How Big Will My Baby Be at 7 Weeks
How Long Can Y'all Wait to Take a Baby?
Deep anxiety most the ability to have children later in life plagues many women. But the decline in fertility over the course of a woman's 30s has been oversold. Here's what the statistics really tell u.s.—and what they don't.
Editor'southward Note: Read more stories in our series nigh women and political power.
In the tentative, post-9/11 spring of 2002, I was, at thirty, in the midst of extricating myself from my first matrimony. My husband and I had met in graduate school but couldn't observe two academic jobs in the same identify, so we spent the three years of our marriage living in different states. Afterwards I accepted a tenure-rail position in California and he turned down a postdoctoral enquiry position nearby—the job wasn't good enough, he said—information technology seemed clear that our living situation was not going to change.
I put off telling my parents almost the separate for weeks, hesitant to disappoint them. When I finally broke the news, they were, to my relief, supportive and understanding. Then my mother said, "Accept y'all read Time mag this week? I know you want to have kids."
Fourth dimension'due south cover that calendar week had a infant on it. "Heed to a successful woman discuss her failure to bear a kid, and the grief comes in layers of bitterness and regret," the story inside began. A generation of women who had waited to start a family was get-go to grapple with that determination, and one media outlet later on another was wringing its hands near the steep decline in women's fertility with age: "When It'south Too Late to Have a Baby," lamented the U.K.'s Observer; "Babe Panic," New York magazine announced on its encompass.
The panic stemmed from the Apr 2002 publication of Sylvia Ann Hewlett's headline-grabbing book, Creating a Life, which counseled that women should have their children while they're young or take a chance having none at all. Within corporate America, 42 percent of the professional person women interviewed by Hewlett had no children at historic period 40, and virtually said they deeply regretted it. Just as y'all programme for a corner office, Hewlett brash her readers, you should programme for grandchildren.
The previous fall, an ad entrada sponsored by the American Society for Reproductive Medicine (ASRM) had warned, "Advancing age decreases your ability to have children." 1 ad was illustrated with a baby bottle shaped like an hourglass that was—just to make the point glaringly obvious—running out of milk. Female person fertility, the group announced, begins to reject at 27. "Should yous have your baby now?" asked Newsweek in response.
For me, that was no longer a viable selection.
I had always wanted children. Even when I was busy with my postdoctoral research, I volunteered to babysit a friend's preschooler. I oftentimes passed the time in airports by chatting up frazzled mothers and babbling toddlers—a 2-year-old, quite to my surprise, once crawled into my lap. At a wedding I attended in my late 20s, I played with the groom'due south preschool-historic period nephews, often on the floor, during the entire rehearsal and most of the reception. ("Do you fart?" i of them asked me in an overly loud voice during the rehearsal. "Everyone does," I replied solemnly, as his grandad laughed quietly in the next pew.)
Just, suddenly single at 30, I seemed destined to remain childless until at least my mid-30s, and perhaps ever. Flying to a friend'due south hymeneals in May 2002, I finally forced myself to read the Time article. It upset me then much that I began doubting my divorce for the first time. "And God, what if I desire to have two?," I wrote in my periodical every bit the common cold airplane sped over the Rockies. "First at 35, and if yous wait until the child is two to try, more than than likely you have the second at 38 or 39. If at all." To reassure myself most the divorce, I wrote, "Nil I did would have inverse the state of affairs." I underlined that.
I was lucky: within a few years, I married once more, and this fourth dimension the friction match was much better. But my new husband and I seemed to face frightening odds against having children. Most books and Web sites I read said that one in 3 women ages 35 to 39 would not get meaning within a twelvemonth of starting to effort. The start page of the ASRM's 2003 guide for patients noted that women in their late 30s had a 30 percent chance of remaining childless altogether. The guide also included statistics that I'd seen repeated in many other places: a woman'due south risk of pregnancy was twenty percent each month at historic period thirty, dwindling to 5 percent by historic period 40.
Every fourth dimension I read these statistics, my tum dropped like a stone, heavy and foreboding. Had I already missed my chance to be a mother?
