently make plans to achieve conception”. Most couples conceive within a year.
2Why is 35 such an important age?
Thirty-five is “a bit of an oldfashioned definition”, according to Dr Richard Kennedy, a consultant obstetrician and gynaecologist at Walsgrave hospital, Coventry.
“There’s no magical definition at which it’s more difficult to conceive, ” he says. “However, the risks are raised the closer you are to 40, particularly with first babies.”
Sheena Young, Scottish spokeswoman for the Infertility Network, adds that some women will experience no noticeable decline in their fertility at 35;
indeed, it is “not unusual” for women to be fertile in their forties and a few remain so in their fifties.
3If I already have children, am I less likely to have problems?
If you have had a baby at 33 and are then trying to have another by the same man at 37, then the chances of having difficulties are probably less than if you were trying for the first time at 37, according to Dr Kennedy.
4What can I do to assist my chances of conceiving?
Stay healthy. Healthy eating can help your chances of conceiving by boosting your general health and hormonal balance. Eat a wellbalanced diet, containing all the main food groups. Go for complex carbohydrates and remember to drink plenty of water. Folic acid is an important nutrient pre-conception and many women take it in supplement form. It decreases the risk of neural tube birth defects which affect the brain and spinal cords and occur in the first month after conception. Maintain a sensible body weight: being very overweight is associated with lower fertility, while underweight women may not ovulate regularly. It is also worth establishing a good exercise programme before you conceive when you still have plenty of energy. Strength training, especially of the abdominals, will help prevent back pain during pregnancy.
Discuss any pre-existing medical conditions with your doctor.
5Do I have to give up drinking and smoking?
Avoid binge-drinking. You should avoid smoking, as it has been linked to decreased fertility.
6My wife and I are planning to start a family. Is there anything I can do to boost our chances of conceiving?
Apart from the obvious, you should avoid binge-drinking or smoking very much. In addition, the Infertility Network advises that men should try to keep the area around the scrotum cool.
7Do I have to have “timed sex” with my partner?
Some doctors, including DrGoetzl, advocate “timed sex” – in other words, having sex around times when the woman is at hermost fertile. Methods of predicting this include calculating your ovulation period and monitoring fluctuations in body temperature.
Dr Kennedy, however, counsels caution. He says: “For a couple who are having regular sex, two to three times a week, their chances are as good as having timed intercourse.”
Timed sex has downsides, particularly in terms of changing the dynamic of the sexual relationship. According to Dr Kennedy, it may be more beneficial for people who are having sex infrequently.
8It is disheartening to find you’re still not pregnant month after month. Can stress and worry make things worse?
It is hard to prove conclusively, but the anecdotal evidence is strong.
Stress can get tied up in a vicious cycle with fertility problems – it can impare ovulation, making conception more difficult, which in turn creates more stress. If it helps to try alternative therapies, then do so. Dr Goetzl advises planning a “fertility holiday”where you and your partner are not trying to conceive.
9If we do have trouble, what sort of tests and treatments can we have?
Your partner’s sperm can be tested and a questionnaire and blood tests carried out to make sure you are ovulating. If all is normal, you may be given an examination to see if your fallopian tubes are open or to look at your uterus. Treatments vary. In women with polycystic ovary disease, fertility pills may be enough. If not, the next step is a combination of hormone injections and assisted fertilisation, in which your doctor introduces a sample of your partner’s sperm into your uterus. If your partner’s sperm count is low, your fallopian tubes are blocked, or other treatments fail, you will probably be offered in vitro fertilisation. IVF involves combining your eggs with your partner’s sperm in a petri dish in the lab. If there are problems with your partner’s sperm, a single sperm can be injected into your eggs – intra cytoplasmic sperm injection (ICSI) – and the healthy embryos returned to the uterus.
10 When should I seek help?
If you are over 35, have followed advice relating to diet, exercise and body weight and have not conceived within sixmonths, you should “touch base”with your family doctor to discuss possible tests, according to Dr Kennedy.
After one year, he recommends specialist referral. The age cut- off for assisted conception (IVF and ICSI) in Scotland is 38. Sheena Young says: “With waiting lists being what they are, the age of the female partner is crucial.”
The National Infertility Awareness Campaign has welcomed an indication by the Scottish Executive yesterday that it will consider a waiting time target for infertility treatment. There are huge variations Scotland-wide.
Lorraine Sloan: “I thought I’d never have a family” There are plenty of high-profile women who have conceived and given birth in their late thirties or forties. Madonna, 47 this month, gave birth to Lourdes at 38 and Rocco just before her 42nd birthday while Cherie Blair had Leo, now five, at the age of 45. Celebrities benefit from the attentions of personal nutritionists, trainers and others to help them stay fit, but many women over 35 have happy stories of trouble-free conceptions and pregnancy – sometimes against the odds.
Lorraine Sloan, 37, was 35 when she got pregnant. The pregnancy was unplanned and all the more unexpected as she had a hormone imbalance, polycystic ovary syndrome and endometriosis. She was prescribed drugs and originally medics thought she would neither work again nor have a family. Now successfully running her own business as an alternative therapist, the Angel Sanctuary in Clydebank, she has defied predictions on both fronts. She says:
“They had diagnosed me with polycystic ovary syndrome and wanted to take my ovaries out at 24.
“I just consoled myself that I would not have a family.”
Lorraine decided not to rely on drugs, but turned to alternative therapies instead, such as Reiki.
Then the unexpected happened.
“I was feeling a bit sick and I knew there was something happening to me inside, ” she says. She remembers detecting a change in herself the first week of her pregnancy, a sensitivity she puts down to being attuned to her own body through practising alternative therapies. She went on to have Jack, who is now coming up for two.
Even without such problems to overcome, few women over 35 take pregnancy for granted.
Elaine Bell, 38, mother of Murray, one, says that she was surprised to get pregnant at 36 “pretty much immediately”.
“I never thought I would get pregnant so quickly, ” she says. “All the literature says that fertility drops as you get older, that highpressure jobs have an impact and so on.
“But most of my friends conceived first time, too.”
THE BABY BOOM
Births among women aged 35+ in Scotland as a percentage of overall births
35-39 40-44 45+
1976-80 4.4 0.9 0.0
1986-90 5.8 0.9 0.0
1994 8.7 1.2 0.0
1999 12.8 2.0 0.1
2004 6.5 3.0 0.1
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