Fertility in Your 30’s
By The Time You’re 30, Here’s What You Should Know About Your Fertility
Many individuals are having their first child later in life than in previous generations. Therefore, it’s important for people to understand the timeline of their fertility.
In the U.S, the average age that a woman has her first child is 26, up a full five years from the average age of 21 in 1972. A growing percentage of women are choosing to wait to have children until their 30s. This is influenced by factors including demanding careers, longer times spent in college or graduate school, or getting married at a later age.
By the time you’re 30 or 35, what do you need to know about your ability to conceive and have a healthy pregnancy?
Below we’ll look at how hormones, egg count and quality, and other factors involved in reproduction change once you’re in your 30s. We’ll also cover fertility treatments most often recommended for those over the age of 35 and cover the basics of freezing your eggs.
Fertility In Your 30’s
If you recall learning about reproduction in high school biology class, you may remember that women are born with all of their eggs. Unlike men who continuously make sperm throughout their lives, women don’t make any new eggs over time. Therefore, the quantity and quality of a person’s eggs start to diminish the older they get, starting from a young age.
According to the American College of Obstetricians and Gynecologists, “Peak reproductive years are between the late teens and late 20s. By age 30, fertility (the ability to get pregnant) starts to decline. This decline becomes more rapid once you reach your mid-30s.”
By the age of 45, the average person’s ability to get pregnant naturally has substantially decreased, to the extent that they’re very unlikely to get pregnant without any intervention.
“Ovarian reserve” refers to the number of healthy, normal eggs that a woman has left inside her two ovaries. This number decreases with age. Having “diminished ovarian reserve” becomes more likely in a person’s 30s, indicating that reproductive potential is lower based on the number and quality of eggs left.
Not only does the quantity of eggs decrease over time, but egg quality also diminishes as a person gets older; remaining eggs in older women are more likely to have abnormal chromosomes compared to eggs in those that are younger.
Changing hormones and pre-existing conditions are two other fertility factors to consider during your 30s. Women in their mid to late 30s have a higher risk of having disorders that can affect a healthy pregnancy, such as uterine fibroids, ovarian cysts, endometriosis, and pelvic inflammatory disease.
Levels of estrogen, the key hormone that controls a menstrual cycle, start to decrease in your mid-30s, resulting in less regular ovulation and irregular periods. Estrogen does not control the menstrual cycle. I would say something like the incidence of ovulation dysfunction increases as we age, resulting in fewer ovulatory cycles per year and irregular periods. Some women enter perimenopause (the stage prior to menopause) as soon as their late 30s, which can make conception less likely.
Finally, although it’s usually only temporary, past birth control use can also impact fertility, especially birth control forms such as injectables/shots. It can sometimes take up to 18 months for ovulation to resume once stopping birth control injections, which is something to take into account if you currently use birth control and wish to get pregnant in the near future.
Success Rates of Getting Pregnant
The average 30-year-old woman without any preexisting reproductive conditions has about a 20% chance of getting pregnant each month. In comparison, someone in their 20s has an even greater chance, about 25% per month.
By the time a woman reaches 40, the success rate of getting pregnant naturally drops to about 5% per month, meaning about one or two out of 10 would be able to get pregnant each month when actively trying to conceive.
Once an individual reaches their mid-30s, the older they get, the higher the risk of having a miscarriage or having a baby with fetal abnormalities. It’s estimated that about 15% of pregnancies in those under 35 result in miscarriage, but this number increases up to 25% to 50% if the person is between 39 and 44 years old.
Other factors to consider are the increased likelihood of chromosomal abnormalities, including Down syndrome, the most common chromosome problem that occurs among women who have children in their 40s. Down syndrome affects about 1 in 85 fetuses if the mom is 40 or about 1 in 35 if the mom is 45.
There are also increased maternal risks involved in having a baby at a later age, including preeclampsia (high blood pressure during pregnancy that can lead to organ injury). Older people pursuing pregnancy also have a higher chance of having twins/multiple pregnancies since the ovaries are more likely to release more than one egg per month.
Fertility Treatments Available
Tracking Your Cycle
If you’re in your 30s and trying to conceive, first start by tracking your menstrual cycles to get an understanding of how regular your periods are and when you’re most likely ovulating.
You can use any number of fertility apps on your phone to help you track your cycles, plus ovulation strips to help you pinpoint which days are best for having sex (a strip will turn positive 24 to 36 hours before ovulation, indicating to have sex at that time).
Additionally, you can monitor changes in your cervical mucus and basal body temperature to determine if and when you ovulated, which is helpful for predicting the following month’s cycle.
Visiting A Reproductive Endocrinologist (REI)
If you haven’t conceived on your own after trying for 6 to 12 months, it’s best to visit a healthcare provider for help with an infertility evaluation.
How long should you wait before seeking professional help?
Once you’re in your mid-30s, it’s recommended that you meet with a Reproductive Endocrinologist (REI) sooner rather than later. The recommended point is after about 6 months of trying on your own. REI fertility specialists can help pinpoint any fertility issues that may make conception more challenging.
REIs perform extensive exams and tests to uncover the full picture of a patient’s reproductive health, including a pelvic ultrasound (which can spot issues such as endometriosis or ovarian cysts), tubal evaluation, ovarian reserve testing, hormonal panel tests, and semen analysis for a partner.
Based on test results, your REI can help you decide which treatment options are most likely to be successful. Treatment for infertility, including if it’s related to advanced age, always depends on the individual case, as there are many potential pathways to having a successful pregnancy.
Potential fertility treatments that may be used to help you get pregnant in your 30s or 40s include IUI (most often for women under 35), IVF, or use of donor eggs, donor sperm, or possibly a gestational carrier (surrogate) if necessary.
Assisted reproductive technologies, including in vitro fertilization (IVF), can help with a variety of infertility causes that come into play in your late 30s or 40s, such as damaged or absent fallopian tubes, genetic abnormalities of embryos, low ovarian count, or a partner with low sperm quantity or quality.
Your REI can also perform prenatal and diagnostic screening tests, both before you become pregnant and once you’re pregnant, to assess the risk of birth defects or genetic disorders, including those that are more common in later-age pregnancies.
Keep in mind that no matter how you plan to become pregnant, and no matter the age, it’s important to take care of your body holistically — by maintaining a healthy weight, eating a nutrient-dense diet, quitting smoking, exercising enough, and managing stress.
Freezing Your Eggs
Egg freezing (fertility preservation) may be a good option for women in their 30s if they want to build their families later in life.
Also called oocyte cryopreservation, egg freezing essentially pauses the progression of chromosomal abnormalities that eggs experience past a certain age. This option allows women to preserve higher-quality eggs that are more likely to be chromosomally normal so that they can get pregnant at a later age through IVF.
Egg freezing can result in a lower risk of miscarriage and a lower risk of Down’s syndrome. One drawback is that it can be expensive and somewhat invasive, considering it involves many of the same medications and steps as IVF; however more employers and insurance companies are beginning to cover some costs of egg freezing.
If egg freezing seems like it may be a good fit for you, speak with your OB-GYN or an REI to discuss your future family building plans and next steps that will help you prepare as best as possible.