Enhance your relationship during infertility- Sharon Covington- Shady Grove

Enhancing Your Relationship During Infertility

Sharon N. Covington, MSW, LCSW-C
Director, Psychological Support Services

Most couples enter the path towards parenthood expecting that it will occur without too much problem. After all, they spend most of their lives trying not to get pregnant and assume that when they consciously start trying, pregnancy will soon be achieved. As the months or even years go by without a baby, and efforts to achieve pregnancy are increased—from intrusive testing to high technology treatments—the path turns into the emotional rollercoaster of infertility.

Infertility can be a real test of a couple’s relationship and shake the foundation of a marriage. It can make a solid relationship stronger and weaken the core of a troubled one. Because infertility is a crisis, it is out of the realm of experience of most couples and thus challenges them to develop new strategies and coping mechanisms to deal with this life crisis. The good news is research has shown that, for most infertile couples, the experience strengthens their marriage by teaching them life-long skills to deal with problems. Since infertility is one of many challenges couples may face in their life together, the skills learned can be adapted to use at other difficult times.

Relationships, like anything you want to grow and thrive, have to be tended to flourish. They are like a garden that must be carefully planted and then receive adequate amounts of nutrients such as sun, water, fertilizer, and cultivation to blossom. If the garden is neglected too long or receives too much of these nutrients, the plants will wither and die. Relationships are also like a bank account—you can’t continue to make withdrawals without depositing something back or you will end up overdrawn. Infertility can be like a “withdrawal,” draining intimacy from your marriage and depleting your emotional resources. It can cause you to neglect your relationship, focusing all energy on the baby quest. In effect, infertility can create a life of its own in a marriage, causing you to lose sight of what brought you together in the first place and what is necessary for a healthy family to grow in the future.

For a marriage to survive the crisis of infertility, couples have to learn to continue to make “deposits” and “tend the garden.” Understanding the ways in which the stress of infertility can strain a relationship, couples must make special efforts to put positive energy into a marriage during this time. If you are an infertile couple, there are steps you can take to enhance your relationship so that it grows and thrives. The following are some suggestions to help you along the way:

  1. Work as a team. No matter who is identified as “the patient,” infertility is a couple problem. Always approach the issues as a team, working together and finding ways to share responsibility regarding treatment. Avoid finger-pointing as nobody ever wins the blame game.
  2. Plan playtime. Since dealing with infertility can feel like a full-time job, it is important to “take time off” by consciously make time for each other. Have regular dates where you can have fun and take a break from infertility. Vacations are also playtime, and having things to look forward that are under your control is positive. Look for ways to put nurturing energies in the relationship, making your partner a priority.
  3. Separate baby-making from love-making. Infertility often puts strain on a couple’s sexual relationship and what was once fun has now become a tedious job. You may want to designate different rooms in your house for your intimate work versus play. Remember the ways you enjoyed sex early in your relationship and find ways to recreate it. Plan romantic encounters at non-fertile times, such as a bubble bath together or giving a massage. Understand that sexual intimacy does not have to mean intercourse and use your imagination to plan recreational sex.
  4. Build a support system. Couples often have an unconscious expectation that their spouse will be able to take care of all their emotional needs. This is a daunting task during infertility and an impossibility for any relationship. Infertility can be an isolating experience and put undue pressure on a partner for providing all emotional support. Support from others can strengthen relationships, especially during times of stress. Encourage friendships for yourself, your spouse, and as a couple. Work towards balance in your support network by having friends both in and out of the infertility world.
  5. Identify individual coping styles under stress. Know your own and your partner’s styles for dealing with stress. Learning how to accept differences in the way each of you handles and deals with your feelings can lessen conflicts. Like many things in life, men and women will feel and deal differently with infertility. However, different doesn’t mean better or worse; it only means not the same.
  6. Allow breathing room in your relationship. Realize that marriages are fluid and in a constant state of change due to the many external and internal factors in your life, including infertility. During times of stress, try to give each other some space and distance to allow for transition. Understand that couples are seldom at the same place, at the same time, when at treatment crossroads.
  7. Communicate the positives. Often we neglect to communicate our positive feelings to our partner, and all he or she may hear are negatives. Changes in behavior come more from positive reinforcement than from negative. Also, infertility may consume your life and engulf all your conversations. It may be necessary to put limits on the time you talk about infertility to designated periods, such as 20 minutes in the evening, so that it does not overtake all your communication.
  8. Keep a sense of humor. No matter how tough things get, being able to find something humorous about the situation helps to relieve the tension. Laughing together is good for the health of your relationship.
  9. Seek help before problems get too big. Infertility can put terrible strains on relationships and couples need to consider counseling as a resource of support and information to deal with problems. If you find that you are at an impasse or your usual coping strategies aren’t working in the relationship, counseling may help. Don’t wait until things get critical. Ask your doctor or visit the American Society of Reproductive Medicine website for a listing of mental health professionals specializing in infertility.

