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This narrative is outdated—and dangerous—for women looking to conceive. Here’s the new way of thinking, from experts. (Spoiler: It’s hopeful.)
Tick, tick, tick. If you, like me, are a woman in her childbearing years, you may recognize that sound as your biological clock.
The noise isn’t so bad in your mid-to-late 20s, a faint hum, maybe. But once you turn 30, the volume gradually turns up, and if you’re anywhere around the age of 35, the ticking has likely turned into a booming echo that drowns out a lot of other stuff.
It’s a still-common belief for many women that they need to have their reproductive life figured out before the big 3-5, out of fear that their ability to get pregnant and stay pregnant will take a massive hit and only get grimmer from there. And that age has been referred to as the “fertility cliff,” by medical experts, articles, you name it. Anyone who is 35-plus is considered to be of “advanced maternal age” and experiences a “geriatric pregnancy” in (quite harsh) medical terms. Women structure their lives around that dreaded number…which is not old at all in the grand scheme of things!
The pandemic only made matters worse for anyone with a shred of anxiety who was considering kids. “For many, 2020 felt like a year when they couldn’t move the dial forward or make any personal progress,” says Taraneh Nazem, MD, a reproductive endocrinology and fertility specialist in New York. The worries led to increased interest in fertility preservation services, like egg and embryo freezing, in the past year. One clinic example: At Shady Grove Fertility (which has several dozen locations in the U.S.) there was a 50 percent jump in the number of egg freezing cycles started between June and November 2020, compared to the same time period the year before.
But the truth is, what we *think* we know about a woman’s age and fertility—and the root cause of much of this time-clock stress—is, uh, pretty inaccurate. More and more experts are coming forward to say the research that the fertility cliff is originally based on is actually outdated, and point to newer studies that show much more promising
results. Take this one out of the University of North Carolina School of Medicine that found that 81 percent of 38- and 39-year-old women (who had been pregnant before) got pregnant naturally within a year of trying at those ages. Eighty-one percent! That development is just one of many reasons you should detangle yourself from the cliff concept—and the heavy anxiety that comes with it. Instead, let doctors explain the latest perspectives; their take should leave you feeling assured and empowered about your future outlook.
Sure, it’s true that fertility (a.k.a. the quantity and quality of your eggs) declines as you age. “But there’s a big misconception that that happens significantly and universally at 35,” says W. Spencer McClelland, MD, assistant professor of obstetrics and gynecology at Denver Health/University of Colorado. In fact, in one of the largest studies on fertility and age in Fertility and Sterility, researchers studied the length of time to conception, and found that while 84 percent of women ages 20 to 34 will get pregnant within a year of trying, that number is 78 percent for women who are 35 to 40—on average, not a big difference—and still good chances!
“Fertility is much more individual than people realize,” says Dr. McClelland. “For some, 30 could be the age at which things become more difficult; for others, it could be 45.” What’s more, a variety of factors play a role in fertility, a few being lifestyle-driven, says Jaclyn Tolentino, DO, a physician at Parsley Health who specializes in hormone optimization. “It’s hard to know if someone’s struggles are age-related or whether they would have had them if they started trying to conceive when they were younger too,” Dr. McClelland adds.
So why is 35 seared into our brains as the time when chances plummet? First, the emphasis placed on 35 as “advanced maternal age” comes from outdated research related to pregnancy complications—which is not the same thing as fertility, or the likelihood of getting pregnant, says Dr. McClelland.
Let’s take a trip down memory lane, shall we? In the ’70s, genetic testing became more widely available for women to find out about chromosomal abnormalities in the fetus (mainly, ones that indicate Down syndrome), and doctors had to determine when it was worth recommending that women have these tests. The risk of genetic abnormalities goes up with a pregnant person’s age, but the test is invasive and can lead to miscarriage, so it only made sense to recommend it when the odds of Down syndrome were higher than the risk of miscarriage from the testing procedure. That tipping point, as you can guess, ended up around age 35. But what we know about the test has changed since then, says Dr. McClelland, and also…it doesn’t have much to do with fertility or pregnancy complications.
Yet the idea of 35 being “advanced maternal age” stuck, and several population studies on fertility furthered the notion, but again, not in the way you might assume. They tended to show that the risk of infertility as well as miscarriage, conditions like preeclampsia and gestational diabetes, and fetal chromosomal abnormalities climbs more significantly at 35. But the numbers don’t skyrocket. “The perceived change in fertility is much more extreme than the reality of it,” says Dr. Nazem.
Also alarming: The studies reported on in the past are based on (disturbingly) antiquated research. It’s commonly stated that one in three women ages 35 to 39 will not be pregnant after a year of trying, but those stats are based on a study from 2004 that uses French birth records from 1670 to 1830 (!). Seems borderline impossible to believe, but we still rely on historical data in the fertility discussion because it’s difficult to perform large and accurate studies on the topic.
