Geriatric Pregnancy: Is It A Real Concern Or Just An Antiquated Idea?
As I have honed my practice over the years to focus on women’s health and hormone balance, naturally, infertility has been a growing part of my practice.
However, fertility is also of personal interest to me. I am a few months away from officially being in my mid-thirties and want to have children of my own someday. While this was not part of my plan to wait this long, completing medical school and growing my practice were goals I wanted to accomplish. And I knew that I wanted to be further established in my career before introducing kids into the mix.
Statistics show that I am not alone. There is a growing trend that more and more women are putting having children on hold while they pursue higher education and develop their careers, waiting to have their first child after age 35. In fact, 1 in 6 U.S. pregnancies are in women over 35.
With this trend there has been an increase in acceptance of treatments like IUI (intrauterine insemination) and IVF (in vitro fertilization). Clinics like our local Shady Grove have been growing to accommodate the increasing demand to help women achieve pregnancy. Michelle Obama even shared her own personal struggle with infertility and IVF in her fantastic memoir, Becoming.
Unfortunately the rhetoric surrounding these post-thirty-five pregnancies has not evolved with this shift. Once you cross this magical line into mid-thirties, you are considered a “geriatric pregnancy”, also known as advanced maternal age, which is the more acceptable term. While some doctors still use the former antiquated term, neither description inspires confidence or consolation about pregnancy over the age of 35.
Speaking honestly, even I am a little afraid to plan for pregnancy, knowing that conventional medicine will automatically label me as an advanced maternal age with no consideration to all the other factors that contribute to having a healthy pregnancy. Despite helping women with infertility and hormone imbalance daily as part of my job, I too, am susceptible to this judgment of female bodies that is deeply rooted in our culture.
Having never attempted to become pregnant in the past, it makes me worry about: how long it may take, will I have to consider IVF, or even adoption? Can I even afford these things? Leave it to the patriarchal conventional medicine to make women feel bad about wanting to have a career and be more settled before becoming a parent.
With attitudes changing towards pregnancy later in life, why are we still so negative towards these “older” women? Yes, there is an increased risk for some birth defects, miscarriage, and all the horrible stuff that keeps you up at night but the reality is those risks don’t dramatically increase as you’ve been led to believe. This great article by Bloom Life explains how yes, certain risks increase as it does every year you age but for most of these concerns, the risk is still relatively low.
Reading these stats helped settle my fears but if you’re thinking about becoming pregnant over 35, another thing to consider is the health of the average population of women that are becoming pregnant.
In the U.S., it is estimated about 1 in 10 women have PCOS and another 1 in 10 women have endometriosis. Also, with diabetes and pre-diabetes affecting at least 43% of our population, these pregnancy risks are calculated from data from an average of our unhealthy population. So women that may have some underlying health conditions, are eating the standard American diet, don’t exercise, are stressed, and possibly on medications are being lumped together with women who are healthy, exercise, manage their stress, and are on no medications.
Thankfully, there is research to back this up. A Canadian study of thousands of women found that “the outcomes of pregnancy and childbirth and for newborns born to women ≥ 40 years did not vary significantly from those of younger women if the following conditions were met: a) pre-existing chronic diseases were treated medically and dietetically; b) pregnancy-induced morbidity was monitored regularly and controlled medically; c) women attended regular prenatal check-ups; d) a healthy lifestyle was adhered to during pregnancy, and e) delivery occurred in a perinatal center.”
And let’s not forget about the sperm! The man’s health is also an important consideration when it comes to the baby’s health. It’s not all on us ladies.
There is never an ideal age or time of your life to have children. But let’s be realistic. It’s not as though if you have kids before you’re <insert magical age before 35 here>, you have no risks of miscarriages or birth defects. Complications can happen at any time and at any age.
So instead of focusing on things out of your control (such as being labeled an “advanced maternal age”), I’m going to share some well-researched options to help improve fertility and have a healthy pregnancy.
