Delaying Conception: What Are The Risks?

Women are living longer these days, more are choosing careers over baby-raising in their younger years. More and more women are having healthy babies in their late thirties and even forties. Here are some figures: between 1990 and 1997, birth rates for women in their 30s rose 9.65%. For the same period, birth rates for women in their 40s rose a staggering 29%.

And there are good reasons: the mother is likely to be in a better financial position in her 40s than in her 20s; she may have learned patience and is likely to enjoy children more and have a more relaxed attitude concerning them. Also, women are putting off childbearing until later because they are marrying later in life, after they complete their education, or because they want to travel the world or get out of a bad marriage. All these experiences make for a wiser woman with a rich storehouse of experience to assist them in motherhood.

If I decide to wait, what is the downside?

Women have been told again and again that they can have it all: education, a career, and after that, children. But that rosy dream doesn't always come true; women may struggle through their 20s and 30s - working at low-paying jobs - to get their education, with the result that they're in their early 40s before their career really starts. It then becomes a choice: children or a career.

As reported in the San Francisco Chronicle, Diane Brown spent her 20s and 30s stuck in a bad relationship while studying for a master's and doctorate degree in psychology. She was 35 when she found a man she wanted to marry, and did so, two years later. Shortly thereafter, they decided to start their family. But nothing happened. "We tried for six months," Brown said. "By then I was 38. Luckily, I had a doctor who understood. I said, `When should I start worrying?' He said, `Now.' "

Waiting to have a child means increased risks for the mother: of pre-eclampsia (high blood pressure caused by the pregnancy), vaginal bleeding and gestational diabetes. The baby is at risk for premature birth, miscarriage, low birth rate, placental abruption, and placenta previa. Placentia previa is a condition in which the placenta covers the opening of the cervix, blocking the birth, and placental abruption means the placenta has partially separated from the uterine wall. These conditions cause heavy bleeding, endangering mother and baby. A Cesarean section can prevent complications from arising.

If you wait until you are 40 or older, you may not be able to conceive at all. As we age, our fertility lessens and our health risk rises. After 30, a woman's eggs are more difficult to fertilize. The American Fertility Association has said that "The chances of having a baby decrease 3-5% each year after...30 and at a faster rate after age 40." The older woman is more likely to miscarry than the younger, and among babies born to older mothers, congenital abnormalities such as Down Syndrome are seen more often. Women are born with all the eggs they will ever produce already formed in their bodies, and as they age, their eggs age also. Old eggs may malfunction. The chance of a 25 year-old woman giving birth to a Down syndrome child is 1 in 1,250, while in a 35 year-old woman the risk is 1 in 378. The chance with a 45 year-old woman is 1 in 30.

If I am found to be infertile, what are my options?

You may, of course, decide to forego having children altogether. But if your heart years for the pitty-patter of little feet around the house, help is available. But it will cost you. Insurance rarely covers infertility treatment, and only a few insurance plans cover the costs of adoption. In vitro fertilization is indicated in cases of pelvic adhesions, blocked fallopian tubes, tubal or vasectomy reversal surgery, reduced ovarian reserves, endometriosis, and other such problems. The treatment is done in cycles, and each costs $10,000 or more, and offers only a 25-35% chance of success even if circumstances are perfect. IVF treatment consists in taking eggs from a woman, fertilizing them with her partner's sperm and 3-5 days later, replacing the eggs in her uterus. If the woman cannot produce viable eggs, donated eggs may be used, but this option will add another $7,000 to $15,000 to the cost.

IUI

Another option is IUI - intrauterine or "artificial" insemination is a basic, low-tech method to increase the chance you will become pregnant. You may choose to check your own body for ovulation, and when it is detected a sperm sample will be collected. Drugs such as Clomid may be administered to promote ovulation.

The IUI itself requires no anesthesia. A thin catheter is inserted into the uterus and the sperm fed through it. The procedure takes only one or two minutes, but you will be asked to remain still for at least 15 minutes.

You may feel cramps or a bit of discomfort from the catheter. If you have taken Clovid or other drugs you may run into an allergic reaction or other problems, but your recovery should be quick and easy. This method costs less than in vitro - how much less depends greatly on what kind of drugs you take in connection with the treatment. You may pay from $750 per cycle to $15,000 per cycle.

ADOPTION

Adopting.org reports that a domestic public agency adoption can cost up to $2,500. Most public agencies will only place children with special needs. This figure includes an estimate of travel, attorney's fees, etc. Your state may reimburse you for one-time expenses connected with the adoption, up to $2,000. Other funds may be available for special needs children, but it must be arranged for before the adoption.

A private agency adoption will charge from $4,000 to $30,000, which figure includes the home study, birth parent counseling, post-placement supervision and agency costs. Some agencies operate on a "sliding fee" basis based on income.

A domestic independent adoption will cost you from $8,000 to $30,000. If you have to advertise for a birth parent (make sure this is legal before you proceed) this will add about $5,000. With this method, there is always the risk that the birth parent(s) will change their mind and take the baby back, in which case you are simply out the money.

An overseas adoption will also bite deeply into your bank account, to the tune of $7,000 to $25,000 or more, plus greatly increased stress caused by dealing with authorities who may reverse their decisions, hold you up indefinitely with paperwork, etc.

A YOUNGER WOMAN'S EGGS

Diane Brown of San Francisco, after much effort - including four tries with in vitro fertilization - finally became pregnant. Her son is now two. She wants another child but after another six tries she has given up on this method. She has now begun to think about using another, younger woman's eggs, to be fertilized with her husband's sperm. The only problem with this, besides its cost, is that the baby is not and never can be related to her.

But she feels it's her only chance. "'It's going to be a long process of adjusting,' she said. 'But my eggs are done. There is no more chance. I feel like I did everything I could possibly do.'"

Before you make any decisions on this question, be sure to talk things over with your doctor. Pre-conception counseling may help both woman and partner decide on the right thing for them.