The Age Factor

Q: I know someone who is 40 who conceived without any problems. How likely is it to conceive quickly and without assistance after age 36?

Wisot: At 40, your fertility rate is not what it was at 30, but we still see women getting pregnant. One of the most common scenarios is to have a woman sitting across the table from me who says 'I'm vice president of a big company and I have it all, but I forgot to have a baby.' It may still be possible, especially with reproductive technology. But it's important to realize that you do get to a point in your life where biology won't allow you to have babies with your own eggs.

Singleton: When most of us were growing up, everyone joked about our clock ticking and we were encouraged to go and have wonderful careers and told that we could have babies anytime. That's just not the case. I think we need to do a better job of educating young women that they need to be thinking about family planning at the same time as their careers. There are 40-year-old women who run marathons, eat all the right food and think that because of that they should be able to have kids. But it has little to do with our habits. It is determined very much by our age. There is so much of it that we cannot control.

Redmond: The data show the overall effect of age. However, in my experience, any given woman age 40 may conceive on her first try. And any given 30-year-old may fail. You can only try and see.

Willman: Studies have demonstrated that almost 50 percent of women over the age of 40 will experience infertility. To compare numbers, the average 25-year-old woman who is trying to conceive may have a 25 percent per month chance for pregnancy, if all fertility factors are optimal. Compare this with the 5 percent per month chance for conception that the average 40-year-old woman has.

This age-associated decline in fertility, and increase in miscarriages, is largely due to abnormalities in the egg itself. Women over age 40 have approximately a one-in-three chance of having a miscarriage in any given pregnancy. In addition, at age 40, one in 60 live births is genetically abnormal.

With this in mind, it seems reasonable to promptly evaluate women over 40 who are concerned about fertility. Before starting an evaluation, however, it is important to discuss some of the special considerations for the older woman trying to conceive. These would include general health issues, since women over 40 are more likely to have medical problems - diabetes, hypertension, heart disease - that can complicate a pregnancy. Therefore, an older woman contemplating a pregnancy should have a thorough medical evaluation, including a mammogram.

Some women seeking to conceive after the age of 40 have little difficulty in achieving a pregnancy. For those who do, however, prompt evaluation and aggressive treatment are critical. The serum FSH level, along with the patient's comfort with aggressive treatment, can help guide treatment.