When I was 20 I used to think about when I would have a baby and with whom. Now that I’m 34, I often wonder if I’ll ever have a baby. Occasionally, I’ll worry if I even can have a baby—the ‘with whom’ part is right out the window. I know I’m not alone in this reproduction-related anxiety.
Fertility is an issue that has many women asking tough questions. Single, married or in a long-term relationship, the fear that they won’t be able to conceive because of their age is a real worry.
The concern is justified, says Dr. Yaakov Bentov, an infertility specialist at the Toronto Centre for Advanced Reproductive Technology (TCART). In honour of infertility awareness week, Dr. Bentov shares his thoughts on when women should get pregnant, why they need to educate themselves about fertility, and why some of us are missing the boat entirely.
Q: It’s Infertility Awareness Week, and as a doctor whose specialty is helping women struggling with infertility, is there one main message you would like to get across to the world?
A: Yes. There’s a false belief amongst women that they can be fertile forever, and this is not true. Almost on a day-to-day basis we have those conversations with women that come here for the first time, when they’re 43 and 44, when it’s too late, and we have to tell them ‘OK, you’ve missed the train.’
They look at the magazines and they see all those film stars holding babies when they’re 50 and they presume that this is how it works. But it doesn’t. Fertility starts to decrease at the age of 30. There’s a major difference as you age and the crucial age is between 30 and 40.
Q: At what rate does it start to decrease?
A: It starts to decrease at the age of 30—I’m talking about the chances not to just get pregnant but to have a live birth. The chance of having a live birth at the age of 30 is about 40 per cent per cycle. Then it starts to drop. At the age of 35 it would be about 30 per cent. By the age of 40, it’s 20 per cent. By 43, it ends.
Q: When you say the chances of a live birth, you mean what exactly?
A: This is what prevents a live birth: not getting pregnant, or getting pregnant and losing the pregnancy. Most of them are lost in the first trimester, but some are lost later on, which is even more devastating. If you look at miscarriage rates, very often after all the struggle of getting pregnant, the chance of losing the pregnancy is so much higher. If you’re a woman under 30, it’s 10 per cent. If you’re a woman of 40, it’s more than 50 percent.
Q: Thirty isn’t that old, but why is it old in terms of fertility?
A: We have a lot of thoughts about it. There was actually a study published this week that was asking the same thing. Most of the other systems in our body seem to work perfectly well until we’re 70 or 80 or 90. But [the reproductive cycle for women] is probably the only example of something that stops working at the middle of life… There are many thoughts [as to why that’s true]. But regardless, the fact is that [fertility] stops at the middle of life [for women.]
The study this week showed that women can carry pregnancies older—we’re seeing some women use egg donors until the age of 60. That’s not the issue. It’s something else. The really interesting question is why is it that the eggs act so much differently at different ages? All of these eggs were formed when this person was an embryo. There’s no difference between an egg that you ovulate at the age of 20 and one at the age of 40. They’re the same. They were formed at the same time. They’re the same weight. So how come so many more miscarriages? How come the chance for Down syndrome is so much higher? Down syndrome at the age of 30 is one in 2000-3000. After the age of 40, it’s one per cent.
Q: Why is this the case?
A: There are a lot of theories. But our thought is that it’s not the egg that’s different; it’s the ability of the egg to produce the kind of energy needed to complete all the processes that are involved with maturing and being fertilized. That’s why we’re recommending that women use all these supplements like co-enzyme Q10.
Q: You brought up female film stars who seem to be having babies a lot older nowadays. Why are they able to do it?
A: Everyone is entitled to her own privacy, but I’m going to guess that most of those babies are born from egg donation.
Q: If a woman is 35 and single what advice would you give her?
A: Not to waste time. To get pregnant immediately, or to freeze her eggs. The rate of deterioration at 35 is really fast. So there will be difficulty getting pregnant, increased risk of losing the pregnancy and having a child with birth defects. They have to do things fast if they’re seriously thinking about becoming a parent.
Q: Is freezing your eggs expensive?
A: No. Medicine has made tremendous improvements in all the science that has to do with freezing. There are new methods that allow eggs to freeze well but also to thaw well, become fertilized and become good embryos later on.
I really think that for women who can’t become mothers right now it’s a really good solution. And it’s not expensive. They can spend less than $5000 and have some eggs frozen for the future. It’s a double-edged solution, however, though because it’s not a guarantee. Those eggs may not fertilize.
Q: Is there anything health-wise women can do to preserve or prolong their fertile years?
A: We don’t have proof on humans, but we do have a study that was conducted on mice. I did mention the co-enzyme Q10, which at least in mice was able to prolong their fertility. This is something that we obviously need to prove in humans, but that may be a solution in the future.