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FAQ’s

INFORMED CHOICES FOR LATER MOTHERS:
What Women Should Know About Fertility, Birth and Parenting After 40

Discover what our experts have to say through our videos and FAQ’s on reproductive endocrinology, Chinese fertility medicine, pregnancy, birth, parenting, and the often controversial social issues surrounding the rise in later motherhood.

WATCH Dr. Paula Amato talk on later motherhood.
Go to our Experts Page (http://www NULL.achildafter40 NULL.com/our_expert_panel/)

1. What is the possibility of a woman conceiving naturally after 40? After 45?

We don’t have as good data on spontaneous pregnancy as we do for IVF.  The chance of a woman over 40 conceiving with IVF is 10-20% per cycle.  The rate with natural conception is probably < 5% per month.  We don’t have good data on women over 45, but it’s probably < 1%.

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2. It’s true that some women do seem to get pregnant naturally after 40. What are the factors that influence fertility—eg. why can some women get pregnant later and some not?

Yes, some women do get pregnant naturally after age 40. This is probably due to a combination of genetic and environmental factors.

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3. If she’s trying to conceive from 39 or older, when should a woman go to a fertility specialist and why?

Women over 35 should seek consultation with a fertility specialist after 6 months of unsuccessful trying because of the well known relationship between advancing age and decreasing fertility.

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4. How much of an impact does a man’s age have on a couple’s ability to get pregnant?

Some studies show a slight decrease in fertility rates associated with increasing paternal age, although the data is not consistent.  The impact is nowhere near as significant as a women’s age.

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5. Depending on age, how long does it usually take to get pregnant?

In young women, the chance of pregnancy in any one month is about 20-30%.  So, in 6 months, about 60% of couples will be pregnant, and in 1 year, approximately 85% of couples will be pregnant.  The remaining 15% should be evaluated for fertility problems.

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6. If I’m 39 or older, will using IVF make a difference to my ability to get pregnant? Under what circumstances should I use IVF?

In general, pregnancy success rates are higher with IVF than with natural conception.  IVF is indicated for certain fertility problems, such as blocked tubes or very low sperm counts, or after more conservative fertility treatments have failed.

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7. When should a woman over 40 consider egg donation and how does it work?

Egg donation is indicated in women over 40 who have failed to conceive using their own eggs and/or when their chances of conceiving with their own eggs are determined to be very low.  Egg donation involves one woman (usually a younger woman) donating her eggs to another women to be used in an in vitro fertilization (IVF) procedure to achieve  pregnancy.

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8. Is there any research that suggests that delaying pregnancy will impact the onset of menopause, perimenopausal symptoms or the duration of perimenopause?

To my knowledge, there is no association between the age of first pregnancy and the age of onset of menopause.

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9. How does the sudden decrease in hormones after giving birth influence, impact or change perimenopause or menopause?

Pregnancy does not influence the timing of menopause per se.  But, perimenopause/menopause can coincidentally occur during or soon after pregnancy.  This is more likely in older women.

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10. If you are experiencing symptoms of perimenpause or have reached menopause but become pregnant, does the pregnancy influence this process or do hormone levels return to the way they were once you’ve given birth? (Mache, one of our moms, who used DE at 50 asked this question. I wonder if we should also be asking if the use of fertility drugs from 39 upward has any medium-to-long-term impact on the onset of perimenopause/menopause?)

Pregnancy does not influence the timing of menopause.  However, it may mask the symptoms of menopause that occurs during the pregnancy until after delivery.

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For more info on Paula Amato, M.D., go to:

www.ohsu.edu (http://www NULL.ohsu NULL.edu/xd/health/services/providers/amatop NULL.cfm?WT_rank=3)

WATCH Dr. Lorne Brown talk on later motherhood.
Go to our Experts Page (http://www NULL.achildafter40 NULL.com/our_expert_panel/)

1. How does Traditional Chinese Medicine (TCM) regard aging and fertility?

While fertility declines with age in all women (and men), the rate at which it declines depends upon our genetic inheritance and lifestyle factors as well as our chronological age. According to Chinese medicine a woman, optimally, should be able to conceive until she reaches menopause at approximately age 49.

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2. What Factors Affecting Aging?

Our current lifestyle in the West, characterized by chronic stress, lack of sleep, a fast- food diet and overconsumption of stimulants, accelerates the aging process, and hastens the ticking of the reproductive clock.

According to Chinese Medicine factors that determine your reproductive potential include Essential Jing: This is the vital essence that, according to Chinese Medicine, you are born with and can protect (slow down how fast you consume your jing) through diet and lifestyle.

  • Factors that affect your Jing are:
  • Diet/nutrition
  • Stress/cortisol levels
  • Inflammation levels
  • Lifestyle factors including exercise and quality of sleep
  • Relationship and support network
  • Environmental factors

As we age the reproductive hormonal system, governed by the hypothalamic – pituitary – ovarian axis (HPOA, becomes more unbalanced and less able to return to homeostasis. Hormonal fluctuations increase and the eggs are less sensitive to hormonal messages. Once eggs become less responsive to the FSH, more of them fail to develop and return to sleep. Blood flow to the reproductive system also decreases with age. Hormonal fluctuations and lack of adequate blood flow can reduce negatively impact the quality of the eggs.

In addition any environmental insults like excessive insulin levels or high stress levels are harder for the body to recover from in an older woman and further destabilize the hormonal system.

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3. Can Chinese medicine reverse the aging process?

