health

There's a story we're told about women's fertility. Not all of it is true.

If you're in your thirties and the sound of fertility is playing on your mind (in GIANT, SHOUTY, CAPS LOCK), please take a seat. We need to talk.

Because for a really long time we've been sold this whole idea of the 'fertility cliff', yeah? We're told that as we reach age 35, our likelihood of falling pregnant decreases. Dramatically. 

Our quality and number of eggs is on the decline. We're more at risk of health issues. We have a higher chance of miscarriage. From 35 onwards, a pregnancy is immediately labelled 'high-risk'.

It's all pretty terrifying. And it means there are generations of women who feel the pressure to get pregnant before they hit their mid-thirties - or risk struggling to fall pregnant later on and losing their chance to become a mother.

Watch: Things pregnant people never say. Post continues below.


Video via Mamamia

Of course, the pandemic has only ramped up the worry and anxiety around fertility - a lot of us feel our life has been put on 'hold' for the last couple of years. And it has! Goodness it has. 

For single women in particular, it's meant dealing with delay and uncertainty around their personal timelines, forcing many into considering other options for peace of mind.

Since the pandemic began, demand for egg freezing has absolutely exploded. Monash IVF in Brisbane reported a whopping 250 per cent increase from 2019 to 2020, showcasing a growing awareness in young women about fertility decline. 

There's no denying that the dread of hitting age 35 and nearing the 'fertility cliff' is so pervasive that more and more women in their late twenties and early thirties are already feeling they are falling behind this ‘ticking clock'.

Take Jessie, for example. At 31, she feels her time is almost running out.

"I'm 31 years old and feel incredibly anxious about my fertility. A number of women in my family went through menopause really early and that worries me, and I've always had painful/irregular periods so I worry too that there might be undiagnosed endometriosis or something."

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"I think the reason I feel anxious too is that I know how much I've always wanted this, and I hear stats about one in four women struggling with fertility. I wonder if that's because so many of us are waiting until later. I don't feel entirely ready, but then everyone says you'll never feel that."

She adds, "I feel an absolute maternal pull. Every time I see a pregnant woman or babies I feel a hint of envy. I also think I'm watching my grandfather get older and I would love him to meet my children. My parents would LOVE grandchildren and I can see how excited they are. I would like more than one child, and I know that if I want that to happen I don't have all the time in the world."

Relatable much? 

However, baby panicked as we may be, we can't help but look around and see just how many women there are in their mid-thirties who are in no rush when it comes to having kids. 

There are so many women out there focusing on their career, finding their perfect match, planning on travel. They're holding off and falling pregnant in their early forties.

This is the case for Gabrielle, who told Mamamishe started trying for a baby at 40 and ended up having her first at age 44. She said the decision to wait until later in life was one that was influenced both by her career and finding the right person to start a family with.

"I was very aware that time was not on my side as I progressed through my thirties. My job did not feel like it would work with being a single mum, and as much as I thought about it, it was too big and scary. I met someone in my late thirties and I fell pregnant quite quickly but I had a miscarriage a few months in. I was 40."

"This made me realise that I really did want a baby, and thankfully my partner did not run away in fear. I then spent the next few years going down the natural path with acupuncture, herbs and [focus on] diet. I had four more miscarriages and lots of tests to see if I had viable eggs. I had a lot of friends who I am sure thought I was fooling myself, and an incredibly supportive GP. At 43 and ready to give up, I fell pregnant. I was of course very nervous, but everything was looking good and at 44 I had a healthy baby girl."

While stories like these give you a glimmer of reassurance, in the midst of all this are alarming statistics that make it seem like the odds are stacked against you if you decide to wait. 

Take, for example, the statistic that one in three women aged 35 to 39 will not be pregnant after a year of trying.

While this study came out in 2004 in the journal Human Reproduction, it's worth noting that the data used was from French birth records from 1670 to 1830. So, it's basically an over 300-year-old statistic, but one of the most widely cited. 

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So... what's actually going on? Is the level of concern overblown?

What do we really know about when fertility supposedly "falls off a cliff"? And what can we do if we want kids, but we're not ready yet?

Here, we speak to A/Prof Dr Gino Pecoraro, an obstetrician and gynaecologist, to get to the truth about women's fertility.

Is the 'fertility cliff' a real thing?

Yes, the quality and quantity of your eggs declines over time - this is a scientific fact. 

According to Dr Pecoraro, the fecundity rate (or the chance of becoming pregnant in any given month) drops from a peak of 30 per cent in a woman’s twenties to less than five per cent at 40.

"There is the inalienable fact of life that a woman’s fertility does steadily decrease as she ages and the rate of decline of fertility does speed up after about age 35."

However, using 35 as a threshold is not as clear cut as it seems.

Because no, you don't go from a fertile 34-year-old to an infertile 35-year-old. Your ovaries don't suddenly just ~change~ and everything "plummets" off a steep cliff. It's a way more individualised process, with many different factors at play. 

