Hidden Hope in Fertility Stats for Women 40+

Why we’re looking for luck in all the wrong places

Current conversations about fertility are failing the millions of women around the world who are 40 or over and trying to get pregnant. When we talk about when women should get serious about trying to conceive or of how much fertility declines with age, we talk past a huge community of women who are hoping to become mothers after age 40.

I remember the recurrent sorrow and crazy-making frustration of trying to get pregnant, starting when I was first ready to become a mother—not until I was 41—and lasting until I was lucky enough to conceive my first child at age 45. She was born when I was 46 and she is, I’m incredibly grateful to report, now a healthy, happy 3 and a half year old. I also remember how unhelpful much of the discussion around fertility and age was, during those years when I was trying and failing to get pregnant or to carry a pregnancy to term.

Because here’s the thing: Women like these, and like I once was, are not in the position of deciding when to have a baby or whether they should try before reaching “advanced” or “very advanced maternal age.” The ship has sailed on that one. The reality is, they are already in their 40s. And the teeth-aching desire to meet and hold their baby has not declined with age.

But I’ve realized recently that, surprisingly, the most relevant—and it turns out, most hopeful—information for my fellow 40+ year olds isn’t even found where people tend to look during discussions of fertility. Instead of focusing on studies comparing fertility at various ages or surveys of ART successes and failures, we should look to US census data on births and, perhaps paradoxically, to statistics on abortion, menopause, and sterility.

To be clear: I’m not arguing women should wait. I’m not arguing they shouldn’t. I’m saying, is that if a woman happens to be in her 40s and trying to conceive, she should know there actually is some hope, tempered though it may be. The chances are certainly smaller than when she was 25, and even 35. But that’s immaterial now. And it doesn’t by any stretch mean there is no chance. This point bears stressing and examining in the absence of comparisons with younger women.

Besides having given birth to a healthy baby conceive naturally when I was 45, I’ve also been unusually lucky to have heard from over 500 women, aged 40+ who are trying to conceive or who are already pregnant and who have found me through this blog and  left comments here or contacted me directly. I love hearing from all of you and am grateful to be privy to some of the uncensored thoughts, concerns, questions, and emotions being shared among this population.

Especially for those women 42 and older who get in touch, I hear frequently that they’ve either heard or just feel they have “no chance,” a “0%” likelihood of becoming mothers with their own eggs. A significant number also tell me they feel ashamed, have been told they’re “crazy” for thinking they might have a shot. These are the women I’m writing this for now. (And you go, ladies, for trying!)

Overlooked Stats Show Hope for Women 40+

Census statistics on live births & medical abortions

https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_03.pdf: According to the Center for Disease Control and Prevention, in 2015, there were 111,611 births, (1.1% of population) to women 40-44. This covers all births, not just births to women who were trying to conceive, suggesting that if all 40-44 year olds in 2015 tried to conceive every month, the percentage of women in this age group who’d had babies would be considerably higher. To women between 45-54 (with the great majority falling between 45-49), 8,827 babies were born.

Combining these stats with those on abortion in the 40-44 age group, (20,962), the latest age group for whom statistics were collected, and then dividing this number by 3 (accounting for expected 33% miscarriage rate), we could expect to add almost 7,000 babies, totaling close to 120,000 births. This number would actually be a low estimate, since many miscarriages occur before scheduled abortion dates.

All together, we could expect between 125,000-130,000 live births in 2015 to women 40-49. Put into context, that’s a population of babies likely greater than the total population of most of our hometowns.

Perhaps most significantly, these statistics hold steady or decline only somewhat when viewing births before egg donation was available in the US (See births 1933-1998 @ https://www.cdc.gov/nchs/data/natality/mage33tr.pdf.)

Sterility & menopause

https://www.ncbi.nlm.nih.gov/pubmed/12268772: According to a review of the literature pertaining to declining fertility with age, the likelihood of permanent sterility at age 40 is about 40% and at age 45 is about 80%, meaning one of out every five 45 year olds should be able to become pregnant at some point during their 45th year.

http://www.healthline.com/health/menopause/pregnancy#1: As explained by executive director emeritus of the North American Menopause Society Dr. Marjory Gass, pregnancy even in the mid-to-late 40s is not impossible for most women. “Never assume, ‘Oh, I’m too old to get pregnant,’” Gass has said. “Unless you have gone a year without a period–the technical definition of menopause—pregnancy remains a possibility.”

