Fertility and Conception Beyond 35

Fertility and Conception Beyond 35

One of the most common things that I hear from patients entering our Barefoot Health Fertility Program is that women wish that they would have known what a struggle it was going to be to conceive a child past the age of 35 years.

Around the world women in developed countries are waiting until they are in their mid to late thirties to have babies. There are great reasons for this – women and men are waiting to have children until their education is completed, until they are financially more stable, until they have stable, committed co-parenting relationships and until they feel emotionally ready to welcome a child into their lives. There even seems to be a perception that parenting in general will be easier if childbearing is delayed. The number of births to women ages 40-44 in the US has increased by an astonishing 70%.

Misconceptions about fertility and birth that are perpetuated through our current medical system with persistent and ongoing messaging about pregnancy prevention and hormonal birth control starting in early adolescence . Most women also believe strongly that a healthy lifestyle will lead to increased and extended fertility. I often hear “I know that I’m 42 but I feel 30! Conception should be easier for me.”

In the past we knew that fertility began to decline around age 35. Today, mainly due to environmental factors, we see a detectable drop in female fertility by the age of 32 years. Age does not only play a role in conception –it also plays an important role in health outcomes during and after a pregnancy. We see a dramatic increase in serious risk factors to both mother and baby during a pregnancy after the age of 34.

Many experts are now saying that there is an ideal age to give birth in order to reduce associated maternal and newborn health risks and complications resulting from maternal ages either too young or too advanced. This ideal age has been determined to be a twelve year period between the ages of 22 and 34 .

In addition to the challenge of reduced fertility after the age of 32 there is of course the challenge of egg and sperm that are simply aging as they are exposed to oxidative stress, environmental toxicity and simply time – resulting in genetic changes. The risk of trisomy 21 (Downs Syndrome) starts at around 30 years of age with more pronounced effects over 35 years. Errors in chromosomal displacement and abnormal tubulin placement during early division of the blastocyst increases from 17% in young women (less than 30 years of age) to 79% in women over 35 years. Of note are recent studies have shown the risk of Autism Spectrum Disorder increased significantly with each 10-year increase in maternal age.

Pregnant women over 35 are more likely to have pre-existing hypertension, obesity and diabetes mellitus before conception. Pregnant women over 35 years are at increased risk of complications in pregnancy compared with younger women. These risks include: uterine fibroids, hypertension, placental abruption, gestational diabetes, placenta previa, and malposition of the fetus specifically breech presentation. Advanced maternal age also contributes to an increase in miscarriage. In younger women 13.5% end with fetal loss. At age 42 years, more than half of pregnancies resulted in fetal loss.

If you conceive over the age of 35 years statistically you will worry more about your pregnancy and increased stress hormones during a pregnancy have been shown to cause epigenetic changes in how your growing child will respond to stress and anxiety as an adult. Women older than 35 years and their babies are at increased risk of complications during birth compared with younger women. These risks include vacuum or forcepts delivery , elective Caesarean section, emergency Caesarean section, postpartum hemorrhage, preterm delivery before 32 weeks gestation, low birth weight below the 5th centile, and stillbirth. These effects are all pronounced over 40 years of age.

Postpartum women over the age of 35 may face the challenges of a long and difficult recovery after a complicated pregnancy and an operative, complicated birth. These women also face the possibility of children born with disabilities and the subsequent grief and uncertainty this can bring. Feelings of overwhelm and sadness or trauma from a complicated birth or a sick infant can increase a woman’s chance of developing post partum depression.

Most women and men who delay childbearing find that the disadvantages of this delay in terms of postpartum concerns and parenting concerns are lack of energy for parenting, less available lifetime to spend with children, anticipated ageing related health issues and anticipated stigma as older parents.

Naturopathic Approaches to Wellness

It is an incredible gift that women have to grow and nurture life within their bodies. In my 22 years as a birth worker I have been blessed to be witness to many couples welcoming their babies into their lives. I cannot think of a more fulfilling career than to help create the space for this transformational moment to happen in the greatest of safety and health.

