Starting a Family Later in Life

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"I am over 35 years old, what should I expect?"
If you are 35 years or older, you most likely will have a normal pregnancy and deliver a healthy baby, but you can expect a longer period of time before conception, 2 to 3 times more hospitalizations, and an increase in cesarean delivery and pregnancy complications than women of a younger age.

"I took a longer time to get pregnant, was it because of my age?"
Fertility, the ability to conceive, declines with advancing age. Conception in your mid-30 may have taken you longer than it would have at a younger age.

Ovulation dysfunction is the most common reason it takes longer to conceive. As you get older your eggs are of a poorer quality and are not released each month as normally seen in younger women. In addition, older women may develop more medical (poorly controlled diabetes mellitus, hypothyroidism) and physical problems (endometriosis, fibroids, obesity) that make it more difficult to become pregnant.

All women after the age of 30 have some decrease in fertility. It just takes you a little longer to get pregnant than earlier in life. Realize it is not all your fault if it takes some time to conceive; men also have a decrease in fertility as well.

"What are the medical problems complicating pregnancy due to my age?"
The two most common medical problems complicating pregnancy in older women are hypertension (high blood pressure) and gestational diabetes.

1. High blood pressure has been associated with increased risk to both you and your baby and may worsen as your pregnancy progresses. The risks to you and the baby can be reduced by following your doctor's instructions and keeping all of your scheduled appointments. Even with this, you are at an increased risk for delivering early, having a smaller baby and delivering by cesarean delivery.

2. Gestational diabetes (diabetes that starts during pregnancy) puts you at greater risk for medical complications and your fetus at risk for growing larger than expected (called large for gestational age or macrosomia) and pregnancy loss.

"Does the baby’s risk for genetic problems go up with age?"
Yes, genetic disorders leading to babies with congenital anomalies (abnormal body structure) are seen more frequently in older parents. With advancing maternal and paternal age, your risk of having a baby with a birth defect from a genetic problem increases.

If you are over the age of 35, your doctor will recommend genetic counseling to allow you to become an informed parent. You will learn from a special educator about the genetic risks associated with advanced maternal age, your partner's risks of carrying a genetic disorder and what testing can be done.

Genetic testing will be offered at your counseling appointments. Counseling will help you to choose the type of the screening tests to be performed. You may decide to have none of the testing after your consultation; this is quite common. You may submit to testing that ranges from a simple blood test and ultrasound, to more invasive tests like a chorionic villus sampling or amniocentesis.

If you are going to start a pregnancy in your late 30s, you may want to speak to a physician to learn about the risks associated with advanced maternal age. If you are already pregnant, follow your appointment schedule and become informed about the risks. Remember almost all advanced maternal age pregnancies end well.

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