The Whole Life Fertility Plan by Kyra Phillips\Jamie Grifo released on Jan 27, 2015 is available now for purchase.
Baby, Maybe
Delaying Motherhood
In 1970, the average age for a first-time mother was twenty-one, and about 36 percent of all births were to women who were teenagers or younger. It's only recently that we associate teen parenting with poor choices; it was once the norm. Now, keep in mind that the average age for marriage back then was twenty, and you'll see quickly why the babies tended to arrive a year later.
But a lot has happened since the Baby Boomer generation grew up—for one thing, the divorce rate skyrocketed, with Baby Boomers often explaining, "We were too young." For another thing, the workplace became much more competitive as more jobs began requiring college degrees and advanced degrees. Kids were no longer graduating from high school, getting married and finding good-paying work to support their families on one person's salary without any postsecond-ary education. Today, 66 percent of young adults in the United States go to college, and about 10 percent go on to graduate school.
Then they enter the workforce, where the norm is working your way up from low-level jobs to the position you're aiming for over the course of several years—which could mean into your thirties and forties. Another big change is that women are no longer primarily housewives; they are closing the gap and pulling in nearly half the household income. Women have careers, not just little things they do on the side to make some extra money while their husbands are expected to be the main breadwinners. They even have actual career ambitions, where they now get to have this revolutionary notion that their work can be meaningful and that they're not built solely to be babymaking machines.
We also have easier access to birth control, and less stigma about using it, so we're able to plan more carefully when we want to have kids. Ninety-eight percent of Catholic women say they've used birth control at some point, despite the church's official position against it.
It is in part because of all this that the average ages for both marriage and motherhood has been on the rise. Currently, the average first-time bride in the United States is twenty-seven and the average first-time groom is twenty-nine. People are waiting until they finish school and get more established in their careers before they decide to get married and make babies—not always in that order. In fact, now 48 percent of all babies born in the United States are to unmarried moms! That's right—nearly half. In fact, the only women who follow the script of our ancestors more often than not (marriage first, then babies) are college graduates, who tend to have their first babies at age thirty. Women who don't go to college or don't finish tend to have babies first, then get married a couple of years later, if at all.
And that's the other major change: Marriage is no longer a foregone conclusion. Whereas in 1920, ninety-two women got married each year out of every thousand single women of marrying age, in 2013, that number was cut to a third—thirty-one women per thousand and still dropping. Not everyone has dreams of a big wedding celebration; we're increasingly a society where marriage is optional, not expected. The figures vary based on race as well: Only 26 percent of African-American women are now married, compared to 45 percent of Hispanic women and 51 percent of Caucasian women.1
The thing about babymaking is that you can make all the plans you want, but you can't force the right time. You can't even force the right time when Mother Nature wants it to happen. She's all about the teens and early twenties, but how many people do you know who really have their act together by then? Most of us are busy learning how much alcohol we can consume before we start inding the nearest lamppost attractive, what we're supposed to do with our lives now that we're "grown up" and where we're supposed to live now that we can pay our own rent.
Some of us get it right on the first try and some don't. Our friend Jenna got married at twenty-seven, was pregnant right "on schedule" at age thirty and she planned to have two more kids pretty quickly. Her dream was to have three kids, two years apart apiece. But her marriage failed, and she was left wondering how long she could hang on to her fertility. Would the right guy come along quickly? Or would it be too late for more kids by the time he showed up? And how could she stack the deck in her favor?
Or consider Diem Brown, whose dreams of having kids of her own were nearly obliterated when she got ovarian cancer at age twenty-three and a recurrence seven years later. She needed to have her ovaries removed, but she couldn't force herself to have a baby before that point. If she wanted to have her own biological children, the only possible way for her to do it was to freeze her eggs before the surgeon removed the remaining piece of her ovary, so that's what she did. It's amazing that she had that opportunity.
But the less dire circumstances are more typical—what if you're just a twentysomething woman who knows she wants to have kids someday, but isn't in a life circumstance to have them yet? So many factors come into play before you make the decision to have a baby, and while there may never be a "perfect" time, there are certainly some key factors that go into most people's choices—economic stability and relationship stability topping the list, plus things like emotional readiness and maturity, career flexibility and a support system. You don't want to run out and get pregnant before you have your act together just because you're afraid your eggs are shriveling up.
Don't pressure yourself. Yes, there is a biological clock, and, yes, it will eventually run out for everyone. But there are things you can do to keep that clock ticking until its last possible second, and that's what we're here to help you with.
Your Biological Clock
Unfortunately, when your egg supply runs out (or at least out of good-quality eggs), that's it. C'est la vie. You have to start thinking about your options aside from having children who are biologically yours (and there are, of course, many options for that—adopting, fostering, having an egg donor or using a surrogate). But what often happens is that long before your egg supply runs out, the eggs get depleted or damaged along the way, leading to decreased fertility—so women are behind the 8-ball before they even think about having a child. And in most cases, it happens without any advance notice. Your ovaries don't text you to say, "Egg supply approaching critical—shutdown imminent—make baby now!"
