Over the past decades, more women have been pushing back the decision to start a family until later in life. If you're over 35 when you're ready to get pregnant, what should you know?
You may have already heard that fertility begins to decline in the early 30s for most women. That means women aged 35 and over may have difficulty getting pregnant.
You may also have heard that there are greater health risks for babies born to older mothers. Unfortunately, both of these things are true.
But in light of this difficult news, you should know that you have a great chance of having a healthy and normal pregnancy.
dailyRx spoke with Barbara Dehn, a women's health nurse practitioner based in California's Silicon Valley, and author of the book, Your Personal Guide to Pregnancy, about what hopeful mothers-to-be should know when trying to get pregnant later in life.
The Reality of the Risks
Some women over the age of 35 may have no problem getting pregnant. But most women are less likely to get pregnant as quickly as they may have in their 20s.
Why? “It is the age of the egg in the ovary,” Dehn explained. “ As a woman gets older, her eggs that have been with her since she was in her own mother's tummy are also getting older.”
That means that the eggs are declining in quality – they're just not as fresh as they once were. Older eggs are more difficult to fertilize, and if they are, there's a higher risk of chromosomal abnormalities occurring as the egg divides.
These issues form the basis of most concerns over conception and genetic risks. But Dehn emphasizes that these risks should be put into the correct context.
“When we talk about risk of Down Syndrome, which is the most common genetic defect, the risk is really only about 1 percent when you get to be 40,” she said. Down Syndrome is the result of a chromosomal abnormality. “Ninety-nine percent of women who are 40 will not have a baby with Down Syndrome.”
Dehn advises, “Try not to get panicked about what you're reading and hearing because vast majority of pregnancies are healthy and normal.”
She added that many of the other health concerns that doctors check for in women over 35 – such as gestational diabetes, high blood pressure, and genetic defects – are monitored in all pregnant women.
“It's important for women who are over 35 not to put themselves in a high risk category, because their risk really isn't that much more than younger women,” she said.
Getting Healthy for Baby
If you want to get pregnant, now is the time to get super healthy.
Have you thought about dropping the extra weight you've wanted to get rid of for years? Getting fit is a precaution against gestational diabetes, a common pregnancy complication for women over 35.
In terms of diet, it's a good idea to increase the amount of calcium you take in. Dehn recommends three servings of calcium each day. If you're lactose intolerant, look for other sources such as beans, salmon, and calcium-fortified, non-dairy foods and drinks easily found at grocery stores.
“Eat more fruits and vegetables,” Dehn advises. The recommendation is five – seven servings of fruits and vegetables each day, but most people don't attain that goal. If a woman is motivated to get healthy and pregnant, that goal might become more realistic.
The most important thing, said Dehn, is to take a prenatal vitamin when you're thinking about getting pregnant. The vitamin's dose of folic acid can decrease the risk of spinal cord defects.
“That's important for women of any age,” she said.
See your doctor for a pre-conception visit, and he or she may be able to offer individualized advice.
When to See a Specialist
Dehn said that many women over 35 who are having difficulty getting pregnant stick with their regular OB-GYN. But don't be afraid to go see a fertility specialist, she said.
“The recommendations from the American Society of Reproductive Medicine are that women over 35 need to see a specialist after six months of trying, because there are increased rates of pregnancy once a woman gets more specific help from a specialist,” Dehn said.
She continued, “Women who are 35 and older who have been trying for six months or more should see a specialist, or women who are 35 and under and have been trying for over a year should see a specialist.”
Women over 40 who haven't gotten pregnant after three months should see a specialist as well, she said.
There's a popular misconception that a fertility specialist will immediately place a woman on a course towards in-vitro fertilization, an expensive and invasive treatment by which doctors fertilize eggs with sperm outside the body, and then implant the fertilized eggs back into the uterus.
But that's not the case. Dehn said that often, a simple diagnostic test to find blockages in the Fallopian tubes can increase a woman's chance of getting pregnant after the test.
There's also the option of taking an oral fertility pill, or the treatment of intrauterine insemination (IU). With the simple 15 – 20 minute procedure, concentrated sperm is placed directly in the uterus, increasing the chances of a sperm fertilizing an egg.
Dehn also mentioned that sometimes the stress of trying to get pregnant can cause difficulties. She said many fertility offices have a therapist on site, and recommends acupuncture or massage to reduce the stress surrounding the situation.
A Healthy Pregnancy
It's perfectly normal to have a healthy pregnancy in your late 30s and early 40s. Most women will have a similar experience to women in their 20s, even if they had more difficulty getting there.
Also, tests for potential abnormalities are now less invasive than they used to be, said Dehn. The nuchal translucency, or NT test, can identify up to 90 percent of babies with genetic abnormalities.
The NT test uses ultrasound to check for chromosomal abnormalities such as Downs Syndrome as well as major congenital heart problems. It's conducted in your first trimester along with a blood test and an evaluation for the absence of nasal bone.
These tests are given to all pregnant women, not just those later in life.
Dehn's most important piece of advice? “For women over 35, it's important to try to enjoy pregnancy.”
She said that often, older mothers-to-be are racked with fear about risks. But pregnancy is a special time in your life, and you should take the time to enjoy the experience, Dehn said.
“Nurture yourself during your pregnancy,” she added. Get a massage or a manicure if it makes you feel good.
After you have your baby, you might not have time for such luxuries!