There is a strong correlation between age and reproductive health. However, medical science has identified two types of aging: chronological and biological. While everyone ages at the same speed chronologically, the biological aging process differs greatly among each individual. Identical twins many differ in the age they go into menopause by as much as five years, depending on lifestyle factors like smoking, weight etc. So while it is true that the quality of a woman’s eggs declines as she ages, the eggs of some women in their forties can be of baby making quality due to slow biological aging. 

It is not possible to stop chronological aging, however, we can definitely influence the progress of biological aging. Abusive lifestyle factors such as poor diet, smoking, stress, and insufficient sleep all accelerate the cell oxidation and the biological aging process. Practicing a healthy lifestyle can have a positive impact in slowing down the aging process and prevent premature aging.
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4. How Does Chinese Medicine treat infertility?

Chinese Medicine uses treatments that help to restore a more youthful endocrine system and create an environment that enhances egg quality and the uterine environment. It typically involves diet, mind-body techniques, herbal formulas and acupuncture designed to balance hormones, regulate the menstrual cycle, improve blood flow to the reproductive organs, calm anxiety, and boost overall health.

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5. What is Fertility Acupuncture?

Acupuncture is a Chinese medical treatment that involves inserting hair thin needles at different point in the body to stimulate the flow of energy or “qi”. Fertility Acupuncture combines traditional acupuncture with evidence-based protocols to balance hormones and improve blood flow to the reproductive organs. Acupuncture treatment may be beneficial in promoting follicle production, enhancing uterine blood flow and improving uterine lining thickness. Recent clinical studies suggest that acupuncture treatments can lead to increased implantation and live birth rates with IVF.

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6. What is Chinese herbal Therapy?

Custom Chinese herbal formulas are another treatment modality used to treat infertility. Chinese herbal therapy is used to correct underlying deficiencies, balance hormones and regulate the menstrual cycle. Herbal therapy can improve the quality of blood nourishing the ovaries and supporting follicular development and enhance egg quality and embryo health. Herbal formulas can also help normalize the function of the hypothalamic – pituitary – ovarian axis (HPOA) to regulate and improve the body’s natural hormone production.

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7. Can Chinese Medicine treat recurrent pregnancy loss?

The rate of miscarriage increases dramatically in older women who conceive. Chinese medicine offers options for recurrent pregnancy loss that may be the result of immune factors (http://www NULL.nurtureacupuncture NULL.com/info_immunological_factors NULL.php), hormonal imbalances, and stress
Acupuncture helps improve blood flow to the placenta, supports the developing fetus, and prevents uterine contractions. It normalizes the function of the Hypothalamus-Pituitary-Ovarian axis (HPOA) to regulate and improve the body’s natural hormonal production, which in turn improves ovarian function, egg quality, and optimum progesterone levels. In addition acupuncture reduces stress levels helping to prevent early uterine contractions.

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8. Can Chinese Medicine improve FSH?

An increasing number of women are visiting acupuncture clinics seeking help in correcting the hormone imbalances (FSH, LH, E2, progesterone, prolactin etc.) they are suffering from. 

Regular acupuncture treatments can be very helpful in regulating hormonal imbalances, although it should be noted that acupuncture does not directly alter the female hormones. Rather, acupuncture is considered to influence the hormonal regulation centers in the brain and autonomic nervous system (i.e., the hypothalamic-pituitary-ovarian axis) and as a result, improvement in hormonal status can occur over time.

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9. What are other aspects of age and fertility does Chinese Medicine address?

Diet and Weight loss: Ovulatory imbalances, PCOS, insulin insensitivity and weight gain are common issues with women over 40. Chinese medicine has a long history of treating hormonal disorders and regulating the menstrual cycle with diet therapy. Recent studies have shown that weight and diet play a significant role in ovulatory causes of infertility. A landmark study published in 2008, based on the Harvard Nurses Study, and associates a slow carb, whole food, mostly plant-based diet with a six-fold increase in fertility.

Stress Reduction: techniques including hypnosis, acupuncture, breathing and mindfulness based stress reduction can reduce chronic stress. Studies have shown that stress can accelerate aging, create chronic inflammation and interfere with the functioning of the HPO axis.

Lifestyle: Chinese Medicine encourages women to develop habits that increase wellness, contentment and alignment with the way (Tao) of nature.

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10. Can acupuncture help Male Factor?

Clinical studies indicate acupuncture may help sperm motility and decrease abnormal forms (morphology). As well, acupuncture and Chinese medicine have been shown to improve erectile function, libido, and prostate-related issues such as pain or urinary problems.

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For more info on Lorne Brown, Dr. TCM, go to:

www.acubalance.ca (http://www NULL.acubalance NULL.ca/)

WATCH Dr. Bill Chun talk on later motherhood.
Go to our Experts Page (http://www NULL.achildafter40 NULL.com/our_expert_panel/)

1. I’d like to try to get pregnant naturally, where do I start?

With all women, it is most important to start with getting yourself healthy, both mentally and physically, prior to conceiving. This means quitting if you smoke, achieving a healthy body weight, following a healthy diet, and finding appropriate ways to manage stress. It is also best to start a prenatal vitamin at least six months before conceiving, preferably one that contains at least 800mg of folic acid. In terms of conceiving, if a woman is in good health with no known medical complications, and having regular menstrual cycles, it is perfectly reasonable to try and conceive on their own first without immediately seeking assistance from a medical professional. There are many ways to try and track when ovulation occurs during your cycle. Generally, if you are having regular, predictable cycles between 26-35 days long, ovulation should occur around 14 days BEFORE your menstrual flow begins. A good place to start would be to have intercourse at least every other day, starting on day 5 of your cycle (day 1 of your cycle is the first day of your menses), and continue until day 20. Another option is to use over the counter ovulation predictor kits, which use urine to predict when you will ovulate. If a couple has been having unprotected intercourse for six months, and has not achieved pregnancy, it would be advisable then to consult with a fertility specialist to discuss options and strategies, if desired, to minimize the time it will take for a couple to achieve pregnancy.