Birth defects & miscarriage

I get a lot of questions over email and on this blog about whether getting pregnant in the 40s, especially in the mid-40s, guarantees a miscarriage or a child with a genetic abnormality. Many women, myself included, field questions from family members about whether it’s even wise to get pregnant or hope for a positive outcome given the dire statistics on Downs, etc., for older mothers.

When viewed from the perspective of high the risks are compared to pregnancy at 25, the numbers do look grim. But when viewed from the perspective solely of the chances for a healthy baby at various ages throughout the 40s, the numbers are much more hopeful (and again, relevant):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071156/: “For women at 42 years of age, more than half of the intended pregnancies (54.5%) resulted in fetal loss…The risk of spontaneous abortion [was] 84.1% by the age of 48 years or older.” So yes, these are scary statistics, and they aren’t great, but they are better than many people fear and assume, especially if we look at them in reverse, from the perspective of a positive outcome rather than negative: a 45% chance of success for a 42-year old to carry a pregnancy to term, and even a 15% chance of success for a 48-year old.

https://www.ncbi.nlm.nih.gov/pubmed/6455611 & https://embryology.med.unsw.edu.au/embryology/index.php/Genetic_risk_maternal_age : The estimated rate of all clinically significant cytogenetic abnormalities at age 40 is 15.8 per 1000, meaning we can expect between 98-99% of all babies will be born genetically healthy. For age 45, it’s 53.7 per 1000, or between 94-95% of babies. Even for women giving birth at 49, only 12.5% of babies will carry a genetic abnormality, meaning 87 out of every hundred babies will be born genetically average.

So if you’re out there now and are trying to conceive in your 40s, please know that I’ll be keeping you in my thoughts and hoping you have the same good luck I—and almost 9,000 other women aged 45-49 in the U.S. last year—had. And please know that I and thousands of other women are out there, pulling for you.

The fastest way to get in touch with Tracy is here.

(Note: For more about trying to get pregnant, you can also see An Honest Take at Getting Pregnant Naturally at 45Getting Through to Getting Pregnant at 45 and On Delivering My First Child at 46, other blog posts I wrote in the hopes of supporting people slogging through infertility, although some of the content from these is reproduced in this post. I’ve also gotten quite a few questions about my pregnancy and birth experience, and I’ve written a bit more about those in the Washington Postonline and in Brain, Child Magazine online — although please note that the picture in this latter article is not my daughter! It’s a stock photo the magazine used. In any case, I will continue to keep you all in my thoughts. Finally, if you’re *still* interested in my story [bless you for your patience if so!], the story of how I met and fell in love with my husband–a bit late in life– and then went through years of IVF and finally got pregnant naturally, is in my book The Good Shufu.)

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Navigating a Safe Pregnancy in Your 40s

I’m so touched by all the emails I get from women trying to conceive in their 40s and from people interested in pregnancy at a later age. One person I loved hearing from through this blog is reporter Kristine Crane, who writes about women and health for US News & World Report‘s Wellness section. Her latest piece is “Navigating a Safe Pregnancy in Your 40s,” and it starts with our story, then goes on to look at those of other women, couples, and doctors involved in later-life pregnancies and the quest to conceive in your 40s:

At age 45, Tracy Slater, an American expat writer living in Osaka, Japan, resigned herself to the fact that she might never be a mother. After a few years of failed fertility treatments and two miscarriages, she and her husband continued trying to have a baby – but shifted their focus to Slater’s husband’s dying father.

So when Slater developed what they assumed was a stomach bug, they figured she had picked it up at the hospital while visiting him. But it turned out she was seven weeks pregnant. “They already saw a heartbeat,” Slater says. “And I’d been drinking one or two glasses of wine a night, and a cup of coffee everyday.” In addition to drinking alcohol and caffeine – not advised for women trying to conceive – Slater was also overwhelmingly stressed over the prospect of losing her beloved father-in-law.

In other words, she was not in ideal fertile conditions – and yet, she had become pregnant with her daughter. “I still have dreams they made a mistake. I still can’t believe I carried to term this healthy child,” says Slater, author of “The Good Shufu.”

While Slater’s outcome is certainly not the norm, and one she attributes to good luck, it’s increasingly common to see women in their 40s have successful pregnancies – through IVF, egg freezing, donor eggs or more rarely, as in Slater’s case, natural conception.

