In the realm of birth statistics, delaying motherhood stands out.

Overall, births are on the decline in the United States, but increasing numbers of women in their 40s are having babies -- the only age group to register an uptick in the latest statistics from the U.S. Centers for Disease Control and Prevention.

Yet experts warn that waiting until your 40s to begin a family may be too late.

"In our society, especially on Long Island, women go to school first, establish their careers, and they start thinking about childbearing at an older age," said Dr. Steven Brenner, a reproductive endocrinologist, clinical associate professor of obstetrics and gynecology at Hofstra University and co-director at Long Island IVF, who sees patients in Lake Success and Melville.

But that doesn't mean that women's bodies are following the trend.

"The biology of the egg has not changed in 10,000 years, and women are not designed to get pregnant when they're older," Brenner said. "It's very age-dependent."

Yale University researchers, in fact, reported in the May issue of Fertility and Sterility that "modern women have alarming misconceptions about their own reproductive systems and the effectiveness of assisted reproductive technologies." They found that more women were coming to fertility clinics after age 43 and were upset to learn that getting pregnant at that age is neither easy nor automatic.


Fertility can begin to take a significant decline even as early as age 32, definitely by age 35, and the decline becomes more rapid by ages 37 to 38, explained Dr. Eric Flisser, the Long Island medical director of Reproductive Medicine Associates of New York in Garden City. "It's not a straight line, it's a curve," Flisser said. "And it gets steeper and steeper as you get older," with the change from 33 to 35 years old not nearly as dramatic as from age 37 to 40.

Though the textbook definition of infertility is trying to conceive for a full year without success, Brenner said that he advises older women not to wait a whole year before seeking help and that even younger women who don't conceive in a couple of months might want to get evaluated.

Flisser agreed. "There's no reason to delay seeking attention if you suspect a problem," he said. "The worst that can happen is your doctor tells you you're young and healthy, says you haven't been trying long enough and sends you on your way."

Despite what many women seem to think, the two fertility experts said, the longer a woman waits, the more difficult it generally becomes to get pregnant. Miscarriage rates go up with age, too, Brenner said.

"Eggs age differently than the rest of our bodies," Brenner said, noting that many women don't seem to be aware that their ovaries and the health of their eggs may be changing, regardless of their physique. "You may be in the best shape of your life in your 40s," he said, but "there is a true biological clock. Science really hasn't found a way to get around that."

The best option, he said, is fertility preservation, in which a woman decides at a younger age, about 28 to 32, to freeze her eggs for the future.


Dr. Pasquale Patrizio, co-author of the Yale study and director of the Yale Fertility Center, said that egg freezing is "rapidly transitioning into a successful option." Not only does it "eliminate the need of using donated eggs for late reproduction," he said, but it "would remove the psychological issues related to disclosing this to children."

According to Flisser, the most striking advancement in infertility treatment has been an improvement to in vitro fertilization, the procedure in which eggs are taken from a woman's ovaries and fertilized by sperm in a lab setting, with the embryo or embryos then implanted in her uterus. Now, he said, doctors have the ability to screen all the chromosomes and identify the presence of some diseases in an embryo.

"This is something the field has been trying to do for years," Flisser said, "but they never had the technology to rapidly test all the chromosomes -- until now."

Whatever type of infertility treatment a woman chooses, testing and treatments can range from hundreds of dollars to tens of thousands, but Flisser said the costs are increasingly being covered by insurance, which he described as a big change in the past 15 years.

Precisely what's covered, and how much an insurer will pay, though, varies greatly and depends on the benefits included in a person's specific insurance plan. For instance, some plans have a cap on total costs for infertility treatment, some cover diagnosis but not treatment, others cover only certain procedures, and some limit the number of times a procedure can be done, Flisser said.

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