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2. How long will it take the average women to get pregnant over 40?

This will vary from woman to woman. Fertility begins a gradual descent around age 32, and a more rapid decline once a woman reaches forty. Statistically speaking, at age 40, the chances of becoming pregnant during any one ovulatory cycle ( when an egg has been produced and released) is about 5 percent . After a year of unprotected intercourse, about 40-50% of 40 year old women will have conceived. However, this information does not mean that pregnancy is impossible. Many women 40 and older are able to achieve pregnancy, some on their own and others with some fertility assistance. It may take longer, but for most who wish to become pregnant, it IS possible.

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3. My periods are irregular, will this make getting pregnant more difficult?

Generally speaking, yes–irregular cycles do make conceiving more challenging, but it is not a deal breaker. Irregular menstrual cycles, or abnormal uterine bleeding, pose challenges to women trying to conceive not so much because of the irregular bleeding itself, but because the bleeding signals an underlying cause which often will interfere with the fundamental process of conception. Some of the common culprits for abnormal uterine bleeding include polycystic ovarian syndrome, annovulatory cycles (cycles without ovulation), ovarian cysts, uterine fibroids, and premenopausal changes. Alternatively, there may not always be a physiologic reason for abnormal bleeding. If you are having irregular cycles and wish to conceive, it is always best to consult with your OB/GYN or a fertility specialist immediately to try and identify the cause of the irregular cycles and treat them accordingly. By doing this, you optimize your chances for conception, and will have some clear expectations moving forward.

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4. What are the odds of my baby having a chromosomal abnormality?

This topic is perhaps the most upsetting for women trying to conceive, and understandably so. Regardless of age, women worry for the health of their unborn child and hope to find some peace of mind by knowing their odds and utilizing available screening and testing. Unfortunately, as with the statistics on age and fertility, there are no guarantees, and with advancing age also comes the increased likelihood of genetic and chromosomal abnormalities. For 40 year old women, the risk of conceiving a child with a chromosomal abnormality is approximately 1 in 66, and the risk of having a baby with Down’s syndrome is about 1 in 106. However, it is important to say that a healthy 40 year old woman who is seeking appropriate prenatal care, will most likely have excellent outcomes. With every pregnancy there is risk, and unfortunately there are never any guarantees when it comes to the life of a child. The best advice is to start healthy, stay healthy, and be honest with yourself and your partner about your expectations and thoughts about the various outcomes throughout the process.

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5. How long should I wait before I see my doctor for help getting pregnant?

This is a personal choice. It is important that a couple discusses how they would like to approach their journey towards conception prior to starting the process. Some couples prefer to try and conceive on their own first, other couples want to dive right in using every tool available to maximize their chances and minimize the time it will take to conceive. Once a woman is over age 40, she has the option of seeking fertility assistance right away without the “wait and see” period of time that usually comes before seeking these services. It is a matter of choice. However, it would be advisable for a couple to discuss options, if they desire to do so, no later than six months after trying on their own.

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6. What is assisted reproductive technology?

Assisted reproductive technology, or ART for short, refers to any method by which outside assistance is used to try and achieve pregnancy. There are many options available, ranging from minimally invasive, such as medications or intra-uterine inseminations, to more invasive, like in-vitro fertilization and surrogacy. Most often the journey would begin with some testing to make sure there are no obvious underlying challenges to achieving pregnancy. This may include checking ovarian function, inspecting the fallopian tubes for patency, and analyzing the partner’s sperm for any abnormalities. From there, the couple and their physician would discuss options that closely align with the couple’s own comfort level and the best odds for success.

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7. What risks are associated with getting pregnant over age 40?

Mothers who are older than 35 do have some increased risks of developing health complications during their pregnancy. These risks include increased rate of miscarriage, ectopic pregnancy (a pregnancy that occurs inside the fallopian tube instead of the uterus), hypertension, diabetes, and placental problems (placenta previa and abruption). Although these increased risks exist, women are closely monitored by their healthcare team throughout the duration of their pregnancy to watch for signs of any developing issues, and are treated promptly when and if those issues arise. As long as a mother is maintaining a healthy lifestyle–eating a balanced and healthy diet, engaging in daily movement, refraining from smoking/drinking/using drugs, and seeking routine medical care– the odds are always in her favor for maintaining good health and having healthy pregnancy. This is what is most important to recognize.

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8. Is my baby at risk?

Similarly, there are some increased risks for babies born to older mothers. Some of these include: increased incidence of low birth weight, increased rates of preterm delivery, and increased incidence of stillbirth. Though, it is very important to note that risk for still birth is still very small—for women age 40, the risk of still birth is only 8.65 births per 1000, less than 1%. What is most important for women to know is to make sure they are not only staying healthy themselves, but also remaining mindful of fetal movement, noting any changes in frequency. It is very important to make sure women routinely attend all prenatal appointments and promptly report any changes in the baby’s movement to their healthcare provider. Again, as long as both mother and baby are followed routinely for prenatal check-ups, all bets are for a healthy bundle of joy.

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9. What prenatal fetal testing do you recommend?

