Is Hope Ever a Negative?

I get a lot of email from readers of this blog, thanking me for the hope they’ve found in my story of getting pregnant naturally with my first child and giving birth to a healthy baby girl at 46. And I’m moved by and grateful for these messages.

But here’s a question that I can’t stop asking myself when I read messages like this: Is it possible that the hope my story provides could be a negative?

I remember hope feeling like a double-edged sword when I was trying, and failing, month after month to get pregnant. (Until, of course, I beat the odds and did.) I know getting pregnant naturally at 45 and giving birth to a healthy first child at 46 is not the norm, and sometimes I worry I’m giving people the false impression that it happens easily, or can happen for everyone.

In the end, I always come back to the thought that it’s important for people to be reminded that, although it’s relatively rare, it does sometimes happen, and with all the negatives out there that women in their 40s hear all the time, it’s important also to hear some positive stories, too, as long as they are honest.

So that’s I’m trying to do with the posts on this blog about my pregnancy.

Am I right? I go back and forth. Why is hope important to you? In what way is it helpful? Is it hurtful in any ways? I’d love to hear what you think.

And if you’ve decided that the mix of hope and infertility is no longer a positive one for you, here are some resources that might feel supportive, from the great organization Resolve.

New Online Group for Mothers 45 and Up

I’ve gotten so many emails and comments on this blog asking me about starting an online group for new mothers at or around 45, or for women who want to feel some of the hope these women’s stories can provide, so here it is!

The group can be found on Facebook at https://www.facebook.com/groups/651842948606644/ or by searching under “New Mothers 45 and Up”

Here’s the description:

A group for new mothers, moms-to-be, and the many brave women who are trying to become parents near or after 45 and who want to connect with others who have overcome the odds or are trying to do so. Hopefully, it’s a group that will balance honesty and a nod to the tough statistics facing women trying to conceive at 45; with hope and an acknowledgment that sometimes women do get pregnant after 44 and give birth to the babies they’ve been waiting so long to meet. This group has been inspired by the hundreds of emails I’ve gotten from women who’ve learned that I got pregnant naturally and gave birth to my first and only child, a healthy, fantastic, now-almost-5-year-old, when I was 46. Many of these women have asked me, either in email or on my blog, to start a group like this. I hope it offers support, hope, and community in a world that I know can feel hopeless when trying to conceive a bit later in life.

Please feel free to join us!

How Did You Know It Was Time To Stop?

I’ve been lucky to get close to a thousand personal emails from women who’ve visited this blog, women who’ve generously shared their stories and their hopes–and frequently their sadness–with me. Many have also asked me the same question: When did I know, or how did I decide, it was time to stop fertility treatments?

In my book, I wrote about how I dealt with this question, and how my answer ultimately–and with a huge dose of great luck–led to my natural pregnancy at 45 and the birth of my first child, a healthy baby girl who was born 4 months after I turned 46.

I also wrote about how it felt to mourn the child I believed at one point that I’d never meet, a strange mourning of missing what I never had, after spending almost everything I had inside me trying to achieve it.

For those of you struggling with this question now, I’m happy to offer here the part of the book where I write about all of this, in the hopes that, like so much of what’s already on this blog, it helps you feel less alone:

———-

For God’s sake, you’re not going to get pregnant, Tracy,” my mother—never one to mince words—tried to level with me a few months later over Skype. She worried we were wasting precious time. Toru and I had stopped the IVF treatments, but I insisted we still try every month with ultrasounds and hormone support from the clinic, plus new twice-a-day injections of a blood thinner for a “clotting disorder” the clinic had diagnosed, which they claimed could cause early-state miscarriage. My stomach bloomed with red and purple welts, but I was undeterred.

My eldest sister said she cried for me, she was so sad that I wouldn’t have a child with Toru, but she also couldn’t understand why we didn’t “just adopt.” “I mean,” she said, “If you’re still not willing to do egg donation.” Both she and my mother pointed out that with adoption too, we might need to hurry, since many agencies had age cutoffs.

****

“A therapist once told me,” one woman wrote on my Over-40 online TTC forum, “that if what I wanted most in the world was to be a mother, then I would be one; I would find a way, no matter what.” The writer found deep comfort in this truth, and when I read her post, I admired her, but I knew that wasn’t true for me.

What I wanted most in the world was to be with Toru, and then to have his biological child.