As a psychology researcher who'd published articles in scientific journals, some covered in the pop press, I knew that many scientific findings differ significantly from what the public hears well-nigh them. Soon after my 2d wedding, I decided to go to the source: I scoured medical-enquiry databases, and apace learned that the statistics on women's age and fertility—used by many to make decisions about relationships, careers, and when to accept children—were one of the more spectacular examples of the mainstream media's failure to correctly report on and interpret scientific research.
The widely cited statistic that one in three women ages 35 to 39 volition not be pregnant after a twelvemonth of trying, for example, is based on an article published in 2004 in the journal Human Reproduction. Rarely mentioned is the source of the data: French birth records from 1670 to 1830. The take chances of remaining childless—xxx percentage—was also calculated based on historical populations.
In other words, millions of women are being told when to get pregnant based on statistics from a time earlier electricity, antibiotics, or fertility treatment. Virtually people assume these numbers are based on large, well-conducted studies of mod women, but they are non. When I mention this to friends and associates, by far the most common reaction is: "No … No style. Really?"
Surprisingly few well-designed studies of female age and natural fertility include women born in the 20th century—but those that do tend to paint a more than optimistic motion picture. One study, published in Obstetrics & Gynecology in 2004 and headed by David Dunson (now of Duke University), examined the chances of pregnancy among 770 European women. Information technology found that with sex at least twice a calendar week, 82 pct of 35-to-39-year-old women excogitate within a yr, compared with 86 pct of 27-to-34-year-olds. (The fertility of women in their late 20s and early 30s was almost identical—news in and of itself.) Another report, released this March in Fertility and Sterility and led past Kenneth Rothman of Boston Academy, followed 2,820 Danish women as they tried to become pregnant. Among women having sex during their fertile times, 78 per centum of 35-to-40-year-olds got pregnant within a year, compared with 84 percent of xx-to-34-twelvemonth-olds. A study headed past Anne Steiner, an associate professor at the Academy of North Carolina School of Medicine, the results of which were presented in June, found that among 38- and 39-year-olds who had been pregnant earlier, 80 percent of white women of normal weight got meaning naturally within half dozen months (although that percentage was lower among other races and among the overweight). "In our information, we're not seeing huge drops until historic period 40," she told me.
Even some studies based on historical nascence records are more than optimistic than what the printing normally reports: One constitute that, in the days before nascency control, 89 percent of 38-year-old women were nonetheless fertile. Another concluded that the typical woman was able to get meaning until somewhere betwixt ages xl and 45. Even so these more encouraging numbers are rarely mentioned—none of these figures announced in the American Society for Reproductive Medicine'due south 2008 committee opinion on female person age and fertility, which instead relies on the virtually-ominous historical data.
In short, the "baby panic"—which has by no means abated since it hit me personally—is based largely on questionable data. Nosotros've rearranged our lives, worried endlessly, and forgone endless career opportunities based on a few statistics about women who resided in thatched-roof huts and never saw a lightbulb. In Dunson's study of mod women, the difference in pregnancy rates at age 28 versus 37 is only nigh 4 percentage points. Fertility does subtract with age, but the decline is not steep enough to keep the vast majority of women in their late 30s from having a child. And that, after all, is the whole point.
I am now the female parent of three children, all born after I turned 35. My oldest started kindergarten on my 40th birthday; my youngest was born five months later on. All were conceived naturally within a few months. The toddler in my lap at the airport is at present mine.
Instead of worrying about my fertility, I now worry about paying for child care and getting three children to bed on time. These are good problems to accept.
Yet the memory of my abject terror most age-related infertility nonetheless lingers. Every time I tried to get pregnant, I was consumed past anxiety that my historic period meant doom. I was not alone. Women on Internet bulletin boards write of scaling back their careers or having fewer children than they'd like to, considering they tin can't acquit the idea of trying to go pregnant subsequently 35. Those who accept already passed the dreaded birthday inquire for tips on how to stay calm when trying to go pregnant, constantly worrying—just every bit I did—that they will never have a child. "I'grand scared because I am 35 and anybody keeps reminding me that my 'clock is ticking.' My grandmother even reminded me of this at my wedding reception," ane newly married woman wrote to me after reading my 2012 communication book, The Impatient Adult female's Guide to Getting Pregnant, based in function on my ain experience. Information technology's not just grandmothers sounding this note. "What science tells united states of america nigh the aging parental trunk should alert us more than it does," wrote the journalist Judith Shulevitz in a New Republic embrace story late terminal twelvemonth that focused, laser-like, on the downsides of delayed parenthood.