Fertility treatment outcomes dependant on sperm quality, not age of donor- Medical News Today

Contrary to previous studies, new research finds that the outcome of fertility treatment using sperm donors may not be dependent on a man’s age, but the quality of their sperm.

Study co-author Dr. Navdeep Ghuman, of the Newcastle Fertility Centre at Life in the UK, recently presented the research at the European Society of Human Reproduction and Embryology (ESHRE) Annual Meeting in Munich, Germany.

The team says their findings may have important implications for current recommendations regarding the maximum age of sperm donors.

In the UK, current professional guidelines state that sperm should not be taken from donors aged 41 years or over, although this can be judged on a case by case basis. In the US, most sperm banks require donors to be between the ages of 18-39, while some even set the maximum age limit at 34.

According to the researchers, such guidelines are a result of past research that has suggested older men have lower sperm quality and are more likely to have DNA mutations that present an increased risk of genetic abnormalities in offspring.

Furthermore, studies have indicated that older men have lower semen volume, motility and concentration. But the researchers say this does not necessarily prevent conception.

Overall, the team says the association between age and sperm quality is under-researched, so they set out to investigate whether a man’s age affects live birth rate from fertility treatment.

Analysis of all UK fertility treatment cycles between 1991 and 2012

The team, led by Dr. Meenakshi Choudhary of the Newcastle Fertility Centre at Life, analyzed all fertility treatment cycles with sperm donation in the UK between 1991 and 2012 using data from the Human Fertilisation & Embryology Authority.

Researchers say their findings suggest the outcomes of fertility treatment involving sperm donation are dependent on sperm quality rather than the age of the donors.

Of 230,000 sperm donation cycles during this period, the researchers included 39,282 that were first cycles by either in vitro fertilization (IVF) or donor insemination.

The researchers note that since female fertility is well known to decline with age, they divided the female study participants into two age groups: those who were treated with donor sperm between the ages of 18-34 and those who were treated after the age of 37. The two groups were then divided again dependent on whether their treatment was through IVF or donor insemination.

The team then divided the sperm donors into one of six age groups: under 20, 21-25, 26-30, 31-35, 36-40 and 41-45.

The researchers say that unsurprisingly, women who were treated with donor sperm after the age of 37 had a lower birth rate (14%) that those were treated between the ages of 18-34 (29%).

But they found that the age of a sperm donor did not appear to affect live birth rates among women who received donor sperm in the younger age group.

Of the women who received IVF between the ages of 18-34, sperm donors aged under 20 and 30 represented a live birth rate of 38.3%, while donors aged 41-45 represented a live birth rate of 30.4%. Of younger women who were treated with donor insemination, sperm donors under 20 represented a 9.7% live birth rate, while a 12% live birth rate was accounted for by donors aged 41-45.

However, the researchers noticed a different trend among women who underwent sperm treatment over the age of 37.

‘Up to the age of 45, there is little effect of male age on fertility treatment outcome’

Among older women, younger sperm donors appeared less likely to produce a successful outcome than older donors.

They found that among older women who underwent IVF, sperm donors under the age of 20 represented an 11% live birth rate, those aged 26-30 represented a 17% live birth rate, and a 16.6% live birth rate was accounted for by donors aged 41-45. Of older women who underwent donor insemination, sperm donors under 20 represented a 3.1% live birth rate, while those aged 41-45 represented a 4.6% live birth rate.

But Dr. Choudhary notes that women in the older group were less likely to conceive than those in the younger group, who are described as being in the “peak of reproductive potential,” therefore the link between older sperm donors and increased live birth rate is not statistically significant.

Explaining a potential reason behind this finding, Dr. Choudhary says:

“This trend of less likelihood of live birth with younger sperm donor age might simply be explained by the fact that younger men who donate sperm are less likely to have proven fertility themselves than older sperm donors with proven fertility.”

