The Truth About Fertility After 35

If you’re 30 or older and hope to be a mom one day, then a new story in the June issue of The Atlantic is probably already on your radar. Its much-buzzed-about premise: That baby-making panic among 30-something women is overblown, and the fertility cliff you hit during this decade isn’t as steep as you’re led to believe.

The author, Jean Twenge, tears apart some scary statistics. First, an often-cited 2004 study, which shows that one in three women between 35 and 39 will not be able to conceive on their own, turns out to have been based on data from French births that took place from 1670 to 1830. And rather than fertility dipping at 27 before plunging hard at 35, a study of modern women shows only a 4 percent drop in conception rates from ages 28 to 37, reports Twenge.

Reassuring news, right? Well, not quite. While fertility anxiety for women in their early 30s is probably not warranted, well-established research left out of The Atlantic article shows that your ability to conceive a healthy pregnancy really does decline in your mid-30s.

“Most women who want to be moms in their 30s will be able to get pregnant on their own,” says Alyssa Dweck, an ob-gyn in Westchester, New York, and coauthor of V Is for Vagina. “But some won’t, and that fact can’t be brushed aside.”

What triggers the fertility fail? No matter how young you feel at 35, your eggs are more fragile than they were even a few years earlier. Data from the American College of Obstetrics and Gynecology (ACOG) demonstrates this: In analysis done on the embryo transfers that took place in the year 2006, 44.9 percent resulted in live births in women younger than 35 years—compared to 37.3 percent in women 35-37, 26.6 percent in women 38-40, 15.2 percent in women 41-42, and 6.7 percent in women 43-44. When the eggs were donated by healthy young women, however, 54 percent of transfers resulted in live births, no matter what the age of the recipient was (suggesting that eggs become less viable with age).

As you get older, you’re also more likely to deal with health problems that may affect your fertility, according to the Centers for Disease Control. Diabetes, obesity, and even high blood pressure all put a dent in your baby-making ability, says Dweck.

When older moms do conceive, they have higher odds of having a baby with chromosomal damage, which can result in birth defects such as Down Syndrome. They also face an increased risk of  complications in the delivery room, according to a 2007 study that examined data from births between 1980 and 2004 (when more older women started having babies).

The Atlantic article does make some solid points, though. Fertility anxiety may be unintentionally fanned by reproductive specialists who regularly treat fertility-challenged women and don’t take into account all the older moms who pop out a kid problem-free, says Dweck. And the lower bambino rates among post-35 women might be skewed by the fact that in general, older women may be having less sex, she adds.

Finally, the post-35 plunge is just a guideline. Some women will have trouble conceiving in their 20s, while for others, it’ll be smooth sailing past 40. “But since you really can’t predict whether you’ll have problems or not, it’s best to play it safe and start trying to conceive by your early 30s,” says Dweck—if you can, that is.

If you’ve already hit that threshold and your life isn’t settled enough to try for a baby right now, there are some steps you can take to increase your motherhood odds when you are ready. “See your ob-gyn for a pre-conception exam, where she checks your overall health and tests you for conditions that can make it tougher to conceive and carry a child,” says Dweck. “By maintaining good health, you improve your chances of being a mom at any age.”

photo: iStockphoto/Thinkstock

More From Women’s Health:
Should You Get Your Fertility Tested NOW?
Fertility Questions
Fertility Treatments: Is IVF Dangerous?

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Short Walks After Meals Can Help Fend Off Diabetes

After dinner, you probably just want to kick off your shoes, curl up on the couch, and fire up your DVR—but here’s why you shouldn’t: Taking a 15-minute post-meal walk can help regulate your blood sugar level and reduce your risk of type-2 diabetes, according to a new study conducted by researchers at the George Washington University School of Public Health and Health Services (SPHHS).

In the study, 10 healthy seniors spent three 48-hour spans in a lab. During each session, participants ate the same foods and followed one of three exercise routines: They either walked at an easy-to-moderate pace on a treadmill for 15 minutes after each meal, walked 45 minutes in the morning, or walked 45 minutes in the afternoon. In each of the three scenarios, researchers continuously monitored participants’ blood sugar levels. What they found: The short post-meal walks were more effective at regulating blood sugar levels for up to 24 hours.