How did the baby panic happen in the first place? And why hasn't there been more public pushback from fertility experts?
One possibility is the "availability heuristic": when making judgments, people rely on what's correct in front of them. Fertility doctors see the furnishings of age on the success rate of fertility treatment every 24-hour interval. That's particularly true for in vitro fertilization, which relies on the extraction of a large number of eggs from the ovaries, because some eggs are lost at every stage of the difficult process. Younger women's ovaries respond meliorate to the drugs used to extract the eggs, and younger women's eggs are more likely to exist chromosomally normal. As a result, younger women'south IVF success rates are indeed much higher—nearly 42 percent of those younger than 35 volition requite birth to a live infant later 1 IVF cycle, versus 27 percent for those ages 35 to 40, and just 12 percentage for those ages 41 to 42. Many studies have examined how IVF success declines with historic period, and these statistics are cited in many inquiry articles and online forums.
However only about 1 percent of babies born each year in the U.S. are a result of IVF, and most of their mothers used the technique not because of their age, only to overcome blocked fallopian tubes, male infertility, or other issues: about 80 per centum of IVF patients are 40 or younger. And the IVF statistics tell united states very little about natural conception, which requires only ane egg rather than a dozen or more than, amidst other differences.
Studies of natural formulation are surprisingly hard to deport—that's one reason both IVF statistics and historical records play an outsize role in fertility reporting. Modernistic nascency records are uninformative, because most women have their children in their 20s and then apply birth control or sterilization surgery to preclude pregnancy during their 30s and 40s. Studies asking couples how long it took them to conceive or how long they take been trying to get pregnant are as unreliable as human memory. And finding and studying women who are trying to go meaning is challenging, as in that location'due south such a narrow window between when they first trying and when some volition succeed.
Millions of women are being told when to go pregnant based on statistics from a time before electricity, antibiotics, or fertility treatment.
Another problem looms even larger: women who are actively trying to get significant at age 35 or subsequently might exist less fertile than the average over-35 woman. Some highly fertile women volition get significant accidentally when they are younger, and others will get pregnant quickly whenever they attempt, completing their families at a younger age. Those who are left are, disproportionately, the less fertile. Thus, "the observed lower fertility rates amid older women presumably overestimate the effect of biological aging," says Dr. Allen Wilcox, who leads the Reproductive Epidemiology Group at the National Institute of Environmental Health Sciences. "If we're overestimating the biological reject of fertility with historic period, this will merely be good news to women who have been nearly fastidious in their nascence-control use, and may be more fertile at older ages, on average, than our data would atomic number 82 them to expect."
These modern-day enquiry problems help explain why historical information from an age before nascency command are then tempting. Notwithstanding, the downsides of a historical approach are numerous. Advanced medical care, antibiotics, and even a reliable food supply were unavailable hundreds of years ago. And the decline in fertility in the historical data may also stalk from older couples' having sex less often than younger ones. Less-frequent sex might have been especially probable if couples had been married for a long fourth dimension, or had many children, or both. (Having more than children of class makes it more difficult to fit in sex, and some couples surely realized—eureka!—that they could avoid having another mouth to feed by scaling dorsum their nocturnal activities.) Some historical studies try to control for these problems in various ways—such equally looking only at just-married couples—just many of the aforementioned bug remain.
