A Glimpse into a Woman’s Fertility After 40
By Danielle Dellilo
Fertility has been a taboo topic for decades and most women are too shy to talk about it. Recently, I discussed it amongst a few friends who have used fertility assistance and those who haven’t, and their response was fascinating. These women, who are close to or over 40, didn’t know how many people were affected by infertility until they started on their own journey.
After having a miscarriage at 32, I swore I would never try to conceive again. Ten years later, the pain of losing my baby still hurts today. I felt like a failure and that I did something wrong. I kept asking myself did I eat something I shouldn’t have? Did I have a bad fall? Did I run too fast on the treadmill? I didn’t know anyone that went through what I did, but after speaking to my doctor and a therapist, I learned that miscarriages are more common in the early stages of pregnancy. According to Healthline.com, “Miscarriage is the loss of a pregnancy before week 20. About 10 to 20 percent of pregnancies end in miscarriage, though the actual percentage is likely higher because some pregnancies are lost very early before a woman even realizes she is pregnant.”
Years after my miscarriage, I began to have abnormal bleeding which was a result of fibroids and polyps growing in the wall of my uterus. My gynecologist explained I would need to remove them if I wanted to conceive again. Before my myomectomy (the medical term for surgically removing fibroids from the uterus), my gynecologist thought it would be ideal to preserve my eggs. There was some concern that I would enter menopause early and if that were the case, preserving my eggs would be critical for my future as a mother. At this point, I was 38, in the advanced maternal age range, and already delayed childbearing. Again, not knowing anyone who did this, I started researching egg preservation and made an appointment to speak to a fertility specialist about it.
After meeting with Dr. Bradley Trivax, a very successful reproductive endocrinologist at Island Fertility in Commack, NY, we discussed a plan for undergoing oocyte cryopreservation, the freezing of eggs. He advised me not to wait past the age of 38 as the quality and quantity of my eggs would decline over time. Without hesitation, I decided to preserve my eggs under Dr. Trivax’s supervision and guidance. The process was relatively easy with two weeks of hormone self-injections, coupled with in-office ultrasounds to monitor the growth of the eggs and blood tests to check hormone levels every two to three days. Two days before the egg retrieval, I administered my last shot, called the trigger shot, which helps the eggs mature and signals the body to release them.
On the day of retrieval, I was sedated and closely monitored while Dr. Trivax used an ultrasound-guided needle aspiration. After two weeks of injecting myself with hormones, I produced 15 eggs and after the embryologist examined them, 12 were cryopreserved.
After speaking to several professionals in the fertility field, women who had to use fertility treatments and those fortunate enough not to use any assistance, I am far more prepared for what’s to come. Because fertility isn’t discussed very often, I became passionate about sharing my story and what I’ve learned with others.
Dr. Trivax Talks About Preserving Your Fertility
What happens to a woman’s eggs as she ages?
One of the first questions a fertility doctor asks when they meet a new female patient is, “how old are you?” The answer gives the doctor an idea about the age of the patient’s eggs. A woman is born with a lifetime supply of eggs but experiences a decrease in quantity as she ages. Research has shown that women are born with approximately a million eggs, and the number declines over time, and at menopause, the eggs are gone.
Source: Wallace W, Kelsey T. Human Ovarian Reserve from Conception to Menopause.
When it comes to fertility, age is not on your side. It is quite the opposite; it can make conceiving extremely difficult and the chances of getting pregnant after 40 are slim. According to CNY Fertility, “Under normal circumstances, a 40-year-old woman has approximately a 4-5% chance of conceiving naturally each month. Unfortunately, these numbers continue to decline the further you go into your 40s. For comparison, a 30-year-old woman has about a 20% chance of getting pregnant each month.”
Egg quality also declines with age. “If we give medication to somebody who is 30 years old, and they make 10 eggs, arguably seven or eight out of those 10 eggs are chromosomally normal. At 40, seven or eight out of 10 are chromosomally abnormal,” Dr. Trivax explains.
The chances of having a miscarriage also increase as abnormal eggs accumulate over time. According to the American Pregnancy Association, “Women under the age of 35 years old have about a 15% chance of miscarriage. An increase in maternal age affects the chances of miscarriage. Women who are 35-45 years old have a 20-35% chance of miscarriage. Women over the age of 45 can have up to a 50% chance of miscarriage.”
Bethany Baron, 45, of Brooklyn, NY, has been using in vitro fertilization (IVF) for over four years. She conceived her first child naturally at age 40, has been trying for a second, and has been unsuccessful. Each round of IVF that Baron had resulted in miscarriages or medical abortion. Baron shared, “We knew after the fifth round; we were calling it. We decided to focus on the family that we had.”
Harriette Rovner-Ferguson Talks About Miscarriages and Honoring the Loss
What are the psychological effects of fertility after 40?
