Study suggests fertility window has increased

‘If your menopause is later, your opportunity for fertility may be longer, but it may not be. The real concern as we get older is about the quality of the eggs. It’s not about can you get pregnant, it’s much more about, can you stay pregnant?’ Bernadith Russell, New York City-based obstetrician-gynecologist

Christa Nader and her husband have been talking about having children for at least 10 years. As a former teacher and the founder of a nanny agency, children and child care are often on her mind.

But like for so many, the timing never seemed right. She went through long stretches with no health insurance or poor coverage. It took a while for Nader and her husband to feel financially secure enough to start a family.

Last year, she decided to go off birth control and start casually trying. After eight months, she visited a fertility clinic and took some tests which revealed that her ovarian reserve was a little low. She says because she was 34, and not say, 30, she was told it would be a good idea to take more tests.

But an hour before her appointment, she learned that the clinic wouldn’t accept her insurance. So she canceled.

Before she could reschedule, she realized there was no need: Her period was late. She is currently 12 weeks pregnant.

When she delivers, she’ll be 35. She says while that sounded old to her when she was 20, it doesn’t quite seem deserving of being called a “geriatric pregnancy,” the term used for pregnancy in people 35 years and older.

Thirty-five has commonly been cited as the upper threshold of female fertility. That’s when “advanced maternal age” kicks in. “The term is intended to highlight the increased risk of complications that can occur with these pregnancies, such as difficulty conceiving, miscarriage, birth defects, high blood pressure, and gestational diabetes,” according to the National Women’s Health Network.

But a research letter published April 6 in the Journal of the American Medical Association, has reignited the conversation around fertility, especially for people in their 30s. The study suggests the reproductive window for people in the United States has increased over the past six decades, due to both menstruation starting earlier and menopause occurring later.

The observational study, led by epidemiologist Duke Appiah, tracked the data of 7,773 women from 1959 to 2018, from ages 40 to 74. During those 60 years, the average age of menopause increased by 1.5 years, from 48.4 to 49.9, while the average age of a first period was lowered by 0.8 years, from 13.5 to 12.7. Using that data, women’s average reproductive life span was extended by 2.1 years, from 35 to 37.1, Appiah’s team concluded.

Women who had menopause from medical treatments, who went into natural menopause before 40 or after 62, or identified as a race or ethnicity other than Black, white or Hispanic, were excluded from the study. That means the study did not include any Native American women or women of Asian descent.

Some OB/GYNS warned against misinterpreting the study to mean that those in their mid- to late 30s have fewer fertility issues than previously thought.

“If your menopause is later, your opportunity for fertility may be longer, but it may not be. The real concern as we get older is about the quality of the eggs,” said Bernadith Russell, a New York City-based obstetrician-gynecologist. “It’s not about can you get pregnant, it’s much more about, can you stay pregnant?

Russell also notes what she calls a “predatory” societal pressure to have children early, noting that the social media feeds of her patients are often full of ads about fertility centers and egg freezing.

“There’s a lot of messaging for women to get home and get to having some kids. Get to it as your time is running out,” she said.

But Russell points out that a person’s eggs being ready and being ready are not the same thing.

“As a gynecologist, I agree, in a sense, that as soon as your life is ready would be a really good time to do it,” she said.

“It’s about when my life is ready. And that is the harder piece of the puzzle. Looking at it right now, it doesn’t look like my life is going to get ready until I’m in my mid-40s and my eggs may not want to contribute at that time. So I might want store some eggs because of that,” she said.