This isn’t to say that fertility and complications shouldn’t be a concern at all for women as they age—simply that the level of concern may be overblown, says Dr. Nazem, particularly when it comes to the ease of getting pregnant. It’s important to be aware of risks you may be facing, yet also understand that stressing about how your age might impact your pregnancy isn’t helpful either.
Information Overload Knowing that fertility is incredibly individual, the idea of testing it probably sounds pretty great. Several at-home kits and fertility clinics promise to help you see where you stand. Unfortunately, they can’t actually tell you much.
One common test in question is the anti-müllerian hormone (AMH) blood test, which is meant to determine ovarian egg reserve (how many eggs you have left). Studies show these tests are “notoriously unreliable,” says Dr. McClelland.
They can only tell you if your reserve is above or below what’s normal for the decade of life you’re in, and there’s no way to know how it might change. And your reserve says nothing about egg quality. “Evaluating fertility is a bit of a misnomer,” says Dr. Nazem. “It can really only be proven by trying to conceive.” One way to get data on how that might go? Track your cycle, says Dr. Tolentino. Irregular periods, heavy bleeding, painful cycles, and PMS can indicate issues (diagnosed or not) like PCOS, endometriosis, or fibroids, which can make getting and staying pregnant harder.
So, despite what we’ve been taught, doctors and researchers do know that a woman doesn’t go from perfectly fertile at 34 to suddenly doomed to struggle at 35. But, for the sake of simplicity, many docs treat 35 as a time when pregnant women become “high-risk” based on age, not individual health and history, and offer increased testing throughout those pregnancies.
This would seem harmless and maybe even like a good idea, but again, testing comes with its own risks. For instance, women who are 35 or older are often told to have extra ultrasounds to check their baby’s progress, says Dr. McClelland. Essentially, early testing may detect an abnormality that, for some women, will clear up before routine testing, and that can unnecessarily prompt another test that can increase risk of miscarriage, as well as anxiety. There’s something to be said for the pressure women feel about trying to conceive or becoming pregnant at 35 and beyond—that anxiety might be more detrimental to fertility and pregnancy than age itself. “Stress certainly doesn’t help overall health, fertility, and pregnancy,” says Dr. McClelland. “And people aren’t even worrying for a valid reason.”
This perception may be so prevalent because fertility specialists, in particular, are constantly surrounded by people who are having fertility troubles, so they’re more likely to be aggressive in how they counsel anyone coming in with concerns about their future. There’s also the fact that no one wants to have a patient who regrets not taking action. “It’s always easier to do something than do nothing when it comes to testing and treatment,” says Dr. McClelland. “If you try, and something goes wrong, that feels more defendable than trying nothing, and something still going wrong, even though often, doing nothing is the smarter move.” It’s also undeniable that fertility is a $25 billion dollar industry globally that, while life-changing for some, leaves others feeling disappointed.
So, Should I Freeze My Eggs?
Using younger, frozen eggs when you’re older could increase your odds of conceiving, but there’s no guarantee. Success depends on when your eggs were frozen, how many you have, and when you’re trying to get pregnant, among other factors. Still, freezing may offer some level of insurance. If the following factors describe you, you might be a good candidate—and it’s worth looking into.
Look, everybody wants to put the ticking to rest. But worrying about your age, testing your fertility, and planning your life around those things isn’t the way to do that. What it really comes down to is accepting that the ease with which you’ll be able to conceive and have a healthy pregnancy is a bit of a mystery—but it’s actually more likely that you’ll have success at any childbearing age. And hopefully that provides some relief.
“If we’re going to let population data guide us, we should feel optimistic, because chances of getting pregnant on your own are still very high from 35 to 40,” says Dr. McClelland. Think back to that positive stat from earlier: “If you ask me, an 81 percent chance of getting pregnant is really good odds,” says Dr. McClelland. “Most people don’t believe they’re in that group, and as medical professionals, we need to rewire that automatic pessimism.” A lot of those assumptions come from the fact that you’re more likely to hear about fertility struggles than someone who got pregnant quickly when they were older “because that’s just not talked about,” he adds. “For every patient I have who is 37 or 38 and trying for the first time and having trouble that may or may not be age-related, I have 10 to 20, if not more, stressing out about issues they think they’re going to have, but don’t,” says Dr. McClelland. “I can’t tell you how many patients have gone through unsuccessful IVF then gotten pregnant naturally; they’d pulled the trigger for IVF after only six months or a year of trying, which probably wasn’t quite long enough, but everyone is afraid to keep trying because they think their chances will only get worse.”
Ultimately, the decision of when to have kids and preserve your fertility, if at all, is an extremely personal one, and no one wants to have any regrets about not trying every single option they could have put into place when they were younger. But one thing is for sure: Fertility is much more complex than we’ve been made to believe, and the constant obsession and ongoing discussion about how age will impact it doesn’t actually seem to be helping anyone. So once and for all, let’s put the idea of falling off the fertility cliff to bed. Taking a walk down a gradual hill seems like a more accurate metaphor—and sounds much better to me.