Address Any Underlying Health Conditions
As mentioned above, if you have any chronic underlying health conditions like diabetes, prediabetes, or high blood pressure, taking steps to treat that condition can have a large impact.
Along this same reasoning, also take into account your reproductive health. If you’ve been on birth control for a decade due to your menstrual issues, achieving a healthy pregnancy may take some time. Whenever I treat women for infertility, how “normal” their menstrual cycle is a key factor in my evaluation and if abnormal, something we address.
Another common condition that I screen for is thyroid issues. Hypothyroidism is underdiagnosed and can significantly impact fertility. Some tests you may want to ask your doctor to run include TSH, fT3, fT4, TPO and Tg antibodies, and reverse T3. Most doctors will only run TSH or, if you’re lucky, they might throw in a total T4 but we care more about the free hormones (fT3 and fT4) so we know it is available to be utilized by the body.
While some doctors may balk at this request, I’ve regularly seen women who have a normal TSH but low fT3 and fT4 or have normal hormones but high antibodies so it’s important to be thorough when it comes to thyroid and fertility.
Top 3 Supplements For Fertility
While it is easy to think you need to take an entire shelf of supplements, I like to focus on a few key supplements to help with fertility.
-Inositol: This lesser known B vitamin has been shown to improve ovulation and egg quality. Inositol has also been demonstrated to improve insulin sensitivity and decrease elevated blood pressure. Most of the research supports myo-inositol instead of d-chiro form. This has even been shown to help reduce miscarriages if taken during pregnancy.
-N-acetyl cysteine: NAC for short, this amino acid also helps improve egg quality. NAC is a precursor to glutathione, a potent antioxidant in the body, which can help reduce any oxidative damage.
-Good quality multivitamin: Just like you need all your supplies and tools to build a house, having adequate amounts of vitamins and minerals are crucial to have a healthy pregnancy. Any good quality supplement will not contain extra and unnecessary “stuff”. Be sure to read through the ingredients list of your multivitamin and make sure it doesn’t have any added sugars, dyes, soy, etc that is unnecessary. Another way I judge good quality is to see if it contains the methylated forms of B12 (cobalamin) and folate (B9).
My Favorite Herb For Fertility
Ashwagandha (Withania somnifera) is an Ayurvedic herb that I use frequently in practice. It not only helps with fertility, but it is a great antioxidant, helps the thyroid gland function better, improves the quality of sleep, and helps with stress and anxiety. While traditionally Ashwagandha has been given to men to increase virility, Shatavari (Asparagus racemosis), the female version of Ashwagandha, is primarily for fertility, which is why I still use Ashwagandha for most women.
Managing Stress and Expectations
In our next article, Margie will cover the connection between stress and infertility in more depth but evolutionarily, it is easy to understand that if your body is chronically stressed, it assumes that this is not the safest time to bring a newborn into the world. Chronic stress also negatively impacts your thyroid function, which can further worsen infertility. To learn more about stress, click here, here, here, or here.
It may be hard to believe but the egg that you ovulate this month, started its long journey to maturity approximately nine months ago. So just like you wouldn’t expect to get pregnant and then have a baby in your arms a week later, have reasonable expectations that the changes you make in improving your health is going to likely take time to increase your fertility.
Feeling a sense of urgency to get pregnant now only adds fuel to that fire of stress, whichdoesn’t help your health. And from all of my discussions with patients that have pursued IVF, it seems that fertility clinics do their part to discourage delaying any treatments.
So consider giving yourself a snooze button on worrying about becoming pregnant and focus on improving your overall health. Making improvements in your health at least 3 months prior to trying to conceive is recommended so use that as a chance to breathe a little and know that you can still join the ranks of “geriatric” women in a few months.
Also consider that some studies have found that having children when you’re older can have added benefits of financial and emotional stability. So instead of viewing having children over 35 as something to be dreaded, perhaps it is an ideal time to enter the role of motherhood.
I’d love to hear from you! What are your thoughts on age being such a factor in pregnancy? What has your experience been?
Previous Post
Next Post
