Risks of Forming Babby
September 17, 2012 12:27 PM   Subscribe

My partner is in her her mid-30s. We've got at least a year before we're in a position to be trying to have children. Just how freaked out should I be about the increased risk of health problems in the kids/etc?

I'm a guy, dating a fantastic woman. I love her and I want to marry her and have kids with her, but right now we're both in a pretty unstable, low-income place (grad school). Our timeline has us both graduating and (knock wood) employed in decent jobs in about a year. The plan that we've discussed is to get hitched after we graduate, and start trying to have kids then. That puts her in her mid-to-late thirties, depending on the exact particulars. I know it's possible to have kids well into the 30s without too many problems (my mother was in her mid 30s when I was conceived, and I turned out alright, except for this whole "going to grad school" lunacy), but I've read a lot of Fear, Uncertainty and Doubt about these things. I realize this is likely to get a lot of anecdotes (which are not the singular form of "data"), but I guess I'm just hoping for some pointers to things I should read/know about the risks, and ways to minimize them.
posted by anonymous to Health & Fitness (31 answers total) 22 users marked this as a favorite
Just FYI, if you're close to her age, you should also look at the risks of advanced paternal age if you're worried about this. Your age affects your reproduction just as much as hers does, so you'll want to look at the data on that as well. It's a somewhat new field of research, but there's a lot to look at there, including recommendations for specific things you should be doing now to lower your risks of infertility and/or birth defects. Don't just make this about her when it's about both of you.
posted by decathecting at 12:34 PM on September 17, 2012 [22 favorites]

Your sperm is also a significant issue.

The primary decisions you will be making will concern the prenatal testing that is recommended for women in that age range. There isn't a way to prevent or minimize the risk that various defects and problems that can occur. Your choices will be more about identifying them and terminating the pregnancy or treating the resulting medical issue. There are also risks to the mother that increase with her age, but from what I've read most of those aren't preventable either. Good medical care can reduce the impact they have on her and the pregnancy.

Working with a good doctor who is well-versed in the different risk-profiles that come with advanced maternal age (sorry to use that term) would be a good idea, and depending where you live, the time to start looking for that ideal doctor is sooner rather than later. Many of the better OBs here in NYC aren't taking new pregnant patients.

The other issue is potential infertility, which I am not well-versed in, but there are multiple options, each with their own risks and side-effects.
posted by the young rope-rider at 12:42 PM on September 17, 2012 [4 favorites]

This may help, although I do realize there are millions of articles on this subject.

I was 42 when I had my child--no problems whatsoever for both of us, thankfully. I must say, however, putting a child into daycare costs about $12K/year, for five years. That's $60K before she gets to kindergarten. I wish my mother would have watched her but she would have nothing to do with that after having raised 5 of her own kids.
posted by waving at 12:42 PM on September 17, 2012 [2 favorites]

Not sure if this really answers your question, but you seem to know logically that, under the care of a physician, this is not toooooo big of a deal. On the other hand, if you *do* have a kid, you're going to have, like, 25 years of Fear, Uncertainty and Doubt to deal with. Plenty of things can go wrong even if the birth goes right. Surely you've spent some time around teenagers, right?

My point is it might be worth doing a bit of cognitive re-arranging here to determine how you really feel about having kids.
posted by Brittanie at 12:44 PM on September 17, 2012 [3 favorites]

Congratulations, they'll label yours a "geriatric pregnancy"! Fun and reassuring, huh? Don't panic, somewhere around 1/4 of U.S. births these days fall in that category (mother is 35+).

IANAD, but my anecdata is that my wife and I just went through a geriatric pregnancy and our son is beautiful and healthy. Ditto many of our friends. So much of your child's quality of life is determined by genetics- are there incidents of chronic disease or developmental problems in your family history? If so, or you're otherwise concerned, you can get genetically tested to your hearts' content.

Aside from that, the best thing your wife can do, IMO, is be in shape. Eat well. Being pregnant is tiring. Just looking at my wife made me tired. It's particularly no fun on your knees and back.

