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Sept. 1, 2000 -- If you're in your thirties and plan to wait to get pregnant until after you've bought a house, finished your PhD, or secured that corner office, you may want to rethink your strategy.
For the would-be mother who waits until she's close to 40 to try to get pregnant, it might be difficult when relying on Mother Nature. However, even with fertility treatment, the chances of becoming pregnant in the forties are very small, perhaps as little as 2% to 7%, even for women in their early forties.
According to a study published in September's issue of the journal Fertility and Sterility, these findings suggest that "the cost-effectiveness of such treatment of patients should be examined."
In the study, the authors report on about 430 attempts to become pregnant with the help of technology at their institution for women 41 years old and older. Among almost 380 patients, 47 became pregnant. However, only 17 pregnancies resulted in a birth, so the delivery rate was 4.5%.
The authors report that among the women 44 years of age or older, only one pregnancy, which ended in a miscarriage, occurred, so none of these 56 patients gave birth.
The findings underscore the urgency of beginning infertility assessments sooner rather than later in women who are having difficulty conceiving, lead author Raphael Ron-El, MD, tells WebMD. Patients who are 41 years old and have difficulty conceiving should see a fertility specialist promptly because their ability to become pregnant will only lessen with time, he says. When seeing the specialist, "patients and their doctors [should know] the real rates of success for the specific age groups." Ron-El is the head of the in vitro fertilization and infertility unit at Assaf Harofeh Medical Centre at Tel-Aviv University in Israel.
Part of the puzzle is not only the individual woman's chances of success, but also her desire to continue a stressful treatment with uncertain outcomes, says Francesca Lindquist, a 45-year-old woman in Bricktown, N.J., and a veteran of fertility treatment. In both of the medical and psychological arenas, each woman's circumstances will be different, she says.
After 11 attempts to conceive with fertility medication and artificial insemination, "I had my first in vitro fertilization at 41. I had three of these treatments, and I didn't have success," Linduist tells WebMD. "When I thought about a fourth attempt, I got depressed and I decided that was a sign. My husband and I decided to remain childless. We tried to adopt, and several attempts fell through. ... I just had to move on. I want women who struggle with this issue to know: you will survive infertility, and you can survive it happily." She is a co-founder of Child of My Dreams.com, an Internet-based infertility and adoption resource center and has facilitated infertility support groups for several years.
"Every woman should know what the expectation for success is for her age" at a given fertility program, says Zev Rosenwaks, MD, director of the center for reproductive medicine and infertility at the New York-Presbyterian Hospital of the Weill-Cornell Campus in New York City. In an opinion article in the June 24 issue of the New York Times, Rosenwaks urged his colleagues to "put the fable of rewinding the biological clock back on the shelf with the other fairy tales and give women the tools to write more realistic happy endings." Rosenwaks was not involved in the study.
Even younger couples do not necessarily conceive on the first few tries. However, a woman in her late thirties who does not get pregnant after three to six months of trying should talk with her gynecologist. Special tests -- such as a sperm count or blood hormone test -- or possibly a referral to a specialist in fertility might be needed, says Steven Williams, MD, of Ohio Reproductive Medicine Group at the Ohio State University College of Medicine in Columbus.
Richard T. Scott, MD, who was not involved in the study, says a woman in her mid- to late forties that has not become pregnant without assistance may need to consider donor eggs or adoption in order for the happy ending to include children. "These statistics are definitely not representative, and there are individual variables, but results for women over 45 are uniformly poor," says Scott, who is with Reproductive Medicine Associates of Morristown, N.J.