Every woman is different, but for many of us, when our biological clock starts ticking, it’s loud… think of it more like a gong being struck in a big echoing stairwell. The need to become pregnant takes center stage. Ovulation tests fill the bathroom medicine cabinet, and phrases like luteal phase and follicular phase enter our vocabulary. It’s all part of the TTC (message board short-hand for trying to conceive) journey that will hopefully end in a BFP (translation: big fat positive on an at-home pregnancy test).
Just as every woman is different, that biological clock may start to tick when she is in her 20s, 30s, or 40s (and beyond). Trying to conceive at any age comes with its positives and negatives (see what we did there?), and questions. A lot of questions. We tapped the knowledgeable doctors at Oregon Reproductive Medicine to answer a few of the most frequently asked questions of women in their 20s, 30s, and 40s who are trying to conceive. Bottom line: no matter the age, a healthy lifestyle and patience are key.
TTC In Your 20s
StrollerTraffic: Your 20s are your best reproductive years. Why is that?
Dr. Elizabeth Barbieri: Women’s eggs age as we age. We are born with all the eggs we will ever have. The number of eggs actually peaks while we are a fetus, and by birth, we have about 1 million eggs left. When a girl begins her menstrual cycle during puberty, she has about 500,000 eggs left.. and she hasn’t even had a chance to use one yet! As women get older, our eggs do not function as well – meaning they are less likely to result in a pregnancy, and that if a pregnancy occurs, the risk of miscarriage increases as well.
ST: How can you boost your fertility in your 20s?
Dr. Elizabeth Barbieri: At any age, ways that a woman can optimize her ability to successfully conceive includes having a healthy lifestyle. Do not smoke. Limit alcohol intake to 4 or fewer drinks per week (for both partners). Maintain a healthy weight as women who are underweight or overweight can take longer to conceive. Take a daily prenatal vitamin (or folic acid supplement). Monitor your menstrual cycle as having regular periods (which is defined as occurring every 24-35 days) to ensure you are ovulating so that you have a chance to conceive when you are ready. If a woman’s menstrual cycle is irregular, she may not be ovulating, and therefore, it will be harder (if not impossible) to get pregnant. Seeing your OB/GYN to evaluate for causes of anovulation/irregular periods can help identify and treat the reason you are not ovulating to help restore regular menstrual cycles.
ST: In 2016, the CDC released new information on the first time mom. The data confirmed what we’ve all been seeing – the average of age of first time mothers is on the rise — from 24.9 in 2000 to 26.3 in 2014. What kind of things should a women in her 20s consider if she wants to wait to conceive?
Dr. Elizabeth Barbieri: Many women in their 20’s are not yet ready or are not in a position to have children because they are still completing their education, blazing their career path, don’t have a partner, etc. From a reproductive standpoint, the vast majority of these women will still successfully conceive in their 30s as the decline in egg health is very subtle from our 20s to our mid 30s. However, today a woman has the option of freezing her eggs to then use such eggs at an older age. Additionally, women in their 20s who know they want to have children in the future can undergo some simple testing (ultrasound and blood tests) to assess their egg health and help determine if egg freezing is a treatment they should consider now or something they can wait to pursue at an older age if needed.
TTC In Your 30s
ST: Women in their 30s know it won’t be as easy to get pregnant as it was if we were in our 20s… but just how much harder will it be?
Dr. Amanda Hurliman: The chance of getting pregnant each month declines progressively throughout a woman’s 30s. In the early 30s, the chance of pregnancy each cycle is approximately 20%. At age 35 the chance of pregnancy each cycle is 15% and decreases to 5% as a woman approaches the age of 40. The age related decline in fertility is accompanied by a significant increase in the risk of miscarriage. The risk of miscarriage for women under age 35 is approximately 15% and increases to 30% at age 40.
ST: When should women in their 30s get help if they can’t conceive?
Dr. Amanda Hurliman: Honestly, it is never too early for a woman to begin a conversation with her health care provider about her fertility. Women who are under 35 years old should seek evaluation if they have failed to conceive after 12 months of regular, unprotected intercourse. Given the age related changes in fertility, women over the age of 35 should seek help after 6 months of trying.
ST: What risk factors may make it more difficult to become pregnant?
Dr. Amanda Hurliman: There are several factors that can affect a woman’s ability to become pregnant. Some of these are modifiable and some of them are not. It can be more difficult to conceive if a woman has irregular menstrual cycles or issues with the uterus or fallopian tubes. The uterus can be affected by the presence of fibroids or scar tissue, whereas, having a history of pelvic infections or endometriosis can affect the fallopian tubes.