Dr. Choudery believes that overall, their findings indicate that it is sperm quality, not the age of the donor that influences successful outcomes of fertility treatment. She says:

“Our results suggest that, up to the age of 45, there is little effect of male age on treatment outcome, but sperm donors are a selected population based on good sperm quality.

Our study shows that we are good at selecting the right sperm donors with the right sperm quality – and that’s why we found no difference in live birth rate despite the increasing age of sperm donors. This confirms the view that a man’s age doesn’t matter in achieving a live birth provided his sperm quality is good.”

In a recent spotlight feature, Medical News Today looked at whether infertility is primary seen as a woman’s problem, and discussed whether there should be more focus on support and treatment for men with fertility problems.

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Gene Crucial for Embryo Implantation Discovered- Medical Journal

Gene Crucial For Embryo Implantation
Discovered; May Offer Important Insight Into
Variety Of Infertility Issues
By Dana Dovey | Jul 19, 2014 05:23 PM EDT
It is estimated that infertility affects 6.1 million American couples of childbearing
age. For many of these couples, the cause of their infertility remains unclear. On a
global level, infertility is believed to affect around nine percent of the female
population. A recent discovery of a very small but very important molecule may
offer a clue into the complex mystery of female infertility.
A study led by researchers from the Cincinnati Children’s Hospital Medical Center
has identified a crucial molecular key to healthy embryo implantation and
pregnancy. The gene, called Wnt5a, was found to be absolutely critical for the
healthy embryo implantation in the uterus wall, according to a press release. It
works along with its co­receptors ROR1 and ROR2 to help direct embryos in the
right direction in order to safely make their way into the womb. Signaling from this
molecule also causes uterine implantation chambers to form at regular intervals.
What It Means For Infertility, Miscarriage, and Preterm Birth
Although discovering the role of Wnt5a was exciting, it’s what happened in its
absence, or when it fails, that makes this study truly groundbreaking. When
signaling from the special molecule is disrupted or distorted, adverse effects such
as abnormal uterine formation, and disorderly spacing of embryos and
implantation result. Eventually, these side effects will go on to cause conditions
such as defective decidualization, placentation, and compromised pregnancy
outcomes. “If something goes wrong at this stage, there could be adverse effects
throughout the course of pregnancy — whether it is subfertility, infertility, restricted
growth, miscarriage, or preterm birth,” explained senior investigator Sudhansu
Dey, director of the Division of Reproductive Sciences at Cincinnati Children’s
Hospital, in the press release.
Conception Is Still A Mystery
When a female egg is fertilized by a male sperm, a zygote, the earliest stage of an
embryo, is formed. However, in order for the pregnancy to result in the
development of a human fetus, the embryo must find its way into the uterus, where
it can become implanted on the nutrient­rich uterine wall. Dey explained that as of
now “it is not clearly understood what prompt embryos to move and implant within
a uterine crypt with regular spacing.”
Failure To Implant
When an embryo fails to implant onto the uterine wall, a miscarriage will result. It
is estimated that as many as 40 percent of pregnancies result in miscarriage, and
often, this is nature’s way of selecting only the most genetically fit embryos todevelop into a fetus. However, sometimes the female’s body will continue to reject
perfectly healthy embryos. Other times the embryo will implant in the wrong
location, such as the cervix or fallopian tubes.

New Successful IVF technique could make treatment easier

Approximately 3% of infertile women in the US undergo IVF in an attempt to get pregnant. But for some, such treatment can result in severe side effects. Now, a new study published in the Journal of Clinical Investigation details a new, safer technique that has been found to successfully boost ovulation in women undergoing IVF, resulting in 12 newborn babies.

Around 1 in 8 couples in the US have problems getting pregnant or sustaining a pregnancy, and around a third of these cases are attributable to the female partner. Most infertility cases are treated with medication or surgery, but when these fail, assisted reproductive therapies – such as IVF (in vitro fertilization) – become an option.

in vitro fertilization
Researchers say a naturally occurring hormone – kisspeptin – is safer than the hCG hormone for boosting ovulation in women undergoing IVF.

IVF involves manually inserting sperm into an egg in a laboratory dish. If fertilization is successful, the embryo is then physically placed in the uterus. Prior to this procedure, patients may be required to take injectable fertility drugs – such as a hormone called hCG – to trigger egg production.

But the research team, led by Prof. Waljit Dhillo of the Department of Medicine at Imperial College London in the UK, notes that as a result of such drugs, some IVF patients experience ovarian hyperstimulation syndrome (OHSS).