Have a frank discussion about abortion, and how far into the pregnancy you're willing to go and still abort. You'll have a series of tests during pregnancy to identify the odds (usually infinitesimal) of various serious disorders in the fetus, which you should use these as mileposts in that discussion.
posted by mkultra at 12:45 PM on September 17, 2012 [3 favorites]

Having a child is a fundamental leap of faith. It is a long adventure in trying to be prudent and well-informed without spiraling into paranoid insanity. Start now. Do the very basics (eat right, exercise, find a good OB/GYN) and let go of the rest.
posted by Ausamor at 12:49 PM on September 17, 2012 [7 favorites]

Book an appointment with a fertility specialist. FWIW, my wife had kids at 37 and 44 if you can believe it. The first child was no big deal in terms of the problems you are wrestling with, but our second child was certainly a nail-biter in terms of waiting for the Downs Syndrome test results.

In short, I wouldn't worry too much about it.
posted by KokuRyu at 12:49 PM on September 17, 2012

I would not worry, there are risks no matter what age you are. It is possible to become pregnant at a younger age, men carry DNA that may (I stress the word MAY) as he gets older.

I conceived my daughter at 38 and gave birth to her at 39. The doctors scared the living daylights out of me. I took all of the tests and did everything they asked. I had a healthy baby who is now going to be five in a week. My mother told me that I was insane to listen to everything they said about how there was a possibility of having a child with a birth defect. I switched to a different OB/GYN (for convenience and not because I didn't like the other doctor) and the new doctor looked at my chart and asked what on earth made me think I needed so many tests and sonograms. One of the questions my mother asked me and told me to think about was if I would actually have an abortion if I found out my child may have a birth defect. If not, then why bother with all of the tests? In a way, my mother was right. I would have given birth to my child regardless of what was to happen because I didn't believe in abortion so it was silly to go through all of the testing I had.

Everyone will give you all sorts of advice and tell you what may or may not happen. In 100 births, there are 100 individual cases and situations. Don't worry so much and just go and make a baby when you are ready. Everything will be fine.
posted by Yellow at 12:50 PM on September 17, 2012 [3 favorites]

The stats/docs will always scare you with known statistics; and statistics mean if you are one of them.

For birth defects:
At age 25, 1 in 1,250
At age 30, 1 in 1,000
At age 35, 1 in 400
At age 40, 1 in 100
At age 45, 1 in 30
At age 49, 1 in 10

Now you can do what some do--genetic testing. I was 36 when I was pregnant with our first. We tested for Downs, spina bifida, and other major genetic anomolies and defects. We also did amnio. All are optional because in the end, you can look at the answers of it being a positive test as two ways: 1) to prepare you if something goes wrong or 2) choice to terminate.

The stronger issue is fertility. For men you can have anything from slow swimmers to no tails to defective sperm. For women you have a whole plethora from blocked tubes, not ovulating, PCOS, endometriosis, diminished ovarian reserve, and the lovely "who the hell knows why you can't get pregnant.

The genetic tests you can have done by your primary and/or gyn (we did) and they were simple blood tests. We also did update our shots (whooping, hepatitis, etc) as part of a wellness "let's get ready to rumble!"

The fertility though depends on your insurance. With most insurance companies you have to try a year prior to going to assisted reproduction (blood tests, sperm test, and then lovely HSG to see if tubes are clear). But hey, who REALLY knows if you've been trying for a year or not (call your insurance to find out particulars).

And each case will vary. Some women have trouble conceiving at 25. Some in their 40s after having a first child (secondary infertility). Some are all fine and dandy and pop those kids out like rabbits.

The smartest thing you can do is determine when you comfortable with your situation in having a child. If you feel that grad school will financially and emotionally stress you both out then wait because those cute newborns are hard work. But you know, honestly, I don't know of many people who are 100% ready.

The other option is to freeze her eggs/embryos now and transplant later. As long as you have healthy eggs/embryos, transfers are fairly successful.

Just don't wait too long for the whole kit and kaboodle. I had to go through (easy) assistance at 35 to get pregnant. I went back when I was 39 to see my chances of having a second child.

