The fertility window: are we lying to women about their biological clocks?

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Laura Linney was 49 when she had her first. Hilary Swank was 48. Chloë Sevigny was 45. If you went off celeb headlines alone, you’d be forgiven for considering that almost all women entered the motherhood recreation previous the age of 40 nowadays.

And but, the judgement forged upon women who postpone having kids – and the fixed references to our biological clocks as ticking timebombs – stays as prevalent because it ever was. In a latest article in The Guardian, Laura Barton writes poignantly about the expertise of falling pregnant unexpectedly on the age of 45 after years of making an attempt unsuccessfully, together with through IVF. “All through the long months of pregnancy and the early weeks of my son’s life, I felt I stood under a cloud of suspicion, as if his arrival must be attributable to some act of sorcery or science,” she writes.

It is a wierd place to sit in, as women: fed tales about Naomi Campbell having infants into her fifties, whereas mainstream society tells us to hurry up and get spawning earlier than our fertility takes a nose-dive. It’s a mantra we internalise from an early age: tick-tock, tick-tock, time’s working out, you’re not getting any youthful, should get pregnant by the age of 30, and so forth and so forth. There is little question, although, that the common age at which women are having kids has been steadily rising for years. For the primary time, most women in Britain are now having their first little one on the age of 32 or older, in accordance to Office for National Statistics (ONS) figures launched final month. It’s a part of an even bigger pattern that sees us getting married and shopping for our first dwelling later; authorities insurance policies lately haven’t helped both, with the multitude of limitations to procreation together with extortionate childcare prices and restricted paternity go away. Meanwhile, fertility in England and Wales fell to its lowest recorded stage between 2010-20 for women throughout all academic teams, in accordance to a 2023 examine from the University of Oxford.

Anecdotally, the vast majority of my pals with kids had at the least one among them when aged 35 or over. Particularly for women residing in London and different city centres, it virtually feels extra pure to wait – to get the profession sorted, meet the precise associate, turn into financially safe – earlier than beginning a household. Because of this, my very own concepts about women’s fertility are utterly skewed; however how late can we go away it? Has the fertility window truly been widened?

Part of the issue is that almost all of us have little or no concept about what’s occurring inside our personal our bodies, thanks to an absence of training round ovulation and fertility when we’re younger – aside from the fixed hysterical messaging that having unprotected intercourse means “you will get pregnant – and die!” (to quote Coach Carr from Mean Girls). Toni Belfield, co-author of What Every Woman Needs to Know About Fertility, has spoken to 1000’s of women all through her profession: “Even though there’s masses of information out there, I’ve learnt first hand how little most women know about how their reproductive organs work,” she says. “The reason we wrote our book was that we felt there was a need for good, clear information on how the body works and what it’s doing each month. Fertility is a gift but it has an expiry date. If we understand that, we can think more about the decisions we’re making.”

Dr Ippokratis Sarris, a guide in reproductive medication and director of Kings Fertility, provides me a fast science lesson, easy sufficient for even this laywoman to perceive. Women are born with all of the eggs they’re ever going to have, not like males, who produce new sperm all through their lifetime (therefore why you see Al Pacino turning into a dad once more at 83). Because of that, over time, the variety of eggs a girl has goes down. So far, so apparent. But, identical to the remainder of the physique, eggs age – each one among a girl’s eggs is as previous as she is. Again, that is not like males, whose sperm is barely six weeks previous by the point it’s launched. These ageing results imply the power of every egg to produce a wholesome child goes down.

It’s not that women don’t have sufficient eggs as they become old – solely round 300-400 are launched over a lifetime out of the 300,000 they’ve by the age of puberty – however that the less eggs they’ve, the decrease the prospect that they’ll have a “good” one every month. We don’t simply lose the one egg that makes its manner down the fallopian tube per cycle; prior to that, it has gone up towards a gaggle of different “activated” eggs, in a survival-of-the-fittest battle. After the eggs compete, the one deemed the most effective and brightest is the one put into bat, because it had been, whereas those who didn’t win the ovulation Hunger Games die off. As Dr Sarris places it, “eggs are not friends with each other; they want to become a baby”.

The stats of this course of are a key consider why the prospect of turning into pregnant with a traditional embryo lowers for women as we become old. A lady in her twenties may have round 20-30 eggs competing every month, with one in 4 to six doubtless to be “normal”, leading to two to three good eggs every month. Fast ahead to a girl at 40, and the variety of competing eggs has dropped to 10-12, with a probability that one in 15-20 will likely be regular – which means that there’ll be some months with no good eggs. The likelihood of conceiving drops dramatically. Meanwhile, extra eggs may have chromosomal abnormalities, which means that even when an embryo (an egg fertilised by sperm) does implant, the prospect of miscarrying additionally will increase, as does the probability of a child being untimely or having a genetic situation equivalent to Down syndrome.

However, somewhat than the fertility “cliff edge” post-30 that I grew up listening to about, there’s a really gradual decline from 30-35, then a swifter lower from 35-40, adopted by a a lot sharper drop from 40 onwards. The likelihood of a pure conception in our early twenties is 25 per cent every cycle; 10 per cent by age 40; and simply 1 per cent by 44. “It’s important to stress there’s no absolute knife edge,” says Dr Sarris. “We get obsessed by a round number like 35. I say to my patients, your body doesn’t know your birthday – it’s a constant change, but the slope of the graph tends to accelerate over time post-35.”

