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How age affects pregnancy
Birth statistics over the past twenty years show a huge swing in favour of delaying parenthood till our thirties and beyond. In 1998, the last year for which figures are available, 44% of births were to women over 30. The biggest increase in the birth rate over the last ten years is in women aged 35-39, up by 60%. The number of births to women between 40 and 44 has also increased by 50% over the decade. What effect does age have on fertility? Being 35 or over does raise certain important issues for women choosing to wait to start a family. There is a gradual decrease in fertility after the age of 30, so a couple may take longer to conceive, or have to face problems of sub-fertility. More pregnant women in this age group will have undergone fertility treatment. The effect of age on fertility More and more people nowadays are leaving it later to start a family than ever before. The Office of National Statistics has reported that, since the 1980s the rates for women giving birth at age 30 or over have gone up, while the rates for women giving birth aged under 30 have fallen. There are many factors which make having babies less important for young couples than it used to be. There are such factors as going on to higher education, developing a career, and financial pressures to stay in the job market. The availability and range of effective contraception has also played a significant part in the trend, not only for women to delay starting a family until they are older, but also to have smaller families. Age and fertility As you may assume it can have its problems putting off starting a family until your career is established or your debts cleared. Fertility falls more sharply for women as they age than for men. As you can see from the chart below, women are most fertile between the ages of 20 and 24 years - as women grow older the likelihood of getting pregnant falls steeply while the likelihood of infertility rises sharply. Men can remain fertile for much longer but male fertility still declines with age, although less dramatically.  Chart: Pregnancy rates over the course of one year Both of the line graphs are for women with normal reproductive function. How long will it take to conceive? The Human Fertilisation and Embryology Authority's "Your guide to infertility" states that "At 35 you're half as fertile as when you were at 25; at 40 you're half as fertile as when you were 35". This means that it can suddenly take much longer to get pregnant when you hit your late thirties or early forties and you may have problems conceiving at all. Most couples (92%) will conceive within two years if they do not use contraception and have regular sex. Regular sex means making love every two to three days throughout your cycle - this optimises your chances of conceiving. This means that 8% of couples in the general population do not conceive within two years. If you are over 35 and keep on trying for another year you may still get pregnant but in the next few years your chances of conceiving start to fall rapidly; 6% of women aged 35 years and 23% of those aged 38 years will fail to conceive after three years of regular unprotected sex. This is why if you are over 35 years of age and finding that positive pregnancy test elusive it is so important to seek help for infertility treatment sooner rather than later. It is recommended that most couples try for at least a year before seeking help but if you are over 35 and having problems conceiving you should seek help earlier. Why does fertility decline so rapidly? So why does fertility declines with age? In addition, as we age, our general health can decline. As women get older, there are a number of factors that can make it more difficult to conceive. Some new illnesses may develop with age just as existing conditions may worsen and all that will impact on fertility too. Fertility factors that change, as we grow older, include: • Menstrual cycle - as women approach the menopause their menstrual cycles can become irregular and shorter. • Mucus secretions - vaginal secretions can become less fluid and more hostile to sperm. • Lining of the womb - the endometrium may become thinner and less hospitable to a fertilised egg. • Ovarian reserve - this is the number of functioning follicles left on the ovaries. As you get older you have fewer viable eggs left; in cases of early menopause, the eggs run out much sooner than usual. • Diseases affecting the reproductive system - some conditions can damage the reproductive organs as time passes, or worsen if not treated properly, including endometriosis, PCOS, Chlamydia. • Chronic illnesses- some illnesses can have a negative impact on fertility. What effect does age have on pregnancy? Now an older mother usually means a woman who has chosen to start her family later and is often fit, and well nourished. In the past an older mother often meant a woman who already had a large family and was having her fifth, sixth or possibly seventh baby. Having many pregnancies often led to complications. It is unfortunately true that a woman has had more chance to develop medical disorders such as diabetes, hypertensive disorders or fibroids, which can affect pregnancy and birth, simply by being older. The incidence of pre-existing conditions rises from 5.5 per cent in the under 29 age group, to 11.8 per cent in the over 35s. Studies on the effect of age on childbirth also report an increase in the frequency of pregnancy complications such as bleeding in the third trimester, pregnancy-induced diabetes, high blood pressure, and low lying placenta. The incidence of pregnancy complications rises from 