When Toru had told me years before that he wasn’t open to either egg donation or adoption, I felt an unexpected sense of relief. Since adoption in Japan is so rare, I wasn’t surprised by his stance. But as we’d begun the process of trying to have a baby years before, I’d realized that my growing longing to parent our biological child didn’t necessarily translate into a yearning to be a parent in general.

By now, the experience of going through years of treatments had confirmed another surprising truth to me: just because we think we are open to certain possibilities in the abstract—like adoption—we never know where our true limits lie until we are faced with actual, lasting choices. Rational or not, I felt safest in my gut with the idea of a baby who was half Toru. I believed it would be harder for me not to bond with, not to love a child whose every cell contained half of him. And if Toru and I couldn’t make a baby together, I’d still rather be together and childless than a mother apart from him.

In any case, with my forty-fifth birthday now looming just past summer, the whole issue would become obsolete soon. We’d agreed we’d stop all medical treatment when I passed that milestone. Most fertility studies don’t even consider women giving birth at forty-five or beyond, when the average chance of a someone having a baby with her own eggs drop below one percent. The most recent U.S. National Health Statistics report’s definition of a woman of child-bearing age: one between fifteen and forty-four. I’d entered the territory of a statistical non-entity.

****

A few months later, I lay curled in bed past midnight, sobs shaking through my body. Toru lay beside me, wiping strands of wet hair from my cheeks. “You know,” he said, his steady eyes locking into place my teary ones, “If we can have baby, that would be like miracle,” he said. “But it will still only be like dessert, because you will always be main course.”

I couldn’t believe we weren’t ever going to meet our baby. It seemed both so obvious and so inconceivable. Another paradox I felt deeply carved into my body but still couldn’t quite wrap my head around: how I could mourn something I’d never even had, how to grieve the loss of something that had never actually existed. The tension between my fear of parenthood and my longing to have Toru’s baby began to transmute now into a kind of weird emotional torsion, a swirl of missing and nothingness, numbness and nostalgia.

But as my birthday came and went, I reminded myself of my enduring good luck in other ways, and I knew it was crucial to remember such a fact. The previous January, Toru and I had celebrated our fifth year of marriage, and we’d laughed when we remembered my original “three-year nuptial plan,” long forgotten once I’d gotten over my initial nerves. The night of our anniversary, sitting at our favorite Italian wine bar, bubbles rising in clear flutes, we’d toasted each other, and then Toru had turned momentarily serious. “Thank you for marrying with me these five years,” he’d said, and once again I couldn’t believe my luck that somehow we had found each other across cultures, continents, and half the world’s wide curve. I’d already gotten my most important wish: to be a family, with Toru.

I thought back to him telling me we were “together in always.” I had no idea where I was in my life, how I would start rebuilding after fixing my existence on a dream that now seemed dead, how I would emerge from the limbo of the past four years. But I realized finally that those years wouldn’t be wasted—and I wouldn’t even choose to do them differently, now that I knew their outcome—because they would stay a testament of our love for our baby, even if we never got to meet that baby. It was a testament that felt precious to me, despite the failures that accompanied it. Really, there was no better place to be, I knew, despite the sadness in my chest, than together where we’d been, and now where I was still, with Toru in always.

————–

Excerpted from the book The Good Shufu: Finding Love, Self, and Home on the Far Side of the World (Putnam, 2015), by Tracy Slater.

More about Tracy is here.

Why It’s Not So Rare to Get Pregnant after 45

Hope for Older Women Trying for Healthy Babies

Current conversations about fertility are failing the millions of women world-wide who are over 40 and trying to get pregnant. When we talk about the best time to conceive or  how much fertility declines with age, we talk past a huge community of women who are hoping to become mothers after 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 4 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, a time I’ve written about in my book, The Good Shufu.

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.

Surprisingly, for women over 40 who want to conceive, the most relevant—and most hopeful—information isn’t even found where people usually 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 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 almost 1,000 women, aged 40+ who are trying to conceive or who are already pregnant and who have found me through this blog, then gone to my book’s website to contact me. 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/vsrr/report002.pdf: According to the Center for Disease Control and Prevention, in 2016, there were 111,848 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 2016 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), 9,025 babies were born.

Combining these stats with those on abortion in 2015 for the 40-44 age group, (20,962)–the latest age group and last year in which statistics were collected–and then dividing this number by 3 (accounting for expected 33% miscarriage rate in this age group), we could expect to add around 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 2016 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.

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.  Based on requests in the comment section of this blog and through email, I’ve started a new online group, New Mothers at 45 and Up, and I welcome you to join us there. Finally, if you’re still interested in my path to motherhood later in life, 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