Public consciousness of fertility charges isn’t excessive. Couples in their mid-30s are usually “astounded that they don’t have 70-80 per cent natural conception rate” per cycle, says Mrs Polly Ford, a guide gynaecologist and subspecialist in reproductive medication and surgical procedure for Complete Fertility. A survey of two,000 folks revealed that 78 per cent of respondents didn’t know that heterosexual {couples} over the age of 35 have lower than a 30 per cent likelihood of pure conception on their most fertile day every month.

Unlike different areas of medication the place dramatic advances have been made, women’s fertility window has remained fairly constant. Overall, age remains to be by far the dominant issue – way more so than way of life selections and genetics. “Inherently there’s a ceiling we can’t go above,” says Dr Sarris. “We can’t improve that, we can just be the best we can be and not make things worse for ourselves.” Two of the primary components inside people’ management are smoking and weight problems: each make it tougher to get pregnant and lift the prospect of miscarrying. But nevertheless wholesome we are, it “does not change the time-effect that happens on the egg”.

What has modified during the last 20 years is fertility testing, assisted copy methods and the corresponding success charges. “There’s a better understanding of what’s happening when pregnancy doesn’t occur,” says Belfield. “We have tests and ultrasound scans that can detect polyps and fibroids – it all contributes to a better understanding, and therefore increases the possibility of becoming pregnant.”

There have additionally been dramatic enhancements in egg freezing, with a 95 per cent survival charge for eggs as soon as they’re “thawed”, and an 85 per cent fertilisation charge for frozen eggs. Success charges for IVF have gotten higher within the extra superior age group, too – although that is nonetheless restricted by egg high quality and amount as women become old. “Even with assisted reproduction, it’s much harder to get a viable embryo from an older egg compared to a younger one,” says Professor Evelyn Telfer, a reproductive biologist specializing in feminine fertility and ovarian growth on the University of Edinburgh. “That’s why women are encouraged to freeze their eggs when they’re younger.” It’s additionally why, while you see tales of celebrities getting pregnant at 48, the chances are they’ve used a donor egg from a youthful lady.

Further cutting-edge methods are being developed which have stirred up controversy. Professor Telfer tells me about a course of initially developed for younger women prior to present process most cancers therapies that may have an effect on their fertility, equivalent to chemotherapy. It includes eradicating ovarian tissue and freezing it, prepared to be re-implanted at a later date to rejuvenate fertility. It’s now being provided privately at some clinics to any lady who desires it. But, identical to with egg freezing, it depends on a girl being prescient sufficient to do that when she’s younger.

Amid the entire science and statistics, nevertheless, are the very actual experiences of those that turn into moms previous the age of 35. The women I communicate to spotlight that, as with having kids while you’re youthful, there are positives and negatives.

“The birthing process was definitely tougher compared to friends in their late twenties for whom it generally went quite quickly and seamlessly,” Sally Howard, a 39-year-old world well being and social affairs journalist, tells me. “I had a quite nasty emergency C-section. I don’t think your body’s geared up for it if you haven’t done it before at that age. And I noticed my own biology – I’m much less of a solid sleeper than I used to be before my mid-thirties. Waking up every couple of hours meant I had gruelling insomnia and had to switch to bottle feeding from five months.” But she’s fast to spotlight the numerous plus factors to ready: she was prepared, she’d travelled the world, it was the precise time. “No regrets.”

Kalini Kent, a parenting professional who had her first little one at 37, “felt a lot of pressure, culturally”. Originally from the Caribbean, she was made to really feel that laying aside having a child would imply she was “left on the shelf”. But once more, there have been quite a few advantages: “I’d lived my life, done the things I wanted to do – and you have the maturity to enjoy it. I had a better relationship with my partner, more friends, and we were financially much better off as well.”

Having had the primary of her 4 kids at 28, Ashley Ritchie, a chartered accountant from Northern Ireland, had her final aged 38. While she had “a lot more energy” a decade prior, she too recognises the upside to being a late-thirties mum. “I was a lot calmer about everything; I definitely felt more settled and less anxious. In my twenties, we also had less money.”

What did irk her and Sally was the stigma of being branded with the much-maligned time period “geriatric mothers” throughout their pregnancies. So, are we lying to women about their biological clocks? Not fairly. The fertility window remains to be a window, and statistics are nonetheless statistics. Waiting can have advantages, however the odds of conceiving naturally do begin dropping post-35 – nevertheless many inspiring tales we may learn about Laura Linney.

The causes behind women ready longer to have kids are lengthy and sophisticated although, with lots of them societal, not biological. It’s up to each particular person to weigh up their personal set of circumstances and determine what’s proper for them: “We get these messages about menopause and fertility almost as if they were absolutes, but of course they’re not – there’s a huge range,” says Professor Telfer.

In the meantime, maybe it’s time we hung up the stigmatising language. As Ashley places it: “When you’re young, all the focus is on you not getting pregnant. Then the focus changes to you not being too old to get pregnant. You can’t win if you’re a woman!”