10.43 per cent for women aged 20-29, to 19.29% for women aged between 35 and 39 years. Your maternity care may be influenced simply by the fact that you are an 'elderly primigravida' or an 'elderly multip'. Even fit and healthy women over the age of 35 have more antenatal tests and more ultrasound scans, and more women of that age undergo an amniocentesis. They are also more likely to be under consultant care. Some experts think this is as much a reflection of the anxieties of the medical carers, as the real needs of you and your baby - so take a step back and ask a few questions if you want a more low-key approach. What are the advantages of being an older mother? On the plus side, older mothers have some physical and psychological benefits over their younger counterparts. Women in their 30s or 40s might lead a healthier life-style as they understand the needs of their bodies, look after themselves better in terms of exercise and nutrition. Studies have shown that mature women more readily tolerate the symptoms of pregnancy and have more positive perceptions of their bodies. At this age too, a woman has more confidence to know what she wants, and enhanced people skills to get it. What effect does age have on the birth itself? There is a marked pattern of increased intervention with the increasing age of the mother. Women of 35 and over are more likely to have induced labour, diagnosis of fetal distress, epidural anaesthesia, or forceps or ventouse delivery, and virtually all studies agree that the rate of caesareans rises with maternal age. However, this increase does not appear to be connected with any specific problem. There is a question mark over how much of this intervention is necessary, and how much is caused by a general perception that 'older' mothers are 'high risk'. Once the course of nature is interrupted by one intervention, others frequently follow in what is known as a 'cascade of intervention', so as in pregnancy, if you want to give the physiological processes of birth a chance, be well informed and prepared to ask questions. You should remember that there is however, one small but serious risk to the babies of more mature mothers. Inexplicably more babies die, in utero, right at the end of pregnancy in this group of mothers - 1 in 440 pregnancies of women aged 35 or more, as opposed to 1 in 1000 for younger women. For this reason carers are often more vigilant of the mature mother in the final weeks of pregnancy. The main thing for age pregnant women is to stay calm as far more frequently there is a general expectation of complications which in itself can cause stress to the mother. This in turn may disturb the delicate balance of hormones and natural chemicals. Older mothers who have straightforward births mention how surprised their midwives are when no problems arise. What are the advantages of being an older mother during the birth? On the psychological front, older mothers may again have an advantage. One study shows that they have less fear of helplessness and loss of control than younger women. Also the years can give greater stamina and courage. Despite the real, perceived or potential risks, all studies agree that the actual outcome for the baby is every bit as good as that for younger mothers, which assess a baby's well-being immediately after birth, and the on-going checks through childhood. What are the effects of age on the experience of parenting? Theoretically there seem to be as many pros as cons to being an older parent. The break in your career, or even dividing your energies between work and family, can prevent you reaching the career pinnacles you once aimed for. When you have developed a comfortable routine to your life, have nurtured a certain independence and freedom in your relationship and career, the 24 hours a day responsibility of caring for a baby can come as a shock. Also, since most women earn more at 35 or 40 than they did at 25, there may be a sizeable drop in income if you are planning to be a stay-at-home parent. What effect does increased age have on the baby? It is also well known that older women run more risk of having a Down's syndrome baby. The rate is 1 in 400 at the age of 35, and goes up to 1 in 109 at the age of 40. When a woman is 45 the risk is 1 in 32 (compared with 1 in 1,500 at 25). There are other much rarer chromosomal abnormalities, such as Patau's syndrome and Edward's syndrome, which also increase in incidence with maternal age. Making lots of tests among which is a maternal serum screening and others can give approximations of risk, and amniocentesis can provide firm diagnosis, which allows a woman either to terminate a pregnancy, or help prepare her for the special needs her baby will have. No woman has to undergo any tests if she would rather not have this information. Research suggests that the babies of older mothers are no more at risk of birth defects than the offspring of younger mothers. Despite the increased risk with increased age of mother, it is important to remember that the vast majority of babies are fine, and except for the factor of chromosomal abnormalities. What are the advantages of being an older parent? You are probably more confident and relaxed at this age than you were ten or fifteen years ago - a big plus for motherhood. Thinking materialistically again, you may be more comfortably off, which allays many anxieties. Being better off financially now than when you were younger lessens the anxiety level and enables to be more relaxed with the baby. At the same time, material standards are less important and you feel freer to give energies to the baby rather than worrying too much.
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