Many women worry about their biological clock.  A woman’s fertility drops off dramatically around age 37 and continues to decline sharply until menopause which usually occurs around age 52.

Of course, some women are able to conceive in their early, mid, or even late forties.  But the odds decrease dramatically with the passage of time. 

Some people cite anecdotal cases of women who were able to conceive easily in their late thirties or forties as evidence that it is fine to wait that long.

But such anecdotal evidence should not be mistaken as the norm.  Most women after age 37 will have difficulty conceiving and it could take several years—years that they wish to spend raising a child, not attempting to conceive.

The reason that it becomes more difficult to achieve a successful pregnancy is not that she is running out of eggs, but that the eggs are aging and degrading. This accounts for the higher rate of miscarriage because the eggs are damaged.

Unlike men who produce new sperm throughout their lives, women are born with all the eggs that they will ever have—about 250,000 to 500,000.  And the eggs begin aging as soon as they are created.   Older women still have plenty of eggs, it’s just that the eggs are older.  Also, because the eggs are older,  the chances of having a miscarriage increase with age.  The miscarriage rate for women over 45 is close to 50%.

Many people erroneously think that if a woman is healthy and “feels young” she will not have difficulty conceiving.  However, a 45 year old woman can have the body of an Olympic athlete, but her eggs are still 45 years old.  And that is what will determine her likelihood of conceiving and maintaining a pregnancy.

What If I’m Not Ready to Have Children Before Age 35?

Clearly, there are many factors that go into deciding to have a child beyond just a woman’s age—Factors such as finding the right partner, having the financial resources, and being at a place in one’s professional life where you can safely take off time knowing that your job will still be there for you when you return.  These are not easy things to achieve. 

And unfortunately, in the United States, parental leave is not offered in all workplaces, and paid parental leave is even more rare.

In many countries there are policies in place that make starting a family much easier.   Also there are some people who just don’t decide that they want to be parents until later in life.

For all these reasons and many more, people are not ready to start a family until the woman is in her late thirties or early, mid or even late forties.

What Can I Do If I am Older and Unable to Conceive?

Here enters ART (Assisted Reproductive Technology). Most women will begin with IVF or IUI.   IUI or IntraUterine Insemination is where a woman takes medication to increase her egg production and then the sperm is artificially inseminated to increase the chances of it reaching the eggs.

IVF or In Vitro Fertilization is when a woman takes FSH (follicle stimulating hormones) so that she will produce more than just one egg-anywhere from about 5 to 15. The eggs are then retrieved from her ovaries, fertilized with the husband’s sperm in the lab, incubated and transferred to her uterus.  Older women doing IVF with their own eggs will often transfer several embryos hoping that at least one will implant.

The success rate is influenced by several factors, mostly the number of mature eggs that she produces and the quality of the resulting embryos. However, she is still working with her older eggs and her chances of having a healthy pregnancy that will continue to a live birth are much lower than with embryos made from younger eggs.

The Role of Egg Donors

This is the point at which women often turn to egg donors to achieve a pregnancy.  Young women age 20 to 28 will undergo ovarian stimulation and retrieval to provide eggs for IVF for an older woman.   A typical donor cycle results in about 5 to 10 good quality embryos.

After fertilization and incubation one or two fresh embryos will be transferred to the uterus of the intended mother and the remaining good quality embryos will be frozen.  About 70% of women will achieve a pregnancy with the first transfer.

If she does not, she will continue transferring the frozen embryos until she is either pregnant or out of embryos.  These days the success rate of couples working with donors is in the high 90’s.  Almost everyone who works with a donor is able to achieve a live birth.

The major obstacle is the number of available donors.  Egg donation is a much bigger commitment than sperm donation.  The donor must be on injectable medications for 10 to 12 days and then undergo the retrieval procedure.  Donors are well compensated for their time.

Fortunately, there are young women that are willing to do this, but the demand is much greater than the supply.  For any young women considering this, it is well worth the effort, and it is a wonderful way to have an immeasurably positive impact on the lives of others.  You can easily find egg donation agencies in your area by searching on the Internet.

Carrying a Pregnancy Over 40

Pregnancy over 40 is not automatically considered high risk.  The complications of pregnancy (gestational diabetes, pregnancy induced hypertension, pre-eclampsia, preterm labor, premature birth, etc.) do occur slightly more often in older women.

However, all of these complications and others also occur in younger women and with good medical care they are entirely manageable.  Being pregnant in your late 30’s or 40’s should not be a cause for concern.  It is getting pregnant that will be challenging.

But more and more women are postponing childbirth and there is a wealth of support out there for this growing group of women.   And you are definitely not alone.