Fertility is a journey. There are highs and lows and is often compared to being on a rollercoaster ride. Harriette Rovner-Ferguson, a licensed social worker at Transformations Counseling Group in Hauppauge, NY, and the author of “What to Expect When You’re Experiencing Infertility: How to Cope with the Emotional Crisis and Survive,” had experienced infertility herself and said, “From my point of view, going through infertility is a crisis. It affects everything. It affects you socially, emotionally, psychologically, and sometimes spiritually, what we know is that infertility causes stress.” She also explained, “When staying with infertility treatments for 3-4 years, the levels of anxiety and depression can be as high as women experiencing the diagnosis of breast cancer or HIV positive status.” Lisa Kanter, 41, of Centereach, NY, is a mother of two with one on the way. She explained her fertility journey was emotional after many visits to the doctor, having embryos transferred and resulting in several miscarriages, “It was the worst rollercoaster ride I’ve been on, and I don’t like rollercoasters.” She joined support groups after she had her first child and learned she had postpartum anxiety, which was a result of going through so many rounds of unsuccessful IVF treatments. “I didn’t know it was normal,” Kanter said.
Jennifer D’Auria, 41, of Commack, NY, conceived her first child naturally but had a difficult time conceiving her second. She did rounds of intrauterine insemination (IUI) and suffered several miscarriages, but nothing was happening. “Every time you start a new cycle you have so much hope and then you do the IUI, then you wait, and then you don’t get pregnant, then you’re down again, and then you’re like ok I can’t dwell on it, just tell me what the next step is,” she said. The next and final step for her was IVF and it was successful.
D’Auria, as well as the other women I spoke to all had the same advice: “Don’t give up.” They didn’t let grief, anxiety, or depression stand in their way of creating their families.
Two women I spoke with wouldn’t share their stories because it was too painful for them. One woman stopped trying two years ago after several years of failed fertility treatments, she was 45 at the time. Although so much time has passed, she didn’t want to discuss the topic because she is finally in a good place mentally. She was afraid that, if she dove back into that discussion, it would send her downhill.
Rovner-Ferguson shared some great advice for those going through fertility treatments: “Go easy on yourself, stay in the moment, practice being present, find support, don’t feel obligated to do something that doesn’t feel right.”
What are the risks of becoming pregnant after 40?
There are several risk factors to consider when preparing for pregnancy over 40. Dr. Robert Setton, a reproductive endocrinologist from Shady Grove Fertility in Brooklyn, NY, said, “With an increase in age, there’s an increase in incidents of medical morbidities. Naturally, as we all age, there’s a higher risk for cardiovascular disease, high blood pressure, abnormalities with blood sugar control, and diabetes. And overall, your cardiovascular status is more compromised than it was when you were younger.” He also shared that “There are increased risks of complications with advanced maternal age, including pre-eclampsia, diabetes, and other issues in terms of growth of the fetus.” With these potential risks, a woman must be closely monitored. Another risk that could potentially harm the fetus is placenta previa where the placenta covers some or all the cervix and could cause premature labor or stillbirth.
When should you seek fertility assistance?
For women over 40 who have been trying to conceive for six months and are unsuccessful, it’s time to see a fertility specialist. “You need to find and speak to a fertility doctor that you feel a connection with, and you feel like you’re being heard,” said Dr. Trivax. After the initial examination and lab results, the doctor will present several options that may include assisted reproductive technology (ART) which includes intrauterine insemination, in vitro fertilization, and more. According to Evidence Based Birth, “Today, the U.S. Centers for Disease Control and Prevention (CDC) estimates that 2% of all infants born in the U.S. every year are conceived using ART. Advances in ART are a reason why some people can get pregnant after age 35 and especially after age 40.”
Dr. Setton Talks About Infertility Being a Disease
Why are more women having babies after 40?
Having a baby after 40 is more common today due to women focusing on furthering their education, their careers, and settling down later in life. “Over the last couple of decades, there’s been a massive increase from 30-40 years ago to what it is today in terms of women who are pursuing higher education, graduate degrees, pursuing professional careers, and developing in that sort of way. That often ends up leading to delay in childbearing and starting families,” Dr. Setton said.
Dr. Trivax added, “If you’re working your butt off to become whatever you’re working towards, you have your goals. You don’t want to be sidetracked by focusing on something else that needs a lot of attention at the same time. And this is where the field sort of blew up, we can help women who are 40 get pregnant.” Jessica Rotoli, 44, of Long Beach, NY, is a mother of two and had her second child at age 43. “I feel like 40 is a good age because you’re established, you’ve already lived a life, you’ve been through experiences. You’re not in that party phase where you’re going to be jealous of your friends,” she said.
Jessica Rotoli, Mother of 2 Talks About Having Kids After 40
Women interested in becoming pregnant should learn about their eggs’ quality, quantity, and the type of fertility treatments available. They should also understand the psychological effects fertility and infertility have, along with the risks, and the benefits of conceiving after 40. Learning about fertility after 40 from fertility specialists and hearing from several women who have all had different experiences, proves there is no one formula to creating a healthy embryo.
What’s next for me? When the time is right and in the not-so-distant future, I will rely on the guidance of my doctors, the support of my friends and will continue my fertility journey.
Danielle Dellilo 