This is not a one-size-fits-all kind of issue, but rather a personal preference that requires a couple to first ask themselves—why is fetal testing important to us? What will we do with the results? There are two approaches to prenatal testing – minimally invasive screening tools, and more invasive diagnostic testing. It is always important not to mistake screening for a diagnostic tool—screening will only provide odds and/or statistics and will not provide definitive results about the health of the fetus. Women who are over 35 years old, and increasingly all women, are offered minimally invasive first trimester screening for chromosomal abnormalities using a combination of blood work and fetal ultrasound. This screening can provide some feedback on whether or not the baby is at increased risk for having a chromosomal abnormality. This is not a diagnostic test, but rather a tool that will provide a couple with an updated age related risk of chromosomal abnormalities, and prompt further diagnostic testing if necessary or desired. In addition, a fetal survey, which involves a more detailed review of the fetus’s anatomy via ultrasound, is usually done around the 20th week of gestation. This is often a valuable tool, and one that can provide a great deal of information with a small amount of risk. If the first trimester screening warrants addition testing, OR if the couple decides they would prefer to have definitive answers about their baby, there is more invasive diagnostic testing such as chorionic villus sampling and amniocentesis. These procedures involve removing either a portion of the embryo or amniotic fluid from the uterus, and analyzing the cells for chromosomal abnormalities. Both of these procedures carry their own risks, so it is important to first consider all other options and determine what the results of these tests will mean to them.

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10. What is an amniocentesis? Will I need one?

An amniocentesis is a diagnostic test performed around week 15 of the pregnancy during which a long needle is passed through the mother’s abdomen into the uterus and used to remove a very small amount of amniotic fluid surrounding the baby. This fluid contains chromosomes which can be analyzed and used to determine if there is any genetic or chromosomal abnormality in the baby. Though common, this procedure carries with it a 0.5% chance of miscarriage. Women who are over age 35 are offered an amniocentesis regardless of any increases in age-related risk as shown through first trimester screening. However, although it is routinely offered, amniocentesis is not mandatory and will always be the choice of the mother and her partner. To some, this added testing can provide much needed peace of mind moving forward. For others, the risks are not worth the information it will provide.

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11. Am I at greater risk of having a cesarean section delivery?

Yes, women aged 40-45 years old have about a 50% c-section rate, and the rate jumps to about 80% in women aged 50-63 years old. Some of the reasons for this could include higher rates of induction of labor, medical complications, and “better safe than sorry” mentality when it comes to caregivers and their older patients. However, during a time when c-section rates are approaching 40% for the general population, this is not surprising nor does it mean older mothers are destined for surgery. There are ways to maximize the chances of having a vaginal delivery and all mothers are encouraged to find a healthcare provider that respects their wishes and is willing to work together in creating a birth plan everyone is comfortable with.

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12. Will others judge me because I’m an older mother?

First response—who cares? What matters most is that a mother, regardless of age, is experiencing something truly unique in life. Others may support, or they may judge, but this will not change what is true for that mother. They will also judge a mother who is too young, too heavy, too thin, has too many kids, or isn’t parenting they way another mother may parent. There will always be skeptics and unnecessary judgment and the only thing that we can do as humans is to ignore the negativity and focus on our own path. Becoming a mother is an incredible gift and blessing; one that does not have an age limit.

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For more info on Dr. Chun, go to:

www.billchunmd.com (http://billchunmd NULL.com/about-4/)

WATCH Dr. Elizabeth Gregory talk on later motherhood.
Go to our Experts Page (http://www NULL.achildafter40 NULL.com/our_expert_panel/)

1. How many babies are we talking about?

In 2010, 579,698 babies overall (CDC preliminary count) were born to moms 35 and over—regardless of birth order (out of a total 4,000,279 births).

  • That includes 464,943 overall births to moms 35-39; 107,011 to moms 40-44 and 7,744 to moms 45+
  • That’s one in seven babies born in 2010 to a mom 35 or over.
  • In 2004, 4.4% of the births to moms 35 and over involved IVF (about 27,800).

Also in 2010, of the total 1,604,181 babies born to first-time moms in the United States, 129,034 were born to mothers 35 and over.

  • That includes 105,097 first births to moms 35-39; 23,937 to moms 40-44 and 2,075 to moms 45+
  • That’s one in every twelve first babies in 2010 with a new later mom.
  • Compare that to 1970, when one in every one hundred first babies had a mom 35 or more (that was 14,324 out of total 1,430,680 first births in that year). See Table 3 at cdc.gov (http://www NULL.cdc NULL.gov/nchs/data/nvsr/nvsr60/nvsr60_02 NULL.pdf)

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2. What are some of the benefits of waiting that new later-moms describe?

  • Stronger family focus:
  • Having achieved many of their personal and career goals, new later moms feel ready to focus on family. (See chapter two)
  • More financial power:
  • New later moms have established careers and make higher salaries. (See chapter three
  • Greater self-confidence:
  • New later moms have more career experience, and their skills translate directly into managing a household and advocating for their children. (See chapters two, three and four)
  • More stable single parenting:
  • New later moms who are single have more resources. (See chapter five)
  • High marriage rate:
  • In 2009, about 80 percent of new later moms are married, lending stability to the family structure. (See chapter five)
  • Peer Marriages:
  • Peer marriages bring together “equal companions” who have similar education levels and job experience and who contribute similarly in all areas within the marriage. (See chapter five)
  • Greater likelihood of happiness in marriage:
  • Higher salaries, job skills, and savings create a safety net so that women don’t have to stay in unhappy marriages to avoid impoverishing their kids.
  • Longer lives:
  • Evidence indicates that new later moms actually live longer than moms who start their families earlier. (See chapter eight)

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3. How does later motherhood play out across race (2009)?

