Many women assume they will have no difficulty getting pregnant until they discover they can't, says Rachel McConnell, MD, assistant professor of obstetrics & gynecology at Columbia University Vagelos College of Physicians and Surgeons and medical director of the new Columbia Fertility Center clinic in White Plains, New York.
"A lot of women in their 40s feel that because they are healthy and they exercise that they should still be okay reproductively," McConnell says. "It's important for people to know that the biological clock is a little bit different than physical health."
And looking to the age when their own mothers or grandmothers conceived isn't an accurate guide, she adds. "I've had patients say, 'I didn't worry about this because my grandmother had a child when she was over 40.' But your grandmother's or mother's experience doesn't predict what will happen to you."
According to McConnell, women generally begin to see some gradual changes with fertility starting at around age 30, as a woman's egg reserve and quality decline.
"It's not that fertility falls of a cliff starting at age 30, but the chance of getting pregnant really goes down after age 35."
McConnell explains that even for younger women who are having regular periods, it can be difficult to get pregnant.
"It can be enlightening for couples when you explain everything that needs to take place with the reproductive system and all of the potential causes of infertility," says McConnell, who adds that the chance of getting pregnant after trying for just one month is around 20% and around 70% over a six-month period if there are no fertility issues. "When I hear myself repeat those statistics and think about all of the steps involved in getting pregnant, it truly is a miracle."
There are many reasons a woman may have difficulty getting pregnant, including past gynecologic infections, conditions such as polycystic ovarian syndrome, endometriosis, fallopian tube blockages, or poor sperm quality. A cause may not be found for as many as 15% of couples who are trying to conceive.
"Most patients want to know if there's a reason why they can't get pregnant and we can address those reasons," says McConnell. "It's more frustrating for patients when we tell them all their tests are completely normal, and they have unexplained infertility. But there are still things we can do to enhance their ability to get pregnant."
So when should an individual or couple start thinking about how to preserve or enhance their fertility?
"It depends on what you're trying to do," McConnell says. "For instance, if someone who is over age 35 and doesn't have plans to get pregnant immediately, that would be a time to become educated about what can happen to the body and what obstacles may occur if pregnancy is delayed. And if you are aware of a medical issue that may be interfering with your ability to get pregnant, you may want to consult with a reproductive endocrinologist and find out if they can help."
According to McConnell, it's important to first understand a patient's fertility goals. "When I first meet an individual or couple, I always ask them to tell me a little bit about themselves, including how many children they want. Knowing that I'm really listening to them helps put them at ease."