Why this is so key: Typically, your body can handle the normal blood sugar fluctuations that occur about 30 minutes after you eat: Your pancreas releases insulin, which sends the sugar to your liver, where it’s stored as fuel. But as you get older (or if you’re inactive throughout the day), your body doesn’t react as efficiently, which leads to prolonged high blood sugar levels, says lead study author Loretta DiPietro, PhD, MPH, chair of the department of exercise science at SPHHS. Over time, this can damage the walls of your cardiovascular system, heighten your risk of getting type 2 diabetes and heart disease, affect brain functioning, and even lead to blindness, she says.

Luckily, exercise triggers muscle contractions that work like insulin. Why are post-meal walks more effective than a single 45-minute stroll at another time? They jump-start this process exactly when your body needs it: When sugar enters the blood stream, says DiPietro.

Can’t swing a walk after every meal? Focus on moving more about 30 minutes after you eat your largest meal of the day or after you eat carbohydrate-rich dishes (like pasta or rice) or super-sweet foods (like donuts and sugary drinks). All of these cause your blood sugar to spike faster and hit higher levels, says DiPietro. Bonus: She says that walking can also help you sidestep that post-meal energy zap—so you’ll actually be able to stay awake when you do sit down to catch up on those DVR’d shows.

photo: iStockphoto/Thinkstock

More from WH:
What Your Blood Test Results Mean
Why Fit People Get Diabetes
The Right Way to Walk

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Breaking: SOME Morning After Pills Will Be OTC

The battle over where Plan B belongs in the drugstore continues: First, an April judicial ruling required the FDA to make emergency contraceptives available over the counter without any point-of-sale or age restrictions. Then, the Department of Justice later appealed the decision, asking for a temporary suspension of the case. The latest update: Earlier today, The U.S. Second Circuit Court of Appeals ruled that the FDA must provide unrestricted over-the-counter access to some forms of emergency contraception, but not others, according to a recent press release from the Reproductive Health Technologies Project.

The new ruling says that the FDA does not need to provide OTC access to one-pill versions of emergency contraception (like Plan B One-Step); however, they do need to make two-pill versions available OTC immediately, without any age or point-of-sale restrictions. Essentially, it enforces the original order to put the morning after pill on store shelves, but only as it applies to the two-pill methods. According to the Center for Reproductive Rights, the FDA will now have 14 days to appeal this ruling, or they could comply and start working on getting two-pill doses (like the generic Levonorgestral tablets, 0.75mg) moved out from behind the pharmacy counter.

So why are they allowing the two-pill dose to hit shelves instead of the much more widely available one-pill version? It isn’t entirely clear. “I think it’s based on legal and procedural issues, not with what has been shown to be a safe and effective product—both in one pill and two pill versions,” says Susannah Baruch, interim president and CEO of the Reproductive Health Technologies Project.

While it might seem confusing that some forms of emergency contraception will be on store shelves while others will be behind the counter (and still others will require a prescription!), it’s important to note that all options are safe and effective forms of backup birth control, says Baruch. And this new ruling will mean that you can get the morning after pill whenever you need it—albeit in a slightly less convenient two-pill formula.

“This is a good day,” says Baruch.” We’re happy with the decision and eager to see what happens next. The path to full access to emergency contraception is open and we’re headed down that path.”

photo: WaveBreak Media/Thinkstock

More From Women’s Health:
The Morning After Pill May Soon Be OTC
The FDA Approves Plan B One Step
DOJ Appeals Emergency Contraception Ruling

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Should I Worry About… Driving After a Drink?

Drinking and driving is serious business. Last week, the National Transportation Safety Board (NTSB) recommended that states lower the current blood alcohol concentration limit of 0.08 percent to 0.05 percent or lower.

“We continue to kill 10,000 people annually in these crashes (involving alcohol), injuring 173,000, and 27,000 of those injuries are debilitating, life-altering injuries,” says NTSB chairman Deborah Hersman. Lowering the legal driving BAC limit was one of 19 recommendations released in a NTSB report titled “Reaching Zero: Actions to Eliminate Alcohol-Impaired Driving.”

Experts say it’s tough to provide a number of drinks per hour that would set you above the legal limit of 0.08 (or the suggested limit of 0.05) because there are just so many factors that go into how your drinking affects your body. The strength of the drink (a strong beer versus a light one, for example), whether or not you have food in your stomach, how quickly you’re going through drinks, and your weight all come into play, says Alexander C. Wagenaar, PhD, professor of health outcomes and policy at the University of Florida College of Medicine.