I have diminished ovarian reserve meaning at 40 the chances of having a successful pregnancy using my eggs are less than 1%. They won't even do IVF with my eggs. Adoption or some young chick's eggs are my only option. This was by no means something I planned for nor the doc. For the most part, ALL of my testing showed that they had no clue why I couldn't get pregnant and no one would have guessed that in about 3 years, I was going to be pretty much infertile.

Good luck with your decision. Mefi me if you have questions.
posted by stormpooper at 12:50 PM on September 17, 2012 [5 favorites]

You can look at data for maternal age birth defects all over the web - it's very well studied. Here are some stats for Down's, for example - you can see the risk basically doubles between 37 and 39. You also have to calculate the risk of infertility, which rises as well. Decathecting is right that there is also a male factor here, though I would dispute that it is as time-critical.

As a couple you can do things like charting (to understand peak fertility periods and maximise your chances of conception), and going off all hormonal birth control a year before you try to conceive. You can also make sure you and she are on the same page regarding prenatal screening and termination, adoption, surrogacy and all the "what if" paths.

But all of that is just going to be guessing your own odds against a norm. A really concrete thing you can do right now is go for a fertility work-up to assess her egg age, anatomy and CM quality as well as your sperm motility and volume.

Or you can decide life happens as it happens and roll with it. My mother had my sister at 39, an "oops" baby. My sister was 40 when she had her first child, got pregnant first time. My friend just had her first at 41. Conversely, it took my cousin 18 months to conceive at 30, and I had acquired infertility by 33. You really are just tweaking at the margins anyway.
posted by DarlingBri at 12:50 PM on September 17, 2012 [1 favorite]

I wouldn't worry about it but it's also an issue well worth thinking about. Bad things might happen in your life. You life might be hard. How will you deal with it and still ensure that you will be happy and healthy even under the less fortunate circumstances?
posted by discopolo at 12:52 PM on September 17, 2012

Oops, I realized some words were deleted by accident. A man's DNA may become damaged as he gets older.
posted by Yellow at 12:53 PM on September 17, 2012

One more aside, I asked my doc regarding a second child at my age what are the stats. She pretty much repeated these stats but noted that these stats are for a viable, healthy baby, which includes everything from a Downs risk to (repeated) miscarriage. So if you have questions, ask for specifics from specialists.
posted by stormpooper at 12:53 PM on September 17, 2012

You might rethink your timing plan. Assuming you're in the US, your wife would maybe not qualify for benefits right away (for instance, you don't qualify for FMLA until you've been somewhere a year). So if you're going to "wait" to graduate and be employed, you might be waiting some additional time. Plus the thought of having to take time to be a new parent while doing a brand new job. And there's always the possibility that it'll take more time and effort than you would like to actually get pregnant. I look at all that and think grad school seems like a great time to have a baby, but, hey, YMMV.

My mom was in her mid 40s when I was born, and way back in that day they pretty much figured I was going to have something going on, but I was fine. I was also a fifth child. So there's one anecdote.

But, doctors will help you through all this, and they can give you lots of answers to your fears doubts and uncertainties, if those kinds of answers will help.
posted by dpx.mfx at 12:56 PM on September 17, 2012 [4 favorites]

I just came in to suggest what dpx.mfx did. I knew several pregnant students and women with young children in graduate school. It initially seemed a touch crazy to me, but talking with one of them revealed that she'd planned it quite deliberately: it was easier to qualify for government assistance when she was low-income/a grad assistant and so her health benefits were better than what she'd get if she was entry level in many academic jobs. Additionally, her schedule as a grad student was much more flexible and accommodating than the one she had when she eventually got a hoped-for tenure track job. It depends on your field, of course, but it's something to consider. I'm not sure babies mind the tumult of graduate school as much as their parents do.
posted by PhoBWanKenobi at 1:06 PM on September 17, 2012 [14 favorites]

Just wanted to agree that having a baby in grad school is quite a bit easier than having a baby just out of grad school, especially if you are going to be in jobs where your schedule is at the whim of a supervisor or otherwise out of your control.
posted by Rock Steady at 1:15 PM on September 17, 2012 [2 favorites]

Seconding the "I think it's easier to have kids in most graduate programs than in most actual careers" idea, presuming that your wife's health insurance includes maternity coverage. Grad school is way more flex-timey than most careers, at least that was the experience of most of my friends.