According to the Centers for Disease Control and Prevention, pregnancies among women in their 40s has increased by about 2 percent per year since 2000. In 2014, there were 10.6 pregnancies per 1,000 women in this age group.

Read the full article here at US News & World Report

 

The fastest way to get in touch with Tracy is here.

(Note: For more about trying to get pregnant, you can also see An Honest Take on How I Got Pregnant Naturally at 45,  Getting Through to Getting Pregnant at 45, and On Delivering my First Child at 46, other blog posts I wrote in the hopes of supporting people slogging through infertility. I’ve also gotten quite a few questions about my pregnancy and birth experience, and I’ve written a bit more about those in the Washington Post online and in Brain, Child Magazine online — although please note that the picture in this latter article is not my daughter! It’s a stock photo the magazine used. In any case, I will continue to keep you all in my thoughts. Finally, if you’re *still* interested in my story [bless you for your patience if so!], the story of how I met and fell in love with my husband and then went through years of IVF and finally got pregnant naturally, is in my book The Good Shufu.)

When parents are in the majority, kids in the minority

Grateful to the Wall Street Journal‘s Expat Blog for publishing this piece focusing on some of the issues I’m trying to work out about race, privilege, and identity as a white parent married to a native Japanese man and raising a mixed-race child in Japan.

From ‘Blind Spots’ and Other Problems in Globally Blended Families:

As a woman in a multicultural, multinational, and multiracial couple, I’ve sensed how some people assume I must be uniquely open to cultural differences, and thus uniquely equipped to raise a mixed child. But this assumption betrays a flawed logic. Globe-trotting parents in mixed marriages who grew up in the majority may be aware of racism and may even have faced it themselves, but most still lack a deeper understanding of racism during a child’s formative years.

Read more in the Wall Street Journal online.

The Unsung Benefits of Marrying a Man Who Isn’t Fluent in your Language

Fun at the Four Stories event at the Tokyo International Literary Festival 2016, where I answered questions about about multicultural, multilingual marriage; finding love in another world; and, of course, The Good Shufu!

Here, I’m sitting next to my Four Stories co-reader, Jake Adelstein, author of the knockout book Tokyo Vice: An American Reporter on the Police Beat in Japan.

8 Months Old, Still #1 on Amazon Japan for Foreign Women’s Bios

Two fun pieces of Shufu news this week: As the book turns 8 months, I’m hugely grateful that it’s still making it to the very top of Amazon Japan’s list of women’s bios in foreign books. And I know it’s childish of me, but I have to admit to a little internal fist-bump with myself when I see it edging out Gilbert’s Eat, Pray, Love, on this list at least.

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The second piece of news is that the lineup has been announced for the only English-only official event at the Tokyo International Literary Festival 2016, and I’m really excited to be reading alongside Jake Adelstein of Tokyo Vice fame, Roland Kelts, author of the much-known Japanamerica, and Marc Kaufman, also known as the smarty-pants, stellar short-story writer and assistant prof at Sophia University. Here’s the info on TILF’s Japanese site (http://tokyolitfest.com/program_detail.php?id=105), but, you know, it’s in Japanese…. So here’s the info in English on my author site too: http://www.tracyslater.com/events/

The Good Shufu Does the Tokyo International Literary Festival

Thrilled to be a featured author at:

The 2016 Tokyo International Literary Festival | March 4 | Sophia University | Tokyo, Japan

As part of the event Four Stories at the 2016 Tokyo International Literary Festival, I’ll be reading from The Good Shufu along with three other acclaimed expat authors (TBA), for an evening of stories, discussion, and mingling.

Friday, March 4, 2016
6-8pm, with mingling and drinks with the authors to follow
Sophia University, Yotsuya Campus
Building 12
Room 502
7-1 Kioi-cho, Chiyoda-ku Tokyo 102-8554

More info coming soon!

The Trailing Spouse’s Guide to Surviving Expat Re-entry

Fun having this piece on trailing spouses, accidental expats, and re-entry blues in the Wall Street Journal‘s Expat Blog today, co-authored with a new friend who is a military spouse based in Tokyo, the blogger Susan Dalzell. In it, we give a series of tips for surviving the dreaded “re-entry” phase back into your expat country after even a short trip home.