OHSS is a condition that triggers overstimulation of ovaries, causing them to become swollen and painful. In some cases, women may experience rapid weight gain, shortness of breath, abdominal pain and vomiting.

“OHSS is a major medical problem,” says Prof. Dhillo. “It can be fatal in severe cases and it occurs in women undergoing IVF treatment who are otherwise very healthy.”

Kisspeptin results in ‘good outcome’ compared with standard IVF treatment

For their study, Prof. Dhillo and colleagues tested a naturally occurring hormone called kisspeptin on 53 women undergoing IVF to see whether it could trigger ovulation induction in a safe and effective manner.

After each woman received one injection of kisspeptin, 51 out of 53 developed mature eggs, and 49 had either one or two fertilized embryos that could be transferred to the uterus. Of these women, 12 became pregnant, which the researchers say is a “good outcome” when compared with standard IVF therapy using hCG.

One of the participants, Alison Harper, gave birth to a baby boy, Owen, in October last year. She says that after several cycles of IVF, the one used in this study was the least uncomfortable, causing less pain and swelling.

The research team explains that kisspeptin does not stay in the blood for long periods like hCG. This means the hormone is broken down faster, reducing the occurrence of ovary overstimulation.

Commenting on the team’s findings, Prof. Dhillo says:

“Our study has shown that kisspeptin can be used as a physiological trigger for egg maturation in IVF therapy. It’s been a joy to see 12 healthy babies born using this approach. We will now be doing more studies to test whether kisspeptin reduces the risk of OHSS in women who are most prone to developing it, with a view to improving the safety of IVF therapy.”

The researchers now plan to conduct a second study among women with polycystic ovary syndrome, who have the highest risk of OHSS as a result of treatment with fertility medication.

Medical News Today recently reported on a study published in Nature Communications, which detailed how deep-freezing testicular tissuecould be a promising technique to preserve fertility among boys who undergo treatment for cancer.

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Cycling doesn’t lead to Male Infertility- WebMD

July 9, 2014 — Cycling doesn’t lead to male infertility and erectile dysfunction, but it may raise prostate cancer risk in cyclists over 50, a new study finds.

Although it’s considered a healthy activity, helping to lower the risks of type 2 diabetes, heart disease, and stroke, cycling is commonly believed to affect a man’s fertility.


Cycling Study

Researchers from University College London looked at data from 5,282 male cyclists who took part in the Cycling for Health U.K. Study.

Men were recruited through cycling magazines to do an online survey. They reported whether they had erectile dysfunction, whether they’d been diagnosed with infertility, or had prostate cancer.

Weekly cycling time was grouped into: below 3.75 hours, 3.76-5.75 hours, 5.76-8.5 hours, and over 8.5.

There was no link between infertility or erectile dysfunction and many miles of cycling a week, even for more than 8-and-a-half hours.

Study author Mark Hamer, PhD, says today’s saddle technology may be helping ”to relieve pressure on nerves to prevent the uncomfortable ‘numbness’ sensation that can occur when riding for a long time.”

Cycling and Prostate Cancer

Cycling is linked to raised levels of the protein PSA, or prostate specific antigen, which can be a sign of prostate cancer. This is because pressure from the saddle can massage or mildly injure the prostate in a minor way and cause inflammation, driving up the PSA level. An avid cyclist may end up getting unnecessary testing if a mildly raised PSA level is found that’s due to cycling and not cancer.

But this is complicated by the fact that this study suggests a much-increased cycling time of more than 8.5 hours a week is tied to a higher risk of having prostate cancer.

Hamer says the results should be interpreted cautiously, and there may not be a direct cause and effect: “For example, it may be the case that these men are more aware of their health and visit the doctor more, thus more likely to get such conditions picked up.”

He says more research is needed, adding that the risk was high only in the most avid cyclists: “Moderate levels of cycling are associated with many other favorable health benefits, so any risks are likely outweighed by the benefits.”

Could Nutrition affect Male Infertility? Kannapolis Research

annapolis research institute: Could nutrition affect male infertility?

By Karen Garloch
Published in: Karen Garloch

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Researcher Summer Goodson is used to getting snickers when she tells people she’s studying male infertility.

“It’s expected,” said Goodson, a post-doctoral research associate at the UNC Nutrition Research Institute in Kannapolis. “It’s a sensitive subject. But it’s a fascinating subject.”