  • 9.05 percent of white first births were to later moms
  • 5.21 percent of black first births
  • 5.37 percent of Hispanic
  • 15.39 percent of Asian
  • and 3.27 percent American Indian /Alaska Native

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4. What is the educational breakdown?

In 2009, in a context in which 30 percent of all babies were born to mothers with college degrees, 63 percent of all mothers 40-44 at first birth had at least a college degree, and an additional 20 percent had some college.

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For more info on Dr. Elizabeth Gregory, go to:

www.elizabethgregory.net (http://www NULL.elizabethgregory NULL.net/)

WATCH Dr. Nancy Irwin talk on later motherhood.
Go to our Experts Page (http://www NULL.achildafter40 NULL.com/our_expert_panel/)

1. Are some women simply taking this plunge to offset later regret?

Certainly some are. This conflict is part of what therapists hone in on with patients, so that the best interest of the child is the centerpiece vs. the mother’s needs. While this can be a natural part of anyone’s decision to have children, if this seems to be 100% of the reason, then the mother must look at all facets of the responsibilities of parenting. Interesting that few people ask young mothers if they regret ending/pausing their careers for motherhood. Neither is an easy choice to make, and each individual must make her own decision about the path that is right for her and her child (and mate).

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2. What do you find is the biggest obstacle for later motherhood?

Physical challenges. This can range from the fertility issues to enough energy/vitality to care for young children. Consulting with professionals and taking utmost care of health and fitness can help a mother to overcome these obstacles.

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3. How can women handle the bias, criticism, or lack of support?

With humor. And also with assertiveness. If someone indicates that they could never have a child at “your age” or the like, simply stating that “Any I respect your choice on this matter. My experience, however is my own and simply differs from yours here.” Without these tools, she may be taking others’ judgments personally. Any bias or judgment from others is more about them than the mother. Further, staying focused on the reasons for having this child helps any negativity from others pale in comparison.

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4. Is this simply a trend, like being a “cougar?”

It certainly seems to be becoming more of an accepted social norm vs. a “trend.” Trends come and go, but later motherhood is based on some solid, well-thought out reasons. The “cougar” trend is competing with males’ ability to attract younger partners. Later motherhood is a permanent choice made, for the most part, by intelligent, successful women who take parenting very seriously.

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5. Is this not selfish? Is it putting the women’s needs ahead of what’s best for a child?

Rarely. There are certainly cases of older women whose profiles are similar to “Octomom’s,” yet older women generally are wiser and take time to make major decisions, unlike more immature, youthful women. Older women have typically seen peers’ parenting and the results of their labors. They can see the “big picture” and know what all it entails. They have satisfied their own self-expression, generally, and are ready to model that.

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For more info on Dr. Nancy Irwin, go to:

www.drnancyirwin.com (http://www NULL.drnancyirwin NULL.com/) and www.makeayou-turn.com (http://www NULL.makeayou-turn NULL.com/)

WATCH Dr. Vardit Ravitsky talk on later motherhood.
Go to our Experts Page (http://www NULL.achildafter40 NULL.com/our_expert_panel/)

1. Is it ethically problematic to have a child after 40?

One ‘ethical criticism’ we hear often is that having an older mom is not in the best interest of the child. Critics talk about the mom not having the energy she had when she was younger and possibly not being physically or mentally there when the child is gets older. This criticism is misguided for a few reasons.

First, we live much longer today and are in much better health than before. Oft heard is the saying “40 is the new 30”. Having a baby at the age of 40 definitely does not mean that you won’t be there to see this child graduating, getting married or having her own children. It just means you’ll be older when all this happens and that, as always, it’s a good idea to maintain a responsible lifestyle and stay in good health.

Second, if age is a reasonable criterion for criticizing moms, then so are numerous other criteria that could make them ‘less than ideal moms’. If it is reasonable to criticize women for having children too old, it is also reasonable to criticize them for having children when they are not healthy enough, financially stable enough, or in a good enough relationship. Becoming a parent is not something we reserve for those in optimal circumstances. It’s a fundamental human interest we all share.

Lastly, if age is a reason not to have a child, it means that being born to an older mom is worse than not being born at all! This is an argument we often find in bioethics articles and it brings to our attention a very simple fact: the baby we are considering whether or not to have can only be born to us, in our very unique set of circumstances. To decide that we are too old does not mean that this baby will be born to a younger mom. It means that it will not be born at all. While this argument often entails some counter-intuitive conclusions, it’s worth thinking about!

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2. Do social pressures play a role in the decision to become a mother later in life?

Yes! The decision whether and when to have a child is a personal one and our privacy and liberty in making it should be protected from social and state intrusion. However, it is important to acknowledge its social dimensions. In our society, many young women feel immense social pressure to pursue their education and career before becoming mothers. We spend many more years establishing ourselves and people are getting married much older than in the past. In these circumstances, the reality of older moms cannot be explained solely in individualistic terms. It is also shaped by social factors.

However, women are then criticized for ‘waiting too long to have a baby’, a criticism that seems to disregard those same social factors. As a young medical student recently wrote about the way others discuss her “reproductive future” with her: “instead of voicing support for social policies like paid maternity leave or subsidized child care, the comments seem to place the onus of the problem on me as an individual. In this formulation, I’ll come up short as a physician and as a mother, and that problem will be entirely mine to bear, as if my future employer and society at large – not to mention these hypothetical children’s other parent! – won’t also play a role.” (see: www.thehastingscenter.org) (http://www NULL.thehastingscenter NULL.org/Bioethicsforum/Post NULL.aspx?id=5818&blogid=140) Indeed, to promote women’s autonomy and their capacity to choose to become mothers when they are younger or older, we should adopt social policies that support mothers and families. In doing so we would acknowledge the social realities that exist and exert influence on women today.