Talk to a doctor about all this stuff. The change in statistical risk profiles between having a first pregnancy at 38 as opposed to 36 (or whatever the actual ages are) may be considered an acceptable risk to both of you. Or you may decide that the increased statistical risk is less acceptable to you than the potential stress you see in having a child while you're both in grad school.

Another factor is family history. My maternal grandmother had her first (of two) child when she was 41. When I donated eggs to my friends, I was 34, which was considered to be an extreme edge case by the fertility docs we were working with, until they got in there with the ultrasound and it turned out, per the doc, that I had "the ovaries of a 24-year-old." When I told him that my mum had me at 32 and her mum had her at 41, he said that rate of egg decay seems to be highly heritable.
posted by Sidhedevil at 1:16 PM on September 17, 2012

More anecdotes, but when I turned 35 I realized I had to decide soon how important it was for me to have a child, because I was most certainly not ready, financially. Because I knew the longer I waited, the more likely it would be that I would run out of time if I had fertility issues, and the greater the odds of birth defects.

My son was born a year later. Timing wasn't perfect, but he is and I'm so glad I decided not to wait.
posted by rabbitrabbit at 1:18 PM on September 17, 2012 [1 favorite]

Waiting one year is not a huge deal, healthwise, in your mid-30s. Waiting 3, 4, 5 years is.

I think finances/job situation is a more imoortant consideration here. Balancing a kid and a job is tough, as is taking maternity leave after only a short time on the job. Your partner is kind of perfectly situated to have a kid now, assuming she can finish up school well with a baby. Much better to spend a year between school and the first job caring for the baby, rather than a rushed maternity leave during the first job.
posted by yarly at 1:36 PM on September 17, 2012

I would also recommend looking closely at the risk to the mother at an advanced maternal age. My mother had my youngest brother at 39 and lost her right leg because of complications from his birth.
posted by dd42 at 1:41 PM on September 17, 2012 [1 favorite]

Paternal age definitely affects reproductive success, roomthreeseventeen. The particular issues to which advanced paternal age tends to place developing embryos at risk, and the timetable on which those statistical risks increase, are still being researched, but there is a lot of work being done on the impact of paternal aging.

Again, this is something that the OP and wife's meeting with a doctor will help to clarify. The general rule of thumb is that men over 40 should be mindful of increased risk, which is a slightly later timetable than for women. Men over 50 are considered a high-risk group by fertility docs, just as women over 40 are.
posted by Sidhedevil at 2:01 PM on September 17, 2012

"possible future wife" I should say, I guess. OP doesn't give his age, so we don't know how fast his biological clock is ticking!
posted by Sidhedevil at 2:04 PM on September 17, 2012

Assuming you're both in your mid-30s (let's say 35 years old) and are sure you want to have children together, all I can say is: no time like the present. It's easy to suppose that there's always time for children/whatever. But the reality is that it's not even all that easy just to conceive in your late 30s or early 40s without medical assistance, never mind avoiding/mitigating pregnancy, delivery and genetic complications.
posted by slkinsey at 2:10 PM on September 17, 2012

I would give up any illusion of control over fertility now. Try to have kids as soon as you can, but other than that, you have to leave yourself open to a whole range of outcomes, and though you can pursue some treatments and make some choices if things don't pan out the way you want, this isn't something over which humans have great control. I wish you luck.
posted by Miko at 4:35 PM on September 17, 2012 [1 favorite]

The time to have kids is in grad school.
posted by heyjude at 6:46 PM on September 17, 2012

I just had my beautiful and healthy son at 41. Because my experience and that of everyone else in this thread is utterly irrelevant to you and your partner, I'd recommend that you go get some tests run. For a few hundred dollars (maybe less if you can figure out how to do it on a student health plan), you can have your sperm count and motility evaluated, and/or your partner can get hormonal levels checked and have a look at the number of follicles she has in a cycle. This will give you a bit more information about your specific situation than you can get from just looking at your age, and will help you make a more informed decision about your timeline.
posted by judith at 7:17 PM on September 17, 2012 [2 favorites]

But the reality is that it's not even all that easy just to conceive in your late 30s or early 40s without medical assistance

