When we think of infertility, we tend to think of it affecting someone older, right? Someone in their 40s, maybe? I was 23 when my husband and I started trying to have kids, and we had no idea it would take six years and five rounds of in vitro fertilization (IVF). We had no idea that I had poor quality eggs and would need to use an egg donor. It turns out that I was an exception to the rule that one of the biggest factors in one's fertility is age.
The truth is, getting pregnant at any age isn’t always as simple as it's made out to be. But how old is too old? It’s not as clear cut as you would think. We talked with Dr. Joshua Klein, co-founder and reproductive endocrinologist at Extend Fertility, and got the scoop on fertility as it relates to your age and reproductive health.
Eggs: A BFD when it comes to age and fertility
There are all sorts of factors that go into whether or not you can successfully get pregnant and carry a baby to term. First, let’s talk about your ovarian reserve. You may remember from high school health class that while a man is a sperm-making factory, a woman is born with all the eggs she will ever use in her lifetime. (This isn't necessarily true - keep reading to find out why.) In order to conceive on your own, the eggs need to be of good quality — genetically normal in other words — meaning no damage at the cellular level, and you need to have enough of them in your ovaries. Those eggs need to ovulate, they need to be able to pass through the fallopian tube, they need to be fertilized by sperm and then they need to implant in the uterine wall.
“As a woman ages, because there are more and more genetically abnormal eggs, the likelihood of ovulating a healthy egg in any given month decreases — directly leading to a decreasing chance of healthy pregnancy,” Dr. Klein explains. In older women — as well as some younger — eggs are subjected to damage, and age, just like any other cell in the body. Over time, these things cause damage to the eggs, making them “abnormal” as opposed to “normal.”
So when does fertility actually decline?
Is there a sweet spot where you have the best chances of conceiving? Fertility starts to really decline around age 32, and then more rapidly each year or two once you hit your mid-to-late 30s. He explains that it’s beneficial to investigate your fertility potential and one choice you can make is to freeze your eggs to lessen your risk of fertility problems, but that's also a complicated and deeply personal decision.
Contrary to old adages and plain old misinformation, fertility doesn't come to a halt when you turn 35. That’s a misconception, because while natural fertility is at its peak in your early 20s, there's actually a gradual fertility decline after that and more so in your 30s — especially your late 30s. And while egg reserves start depleting as you age, it’s also important to understand that women in their 20s and early 30s can also have low egg supply — as was the case for me.
Conceiving in your 30s and beyond
"Older" women (over 35) will more likely have a harder time conceiving every menstrual cycle and will, therefore, take longer to get pregnant, according to a recent study. The chances of having a miscarriage, unfortunately, also increase the older you get. Often, this is due to the age of the eggs themselves, as older eggs have a higher chance of being chromosomally abnormal. The likelihood of developing high blood pressure and diabetes, which can complicate pregnancy and birth, also rise. “Both conditions are increased in older women, and exacerbated in those who are overweight,” explains Dr. Klein.
It might seem that a good solution to conceiving when you’re older would be IVF, and while IVF is an amazing option when you’re having trouble conceiving, it’s definitely not a guarantee, and when you’re over 40, it’s unfortunately not very successful.
Fact vs. fiction: Men and infertility
It's a misconception that a man can have kids into old age because he can continuously produce sperm. Both men and women face certain realities when it comes to fertility and aging. According to the data, sperm quality is one aspect of male fertility that deteriorates over time - poor sperm motility and morphology (how well they move and how normal-looking they are), as well as a low concentration of semen, genetically abnormal semen. “It‘s also important to remember that as men age, issues like coital frequency (how often intercourse occurs between couples) and/or erectile dysfunction may play a role in prolonging the time to pregnancy in their partners,” says Dr. Klein.
What do I do with this information if I'm not ready to have kids yet?
The idea of having kids can look very different depending on how old you are and the circumstances in your life. “The only mistake women can really make is not to get the appropriate information to help them make an educated choice,” explains Dr. Klein. He encourages all women to become informed about their fertility so that they can make a decision that is best for them.
Modern Fertility testing can give you a profile on your current fertility and allow you the control to do what you want with the results. I can’t help but feel things could have been different with my infertility journey had I had more information at my fingertips. I wish I would have known I had a low AMH and a genetic mutation that could have been the cause of my miscarriages. I wish I would have moved on to donor eggs sooner instead of endure three rounds of IVF with my own. I am glad, however, about gritting my teeth and going through fertility treatments at 23 when everyone around me told me I was still young and I had time. When it comes to our bodies, knowledge is power and we’re our own best advocates for our fertility and health.