Nan, age twenty-seven, and her husband, Brad, also twenty-seven, had struggled with infertility for several years. "I had a diagnosis of polycystic ovaries from my gynecologist, who started me on fertility pills. But they didn't work. I needed something more," says Nan. They went to see Dr. Rosenwaks, who suggested they try intrauterine insemination (IUI). Two months later, they began an IUI attempt, with Nan taking gonadotropin injections during her menstrual cycle. Nan became pregnant in that first IUI attempt. Their baby, Amy, is now seven months old. "You think that if you just keep trying, it will happen. But if you have a problem, it's better to take care of it in a timely manner," says Nan.
In 1970, American women typically had their first child at twenty-one. Today, most women are about twenty-five when they give birth. A woman in her twenties is likely to have healthier eggs than older women, which generally makes it easier to conceive. High-quality eggs also translate into a lower risk of birth defects. At twenty-five, the likelihood of having a baby with Down syndrome is about 1 in 1,250. Those with Down syndrome generally have one extra chromosome 21, for a total of forty-seven instead of the normal forty-six, and carrying a fetus with Down syndrome or another chromosomal disorder is often the reason women lose a pregnancy. This is one reason that miscarriage is less common in younger women. Younger women are also well equipped to handle the physical demands of pregnancy. But as many twenty-something women learn, fertility problems can arise at any age. The treatments in this book offer women in their twenties who are struggling to get pregnant the tools they need.
A Baby in Your Thirties
After four years of trying, Donna, a thirty-seven-year-old store owner, had been unable to conceive with her husband, David, thirty-nine, an independent filmmaker. "All my life I knew I wanted to be a mother," says Donna. Having seen four different doctors and spent tens of thousands of dollars on treatments, she feared that her time was running out.
Tests at Weill Cornell showed that Donna eggs were healthy but that David's sperm count was very low. The only way Donna could get pregnant was through an injection of David's sperm directly into her eggs in the laboratory, a process called intracytoplasmic sperm injection (ICSI), and then to have the fertilized egg implanted into her uterus. The procedure was a success, and Donna and David now have a one-year-old son, Don.
According to data from the National Center for Health Statistics, birth rates for women ages thirty-five to thirty-nine doubled between 1978 and 2000. In fact, 20 percent of women in the United States now have their first child after age thirty-five.
Having a baby in your early thirties is much like being pregnant in your twenties. Your health, energy, and fertility are still likely to be at high levels, and the quality of your eggs is still very good, making the risks of genetic defects low. However, once you reach age thirty-five, the risk of losing a pregnancy is higher. And once you turn thirty-five, your pregnancy should be monitored more closely because of the rising risk of birth defects. We offer all of our patients an amniocentesis and/or other screening tests to check for Down syndrome and other chromosomal abnormalities. There's no need to panic, because about 95 percent of women who undergo prenatal testing receive good news.
A Baby in Your Forties