Lifestyle factors can also affect fertility. For example, women who are either overweight (BMI > 35) or underweight (BMI < 19) can have difficulty conceiving. Tobacco use and heavy caffeine use can also affect fertility. We recommend that women trying to conceive maintain a healthy diet, avoid tobacco and use caffeine in moderation (<250 mg caffeine per day).
20% of the time the reasons for infertility are due to male factors. It is important that the male partner be included in the evaluation!
ST: What can be done if a women in her 30s is facing infertility?
Dr. Amanda Hurliman: The first step is to have a conversation with a health care professional. This can be a primary care provider, general OB/GYN or a Reproductive Endocrinologist. A Reproductive Endocrinologist is an OB/GYN who has completed sub-specialty training in fertility. Having this conversation will provide for the opportunity to thoroughly review the medical history and determine if there are risk factors present that may be affecting their ability to conceive. Further evaluation can then be performed to evaluate for these factors. The basic fertility evaluation typically includes evaluation of the health of the women’s eggs, confirming that the fallopian tubes are patent and performing a semen analysis to evaluate the sperm. Additional testing may be recommended if other risk factors are present.
ST: What should you keep in mind about risks to mom and baby in your 30s?
The most important thing to remember is that it is absolutely possible for women to have healthy babies throughout their 30’s. Although it may become more difficult to conceive as a woman gets older, there are safe and effective treatments to help women grow their families. Because the risk of chromosomal abnormalities increase as a woman gets older, additional testing may be recommended during a pregnancy to ensure the genetic health of the baby. This may include a simple blood test or a more invasive procedure, such as amniocentesis. There are also fertility treatments available to evaluate this risk prior to conceiving a baby.
TTC In Your 40s
ST: What happens to egg quality once women reach their 40s?
Dr. Thomas Fisher: The total number of eggs in the ovaries decreases as a woman ages. Additionally, a lower percentage of the remaining eggs will contain the correct number of chromosomes (46 chromosomes). Females are born with all the eggs they will ever have, which is approximately 1-2 million—and at the time of puberty, there are approximately 300,000-500,000 remaining eggs. When a woman reaches her late thirties, she has about 25,000 eggs remaining—and at menopause, this number likely reaches less than 1,000. The decline in both the number and quality of eggs can also be influenced by environmental factors including chemotherapy, pelvic radiation, smoking, or ovarian surgery; or by genetic abnormalities such as Fragile X. Despite the multiple tests available to evaluate a woman’s ovarian reserve, the best indicator of egg quality is age.
ST: When should women in their 40s get help if they can’t conceive?
Dr. Thomas Fisher: If a woman is experiencing infertility in her 40s, the best initial step is early evaluation. By taking the first step to make an appointment with an infertility specialist, a woman can better understand her overall fertility potential. At this appointment, a doctor will discuss simple testing that can be used to determine overall ovarian reserve, as well as other diagnostic tests that can evaluate whether she is ovulating, the status of her fallopian tubes, and the semen quality of her sperm source. Earlier detection can lead to earlier intervention and treatment to increase a woman’s chance of success.
ST: What can be done if a women in her 40s is facing infertility?
Dr. Thomas Fisher: After the infertility evaluation is completed, a woman’s provider will often recommend advanced reproductive technologies including standard IVF, minimal stimulation IVF, donor egg, or donor embryo. There are multiple stimulation protocols for IVF. A woman’s provider will work closely with her to personalize the treatment based on her infertility evaluation, personal and medical history, and desired treatment option. If a woman in her 40s is facing infertility, she will discuss all the available options with her provider—as there are many different ways to build a family.
ST: If a woman has had her eggs frozen, can she become pregnant in her 40s?
Dr. Thomas Fisher: Yes! A woman in her 40s can decide to thaw her frozen eggs when she is ready. An infertility clinic will inseminate the eggs with sperm, and follow them in a controlled environment as they grow from fertilization to a blastocyst (day 5 or 6 embryo). Embroys can be transferred into the woman’s uterus at this point, or she might choose to have the embryos tested for genetic abnormalities prior to the transfer. It is important to realize that not all embryo transfers will result in pregnancies or live births. In fact, the literature would estimate a 2-5% live birth rate per embryo. Most importantly, a woman should speak with her IVF clinic to become well informed about her chances for pregnancy.
About Oregon Reproductive Medicine: Oregon Reproductive Medicine (ORM) is a world-class fertility center that is passionately committed to helping people grow their families. Founded in 1989, ORM is accessible to individuals and couples, while offering treatments that are specific to their needs. ORM is committed to achieving the highest success rates and provides a customized, compassionate patient experience. Unrivaled expertise, outstanding results and personalized care make ORM one of the most sought-after fertility centers in the world.
The information contained on this website should not be used as a substitute for the medical care and advice of your doctor. Always contact your doctor so he or she can provide the best treatment options based on the individual facts and circumstances of you and your body.