The other day, I saw a new patient in my office. She was 39 years old, healthy, a successful career woman, pregnant for the first time — and scared to death. After trying for two years to conceive, she had finally done it. But instead of being thrilled, she was worried about the potential complications that come with being pregnant as an older first-time mom. After I answered all of her questions, the tension in the room dissipated, and she began to smile.
I understood her worry. I could sense her excitement and her guilt over having waited so long. She had married at 37 after spending years focused on her career, and she immediately started trying to have a child. She thought it would be easy to get pregnant, and she was truly surprised when it wasn’t. The attempt had strained her new marriage, so news of her pregnancy also brought anxiety.
I understood her because I am her. Only I may never be able to have a child.
As an obstetrician-gynecologist who specializes in the care of high-risk women, I see many patients who are older mothers and older first-time mothers; for several reasons, any pregnancy over the age of 35 — “advanced maternal age” — is automatically considered high-risk. But as a 42-year-old struggling with infertility, I can’t help but feel that the increasing number of women having babies later in life hides the reality of how difficult it can be. Forty-something childbearing may be more common today, but the biological clock is still very real.
Despite my years of training and work with expectant mothers, I never realized how hard it would be to conceive at this age. No matter why a woman has waited to have children or how healthy she is, her ovaries release fewer eggs and eggs of lower quality as she ages. The changes accelerate drastically by 37. Like many of my patients, I was healthy, educated, had traveled the world, and was finally ready to settle down and pursue the next phase of my life. But after two years of trying everything to become a mom, I now see that no matter what we hear about 40 being the new 30, fertility doesn’t work that way.
The average age of first-time mothers in the United States rose from 24.9 in 2000 to 26.3 in 2014, according to the Centers for Disease Control and Prevention. While this is partially a result of a decline in births to teenage mothers, it’s also because the share of first births to women age 35 and over rose by 23 percent.
Older women’s reasons for waiting to start a family are varied and, in many cases, complex. Many have educational and career goals. Some women simply have not yet met the person they want to have children with. Some women have health conditions that need to be addressed or overcome before it’s safe for them to carry a fetus.
Although many of my patients have conceived naturally, even later in life, many owe their pregnancies to my colleagues in reproductive endocrinology and infertility and to treatments such as in vitro fertilization. (Many more women, like me, are still trying.) Advances have helped women of all ages have families. But fertility treatments aren’t just stressful; they’re also expensive ($12,400 per cycle, on average, according to the American Society for Reproductive Medicine) and time-consuming (between four and eight weeks per cycle).
According to the Society for Assisted Reproductive Technology, the success rate for IVF is 40 percent in women younger than 35. But for women between 35 and 37, it drops to 31 percent; to 21 percent for women between 38 and 40; 11 percent for 41- and 42-year-olds; and less than 5 percent for women 42 and older. This does not take into account the number of IVF cycles each woman undergoes. So while IVF is an option, it hardly guarantees you’ll have a baby.
Those are just the official stats. Here’s how things looked for me: one miscarriage, two hysteroscopies, five cycles of IVF, one embryo transfer with my own eggs and one embryo transfer with donor eggs.
I had a perfectly good reason to delay childbearing, one that would seem familiar to many of my patients: I was focused on my career. My sister and I were the first in our family to graduate from high school and the first to go to college. I just kept going. My medical degree and specialty added 11 more years to my training, and I simply didn’t allow myself much time for meeting a partner. I convinced myself that my career would be enough; my career would be my child. That all changed when I was 38 years old and my now-husband walked into the room. I don’t regret my decisions, and I am grateful for a job I’m passionate about. I’m glad I waited to find my soul mate. I just never anticipated the sacrifice it would require.
When I married at age 39, I knew that time wasn’t on my side. But even with my extensive medical training, I didn’t truly grasp how difficult it would be. If I couldn’t get pregnant naturally, I told myself, I’d have IVF to fall back on — I didn’t know those statistics. After I got pregnant naturally and miscarried in late 2013, I panicked. I was turning 40, and I finally realized that I was not going to be like my patients who had beaten the odds and naturally conceived. I was going to need help. Since then, I have tried every form of fertility treatment available to me.
Out of five cycles of IVF that produced 16 embryos, I had only one genetically normal embryo, and its transfer was not successful. I tried using two donor eggs from a younger woman, but this transfer, too, was unsuccessful. That was the most devastating loss of all.
I suppose I was in a bit of denial: I am an obstetrician, for goodness’ sake. I should have known better, and perhaps somewhere deep inside, I did. But I had taken care of many women who had successful pregnancies later in life, naturally or through fertility treatments, and I just assumed I’d be one of them. I was used to achieving my goals. Why would I fail at this?
The most surprising thing is that the pain I’ve felt hasn’t lessened my commitment to my patients. If anything, I better understand the elation they feel when they welcome a child into the world. I also grasp the overwhelming sense of loss when they lose a pregnancy. But I don’t share my own disappointments with grieving patients: My job is about them, not about me and what I am going through. As a physician, I have to be able to tuck my personal pain away so I can be fully present. I can only hope they feel my sincerity and caring when I am with them during the happiest, and sometimes most devastating, time of their lives.
Sometimes, though, it is hard: There is no escape. I am surrounded by pregnant bellies every day. I don’t get a reprieve from the thing that is causing me so much hurt. My feelings of loss sometimes creep in when I am seeing a pregnant patient or delivering a baby, and I have to find a way to close that part of my brain off — but without becoming numb to what has given me so much joy throughout my career. I am an excellent doctor. I refuse to let infertility take that away from me.
I want to be pregnant. I want to feel a growing being inside me. I want to feel the kicks, have the ultrasounds, see my body change and experience all the things my patients experience. I want to be on the other side; I want to be the pregnant patient and not just the doctor. But while I may not experience the basic human endeavor that is childbirth, I still have options. I have three donor embryos left, and surrogacy and adoption are alternatives. My journey is not yet over.
A child is a miracle. No one knows better than I just how true that statement is. Yet I urge women delaying childbearing for any reason to look beyond the headlines about maternal age. Yes, there are many women who get pregnant naturally later in life, and yes, there are many options for becoming pregnant through fertility treatments. But women need to be mindful that there is no guarantee. I never thought I would be a statistic, and I caution women on my path never to assume that their journey toward a family will be seamless. If having children is in your master plan, please consider your options early.