Health

Planning On A Family?

Busy plotting your career? Here's what to consider if motherhood is part of your plan too

Family Planning

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A friend of mine used to have a postcard displayed on her fridge featuring a picture of a 1950s comic strip woman, a` la Roy Lichtenstein, with huge cartoon tears pooling in her eyes. The word bubble above her head read: “I can’t believe I forgot to have children.”

It was a joke, of course. My friend was too busy—and too happy—with her big social circle and the plate- spinning act of attending graduate school while holding down a full-time job to consider having kids, much less regret not having them. Fast-forward to the present and that postcard is nowhere to be found. My friend confided recently that she’d love to get pregnant, but she’s single and uncertain if she’s up for solo parenting. As she approaches her late 30s, though, she’s not sure she has any other option.

Welcome to the modern woman’s dilemma. We have opportunities for work, travel and education that our grandmothers never imagined. Those gains in equality coupled with a pharmacy’s worth of birth control choices have granted us unprecedented control over our lives. And given that freedom, women are increasingly deferring domesticity until after other adventures. In the 1960s and ’70s, women married for the first time at 22, on average. Now it’s 29. As for getting pregnant, today the most common age to give birth is 30 to 34. That’s a big shift, reports Statistics Canada: As recently as the late ’90s, women 25 to 29 were the ones having the most babies.

The downside to this delay is that our bodies haven’t caught up to social progress. For women, fertility peaks in our 20s and begins to decline—sharply—after 35. According to Dr. Andrea Lobo, a family physician at Planned Parenthood Toronto, “Statistics have shown that women under the age of 35 have a 20 percent chance of getting pregnant any time they have unprotected intercourse. For women over 40, it’s two percent.” For someone enjoying the thrills of her 20s, those years might seem a long way off, but Dr. Lobo says it’s important for young women to realize that “fertility is not life- long.” During her patients’ regular physicals, she tries to have a discus- sion about their future pregnancy plans, reminding them “not to leave it too long.”

Nikki Gore, a marketing consultant in Toronto, wanted to have all her kids before she turned 30. By the time she married her husband, Doug, when she was 27, she’d already tossed her birth control pills. “We had good jobs, we had done a lot of travelling, I was super healthy, we were ready,” she says. But then nothing happened. It took a year for her to get pregnant and she gave birth to their first son when she was 29. “When you’re healthy and you’re young, you think, ‘How hard can it be to get pregnant?’ Well, actually it can be incredibly hard.”

Indeed, a dizzying number of factors can affect fertility, including the length of your menstrual cycle, your egg quality, and any trouble with your uterus or fallopian tubes. Another is a lack of knowledge about your own body’s natural rhythm. While most women ovulate on day 14 of their cycle, for instance, others have longer or shorter cycles, so they may ovulate sooner or later. And in any given month, a woman might be thrown off schedule due to illness, travel or stress.

Medical issues such as endometriosis (a condition in which the tissue that lines the uterus grows in other areas of the body) or polycystic ovary syndrome (a hormonal disorder) can affect fertility. Untreated sexually transmitted infections such as chlamydia and gonorrhea can damage your fallopian tubes—so using condoms is one of the simplest things you can do to protect your reproductive health well before having a family is on the agenda. Depo-Provera, an injectable, hormonal form of birth control, can take up to a year to clear your system. So women who want to get pregnant soon shouldn’t consider this method, Dr. Lobo says. And while the pill doesn’t have any impact on fertility, she suggests women stop using it a month or two before they plan to start trying to conceive, to allow themselves time to figure out their body’s natural cycle.

Smoking is a no-no—it can lead to early menopause and it damages your cervix, fallopian tubes and ovaries; toxic chemicals in cigarettes interfere with estrogen production and can make eggs more likely to have genetic abnormalities. Too much booze and caffeine can also wreak havoc on your cycle. Body weight is another issue: Being either over- or underweight may have an impact on estrogen production and affect ovulation. Then there’s the XY factor: your partner’s fertility. Your body might be ready and raring to get pregnant, but he might not have healthy sperm or enough of them.