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For more info on Dr. Vardit Ravitsky, go to:

www.umontreal.academia.edu (http://umontreal NULL.academia NULL.edu/VarditRavitsky)

WATCH Dr. Donald Saposnek talk on later motherhood.
Go to our Experts Page (http://www NULL.achildafter40 NULL.com/our_expert_panel/)

1. I’ve been a career woman all my life before becoming a Mom. Now I’ve stopped to have a family and I often get asked “So, what do you do?” I’m embarrassed to say that I’m a stay-at home-Mom. It almost feels degrading. How can I feel better about this?

2. My child is 10 years old. Whenever I go to the first parent-teacher conference of each school year, the teacher asks “Hi. Are you Kevin’s Grandmother?” While I’m not embarrassed by this anymore, what should I tell Kevin to make him more comfortable with my age?

3. I’ve had a wonderful career, which I have loved and still love. However, I got pregnant later in life and feel resentful for having to give up my career. While I feel it is important to stay home full-time to raise my daughter, who is now 3 years old, I sometimes feel resentful of her and feel empty being home. I crave adult contact.

4. I was raised being spanked for bad behavior. Is spanking still a good idea for disciplining my child?

5. I’m a single 50 year-old lesbian Mom with a 6 year old son. How important is it for my son to have a significant adult male in his life?

6. My husband and I have been trying for 10 years to have children, and just when we had given up, we got pregnant. The result of this is that I feel (and have been told by many) that I am very overprotective of my daughter. I have great anxiety letting her do any (normal) activity that has any risk at all involved with it. I love her so much for being our “miracle baby” that I just can’t risk letting her get hurt, or losing her. What should I do?

7. My husband and I got married late, had children late, and now are divorcing. We were unable to deal with the many changes that arose when we introduced children into our lives so late. How can we best protect our children through the divorce?

8. I am in my mid-fifties, and my son is a very active 12 year-old, and his father works long hours. I cannot keep up with the energy level of my son and worry that I am letting him down. He likes to stay at home and resists outside activities, but he keeps pushing me to play sports with him. What can I do?

1. I’ve been a career woman all my life before becoming a Mom. Now I’ve stopped to have a family and I often get asked “So, what do you do?” I’m embarrassed to say that I’m a stay-at home-Mom. It almost feels degrading. How can I feel better about this?

Adults (both women and men) in American society over the past decades have been groomed and expected to have careers. We have considered maintaining a paid career as giving value to one’s life. Unfortunately, this also has led to the established norm that gives a person with a paying career higher status than a person without a paid work. In the not-so-distant-past, however, being a full-time parent was a high status function (for women). The tides of social expectations have certainly changed.

In spite of these norms, it is widely acknowledged by parenting and child development experts that raising children full-time is among the most difficult and most important jobs in our society. Much research documents that children grow psychologically (and physically) healthier when there is a parent actively on duty to guide the child. Rest assured and remind yourself regularly that if you are lucky enough to be a stay-at-home-Mom, it is the best gift you can offer your child.

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2. My child is 10 years old. Whenever I go to the first parent-teacher conference of each school year, the teacher asks “Hi. Are you Kevin’s Grandmother?” While I’m not embarrassed by this anymore, what should I tell Kevin to make him more comfortable with my age?

It is unfortunate that many adults (including professionals) maintain an assumption that all parents should be younger and, as a result, they often say insensitive things. It’s good that you are not embarrassed by this, since there is nothing at all to be embarrassed about. Your confidence in your own parenting status and abilities will silently be conveyed to your child. Your child watches you for cues as to how to respond to the insensitive comments of others. You can have a talk with Kevin about how much you love him and that love has nothing at all to do with age. You would love him just as much if you were 20 or 50 or 70 years old. If you need to give Kevin a come-back line, there are many available, such as: “You know, I’m really lucky to have a Mom that knows so much.” Or, “I’m really proud of my Mom.” Or, if your child can comfortably be pithy, he might say “Oh, no, this is my Mom. My Grandma is REALLY, REALLY OLD!”

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3. I’ve had a wonderful career, which I have loved and still love. However, I got pregnant later in life and feel resentful for having to give up my career. While I feel it is important to stay home full-time to raise my daughter, who is now 3 years old, I sometimes feel resentful of her and feel empty being home. I crave adult contact.

First of all, a three-year-old can be a handful for any stay-at-home Mom (although parenting three-year-olds can also have many joyful aspects to it, as well). It is quite common for a stay-at-home mom to long for adult contact; this is quite natural. If it doesn’t feel satisfying enough to be involved with activities of your own (e.g. workouts at the gym; book clubs; lunch dates with friends), but you really crave the satisfaction of paid work in your career, you might consider this research fact: Children do better when their Mom wants to be home with them. Children of Moms who would rather be working outside the home actually thrive better when their Moms are working part- or full-time at jobs that are satisfying for them; when they are home with their child, the youngster gets the important benefits of having a happier Mom. Remember, it is not just sheer time spent with a child that nourishes the child; it is quality time spent with the child. When you are a happier, more satisfied person, you are a happier, more satisfying parent to your child. So, if possible, you might consider part-time paid work, as a compromise and balance to your dilemma.

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4. I was raised being spanked for bad behavior. Is spanking still a good idea for disciplining my child?

