Shannon M. Clark
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 mum. 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 specialises 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 realised 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 travelled 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 mum, I now see that no matter what we hear about 40 being the new 30, fertility doesn’t work that way.
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 fertilisation. (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 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 per cent in women younger than 35. But for women between 35 and 37, it drops to 31 per cent; to 21 per cent for women between 38 and 40; 11 per cent for 41- and 42-year-olds; and less than 5 per cent 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 university. 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 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 realised 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.
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.
But while I may not experience the basic human endeavour 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.
Dr Shannon M. Clark is a maternal-fetal medicine specialist at the University of Texas Medical Branch in Galveston, and founder of BabiesAfter35.com. She wrote this for The Washington Post.