Aug 21, 2014

Interview Transcript

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: When is it too late to have a baby from a woman's point of view? I know that there are a lot of couples that are putting that off later and later in their life until they're more comfortable. I've always heard 40 is the cutoff. Is that the cutoff or not?

Is 40 the Cutoff Age?

Dr. Jones: Well, actually yes and no. There is a decline in fertility that begins at about age 28. Now, it isn't like 28 turns the switch off or that 40 turns the switch all the way off, and there's variability from woman to woman but the point is that there's no test. You can't drive in and plug your ovaries in and say, "Am I still fertile?" So, the biggest issue about waiting too long is not that you're going to have a baby with a birth defect or that you're going to have complications of pregnancy, is that you're not going to get pregnant at all.

Interviewer: Really? Because I always thought that after 40, the percentage of complications increased dramatically, is that not true?

Dr. Jones: It starts... so, the question is complications, what's dramatically and when does it start?

Interviewer: And what are complications?

What Are Pregnancy Complications?

Dr. Jones: And what are complications? It always depends, right? So, in fact, I think what people are mostly worried is that the complications of having a baby with a birth defect, that's not something that a doctor can actually fix so we're talking about complications for the mom, complications for the baby, and complications genetically.

So, we know that the older the egg is, the more complications there are in terms of abnormal chromosomes. Trisomy 21 or Down syndrome is the one that most people know about. Well, that number actually starts going up in the 30s.

Interviewer: Okay.

Dr. Jones: And so the chance at 35 is about 1 in 200, the chances at 40 is about 1 in maybe 100, the chances at 44 might be 1 in 20 to 30.

Interviewer: Okay, so, these chances are that there could be genetic defects in the egg, not necessarily that that's going to translate into anything bad.

Dr. Jones: Well, because most genetic defects in the egg lead to no baby at all.

Interviewer: Okay.

Dr. Jones: So, when we're talking about abnormalities in the egg, most of the eggs after women get to their late 30s are abnormal.

Interviewer: Okay.

Dr. Jones: So, if most of the eggs are abnormal, then most of those won't actually even make a baby.

Interviewer: Okay.

Miscarriage Rates

Dr. Jones: So, the chances of getting pregnant and staying pregnant goes down from your early 30s on but it goes down rather dramatically after 35. So the biggest issue is getting pregnant because the chances of getting pregnant goes down and staying pregnant because of those abnormalities leading to miscarriage. So, the rate of miscarriage in women in their early 20s might be 15 percent, by their 30s it might be 20 percent, but by their 40s it might be 40 and then getting into 50 percent.

Interviewer: Okay.

Dr. Jones: And that's miscarriage of those that are detected. A lot of pregnancies that start actually don't even get hard enough to be called a miscarriage.

Interviewer: Oh, really?

Dr. Jones: Right.

Interviewer: Okay.

Male Infertility

Dr. Jones: Now, we haven't talked about sperm yet but please, let me take that opportunity. We know that men as they get older have abnormal sperm too. So, aging and sperm isn't good for sperm and there are diseases that are more common as men age. So sperm quality goes down with age but usually not dramatically until men are a little bit older into their late 40s, 50s, and 60s. So, there is that issue. That's the chromosomal issue that people are worried about.

Clearly women as they get older have an older body. They have more hypertension. They may have more diabetes. They have issues that make them more likely to have complications in pregnancy. All of those go up with age but mostly those things you can get around with a good doctor and a good hospital.

Interviewer: So, not too much to worry about there generally.

Dr. Jones: Generally. Now, the good news for those people who would use the technology is that we have technology that's less invasive to pick up those genetic defects that increase with age. So, women who are older, who manage to get pregnant and manage to stay pregnant can do some early screening and make decisions about continuing a pregnancy if they find that they have a genetic defect.

Now, this is taking populations. Clearly, there are some women who start to run out of eggs earlier and so they'll be less fertile in their 30s, and there are some women blessed with a whole bunch of extra eggs. Those women who have late menopause and they have babies early and often have babies without difficulty, well into their early to mid 40s, but it's rare for any population you study that women have successful pregnancies after 45 with any kind of frequency.

Interviewer: So, for that couple that may come into your office, it sounds like it's a case by case basis, really.

Dr. Jones: It is.

Interviewer: And it sounds like getting pregnant is the hardest part. The other issues not so much.

Dr. Jones: Getting pregnant and staying pregnant.

Interviewer: Yeah, the other issue is not so much the concern.

Dr. Jones: Right, if we can... These are low-risk women so if a woman that comes in who's diabetic or one that comes in who's hypertensive, or someone who's come in who's had cancer treatment. There are situations that are going to be much different. And of course it's not that you should run out and have babies when you're most reproductively fit, which might be your early 20s because you may not have pair-bonded, you may not be ready for the responsibility, for the rest of your life of caring for another person that way. So, that's always a trade-off.

But I think people should be aware that if postponing the pregnancy is a lifestyle issue, meaning, you've pair-bonded, you have enough time, effort, and money to be a good parent, then, putting things off does not really help you very much if you really want that kid.

Interviewer: So, what's the major takeaway that you'd have?

Dr. Jones: The major takeaway is that postponing a pregnancy can be great as a lifestyle issue but remember all these things have trade-offs. So if you're busy in your career and you're busy trying to find someone to pair-bond with, to raise children with, the later you wait, there may be some consequences. We have all kinds of technology to help people who wait too late. So we have what we could do for people who got to their 40s and can't get pregnant or stay pregnant, and we can use other people's sperm, we can use other people's eggs. There are all kinds of stuff we can do but if you wait until after your mid 30s to start a family, it may not go as easily as you hope.

Interviewer: So, the getting pregnant, staying pregnant aside, is 40 too late? Is 45 too late? Is 50 too late? Is there a cutoff line?

Dr. Jones: No, there's not a cutoff line because people... I'd love to say every pregnancy was planned. Remember half our pregnancies aren't planned and we don't say, "Oh, you're so late. You can't carry this pregnancy." No, it's not too late in the sense that I think it's just being informed, and I think most people now know that if you have a baby in your 40s, if you get pregnant in your 40s, there are going to be more things to screen for, more issues to screen for the baby in terms of chromosomal birth defects, but if you can get pregnant, stay pregnant, and have the early screening, you're probably going to be okay.

But then the hard part comes and you get to be a parent at 50. Good luck on that one.

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