This is an incorrect blanket statement. As a group, fertility declines for an age cohort. Plenty of individuals within that group conceive without issue. Fertility is an individual metric, not a mean.
posted by DarlingBri at 10:17 PM on September 17, 2012 [1 favorite]

The fact that you have asked this question at all, especially given the particulars you list, suggests to me you are way into unnecessary freak out mode already. You are doing what most people do in a situation like this: Focusing on the thing you feel you have the least control over which you fear might blindside you. But let me reframe what you said:

"I have a long list of factors in my life which strongly correlate to positive health and welfare outcomes for all concerned parties (both parents and child), such as: high education of both parents, good income prospects based on that education, and conservative personal values. But my entire focus is on this one known negative that I have little to no control over."

The main point I want to make is that the information age combined with certain normal, healthy cognitive biases (like focusing on the thing we have the least control over in an attempt to mitigate it) routinely leads people to give excessive weight in a counterproductive fashion to a concept of a random number generator catastrophic health event. Health outcomes really do not work that way.

So my advice is to make your peace with the parts you have no control over - the genetics part, which no one has control over at any age, and the fact that you cannot turn back the clock - and, in addition to looking at data on "geriatric pregnancies" you should also look at data on the impact of education, income, and a stable, caring family. If you live long enough, you are highly likely to face some kind of serious health event. None of us is getting out of here alive or unscathed. But the strengths you list can go a very long way towards counteracting whatever negative thing life may throw at you.

I want to really drive that point home because almost everyone I talk to seems to seriously underestimate the impact of those things we do have control over. I have a genetic disorder and I have talked to a lot of people over the years. The current average life expectancy for classical CF is about 37 in the US today. Everyone I know with CF who is older than that is well educated, does a lot of their own research, has made substantial dietary amd lifestyle changes and has better than average family and social support. Two of those individuals are in their 70's. I believe they both have PHD's. (I know for a fact one of them does. I believe the other does. But a search of my emails is failing to readily verify that.)

Please understand that when they were born, the average life expectancy would have been more like 18, not 37. That would be like a normal person living to around, say, 200. So the assets you list - education, conservative personal values, etc. - are huge. I think if you really understood that, you wouldn't have asked this at all. So my hope is to make that piece of it clearer to you than it is to 99.999% of people I talk with.

Best of luck.
posted by Michele in California at 7:47 AM on September 18, 2012 [11 favorites]

You also need to think about family size. If you intend to have just one child, you can wait a few years. If you would like to have two or more, and you want to have them a couple of years apart rather than a baby+toddler combo which can be intensive, you need to seriously consider starting now, because one baby at 35 can mean a sibling at 40 which is often very different and difficult.

I am glad for everyone who gets pregnant easily over the age of 35, but it's IMO foolish hubris to ignore the statistics. You'll hear and read lots of "I had a baby at 45!" stories because they are still more unusual than babies in your 20s and 30s, and because the people who are on the other side of the statistics are often silent because it's just bloody sad and time-consuming and painful to talk about how at 38, you're doing another IVF round and wondering why you didn't try when you were 28, would it have made a difference, etc. If you can up your chances of avoiding miscarriages, infertility and other challenges, why not?

Get tested now if you can afford it or it's covered by insurance. It's very possible that you'll get a great bill of health and can wait a few years easily without worrying - plenty of people can.
posted by viggorlijah at 11:22 PM on September 18, 2012 [3 favorites]

I will second that it is foolish hubris to ignore the statistics. Being interested in data on the risks and feedback on how to mitigate them isn't "unnecessary freak out mode". It is the way the question was asked that makes me think "you are there already and should calm down some".
posted by Michele in California at 12:15 PM on September 19, 2012

Another vote for kids while in grad school. You probably have decent health insurance, possibly access to campus childcare, and most importantly flexibility.

Now that I'm a tenure track professor with a preschooler, I know I could never have the leisurely pregnancy and early baby year as I did as a grad student.
posted by k8t at 7:31 PM on September 19, 2012

« Older Roku Grab Bag: Remote control volume? DVD...   |   How does fact checking a book work? Newer »
This thread is closed to new comments.