QuestionHi. Is there anything a woman in her late 30s can do to increase her chances of getting pregnant? Also, what type of health risks are associated with having kids at that age? When a woman finds out she is pregnant with multiples, is there a procedure that can be done so the woman only has one child? Thanks
AnswerHello Danielle,
By late 30's I presume that you are asking about over the age of 35. By the way, that is still very young in my book. However, from a fertility point of view, that is old because the pregnancy rates have decreased significantly. To give you an example, a 23 year old woman has an 85% chance of pregnancy per year, whereas a 37 year old woman has a 15% chance of pregnancy per year. The reason that the fertility decreases is because a woman is born with all the eggs that she will have for her lifetime. The eggs deteriorate with time and are usually infertile by the age of 43 years old. We know that at age 37 yo, only 20% of embryos formed are genetically normal. That means that 8 out of 10 eggs are abnormal. So one way to increase a woman's chances at that age are to increase the number of eggs that she ovulates at a time (usually she only ovulates one) using fertility drugs. However, even with that, the chances of pregnancy are only 5-10% per month. The best way to increase the chances is to do in vitro fertilization (IVF). This has a 52% chance of pregnancy per try in many clinics (like mine). That is because we can stimulate the ovary harder and often get 15-20 eggs at a time. By increasing the number of eggs harvested, you increase the chances of having a good egg which will lead to a good embryo.
The late 30's is still very young from a pregnancy point of view and the risks are not significantly increased. There is a slightly increased chance of diabetes or preeclampsia, and of course, there is an increased risk of genetic abnormality in the fetus. For that reason, genetic testing is recommended.
If you have a multiple, then there is a procedure called "embryo reduction" whereby a specialist (perinatologist) can stop the heart of one of the embryos, causing it to die and be reabsorbed. It is a form of abortion but nothing is expelled. It is usually done at around 12 weeks gestational age.
I hope this answers your questions.
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
