Two years and several failed adoption attempts later, the couple was accepted into a assisted reproduction therapy (ART) program run by Paulson after Randy found the fertility expert in a newspaper article. Three years after later, Nolen gave birth to her twin boys, Travis Steven and Ryan David.
"We really count our blessings that we happen to live when we did," Nolen says, remembering family members in past generations who were unable to have the families they so desperately wanted because of fertility issues.
"There are a variety of things about our society that push both men and women to delay childbearing -- professional achievement, becoming financially secure, what-have-you," says Paulson.
"What ART has done for women is to increase reproductive options and level the playing field a bit. That doesn't mean you should wait until 50 to be a mom, but if your life plays out in such a way that motherhood at an advanced age makes sense, it's nice to know that that option now exists."
It's important to know, however, that this option can also come at a price.
By postponing pregnancy until middle age, women are at greater risk for gestational and birth complications that can affect both mother and child, notes Greenfield.
"By the time you're in your forties, you're more likely to go into the pregnancy with medical problems such as diabetes or hypertension, which can complicate the pregnancy. You are also at higher risk for getting gestational diabetes or hypertension during your pregnancy," she says. Nolen suffered from the latter of these two towards the end of her pregnancy, though she says she was lucky she had no serious complications.
Risk of genetic conditions like Down syndrome increase throughout the forties as well, but the most common issue women face when they try to conceive later -- one they often aren't expecting -- is miscarriage and infertility.
"When you see all these high profile women in their forties having children, women in their thirties think 'Great, I don't have to hurry.'" It's important to be aware that "this doesn't mean that you, individually, will be able to conceive later in life," Greenfield says.
ART can help battle dwindling fertility but the therapy doesn't always work and can itself complicate pregnancies because it makes women more likely to have multiple births.
"Twins confer more risks to pregnancy than any other thing we think of as high risk factors," Greenfield says, "and that's just twins, not triplets or other multiple births."
But if decreasing birth risk was the only consideration, all mothers would be 25, Paulson says, and clearly, there are many factors that feed into when a woman can or wants to conceive.
"Women's lives are complicated, and for some women it's just not feasible to have their children in their early thirties, when fertility is higher," Greenfield says.
Women are taking better care of themselves -- "Forty today doesn't look the same as 40 twenty years ago," she adds, "but that doesn't have anything to do with fertility."
Being young for your age "may affect how active you can be as a parent, but it doesn't help your fertility."