Another big factor is serving size; think about the heavy pours you get at certain restaurants, and check out this infographic to see how the serving sizes of different drinks compare.

Alcohol can also affect women differently than men: When you drink alcohol, the ethanol diffuses into all the water-soluble parts of the body, explains Wagenaar, who has been doing research on road safety and alcohol issues since the early 1980s. In general, women naturally have a higher percentage of fat tissue than men—which means less water-based tissue for the ethanol to diffuse into. So even if a woman and a man of the same weight consume the same amount of alcohol, the woman will end up with a slightly higher BAC.

Under normal circumstances, if you’re 200 pounds, it’s unlikely that you’ll hit the proposed 0.05 limit after two drinks—”but that assumes some time passes between the drinks,” says Wagenaar. “If you weigh 90 pounds, at the other extreme, well then it’s possible—and not at all unlikely—that one drink on an empty stomach could hit a woman to the (proposed) 0.05 limit,” he adds.

For a 140-pound woman, one drink would probably put her around the 0.03 BAC level, says Wagenaar.

Those are all rough estimates, of course; since you probably don’t carry a breathalyzer around in your clutch, there’s really no way to know exactly how a drink will affect you on any given night.

In its recent report, the NTSB cited research showing that by 0.05 BAC, most people experience visual and cognitive impairments. The report also notes that more than 100 other countries—including the majority of European countries—have a BAC limit of 0.05 or lower. “The risk is very definitely there, and it’s not insignificant at 0.05,” says Wagenaar. “That’s why 0.05 is a logical legal standard that’s in place in most developed countries in the world.”

At 0.05 BAC, people are 38 percent more likely to be in a crash than people who are completely sober, according to research cited in the NTSB report. At 0.08 BAC, people are 169 percent more likely to be in a crash than people who haven’t had anything to drink.

Here’s the deal, though: Regardless of whether the legal BAC limit is set at 0.08 or 0.05, the fact remains that even a little bit of alcohol does affect your ability to drive safely. “When you need to cognitively attend to more than one thing at a time—which is a clear part of driving—those types of abilities begin to deteriorate even at the low levels of drinking,” says Wagenaar. “So the safest is to not drink and drive at all—I mean zero BAC.”

If you’re planning to drink, have a designated driver with you, or take a cab home (save taxi numbers in your phone beforehand!). There are even apps and websites out there for connecting you with a designated driver that will get you and your car home safely, like StearClear and this National Directory of Designated Driver Services.

The verdict: A glass of wine or a beer over a long dinner probably won’t put you over the proposed legal limit of 0.05 BAC—depending on your weight, how big/strong the drink is, and other factors. But of course the safest personal policy is not getting behind the wheel after any drinks. And if you educate yourself now about the resources available to get you home safely, you should be able to avoid driving yourself there—even if you end up drinking when you hadn’t planned on it. 

photo: iStockphoto/Thinkstock

More from Women’s Health:
Don’t Mix THIS with Alcohol
This Is Your Brain on Booze
Is Your Drinking Habit Deadly?

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BREAKING: The Morning After Pill May Soon Be OTC

In breaking birth control news, a federal judge has ordered the FDA to make emergency contraceptives available over the counter and without any point-of-sale or age restrictions. That means that all levonorgestrel-based emergency contraceptives (including Plan B, Plan B One-Step, and its generics) would be available without a script to women of all ages (previously, women under 17 had to get an Rx from their doc). Even more exciting: It’ll be available on actual store shelves—right next to the condoms and pain relievers—rather than behind the pharmacy counter. And as anyone who has had to frantically search for a 24-hour pharmacy or deal with a judgy pharmacist can tell you—this is huge!

“Today is an enormous victory for all women,” says Susannah Baruch, interim president and CEO of Reproductive Health Technologies Project. “This decision is giving every woman and couple easier access to a safe and effective birth control option.”

Back in 2011, the FDA planned to make emergency contraception available OTC for women of all ages, but that recommendation was overturned by Health and Human Services Secretary Kathleen Sebelius. In his decision today, Judge Edward Korman of the District Court of Eastern New York wrote that those restrictions were “arbitrary, capricious, and unreasonable.”