Goodson is looking into the hypothesis that the nutrient betaine, commonly found in foods such as beets and spinach, could improve sperm function in certain men.

“Our hope is to see improvement in sperm function,” Goodson said. “It may have potential for (treating) male infertility, which is a growing problem in the United States.”

But before we get to the details, let me tell you how she got to this point. Like a lot of things in science, serendipity played a role.

About six years ago, graduate student Amy Johnson was studying brain development in mice at UNC Chapel Hill. She looked at the effect of a particular gene that helps metabolize the nutrient choline into betaine in the body. She deleted that gene in the mice, expecting to discover effects on brain development. Instead, she wound up with male mice that were infertile.

Trying to figure out what was going on, Johnson contacted an expert in reproductive biology at UNC. Through her, she met Goodson, who was working on her doctorate in cell and developmental biology. They worked together, speculating on the reasons for the infertile mice and what further testing should be done.

Eventually, Johnson studied human males with a particular variant in the same gene that was missing in her research mice. The men had similar problems with sperm function. “Their sperm motility was not as robust as that for men who didn’t have the variant,” Goodson said.

Fast forward to 2013. Johnson had moved to another research lab at UNC, and Goodson, who had finished her doctorate, was invited to the Kannapolis campus to speak about her work. While there, she happened to have a conversation with Dr. Steven Zeisel, the nutrition institute’s director and Johnson’s former supervisor.

Zeisel recalled Johnson’s research with the infertile mice. He said she had noticed the mice had low levels of betaine, and when she put that nutritional supplement in their drinking water, their sperm function had improved. Zeisel suggested that giving betaine to human males with the genetic variant might improve their sperm function.

Goodson, who was looking for a job, took on the project. Today, she is looking for male volunteers whose blood she can test. She’ll select those with the genetic variant and give them supplements of betaine to see if it improves their sperm function.

To find 10 research subjects, she needs to screen about 150 men. Volunteers should be age 18 to 60. Contact: 704-250-5035 or email NRI_Fertility@unc.edu. Those final participants will be paid $600 at the end of the project.


How long can you wait to have a baby- The Atlantic

In the tentative, post-9/11 spring of 2002, I was, at 30, in the midst of extricating myself from my first marriage. My husband and I had met in graduate school but couldn’t find two academic jobs in the same place, so we spent the three years of our marriage living in different states. After I accepted a tenure-track position in California and he turned down a postdoctoral research position nearby—the job wasn’t good enough, he said—it seemed clear that our living situation was not going to change.

I put off telling my parents about the split for weeks, hesitant to disappoint them. When I finally broke the news, they were, to my relief, supportive and understanding. Then my mother said, “Have you read Time magazine this week? I know you want to have kids.”

Time’s cover that week had a baby on it. “Listen to a successful woman discuss her failure to bear a child, and the grief comes in layers of bitterness and regret,” the story inside began. A generation of women who had waited to start a family was beginning to grapple with that decision, and one media outlet after another was wringing its hands about the steep decline in women’s fertility with age: “When It’s Too Late to Have a Baby,” lamented the U.K.’s Observer; “Baby Panic,” New York magazine announced on its cover.

The panic stemmed from the April 2002 publication of Sylvia Ann Hewlett’s headline-grabbing book, Creating a Life, which counseled that women should have their children while they’re young or risk having none at all. Within corporate America, 42 percent of the professional women interviewed by Hewlett had no children at age 40, and most said they deeply regretted it. Just as you plan for a corner office, Hewlett advised her readers, you should plan for grandchildren.

The previous fall, an ad campaign sponsored by the American Society for Reproductive Medicine (ASRM) had warned, “Advancing age decreases your ability to have children.” One ad was illustrated with a baby bottle shaped like an hourglass that was—just to make the point glaringly obvious—running out of milk. Female fertility, the group announced, begins to decline at 27. “Should you have your baby now?” asked Newsweek in response.

For me, that was no longer a viable option.

I had always wanted children. Even when I was busy with my postdoctoral research, I volunteered to babysit a friend’s preschooler. I frequently passed the time in airports by chatting up frazzled mothers and babbling toddlers—a 2-year-old, quite to my surprise, once crawled into my lap. At a wedding I attended in my late 20s, I played with the groom’s preschool-age nephews, often on the floor, during the entire rehearsal and most of the reception. (“Do you fart?” one of them asked me in an overly loud voice during the rehearsal. “Everyone does,” I replied solemnly, as his grandfather laughed quietly in the next pew.)