The all-time way to assess fertility might be to measure "bike viability," or the gamble of getting significant if a couple has sex on the most fertile day of the woman'due south wheel. Studies based on cycle viability use a prospective rather than retrospective design—monitoring couples every bit they attempt to get pregnant instead of asking couples to recall how long it took them to go pregnant or how long they tried. Cycle-viability studies likewise eliminate the demand to account for older couples' less active sex lives. David Dunson's analysis revealed that intercourse 2 days earlier ovulation resulted in pregnancy 29 percent of the time for 35-to-39-year-erstwhile women, compared with about 42 percent for 27-to-29-year-olds. And so, by this mensurate, fertility falls by about a third from a adult female's belatedly 20s to her late 30s. Nevertheless, a 35-to-39-yr-old's fertility two days earlier ovulation was the same every bit a 19-to-26-twelvemonth-old's fertility iii days earlier ovulation: according to Dunson's data, older couples who fourth dimension sexual activity just one day better than younger ones will finer eliminate the age divergence.
Don't these numbers contradict the statistics you sometimes see in the popular press that only 20 percentage of 30-year-onetime women and v percent of 40-year-old women get meaning per bike? They practice, simply no periodical article I could locate contained these numbers, and none of the experts I contacted could tell me what information set they were based on. The American Gild for Reproductive Medicine's guide provides no citation for these statistics; when I contacted the association's press office asking where they came from, a representative said they were simplified for a popular audience, and did not provide a specific citation.
Dunson, a biostatistics professor, thought the lower numbers might be averages across many cycles rather than the chances of getting significant during the first cycle of trying. More women will get significant during the get-go cycle than in each subsequent one because the most fertile will conceive apace, and those left will have lower fertility on boilerplate.
Virtually fertility problems are non the result of female age. Blocked tubes and endometriosis (a condition in which the cells lining the uterus also grow exterior it) strike both younger and older women. Nigh half of infertility problems trace dorsum to the human, and these seem to exist more than common among older men, although inquiry suggests that men'due south fertility declines but gradually with age.
Fertility issues unrelated to female person historic period may also explain why, in many studies, fertility at older ages is considerably higher amongst women who have been pregnant before. Among couples who haven't had an adventitious pregnancy—who, equally Dr. Steiner put it, "take never had an 'oops' "—sperm issues and blocked tubes may be more than likely. Thus, the data from women who already have a child may give a more authentic picture of the fertility decline due to "ovarian crumbling." In Kenneth Rothman's written report of the Danish women, among those who'd given birth at least once previously, the chance of getting pregnant at age 40 was like to that at age xx.
Older women's fears, of grade, extend beyond the power to get significant. The rates of miscarriages and birth defects rise with historic period, and worries over both have been well ventilated in the pop printing. Merely how much do these risks actually ascent? Many miscarriage statistics come from—you guessed it—women who undergo IVF or other fertility treatment, who may have a higher miscarriage risk regardless of age. Nonetheless, the National Vital Statistics Reports, which draw data from the general population, discover that 15 percent of women ages 20 to 34, 27 per centum of women 35 to 39, and 26 percentage of women forty to 44 study having had a miscarriage. These increases are hardly insignificant, and the true rate of miscarriages is higher, since many miscarriages occur extremely early in a pregnancy—before a missed period or pregnancy examination. Yet information technology should be noted that even for older women, the likelihood of a pregnancy'southward continuing is nearly three times that of having a known miscarriage.
What about nascence defects? The risk of chromosomal abnormalities such as Down syndrome does rise with a woman'due south age—such abnormalities are the source of many of those very early on, undetected miscarriages. Withal, the probability of having a child with a chromosomal abnormality remains extremely depression. Even at early fetal testing (known as chorionic villus sampling), 99 percent of fetuses are chromosomally normal amongst 35-year-old meaning women, and 97 percent amidst forty-year-olds. At 45, when most women can no longer get pregnant, 87 percent of fetuses are yet normal. (Many of those that are non will afterward exist miscarried.) In the well-nigh future, fetal genetic testing volition be done with a simple blood examination, making information technology even easier than information technology is today for women to go early information about possible genetic issues.
Wlid does all this mean for a woman trying to make up one's mind when to have children? More specifically, how long tin she safely wait?
This question can't exist answered with absolutely certainty, for ii big reasons. First, while the data on natural fertility amidst modern women are proliferating, they are still sparse. Collectively, the three modern studies by Dunson, Rothman, and Steiner included merely about 400 women 35 or older, and they might not be representative of all such women trying to conceive.