Much of this is within a woman’s control, or can be remedied by medical intervention. Dr. Lobo recommends that a woman who wants to get pregnant start by having a checkup and talking to her family doctor, and then charting her cycle to figure out when she’s ovulating. There are even kits available over the counter, devices similar to home pregnancy tests, in which you pee on a plastic stick to deter- mine which days you’re most fertile. But if you aren’t successful in getting pregnant, Dr. Lobo advises seeing a medical specialist after
a year of trying—or even sooner if you’re in your 30s, or have a known condition that may affect fertility, such as infrequent periods or a history of eating disorders.

Age, however, is one factor where medical science has its limits, says Dr. Ellen Greenblatt, clinical director of the Centre for Fertility and Reproductive Health and IVF Unit at Toronto’s Mount Sinai Hospital. “There really is a biological clock and that’s the bottom line,” she says. Although her clinic offers the most effective infertility treatments available, such as drugs to stimulate ovulation and high-tech procedures such as in vitro fertilization, “assisted reproductive technology cannot bypass the aging process,” she cautions.

It boils down to egg quality and egg quantity, both of which start to decline in your 30s. As you age, the number of genetically abnormal eggs you have increases. That’s why older women are more likely than younger ones to have children with genetic conditions such as Down syndrome and spina bifida, and why they’re more prone to miscarriages. (If you’re under age 35, you have about a 15 percent chance of miscarriage. For women over 45, the risk is up to 50 percent.) Dr. Greenblatt adds that medical problems, such as untreated STIs and endometriosis, tend to “catch up with you” the longer you wait to get pregnant, and that can lead to problems conceiving as well.

Although delaying motherhood is easier than ever, thanks to access to birth control—in particular the pill, which has liberated and empowered women by enabling them to have control over their own bodies—it may also have an unexpected downside: It’s lulled some into thinking they have more control than they actually do. Gore, who was on the pill from age 18 to 27, says regulating her cycle enabled her “to take it for granted. Then when I went off it, I underestimated how long it would take for my cycle to return to my natural one.” Gore has had two more boys since her first, one born when she was 34 after years of trying, and the last conceived unexpectedly on a trip to Paris with her husband to celebrate her 40th birthday. “There’s only so much you plan,” she says, considering her longer-than-expected path to parenthood, which included three miscarriages. “Sometimes you need to let nature take its course.”

She adds that before she and her girlfriends tried to get pregnant, “there was no question in our minds that we’d be able to have kids whenever we wanted.” Later on, she says, when pregnancy didn’t happen as quickly or easily as they’d expected, “we were ask- ing each other, ‘What more do I have to do?’”

Dr. Lobo puts some of the blame for this on a lack of public aware- ness about fertility issues, as well as tabloids that celebrate every baby bump without educating people about what might really be involved in trying to conceive after age 35. “A lot of younger women see Hollywood actresses in their 40s having kids, but it’s never mentioned how these pregnancies came about,” she says. She points out that the prevalence of twins among older celebrity moms is often an indicator that they used fertility drugs or had IVF, but the implications of that don’t get covered in the glossy magazines. “It can give young women a false sense of security: They think, If Julia Roberts can do it, so can I. But we’re doing young women a disservice if we don’t let them know that while becoming a parent is a tough decision and a big decision, they can’t delay that decision forever.”

Even new technologies such as egg freezing, which allows a young woman to put her healthy eggs on hold until her future self is ready to become a mom, are still considered experimental, says Dr. Greenblatt. (For more on the procedure, see our “Baby Boons” sidebar, page 132.) Her concern is that a woman will freeze her eggs as an insurance plan, only to find out years later that she is unable to conceive with those frozen eggs, and then she might have no options left to try.