You can't add time to the biological clock you were born with, but what you can do is make sure that you get every minute that you're entitled to, and not lose time because of bad choices you've made, risks you didn't know you were taking or things you didn't take care of when you should have. Fertility is one of those things that no one teaches you about until you're already having problems.
One of the most frustrating things about fertility is that just as you're ready to launch into your amazing and exciting life, your ovaries are already planning for retirement. Believe it or not, your fertility begins to decline in your twenties, then continues on a steady downward slope all through your thirties. While infertility can be present at any age, thirty-five has been tossed around as the edge of that fertility cliff. We don't agree with that number; forty is the more accurate danger zone. Your chances of conceiving naturally even in your late thirties are still good, but at forty, that changes. Every two years after age forty, your fertility is cut in half again. The trajectory looks like this:
What's more troubling is that these numbers merely reflect the likelihood of getting pregnant. Getting all the way to having an actual crying, spitting up and pooping bundle of wake-me-up-every-two-hours-when-I'm-exhausted-beyond-belief adds another whole degree of uncertainty.
We all know about the exceptions—your mother's neighbor's cousin's best friend who thought she was in menopause and instead had her "surprise baby" at forty-nine, or a fifty-two-year-old woman in China who didn't even know she was pregnant until she was rushed to the hospital with what she thought was appendicitis and turned out to be active labor. Yeah, it happens, but it's crazy rare, and that's exactly why we hear about it. It's surprising news.
Be aware that even in your peak fertility years, it can take quite some time to get pregnant: In fact the chance of conception per month is about 10 percent and it takes thirteen months of trying for 100 percent of fertile twenty-five-year-old women to get pregnant. Not only is it much less likely for you to conceive naturally each cycle once you hit your late thirties, but it's also less likely for in vitro fertilization (IVF) to work as you get older. So your odds of conceiving using IVF are a lot better than your odds without, but it's far from a guarantee. From 2003 to 2011, the New York University (NYU) Fertility Center charted its success rates for each cycle of IVF, and here's what it looked like:
So basically, if you're thirty-two or under and have experienced infertility, the odds are in your favor that you'll have a pregnancy ending in a live birth with just a single IVF cycle. You've got a pretty good chance of hitting a home run your first time at bat. But at age forty-two, your odds are just 14 percent of having that same procedure work on the first try. And remember—IVF isn't cheap.
Egg Quality
They don't teach you about fertility in health class—well, beyond just telling you to keep your legs closed and not get pregnant. But there are things we should all know—things we don't talk about enough as a society—so we can make informed decisions about our bodies and our futures and so we can learn how to exert some control over Mother Nature.
One thing to know is that it's not just a matter of running out of eggs. You can have the best fertility doctor in the world and still not succeed if your eggs are all shot.
So what's a "good-quality" egg?
The first test is its chromosomes: Most egg defects are chromosomal abnormalities. People are supposed to have twenty-three pairs of chromosomes, and these chromosomes store DNA. There are some chromosomal abnormalities that cause birth disorders such as Down syndrome—which results from all or part of an extra copy of chromosome 21. Some abnormalities are worse and can cause certain death of the child if a pregnancy is carried to term. Chromosomal abnormalities in embryos are also responsible for 80 percent of miscarriages.
That's why insensitive people may say that miscarriages are "God's way" or "nature's way" of rooting out babies who would have been born with birth defects. While it's clear that most of the embryos that are miscarried would have had signiicant disabilities or birth defects, each case is different, and doctors don't always know why a chromosomal abnormality causes a miscarriage.
In our twenties and early thirties, most of our eggs should be of good quality with normal chromosomes, but as we age, not only are there fewer eggs left, but those eggs are more and more likely to have chromosomal damage, due to both aging and outside factors that we'll get into later in the book. And you can't tell by looking at someone what her fertility is like. There's this fantasy notion that if you look younger than you are, then you're probably totally fertile. As if because your skin looks youthful, you're probably all youthful inside, too. False. You can't fool those reproductive organs. They're in there getting all geriatric even as you walk around looking hot in a minidress.
Energy production also declines as we age. It takes a lot of energy to make a baby! And not just in that way, you cheeky person, you. For about twelve hours after conception, the fertilized egg is still just one cell, but all hell is about to break loose. Inside our eggs, the mitochondria produce energy to divide the cells and chromosomes. If the conception is successful, then the cell divides over and over until it's a raspberry-shaped blastocyst consisting of hundreds of cells, which then enters the uterus and tries to implant itself into the endometrium—the lining of the uterus. But the problem is that sometimes the mitochondria punk out. Especially as we age, our mitochondria can run out of steam before finishing the job. They can start the marathon looking strong, but end up weaving back and forth and calling for a stretcher before the end of the first mile.
So many things have to go just right for a pregnancy to result in a healthy baby that it's amazing it happens as often as it does!
And, yes, each of us has a "best before" date on our ovaries. But as we've been saying, there are things we can do to make sure that day doesn't come any sooner than it has to, and that's what we're going to discuss, starting…right now!