Current thinking about disciplining children has steered firmly away from spanking as a method. While spanking works for most (but not all) children very swiftly and stops the immediate behavior, it has a lot of serious unwanted side-effects. For one, it teaches children that if you have a problem with somebody then hit them; secondly, it hurts, and for many children this gets them to not trust their parent to keep them safe; thirdly, for many children, it gets them angry at the parent and wanting to get back at them, through an escalation of more bad behaviors; fourthly, it doesn’t allow the child to learn other better methods for conflict resolution through discussion of the problem and how to solve it without violence; fifthly, it increases anxiety in children who are prone to being anxious; and lastly, in the current social climate of heightened awareness of child abuse, some children will tell their teachers, parents of friends or other adults that their parent hit them, leading those adults to report your actions to Child Protective Services. This can result in your being investigated by governmental agencies (even if it was not really harsh spanking), which can be quite embarrassing and can leave a suspicion on you for a long time. Worst, CPS’s investigation might lead to a prosecution of you.

While no approach to discipline works well for any given child, more effective approaches to discipline include using time-outs, and removal of privileges (e.g. electronic devices, TV, play-dates, etc.). Even better is to utilize preventative approaches and reward good, alternative behavior rather than punish bad behavior.

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5. I’m a single 50 year-old lesbian Mom with a 6 year old son. How important is it for my son to have a significant adult male in his life?

This is an important question, as more gay and lesbian single parents are raising children. While there is not a great deal of published research on this topic, clinically we find that there is a range of individual differences in children’s needs for adults of both genders in their lives. We do know that the most basic need of all children is to have at least one loving, caring parent in their lives (regardless of gender). This minimally assures resilience and provides for the child a sense of self-confidence that he or she is clearly and deeply loved. Beyond this, there is quite a range of responses by children. Some boys are perfectly fine with having just a Mom as that caring parent, and they do not seem to crave a father. Other boys are absolutely driven to have male energy, male companionship, and male guidance in their lives. They will relentless nag their Mom to bring a man into their lives. They are strongly in need of connection with a man—a woman alone will simply not do for them. Girls seem to have some of this range, but typically not to the extent shown by boys. So, the short answer is that it depends on the drive of your particular child for male companionship.

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6. My husband and I have been trying for 10 years to have children, and just when we had given up, we got pregnant. The result of this is that I feel (and have been told by many) that I am very overprotective of my daughter. I have great anxiety letting her do any (normal) activity that has any risk at all involved with it. I love her so much for being our “miracle baby” that I just can’t risk letting her get hurt, or losing her. What should I do?

It is understandable how close you feel to your daughter. Yours is such a frequent experience of trying so hard to have a child, and, just when you have given up, your body releases that egg and that sperm gets so darn happy and it excitedly just wants to breed. Your daughter clearly must feel your love for her. However, love contaminated by anxiety translates to a child as uncomfortable and not secure love. Such children may begin to question the sincerity of their Mom’s love because it feels “forced.”. Sometimes, counseling for yourself (and your husband/partner) can be very helpful to sort out your feelings and come to terms with the risks inherent in life for every person, especially for children. You simply cannot control every aspect of your child’s life; you can protect your child from the obvious dangers, but when you go beyond that, you actually produce anxiety or rebellion in your child; a child will get “contagiously” anxious—feeding off your own anxiety, or, the child will become rebellious and non-compliant as a strategy to push you away, so as to give the child some breathing space to just be a kid.

Mostly, you need to come to terms with life’s risks, the limitations of your sense of control, and the damage that you can do to your child in trying to protect her too much.

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7. My husband and I got married late, had children late, and now are divorcing. We were unable to deal with the many changes that arose when we introduced children into our lives so late. How can we best protect our children through the divorce?

Divorce is hard for children of any age and from any family structure. It has been clearly shown from over 30 years of research findings into the effects of divorce on children, that, by far, the most important protective factor for children is keeping the level of conflict between the parents as low as possible from the day of separation on. There is a very, very strong relationship between the degree of conflict between the parents post-separation and the long-term outcome of the children’s psychological well-being. Secondly, if you can get divorced using non-adversarial approaches (e.g. mediation; or collaborative divorce), that is always best. The worst outcome for children is when their parents use traditional adversarial divorce approaches (hiring two attorneys and going to court to fight). That form of conflict resolution tends to enflame and fuel the anger of divorcing spouses, with the effects of that conflict spilling over onto the children.

You can check online at: (www.mediate.com), or at my website (www.mediate.com/dsaposnek) for a lot of useful information about best ways to divorce and how to help children through it.

Supporting your children through divorce is a very, very important thing to do, since it is the long term co-parenting relationship that endures after the divorce proceedings are over. And, for children, divorce is forever! Try, above all, and as difficult as it may seem, to preserve a cooperative relationship with your children’s father. That will last forever, even if the marriage did not.

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8. I am in my mid-fifties, and my son is a very active 12 year-old, and his father works long hours. I cannot keep up with the energy level of my son and worry that I am letting him down. He likes to stay at home and resists outside activities, but he keeps pushing me to play sports with him. What can I do?

This is a great situation for utilizing college students who want experience interacting with children. As part of my university courses in child development, I have many of my students volunteering to work with children. My students are positive, fun, active, and seem to have unlimited energy. They interact with children of all ages, offer tutoring, playing, athletic and social skill development, etc.—anything that a particular child wants/needs. This gives parents with less energy or less time an opportunity to relax, while their child is being stimulated. At the same time, it gives college students amazing opportunities to interact with and learn children, which gives them experience that helps them get into graduate schools—a win-win situation. Just call up the psychology or education department of your local college, or even a local high school who may have honor students needing some volunteer experience.

