After nine years, three rounds of fertility treatments and about $90,000 in medical costs, Grace is having her first baby at 53.
In her 20s and 30s, she was attending college, traveling and pursuing a career in theater and film. In her early 30s, she decided to freeze her eggs in case she decided to have a baby. By her mid-30s, her mom became ill.
“Life happened, and time just flew,” she said. “I had to step up to take care of my mom. By the time I was able to start the process of trying to have a baby, I was in my 40s.’’
Grace underwent in vitro fertilization, a fertility treatment involving fertilizing an egg with sperm in a laboratory dish and implanting the embryo into the uterus. She is now five months pregnant with her significant other of 25 years.
“It’s a beautiful feeling,” she said. “I’ve had small regrets. I’ve thought that I should have prioritized better when I was in my 20s. But I never lost hope that this would happen.”
Women have been delaying childbirth over the last several decades for a multitude of reasons, including pursuing higher education and careers. First-birth rates declined among women under age 30 and 35-39 and increased among women ages 30-34 and 40-44, according to 2010 National Vital Statistics Reports from the Centers for Disease Control and Prevention. In fact, the rate of 40- to 44-year-old women having their first child has steadily increased since 1982, according to the CDC, and the number of births among women ages 45-49 jumped 4 percent in 2014, the second-highest increase (women ages 35-39 had a 5 percent jump).
But as women age, it becomes increasingly difficult for them to become pregnant.
According to the American College of Obstetricians and Gynecologists, fertility in women starts to decline at age 32 and begins to decline substantially after age 37.
“Men form new sperm every day,” said Dr. Dibe Martin, a maternal-fetal medicine specialist with South Miami Hospital’s Center for Women and Infants. “Women are born with a fixed number of eggs, and those eggs stay dormant in the ovaries until ovulation.”
Eggs age as women age, and the number and quality of eggs decrease as they get older. Low egg count and decreased quality of eggs contribute to infertility.
Problems with fertility affect men, too.
“People usually talk about women having fertility issues, but sometimes there is nothing wrong with the woman,” said Dr. Salih Yasin, director of obstetrics and patient safety at the Women’s Hospital Center at Jackson Memorial Hospital. “Just like women need healthy eggs to have a baby, men need healthy sperm.”
Male factors — low sperm count, no sperm or poor sperm motility, the sperm’s ability to move — contribute to about 40 percent of infertility cases among couples, according to Yasin.
Doctors determine that couples are infertile if they haven’t conceived after one year of regular sexual intercourse without birth control, or six months for couples age 35 and older.
Fertility treatments for women include artificial insemination, a procedure in which sperm is inserted directly into a woman’s uterus, fallopian tubes or cervix using a catheter; fertility medication to induce ovulation and in vitro fertilization.
“In vitro fertilization is a good tool to help couples get pregnant, but first, they need a good workup to find out why they’re not getting pregnant in the first place,” said Dr. George Attia, director of the UHealth Reproductive and Fertility Center.
Underlying medical conditions like infection or damage to the fallopian tubes or abnormalities in the uterus or cervix can affect fertility regardless of age. As women age, the possibility of developing medical conditions that could interfere with pregnancy, like diabetes and high blood pressure, increases.
“Women who delay childbirth after 45 end up needing specialized testing to make sure their bodies are healthy enough to have a baby,” said Dr. Ramon Ferra, medical director of the Mount Sinai Ob/Gyn Group, who is treating Grace, the woman who will be having her first baby at age 53.
“They performed tests from head to toe,” Grace said. “It was stressful.”
As a general rule, women who become pregnant at 35 or older are considered to have high-risk pregnancies because of the possibility of complications. Woman who get pregnant at an older age are at risk of developing gestational diabetes and hypertension, having miscarriages, multiple births and going into preterm labor. There is also an increased risk of babies being born with genetic disorders like Down syndrome.
“The goal of all pregnant women is to have a healthy baby born to a healthy mother,” Yasin said. “Women need to know what they’re getting into when they undergo fertility treatments.”
Yasin said the success rate of in vitro fertilization is between 15 percent and 50 percent depending on the woman’s age, the cause of infertility andunderlying medical conditions.
“I think one of the hardest parts is the psychological aspect when pregnancy doesn’t happen,” Attia said. “We have to be very honest and straightforward with our patients and help manage expectations because the letdown is so huge if they’re not mentally prepared for the possibility of not achieving pregnancy.”
Doctors suggest couples schedule preconception appointments to prepare for pregnancy and potential letdowns. Doctors also suggest that women seek regular prenatal care and counseling.
“From my end, the hard part is that even if you try and you do get pregnant, the end product is not always a success because there are all these risks,” Martin said.