Midlife and Childless

Midlife is also a time when a not insignificant percentage of women face the fact that they do not have, and may not ever have, children (it is also a time that many midlife women with teenagers wish they were among the childless ranks...)

Frequently, this is accepted and reflects a decision made years previously, but many times the realization is a shock.

Waiting longer for babies may mean not having them at all. This may be OK and planned, or may be something which "just slipped on by" and is now perhaps beyond your grasp.

Many women temporarily put off childbearing for their careers, "climbing the corporate ladder." It's their 15 year plan: work your tail off for a dozen years, get married somewhere along the line, have children in your late 30s or so. Sometimes that may slide into the early 40s. Many think that women regularly have babies into their 40s--no problem.

The fact is, fertility declines with age faster than modern pop culture has suggested. By age 42, almost 90% of a woman's eggs are chromosomally abnormal, most incapable of being fertilized (and when they are, with a higher rate of abnormal pregnancies). Certainly, the fertility percentage of a woman in her mid 30s is less than 50% of a woman at age 25. A woman's reproductive pinnacle is at age 27, with fertility falling off thereafter. By her late 30s, this percentage is 25%; by 42-43, it's down to less than 5% of her 20-something counterpart.

According to the last census, one in five United States women between the age of 40 and 44 are childless; of high-achieving women earning $100,000 or more a year, almost 50% have no children!

Despite miracle advances in so many areas of medicine, the inevitable biological clock ticks on. Seeing medical miracles in women in their 50s (even 60s) having babies, many women have come to think that there is no problem having babies in their 40s.

Yes, midlife women can have babies, but the options for women over 40 are often limited to using donor eggs or surrogates.

Also unfortunate is how these biological facts collide with competing messages faced by both men and women building careers.

Many women consciously pick a career over having children. But many women don't. "...the time just came and went... By the time it was too late, I didn't know it was too late..."

Additionally startling are pregnancy outcome statistics for women over the age of 40. The miscarriage rate climbs precipitatously and is over 1 in 3 by the early/mid 40s. Likewise, the rates of preterm birth, pregnancy induced hypertension (toxemia) and c-section also soar. The risk of having a child with trisomy-21 (Downs Syndrome) is 1 in 200 at age 37/38. This increase to 1 in 100 at age 40. By age 45 it's more than 1 in 25.

The odds of a genetic disorder increase steeply in women by their late 30s and early 40s-- especially into their mid 40s.

As women age, so do their partners. The increased genetic mutational liability shouldered by midlife women extends to their male partners as well. Among other maladies, the rate of schizophrenia, for example, in adult offspring of "older" men increases precipitously, especially when these fathers are in their late 40s, 50s and 60s.

Cryopreservation of Ovarian Tissue

Cryopreservation (freezing) of potentially fertilizable eggs could have great value for women undergoing egg-toxic chemo– or radiation therapy, or for those women who wish to forego childbearing until their 40s.

Although fertilized human embryos have been successfully frozen for many years (and successfully used in most IVF programs) the successful cryopreservation of human unfertilized eggs has been elusive; the reporting of successes have been relatively few and far between. This is surprising, since cryopreservation has been performed in other mammalian eggs for quite some time.

New work is being done presently with freezing actual ovarian tissue (collected usually by laparoscopic biopsies) isolating primordial and primary follicles, and successfully cryopreserving these cells (although fertilizability and embryo normality is still unknown).

Look for this work to continue. I predict the time is not far off when women will be able to cryopreserve either individual oocytes, or a small portion of ovarian tissue, for later fertilization and IVF embryo transfer.

So, to the 20-25% of you reading this book who are childless: you are not alone. Hopefully it is by choice. If by chance, and if you want it badly enough (and have the funds to see it through), consult your local gyn reproductive endocrinologist (fertility specialist).  SART (The Society of Advanced Reproductive Technologies)  (205) 978-5000) can advise you where to find someone who can help.

The take-home message: choose, or biology will do it for you.