Parenting can be effective even when you sub-contract out some of the busy (high energy) work to others. Your children will benefit, regardless of who exercises them.

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For more info on Dr. Saposnek, go to:

www.mediate.com (http://www NULL.mediate NULL.com/dsaposnek/)

WATCH Dr. Mache Seibel talk on later motherhood.
Go to our Experts Page (http://www NULL.achildafter40 NULL.com/our_expert_panel/)

1. What is the possibility of a woman conceiving naturally after 40? After 45?

Reproduction after age 40 is a real challenge because overall, fertility drops by about 90% from peak fertility in the early 20s. We know this from following groups of women in relationships that do not use contraception and following them over a lifetime. As a result, when a women is over 40 and wants to start her family, I recommend being seen by a fertility doctor as soon as possible to optimize the chances for success. Unfortunately, after age 45, the chances of conceiving are less than 5 percent and the risk of miscarriage and having a baby with a genetic problem increase greatly.

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2. It’s true that some women do seem to get pregnant naturally after 40. What are the factors that influence fertility—eg. why can some women get pregnant later and some not?

When I think of fertility after age 40, a good way to think about it is to compare it to other physical abilities like sports. There are some professional athletes older than 40, but not very many. It has to do with a person’s personal genetics, their overall health and the overall health of their partner.

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3. If she’s trying to conceive from 39 or older, when should a woman go to a fertility specialist and why?

If a woman is 39+, two things happen: the chances of success are lower and the time it takes to conceive in longer. So I would recommend that when a woman reaches 39 or above, don’t wait more than 3 months to see a fertility specialist. It takes time to get an appointment, time to get an evaluation done, and there are things that can be done to try and optimize chances for success.

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4. How much of an impact does a man’s age have on a couple’s ability to get pregnant?

A man’s age is less important than a woman’s for getting pregnant, but is still is a factor. Fertility does decline somewhat and the risk of a genetic problem from an older male also increases. In my opinion, in the optimum situation, the combined ages of the couple will not be more than 100. That will make it much more likely that at least one of the parents will be alive until the child reaches 18 or older.

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5. Depending on age, how long does it usually take to get pregnant?

Infertility is described as the inability to conceive within one year of unprotected sex. About half the people will conceive within 5 months, half the the remaining 50% or about 25% more will conceive over the next 5 months, and half the remaining 25% or about 12!/2% more will conceive within the next 5 months. From age 35 to age 40 and over, these numbers will steadily begin to drop.

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6. If I’m 39 or older, will using IVF make a difference to my ability to get pregnant? Under what circumstances should I use IVF?

It is difficult to make a general statement about age and IVF, but many experts believe that going right to IVF gives a woman the best chance of IVF being successful. In general, if the starting point is age 39, give it 3-6 months before IVF and move forward to have the best opportunity to succeed.

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7. When should a woman over 40 consider egg donation and how does it work?

Egg donation is a very personal decision; not good or bad, but it is usually an evolution of thought and not a revolution. If a woman just wants to have a baby and it really doesn’t matter if the egg comes from her or another woman, than maybe she should move directly forward with egg donation. But in my experience, many women who believe egg donation is a very comfortable choice for them feel that they need to try with their own eggs, at least one or two times, to allow themselves to move on to the next option. I believe doing it this way results in a greater likelihood that the woman will feel comfortable about her decision to go forward with egg donation without regrets.

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8. Is there any research that suggests that delaying pregnancy will impact the onset of menopause, perimenopausal symptoms or the duration of perimenopause?

I don’t think delaying pregnancy affects the onset of menopause, perimenopausal symptoms or the duration of perimenopause.

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9. How does the sudden decrease in hormones after giving birth influence, impact or change perimenopause or menopause?

I do not think the sudden decrease of hormones after giving birth influence or impact changes in perimenpause or menopause.

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10. If you are experiencing symptoms of perimenpause or have reached menopause but become pregnant, does the pregnancy influence this process or do hormone levels return to the way they were once you’ve given birth? (Mache, one of our moms, who used DE at 50 asked this question. I wonder if we should also be asking if the use of fertility drugs from 39 upward has any medium-to-long-term impact on the onset of perimenopause/menopause?)

I had a patient in her 40s that had a baby and never ovulated again. She literally conceived on her last egg. But here are the risks; a woman at that age is more likely to have a baby with a genetic defect or if the egg and pregnancy are normal, to have lower levels of hormones which can result in a miscarriage. Sometimes doctor’s will add progesterone to the second half of her menstrual cycle and beyond. Other medications can also be used.

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For more info on Mache Seibel, M.D., go to:

www.doctorseibel.com (http://www NULL.doctorseibel NULL.com/)

 

2 Responses to Experts FAQ

  1. Why Women Should Never Have an Age Limit on Fertility Treatment (http://time NULL.com/3914293/women-fertility-treatment-age/) says:

    […] 46 or 50—or apply random formulas, such as requiring that a couple seeking treatment have a combined age of no more than 100. The idea is that if she’s 54, her 45-year-old partner would have enough […]

  2. Women Should Never Have an Age Limit on Fertility Treatment (http://nigerianewsstand NULL.com/women-should-never-have-an-age-limit-on-fertility-treatment/) says:

    […] to 46 or 50—or apply random formulas, such as requiring that a couple seeking treatment have a combined age of no more than 100. The idea is that if she’s 54, her 45-year-old partner would have enough […]