Second, statistics, of course, can tell usa merely about probabilities and averages—they offer no guarantees to any detail person. "Even if we had good estimates for the average biological decline in fertility with historic period, that is nonetheless of relatively limited employ to individuals, given the large range of fertility found in healthy women," says Allen Wilcox of the NIH.
So what is a adult female—and her partner—to do?
The data, imperfect equally they are, advise two conclusions. No. ane: fertility declines with historic period. No. ii, and much more relevant: the vast majority of women in their late 30s will be able to go pregnant on their own. The bottom line for women, in my view, is: program to accept your last kid by the time you plough 40. Beyond that, you're rolling the dice, though they may still come upward in your favor. "Fertility is relatively stable until the late 30s, with the inflection indicate somewhere around 38 or 39," Steiner told me. "Women in their early on 30s tin can think about years, but in their late 30s, they demand to be thinking about months." That's likewise why many experts propose that women older than 35 should run across a fertility specialist if they haven't conceived after six months—particularly if it'southward been six months of sex during fertile times.
There is no single best time to have a child. Some women and couples will find that starting—and finishing—their families in their 20s is what's best for them, all things considered. They simply shouldn't let alarmist rhetoric button them to become parents before they're ready. Having children at a young age slightly lowers the risks of infertility and chromosomal abnormalities, and moderately lowers the adventure of miscarriage. Only it too carries costs for relationships and careers. Literally: an analysis by ane economist found that, on average, every year a adult female postpones having children leads to a x percent increase in career earnings.
For women who aren't ready for children in their early 30s but are yet worried most waiting, new technologies—albeit imperfect ones—offer a 3rd option. Some women choose to freeze their eggs, having a fertility doctor excerpt eggs when they are still young (say, early 30s) and cryogenically preserve them. And so, if they haven't had children by their self-imposed deadline, they tin thaw the eggs, fertilize them, and implant the embryos using IVF. Because the eggs volition be younger, success rates are theoretically higher. The downsides are the expense—perhaps $x,000 for the egg freezing and an boilerplate of more than than $12,000 per cycle for IVF—and having to apply IVF to get pregnant. Women who already have a partner can, alternatively, freeze embryos, a more common procedure that also uses IVF engineering science.
At home, couples should recognize that having sexual practice at the almost fertile time of the cycle matters enormously, potentially making the difference betwixt an piece of cake conception in the bedroom and expensive fertility treatment in a clinic. Rothman's study found that timing sexual practice around ovulation narrowed the fertility gap between younger and older women. Women older than 35 who want to go significant should consider recapturing the glory of their twenty‑something sexual practice lives, or learning to predict ovulation by charting their cycles or using a fertility monitor.
I wish I had known all this back in the bound of 2002, when the media coverage of age and infertility was deafening. I did, though, discover some relief from the smart women of Sat Night Live.
"According to author Sylvia Hewlett, career women shouldn't expect to have babies, because our fertility takes a steep drop-off afterward age 27," Tina Fey said during a "Weekend Update" sketch. "And Sylvia's correct; I definitely should have had a baby when I was 27, living in Chicago over a biker bar, pulling down a cool $12,000 a year. That would have worked out nifty." Rachel Dratch said, "Yeah. Sylvia, um, thanks for reminding me that I have to hurry up and have a baby. Uh, me and my four cats will get right on that."
"My neighbour has this adorable, cute little Chinese babe that speaks Italian," noted Amy Poehler. "So, you know, I'll just buy one of those." Maya Rudolph rounded out the rant: "Yeah, Sylvia, possibly your next book should tell men our age to end playing Grand Theft Auto 3 and holding out for the chick from Allonym." ("You lot're not gonna get the chick from Alias," Fey brash.)
Eleven years subsequently, these four women have 8 children amongst them, all only one born when they were older than 35. Information technology'due south good to exist right.
How Big Will My Baby Be at 7 Weeks
Source: https://www.theatlantic.com/magazine/archive/2013/07/how-long-can-you-wait-to-have-a-baby/309374/