Unfortunately, this doesn’t necessarily mean that Plan B will be out on store shelves tomorrow. The Justice Department now has 30 days to make an appeal, though experts believe they’ll have a hard time making a case for it. If there aren’t any appeals, the FDA will then reach out to the manufacturers of Plan B and its generics to update their labeling to reflect these changes, says Baruch. “There is no exact timeline, but we wouldn’t expect there to be too many more delays,” says Baruch.

So what can you expect if all goes according to plan? Essentially, you could buy emergency contraception from any store that sells other OTC medications without having to chat up a pharmacist. “We no longer have to find on a Sunday morning or a Saturday night an open pharmacy counter with a pharmacist on duty,” says Susan Wood, PhD, associate professor of health policy and of environmental and occupational health at George Washington University. “You can purchase it as you would any other over-the-counter product.” And in terms of cost, the price will likely stay the same as it was behind the counter. The only difference will be for women who might have had a prescription for the drug and therefore might have had this covered under their insurance, says Wood. Those women will now have to pay the actual retail cost, which is typically around $ 50.

While we still don’t have a clear ETA for emergency contraception on drugstore shelves, the new ruling sends a message that access to birth control is something that should not come with limitations. “This is a stamp of approval for its safety,” says Baruch. “I hope we will not see any more unnecessary restrictions.”

photo: iStockphoto/Thinkstock

More from Women’s Health:
6 Things You Need to Know About the Morning After Pill
Your Guide to Emergency Contraception 
Are Your Birth Control Rights Endangered? 

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What to Expect When You’re Expecting (After 35)

It’s no longer unusual for a woman to pop out a baby in her late 30s or early 40s (see trendsetting new moms like Uma, Halle, Salma, and Tina). And while most of these pregnancies go smoothly, the fact is, maternal medicine experts classify them as “high risk” because older mothers are more likely to face complications that can affect their health as well as the health of their baby. If you’re planning on welcoming a bambino after age 35, congratulations! Just keep the following considerations in mind.

Conceiving can take longer
Unfair but true: female fertility dips slightly when a woman is in her early 30s, and after 35, it nosedives. A 30-year-old has a 20 percent chance of getting pregnant per cycle, but by the time she’s 40, her odds sink to 5 percent per cycle, according to the American Society for Reproductive Medicine. If you’ve been going at it for six months with no luck, check in with a fertility specialist, who may be able to diagnose the roadblock, suggests Alyssa Dweck, ob-gyn and coauthor of V Is for Vagina. Many of the things that make it tougher for older moms to conceive can be treated, such as uterine fibroids or irregular periods.

Genetic defects are more common
Sure, you look young and fit on the outside, but by your late 30s, your eggs are senior citizens, and they don’t divide as well upon conception. That increases the odds of an embryo with chromosomal problems, which in turn may result in miscarriage or birth defects, experts say. Seeing your obstetrician for a blood test at 10 weeks and then an early ultrasound at 12 weeks (along with the full anatomy ultrasound at 20 weeks) can pick up the majority of genetic abnormalities and let you know if the baby is developing properly, says Dweck says.

You’re at greater risk of pregnancy-threatening conditions
Gestational diabetes and high blood pressure are just some of the medical issues more likely to strike pregnant moms over 35. If left untreated, they can trigger serious health snags for them or their babies. Make sure your doctor is aware of any family history of these or other chronic conditions; the right time to inform her is during a preconception exam, when your ob-gyn evaluates your health before you start baby-making to suss out potential obstacles. And go to all your scheduled prenatal appointments, so if one of these conditions does develop, your doctor can catch it early and monitor you closely, advises Dweck.

You may have a tougher delivery
Complications that develop around the time of delivery, such as placenta previa (when the placenta blocks the cervix), are more common in older moms. Women over age 35 are also more likely to have prolonged labor lasting more than 20 hours and excessive bleeding during delivery, and end up needing a C-section more often than younger moms do. You may want to speak with a doula or birthing coach about how to emotionally prepare for such an event well before the due date.

Twins and triplets are more likely
The chances of having multiples increases in your late 30s, even if you don’t use fertility treatments, according to a 2012 CDC report. What’s the drawback to rolling out more than one bundle of joy? The more babies a woman carries per pregnancy, the greater her risk of delivering early and/or having low birth-weight preemies, who may end up with lingering health issues.

photo: iStockPhoto/Thinkstock

More from Women’s Health:
Should You Freeze Your Eggs?
How to Protect Your Fertility
When You’re Not Sure You Want a Baby

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