“I have more and more educated and successful women in my office every day saying, ‘I wish someone had explained this to me earlier,’” Dr. Greenblatt says. “We use the term ‘family planning’ as a euphemism for birth control, but we really should be family planning. Just as you plan your career, just as you plan your education, just as you plan your RSP, you have to plan your reproductive life. Because there are no guarantees.”

MORE ON FAMILY PLANNING:

Q: Can I choose the sex of my baby?

A: When Victoria and David Beckham welcomed baby Harper Seven—their first daughter in a brood of three boys— gossipers speculated that they’d resorted to “sperm spinning” to get the girl of their dreams. Also known as sperm selection, the procedure involves a doctor sorting sperm in a lab based on whether they’re carrying Xs (girl) or Y (boy), then the preferred swimmers do their swimming. Different labs use different proprietary methods, but Y sperm are lighter and swim faster, so you can use those characteristics to sort them, says Dr. Timothy Rowe, head of the Division of Reproductive Endocrinology and Infertility at the University of British Columbia.

While choosing a baby’s sex via a medical procedure has been possible for years, you may not know it if you live in Canada, where it’s been illegal since the Assisted Human Reproduction Act was passed in 2004. The issue is a moral one, but that hasn’t stopped Canadians from hopping over the border and paying thousands of dollars to private U.S. clinics, which can legally do the procedure and claim a success rate of 91 percent for girls and 76 percent for boys.—Jacqueline Nunes

Q: Are older moms more likely to have abnormal eggs?
A: Your eggs are just as old as you are—you’re born with all the ones you have. And the likelihood of those eggs developing chromosomal abnormalities also increases with each passing birthday. For instance, the risk of having a baby with Down syndrome, one of the most common chromosomal disorders, begins to spike—exponentially—around age 30. For a 25-year-old mom, the incidence is one in 1,200; at age 35, it’s one in 350; by age 45, it’s one in 30, according to the U.S.-based National Down Syndrome Society.

In Canada, women of an “advanced maternal age” (meaning 35 or older by the delivery date) can be referred for extra prenatal screening. Doctors can do specialized ultrasounds, called nuchal translucency screening, around 11 to 12 weeks, to measure the thickness of an area at the base of the baby’s neck. It’s surprisingly accurate in determining whether a baby has Down syndrome or some other chromosomal abnormality. An even earlier (though riskier) test, chorionic villus sampling, can be done at nine to 10 weeks by inserting a fine tube through the cervix to take placenta cells, again to look for chromosomal abnormalities. “It’s the earliest thing that can be done to rule out problems,” says Dr. Timothy Rowe of the University of British Columbia.—J.N.

BABY BOONS
Reproductive technologies can give new hope—but they still have their limits

IVF: Though some people may view in vitro fertilization as a backup plan, the difference of just a few years in age has a major impact on how well it works. For women under 35, the live birth rate is 38 percent for each treatment cycle started. But for those age 40 and older, the success rate is just 11 percent, reports the Canadian Fertility and Andrology Society, which tracks stats from 28 clinics nationwide. To help forecast your chances of success, try ivfpredict.com, a free, new online calculator developed by researchers from three U.K. universities, based on a patient database compiled over years of conception attempts.

EGG FREEZING: Freezing embryos has been possible for two decades, but the ability to preserve unfertilized eggs—to be thawed, fertilized and implanted years down the road—is a relatively new breakthrough. Clinics such as Toronto’s LifeQuest Centre for Reproductive Medicine gear their egg freezing service as an option for women 19 to 37. (In fact, they don’t offer it to those over 37, since after that, the quantity and quality of eggs decline rapidly.) While the technology may offer a chance to extend your window of opportunity (or at least keep it cracked open), it doesn’t mean you’re certain to conceive later—just as IVF isn’t a sure bet for all. As the LifeQuest website cautions: “Egg freezing is still considered a research procedure and there are no guarantees that a pregnancy will be achieved.”—R.G.