It's important to keep in mind that every woman is different, so what we've been sold as the 'fertility cliff' concept is something that is not only really outdated, but wildly unhelpful - especially the crippling stress and anxiety that comes with it.

"I don’t know that “fertility cliff” is a helpful term when there are so many variables to consider," agrees Dr Pecoraro.

"For example, in our hectic modern world, an increasing number of couples suffer from social of lifestyle-related fertility issues where because of work or other commitments, both partners simply aren’t in the same location at the fertile time for natural conception to occur."

"The increase in FIFO workers and people travelling interstate means this is becoming more common," he adds.

It's also important to add that as men get older, they also experience a decline in quality and quantity of sperm - it's just not talked about as much. (Thanks, society).

"Its important to remember it takes two to make a baby. Subfertility can be due to female factor, male factor or a combination of both," said Dr Pecoraro.

"One in nine couples struggle with fertility after one year of trying, with roughly equal numbers of male and female factors contributing."

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Equal numbers, you guys.

"The average sperm count in men all around the world is dropping and scientists aren’t able to explain why," said Dr Pecoraro.

So, why is 35 considered advanced maternal age?

Being 35 or older is labelled by the medical community as “advanced maternal age" and a time when pregnant women become “high-risk”. 

Why 35? Well, back in the '70s, the age became the cut-off for when doctors recommended genetic testing. At that time, it was thought that the chance of a genetic condition was greater than the risk of a miscarriage as a result of the invasive test. 

Nowadays, however, genetic testing can be done with a simple blood test, making it easier and less invasive. Also keep in mind that these age-related concerns rise gradually, not all at once at age 35.

So, what health risks actually increase with age?

According to Dr Pecoraro, increasing maternal age is associated with increased rates of multiple birth, higher rates of pre-eclampsia, gestational diabetes, pre-term delivery, need for delivery by c-section and unexplained stillbirth.

"As well as this, there is a decrease in spontaneous pregnancy and an increase in miscarriage, perhaps related to higher rates of chromosomal anomalies like Down’s Syndrome in the babies conceived."

According to the National Down Syndrome Society, the estimated incidence of Down's Syndrome for a 35-year-old woman is one in 350. This chance increases gradually to one in 100 by age 40 and approximately one in 30 by age 45. 

Will worrying about your age make you less likely to fall pregnant?

There’s also something to be said for the anxiety-inducing stress many women feel about the 'fertility cliff' and trying to conceive at 35 and beyond. Because it's actually making everything a whole lot worse.

As Dr Pecoraro points out, "Before reproductive endocrinology and fertility treatment was as advanced as it today, many fertility doctors recommended “going on holidays” and forgetting about “trying” to get pregnant so anxiety was decreased."

"It is known the release of the stress hormone cortisol can actually stop ovulation and make pregnancy harder to achieve."

How crazy is that?

In other words, the stress and anxiety you're feeling around 'beating the clock', could potentially impact your fertility more than your age.

What can you do if you want kids but you're not ready yet?

So, what does all this mean if you're in your early thirties and trying to decide when to have children? How long can you safely wait to have a baby?

Well, there's not exactly one clear-cut answer.

"It may not always be possible to have children when we want them, be that because of difficulty finding the right partner or even timing to fit in with career and other life demands," said Dr Pecoraro.

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However, for those who are worried about waiting, new technologies and advancements in fertility are offering more options than ever before.

"Egg freezing is one option being explored by an increasing number of women, and offered by some progressive work places."  

"While egg freezing is now a fairly well studied process, thawing of eggs is still not fail-safe and not all eggs survive the process."  

"Better results are available with thawing embryos that have been created, but this obviously requires a suitable provider of sperm."

Importantly, Dr Pecoraro also warns that IVF is not exactly the magic ticket we once thought it was in improving our chances of conception.

"One of the greatest myths that needs to be debunked is that IVF fixes everything," he said.

"While this amazing technology has helped millions of couples around the world to become parents, it is not a panacea and nothing can make poor quality or older eggs suddenly become younger or better quality. Sperm quality similarly can’t always be bypassed by techniques such as ICSI (intra-cytoplasmic sperm injection)."  

"In a significant number of cases, no cause for fertility problems can be found and despite our best efforts, couples with unexplained subfertility may not be able to be helped."

"The most important thing is for couples to consciously discuss their fertility wishes and plans and not just leave it to luck, or they may be disappointed," concludes Dr Pecoraro.

At the end of the day, the decision surrounding if and when you want to have kids is obviously not a one-size-fits-all kind of deal. It's one that is extremely personal and different for every individual.

We know that the fertility game is insanely complex, and influenced by multiple factors - not just a number. 

With this in mind, the never-ending paranoia, obsession and fear-mongering over women and the 'fertility cliff' concept is one that's not only extremely outdated, but it's actually doing more harm than good. 

What do you think of our obsession with the 'fertility cliff' and the number 35? Share your thoughts with us in the comment section below.

Feature image: Canva

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