Everything you need to know about having a baby after 35
Husband Oliver Son Luca Miller, Maile And
Women over 35 who are thinking of having a baby are often anxious about their prospects of success. They’ve read articles in which the age of 35 is compared to a fertility cliff for females. They’ve been told that once they go over that edge, their egg quality will start to decline, and their chances of conceiving will plummet accordingly.
They are right to be worried. A woman’s egg quality tends to hold until the age of 34 or 35 and drop thereafter,” says Dr John Kennedy, medical director of Thérapie Fertility.
“At 32 years old, your chances of having a baby from a single egg are 3.5%. Your chances at 40, when your egg quality has deteriorated significantly, are 1%. Over time and with repeated trying for a baby, the difference between those two figures can be the difference between success and failure.”
However, that drop in egg quality is not as precipitous as sometimes portrayed. Take for example the oft-quoted statistic that one in three women aged 35 to 39 will not be pregnant after a year of trying. What people don’t realise is that it’s based on data from the 1700s — a time when women’s health and nutrition levels were nothing like they are today.
Modern data paints a more optimistic picture. Of the 2,820 Danish women trying to conceive in a 2013 study, 84% of those aged 20 to 35 did so within a year and so did 78% of those aged 35 to 40. That’s only a 6% difference.
Conception is only the first step towards having a baby and a woman’s age can have other negative consequences. “The risk of early pregnancy loss goes up,” says Dr Kennedy. “It’s 20 to 25% of all pregnancies in women under 30 and up to 50% in women over 40. There’s also an increased risk of chromosomal abnormalities.”
While these are valid concerns, figures from the Central Statistics Office show they are not deterring women from having babies in their late 30s and into their 40s. In 2021, there were 58,443 babies born in Ireland. 18,853 of these were born to women aged 35 to 39, another 4,561 to women aged 40 to 44; and 256 to women over 45. That adds up to 40.5% of all babies being born to women aged 35 and older.
There are various reasons for this. Edwina Oakes is a psychotherapist and counsellor at Cork Positive Therapy Centre and chairperson of the Irish Fertility Counsellors Association. She sees a wide range of ages in her practice. “But the majority of clients I see are in their 30s to mid-40s,” she says. “The average age to marry in Ireland is the early 30s so it’s only natural that those are the years the majority of people start to think about their fertility.”
It’s common for women today to gain third-level qualifications and to try to reach a certain level of seniority in their careers before settling down to have a family. They also have to go through a process of trial and error before finding the right partner. Years can go by, and they can easily find themselves aged over 35 by the time they are ready to have a baby.
With their chances of conceiving decreasing the older they get, it’s important for women to be aware of steps they can take to mitigate against this. Getting the right nutrients in their diet is one of the most important.
Jemma Henry is a registered dietitian who specialises in fertility. She firmly believes that nutrition has a role to play in optimising the chances of conceiving.
“There are so many different factors involved in fertility, some of which can’t be changed such as our age or genetics,” she says. “But we know that nutrition can influence our hormones, egg quality, sperm quality and body weight. By focusing on modifiable factors like nutrition and lifestyle and by making positive changes, we can improve the likelihood of conception and pregnancy.”
She recommends starting with a balanced diet. “A Mediterranean-style diet that is characterised by whole grains, fruits, vegetables, legumes, nuts, seeds, olive oil, a low amount of red meat and a moderate amount of poultry, fish, eggs and dairy is best,” she says.
There is science to prove it. A 2018 Harvard study found that folic acid, vitamin B12, omega 3 fatty acids, and healthy diets such as the Mediterranean one were linked to positive effects on fertility. Trans fats, diets rich in red and processed meats, sweets and sweetened beverages were found to have negative effects.
Folic acid is crucial, according to Henry. Women are advised to take 400ug of folic acid to prevent neural tube defects,” she says. “It has also been associated with promoting egg quality.”
She advises taking vitamin D too. “It’s thought to play a role in fertility as there are receptors found on the ovaries, sperm, and testicles,” she says. “It’s found in oily fish, eggs, and fortified food but as our diet isn’t sufficient to support adequate intake and sunlight isn’t widely available in Ireland, we should all take a 15ug supplement during the winter months.”
Iodine and iron are two other critical nutrients. “Iodine is important for babies' development and iron for maintaining regular ovulation,” she says. “Iodine is found in milk, yogurt, and white fish and iron in lean meat, kidney beans, chickpeas, eggs, dark leafy vegetables, and fortified cereals.”
Henry also recommends that her clients eat oily fish for its omega-3 fats, lots of fruit and vegetables, and foods rich in zinc and vitamin B12. “Omega 3 has anti-inflammatory and antioxidant properties that protect female eggs from damage as they mature,” she says.
“Eating an array of different coloured fruit and vegetables will provide a mix of antioxidants that will help nourish those eggs. Zinc contributes to healthy egg development and can be found in whole grains, chickpeas, lentils, and seafood while B12 is crucial for maintaining a healthy pregnancy and can be found in fish, poultry, eggs, dairy products, and fortified cereals.” She discourages them from eating other foods. “I advise minimising processed foods and foods that contain high levels of sugar or trans fats as they can contribute to oxidative damage that can affect egg and sperm quality and overall fertility health,” she says.
Too much coffee is off the menu. Coffee should be minimised to two cups per day as there is a link between high levels of caffeine and an elevated risk of miscarriage.
“I also tell clients to minimise their alcohol intake as it’s been associated with reduced fertility in women,” adds Henry.
This advice doesn’t just pertain to women. Both the egg and sperm need to be optimised to make a baby, so men also have to up their game.
“A man’s fertility is just as important as a woman’s,” says Henry. “Males are responsible for up to 30% of infertility cases and contribute to 50% of cases overall. They too should follow a nutrient-dense Mediterranean-style diet for its anti-inflammatory and antioxidative effects to protect and nourish their sperm and to promote their overall fertility.”
Dr Kennedy advises women to pay attention to their BMI. “It’s been shown to have a role to play in success rates,” he says.
A 2018 German study implies that it may be even more important than that. Not only does it find that the higher a woman’s BMI, the lower her chances of conceiving. It also finds that the higher her BMI, the higher her risk of developing complications such as gestational diabetes and preeclampsia.
Exercise can help with this and it’s yet another lifestyle factor that women can control. According to this 2007 review of 17,544 American women moderation is the best approach. Thirty minutes of moderate-intensity activity five times a week boosts female fertility but too much high-intensity exercise can have a negative effect.
Stress is another factor that’s often linked with failure to conceive. But Oakes isn’t convinced. “The relationship between stress and infertility has been debated for years but I’ve seen no research evidence to suggest stress has an impact on our reproductive system,” she says. “What is clear is that the inverse applies: infertility can cause stress, with women reporting elevated levels of anxiety and depression.”
Dr Kennedy agrees. “Levels of stress go up as couples try to conceive and that makes the whole process so much harder,” he says. “Anything that can be done to manage those stress levels is a good thing.”
Oakes recommends reaching out for support. “The majority of people experiencing infertility do not share their story with family or friends,” she says. “There is no need for it to be a silent struggle. There are specialist fertility counsellors to support them and talk them through their fertility journey.”
While it’s important that women and men know there are things they can do to enhance their fertility, it’s just as important for them to remember that the older they are, the sooner they should seek fertility advice. The HSE recommends doing so after one year of trying if you are under 35 and after six months if you are older than 35.
Dr Kennedy urges them not to delay. “Getting checked doesn’t have to mean getting treatment,” he says. “All it means is taking control of the narrative as much as you can, arming yourself with information about your current state of fertility, and finding out about the options that are available to you.”