There are many things that we can do to help women have healthy vibrant pregnancies over the age of 35!

Specialized Detoxification programs to reduce oxidative stress.
Antioxidant therapy with specific evidence based supplementation.
Acupuncture has been shown to increase fertility, balance hormones and increase the success of IUI and IVF procedures.
Herbal therapy to balance and increase hormones.
Cycle education – when do you ovulate? When do your hormones peak? What does fertile cervical fluid look like?
If we know what disorders complicate fertility and conception or a pregnancy in an older mom we can work hard pre-conception and prenatally to avoid the onset of these disorders using gentle, natural remedies. In this way we increase moms health and decrease the risk of complications. I’ve seen this approach be most effective when working with women suffering with endometriosis, fibroid tumours, PCOS, endometrium thinning and low estrogen levels at the beginning of cycles. I’ve also worked with moms to avoid gestational hypertension, gestational diabetes and breech presentation.
The most common complication for moms older than 35 years is an operative delivery. Discovering care providers for your pregnancy and birth who will help you to avoid an operative delivery is key. In Ontario Midwifery Care is woman centered and informed choice based care that supports women in achieving a healthy birth.
Prevention: We need to start discussing with young women that there is a biologically optimal time to have a family and support young women in their choices around family planning.

Pregnant women who are older than 35 years benefit from care and support with a Naturopathic Doctor. We find that by emphasizing healthy nutrition, stress reduction, regular physical activity, hormonal balancing and care in choosing their primary care team women experience better birth outcomes and reduced pregnancy induced hypertension, gestational diabetes and spontaneous abortion. Women over 35 years old also benefit from good prenatal education and support throughout their pregnancies including counselling activities such as:

fear discovery exercises,
art therapy, and
journaling
identify deficiencies and challenges early and treat them before challenges become real problems in pregnancy
discuss iIssues such as genetic testing, multiple ultrasounds, medication in labour, strep B testing and birth preferences
for first time moms we use a well studies pre-birth acupuncture protocol beginning at 36 weeks to help to prepare the cervix for labour and to avoid the use of chemical induction and the cascade of intervention during birth that often accompanies induction.
The result of all of the intense work during pregnancy means that we can often lower the very common anxiety older moms may feel when they approach the time to give birth. This allows women to feel prepared and empowered when their labour begins. Optimally they will surround themselves with a team that helps them feel safe, they will choose a birth place where they are comfortable and they will be able to relax and trust that their body will labour naturally and normally without the need for intervention or surgical birth.

By encouraging women over 35 years old to participate in wellness care during their pregnancies I have found that this influences their birth experiences and therefore their ability to recover postpartum. A Normal vaginal birth is much easier to recover from than a surgical delivery. Women who recover faster after their birth report more positive feelings about their birth and report that they feel more attached to their infants. Naturopathic care postpartum is often simply supportive and answering questions, assessing post partum mood, assisting with breastfeeding questions and ensuring that optimal nutrition and adequate rest are part of the post partum care plan.

In summary, choosing to begin a family after the age of 35 can lead to serious health implications for both mother and child at every stage of the pregnancy and birth process. Care should be taken to emphasize with women that there is a biologically optimal time to conceive and give birth and that this should be honoured and respected as an important part of our biological rhythms. ND’s work toward optimizing health and lowering risk and although we cannot turn back the clock for many women who have delayed childbearing, we can work effectively as part of their circle of care before and during their pregnancies to help reduce associated risks of advanced maternal age and to help improve outcome, recovery and reported birth experience satisfaction

Check out the Birthful Podcast for more on this topic:

http://www.birthful.com/podcastfertilityandage/

416.305.3789

375 Finley Ave Suite 101 Ajax, ON L1S 2E2

Fertility and Conception Beyond 35

Fertility and Conception Beyond 35

More on fertility and advanced maternal age:

call us now 416.305.3789

375 Finley Ave Suite 105 Ajax, ON L1S 2E2

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