We start,

For those of us who are trailing spouses or “accidental expats”—drawn abroad not necessarily for our own careers or sense of wanderlust but for a partner’s job, family or nationality—global life presents unique challenges and sacrifices. Western culture in particular glamorizes expatriate existence, suggesting a life of global travel, international panache, and a social circle of like-minded explorers: a slightly more multicultural, perhaps sober, version of Hemingway and his brood.

Reality can hew a little rougher, though…

My favorite tip we include is this one, drawn in part from the struggles I explore and the lessons I learn in The Good Shufu:

Don’t feel guilty if you don’t always (or even ever) love your expat “home.” As a trailing spouse–especially if you’re married to someone from the country where you live–you may have asked yourself when you’re going to fall in love with your overseas home just as you once fell in love with the partner who brought you there. If you’ve recently been back to your native country, you may have heard friends and family comment on how exciting your expat life must be and how lucky you are to live abroad. But don’t let this guilt you into thinking you always–or frankly ever–have to love the land you’re in….As long as you’re fascinated by it, or even continually learning from it, you’ll have an expat life worth its weight in yen or euros or…

See our handful of other tips for surviving the re-entry blues in the full article at the Wall Street Journal online–and add some coping strategies of your own, if you have any new ones!

 

Wall Street Journal Profiles The Good Shufu

BN-LH212_japanb_G_20151116155444This weekend, one of the most thoughtful explorations  yet of The Good Shufu appeared in the Wall Street Journal’s Expat Blog by writer Debra Bruno. What I love most about Bruno’s interview is how it captured so many of the nuances and complications of both expat life and multicultural, multilingual love + marriage.

WSJ writes,

Author Tracy Slater, an American writer and academic who fell in love with a Japanese man, married him, and now lives with him and their daughter in Japan, describes her journey in a new book, “The Good Shufu: Finding Love, Life and Home on the Far Side of the World.” (Shufu means “housewife” in Japanese.)

The book is a warts-and-all account of how Ms. Slater, 48, who had barely traveled outside the U.S. when she first visited Japan to teach business English, fell in love with an Osaka salaryman, adjusted to a new culture, made the tough decision to give up her life in Boston, and spent years helping to care for an ailing father-in-law and trying to have a child in her 40s.

Ms. Slater chatted with WSJ Expat about the complications of being a western woman married to an Asian man, why she never really became fluent in Japanese, and how she struggled to keep her sense of self in Japan. An edited conversation follows.

See the full interview here. And thanks, WSJ!

My Father-in-Law Made Me the Mother I Am

BC-Logo_SquareSo happy & honored to have this piece up on Brain, Child Magazine‘s homepage. It’s about how caring for my beloved father-in-law as he died made me both a sadder and a bigger person, about how he “convinced me I could care for a child, that I’d grown big enough in the shadow of his decline to be a mother.”

It begins:

My Father-in-Law Made Me the Mother I Am

By the time I married my husband, I’d already fallen in love with my father-in-law too. Not in any weird way, but alongside all the passion and love for my husband was a deep affection for the man he lived with, the man he called Otousan.

My husband, Toru, is Japanese, and in Japan, it’s not uncommon for people to live with their parents until they marry. Toru was chonan, the oldest son, the one who should care for his parents as they age. When Toru’s mother died in a car accident, he left his company-backed MBA program at the university in Boston where I taught writing, and he moved back to Osaka. Soon after, I went too.

We moved into an apartment a few blocks from Otousan’s. Most nights, I’d cook dinner either at our place or Otousan’s, and we’d all eat together. My father-in-law spoke little English, and like many older Japanese men, he wasn’t what you’d call a loquacious fellow. But in between his silent welcoming of me as family in a country where marriage to foreigners can spell shame; his kind laugh at my dismal attempts to learn his language; and his grateful head-dips towards the tea I poured him after every meal, I grew to love him.

I may have loved my father-in-law, but I was terrified of having his grandchildren—or any child, for that matter. Not because of who or how Otousan was, but simply because having children is terrifying if you go into it with eyes-wide-open. At age 40, the year Toru and I wed, my eyes were pretty wide open.

I knew it was a myth that every mother bonds easily with her baby. I knew people who’d never bonded with their child, and one who said that, if she had to do it all again, she might choose not to procreate at all. I could imagine becoming one of these mothers.

Read the full piece at Brain, Child Magazine online,