Tuesday, April 26, 2011

Busting a Myth: The Age Thing

The age issue with infertility is a tricky one. It's a double-edged sword -- does age matter? Yes. Is age everything? No. 

When I was turning 30 and divorcing, I was panicking and depressed and terrified all at once--here I was, leaving my most fertile decade and starting over in every sense of the word. I had wanted children for years but that hadn't quite meshed with my ex-husband's developing idea of family life (gets in the way of philandering, apparently). So to be hit with single, 30, and fairly wounded from my failed marriage seemed like a huge loss. "You have plenty of time!" exclaimed just about everyone. "Don't worry--I didn't even start my family until 38!" said a woman I worked with. "People have babies into their 40s now, you really don't need to worry!" was the battle cry of just about everyone I knew. I even went to Borders with a dear friend and passed a book on display, "Your Pregnancy After 35," and said, "There it is, my book. Maybe I should just buy it now." She playfully punched me and said "No way! You will have a baby before 35!" Guess not. 

Next week I turn 35. Despite valiant efforts, I am not pregnant. So "Your Pregnancy After 35" is TOTALLY my book. Turning 35 is a little depressing, because it takes a journey that's been difficult for non-age related reasons and makes it start that downhill slide into "old egg" territory. See, this is the funny thing with infertility--it can be totally about your age or it can be absolutely nothing to do with your age. But eventually, the age thing catches up to you if you're not successful. Our actual diagnoses for infertility have zero, zip, zilch to do with my over-30 age range. My husband's male factor issues have been there since at least his mid-to-late 20s and are not at all age-related. I could be 20 and have the best, most plump and sperm-ready eggs ever and not get pregnant without help due to our sperm quantity and quality. And then you have my diagnosis--PCOS. There are women on message boards in their early 20s who are struggling with infertility due to PCOS--it is not only something that visits you when you have left your 20s. My ovaries are and always have been dysfunctional--even when I was a teenager. I used to call my periods my "Immaculate Miscarriages" because they came around every 6-9 months or so and were completely unpredictable. I had a horrible experience when I was 17 and on a cruise to Mexico with my family. My period decided to come in its usual erratic way right as I was to go snorkeling in Xel-Ha, a beautiful nature preserve that I had been really looking forward to. Instead of swimming with technicolor fishies, I ended up pantomiming "tampon" to the Spanish-speaking shopkeepers to no avail and sitting out that part of the trip thanks to my then-undiagnosed PCOS. Even if for some sorely misguided reason I'd tried to get pregnant at 17 it probably wouldn't have worked then without help. Put the two diagnoses together and we are faced with some serious challenges, none of them age-related. 

However, at the same time I can't ignore the age issue. It is a known fact that your fertility takes a dramatic downswing after 35 that continues and gets steeper into your 40s until it dwindles to nothing. Does this mean women don't get pregnant easily and healthfully in their late 30s and early 40s (or even later, completely inexplicably to me)? Nope. There are many of those exceptions that can say "I want a baby!" at 37 or 40 or 42 and POOF! There's their healthy baby despite "old eggs." But, more frequently, you find that fertility starts waning in your 30s and 35 is a definite tipping point. Reasons I know this: 

  • There is a whole  genre of pregnancy and childbirth books for women over 35. There is no such thing as "Your Pregnancy After 25." 
  • Success rates for assisted reproductive techonology start to dip at 35. Typically you will see success rates that say, "Women under 35" and then groupings in 2-3 year intervals after that. They just keep dwindling. But the "Women under 35" group has by far the highest rates--at my clinic an astonishing 51.2% of transfers result in live births. Jump to 35-37 and it goes down to 31.2%.  I am sad to be leaving my current bracket, for sure.
  • Clinics typically begin transferring more embryos to women over 35, because they know that your chances go down as your age advances. 
  • Financial options dwindle as you hit 35. My clinic (like many) has a refund program. It is cheapest up to 34, and then once you hit 35 the amount you pay up front is $2,000 more from 35-37. You aren't eligible after 37. This is because the risk of failure is so much greater as the woman ages, despite the infertility diagnosis. 
  • When you are under 35, you are advised to seek help if you don't conceive naturally after a year of trying. After your 35th birthday, you are put on the fast track--no pregnancy after 6 months of trying? Fertility referral for you! Why is this if 35 is not a tipping point?

It doesn't seem fair, does it? You start out with a non-age-related diagnosis and then BOOM! Your age starts creeping in and making you feel like a ticking time bomb. I used to joke about my kamikaze eggs jumping off into nothingness when I turned 30. Now that I'm turning 35 I am not so amused by that image. 

So, is it true that age can affect fertility? Yes. Is age everything? No. Can women have healthy babies without assisted reproduction into their 40s? Yes. Are they the rule and not the exception? No. Is it because they are models of healthful living and deserve a medal for their fertility? No, they are just really, really lucky. Could you be 24 and have the fertility issues of a 45 year old? Yes. Because you are turning 35 or 40 do you need to throw in the towel? No. But at the same time, once you hit Advanced Maternal Age (which, thankfully at my clinic is 37 and so I haven't quite gotten there yet) your success rates without donor eggs start dropping. Your miscarriage rates start rising. Your possibility for chromosomal abnormalities start rising, too. It is just not fair. 

While our current inability to have a baby is not at all age-related, we are entering territory where my eggs and uterus will start taking the fall for our infertility in addition to the PCOS and male factor. Where I will have to start wondering, are our embryos not super perfect looking and not implanting because we are unlucky, or because my eggs have been sitting inside me since before I was born? Sometimes I curse the lost time of my twenties. But, I have to remember that the pain and heartache of that time spent with the wrong person brought me to the perfect person for me--I can't regret it. Had I met Bryce at another time in our lives it might not have been the right time for us to start our beautiful journey together. And, in a way, since I divorced at 30 it is kind of a miracle that I got to start trying at 33 with an amazing partner in life. I know others who have waited longer for their special someone and are still waiting for their family to expand beyond two loving people. Age is a complication in our fertility journey, not the cause. We have a fabulous medical team at our disposal, but I still can't rest on my laurels and exclaim that "I have plenty of time." I don't. I just have to trust in the process and my firm belief that despite our challenges and the race against time, we WILL be parents. And the experiences age has brought us will help us to be better parents. I can only hope.  

Please visit the following links explaining more about infertility and National Infertility Awareness Week: 

1 comment:

  1. I just have to note... even though the success rates at my clinic fall to 31.2% at 35-37, for some reason they climb back up to 38.1% from 38-40.