But, suddenly single at 30, I seemed destined to remain childless until at least my mid-30s, and perhaps always. Flying to a friend’s wedding in May 2002, I finally forced myself to read the Time article. It upset me so much that I began doubting my divorce for the first time. “And God, what if I want to have two?,” I wrote in my journal as the cold plane sped over the Rockies. “First at 35, and if you wait until the kid is 2 to try, more than likely you have the second at 38 or 39. If at all.” To reassure myself about the divorce, I wrote, “Nothing I did would have changed the situation.” I underlined that.

I was lucky: within a few years, I married again, and this time the match was much better. But my new husband and I seemed to face frightening odds against having children. Most books and Web sites I read said that one in three women ages 35 to 39 would not get pregnant within a year of starting to try. The first page of the ASRM’s 2003 guide for patients noted that women in their late 30s had a 30 percent chance of remaining childless altogether. The guide also included statistics that I’d seen repeated in many other places: a woman’s chance of pregnancy was 20 percent each month at age 30, dwindling to 5 percent by age 40.

Every time I read these statistics, my stomach dropped like a stone, heavy and foreboding. Had I already missed my chance to be a mother?

As a psychology researcher who’d published articles in scientific journals, some covered in the popular press, I knew that many scientific findings differ significantly from what the public hears about them. Soon after my second wedding, I decided to go to the source: I scoured medical-research databases, and quickly learned that the statistics on women’s age and fertility—used by many to make decisions about relationships, careers, and when to have children—were one of the more spectacular examples of the mainstream media’s failure to correctly report on and interpret scientific research.

The widely cited statistic that one in three women ages 35 to 39 will not be pregnant after a year of trying, for instance, is based on an article published in 2004 in the journal Human Reproduction. Rarely mentioned is the source of the data: French birth records from 1670 to 1830. The chance of remaining childless—30 percent—was also calculated based on historical populations.

In other words, millions of women are being told when to get pregnant based on statistics from a time before electricity, antibiotics, or fertility treatment. Most people assume these numbers are based on large, well-conducted studies of modern women, but they are not. When I mention this to friends and associates, by far the most common reaction is: “No … No way. Really?

Surprisingly few well-designed studies of female age and natural fertility include women born in the 20th century—but those that do tend to paint a more optimistic picture. One study, published in Obstetrics & Gynecology in 2004 and headed by David Dunson (now of Duke University), examined the chances of pregnancy among 770 European women. It found that with sex at least twice a week, 82 percent of 35-to-39-year-old women conceive within a year, compared with 86 percent of 27-to-34-year-olds. (The fertility of women in their late 20s and early 30s was almost identical—news in and of itself.) Another study, released this March in Fertility and Sterility and led by Kenneth Rothman of Boston University, followed 2,820 Danish women as they tried to get pregnant. Among women having sex during their fertile times, 78 percent of 35-to-40-year-olds got pregnant within a year, compared with 84 percent of 20-to-34-year-olds. A study headed by Anne Steiner, an associate professor at the University of North Carolina School of Medicine, the results of which were presented in June, found that among 38- and 39-year-olds who had been pregnant before, 80 percent of white women of normal weight got pregnant naturally within six months (although that percentage was lower among other races and among the overweight). “In our data, we’re not seeing huge drops until age 40,” she told me.

Even some studies based on historical birth records are more optimistic than what the press normally reports: One found that, in the days before birth control, 89 percent of 38-year-old women were still fertile. Another concluded that the typical woman was able to get pregnant until somewhere between ages 40 and 45. Yet these more encouraging numbers are rarely mentioned—none of these figures appear in the American Society for Reproductive Medicine’s 2008 committee opinion on female age and fertility, which instead relies on the most-ominous historical data.

In short, the “baby panic”—which has by no means abated since it hit me personally—is based largely on questionable data. We’ve rearranged our lives, worried endlessly, and forgone countless career opportunities based on a few statistics about women who resided in thatched-roof huts and never saw a lightbulb. In Dunson’s study of modern women, the difference in pregnancy rates at age 28 versus 37 is only about 4 percentage points. Fertility does decrease with age, but the decline is not steep enough to keep the vast majority of women in their late 30s from having a child. And that, after all, is the whole point.

I am now the mother of three children, all born after I turned 35. My oldest started kindergarten on my 40th birthday; my youngest was born five months later. All were conceived naturally within a few months. The toddler in my lap at the airport is now mine.

Instead of worrying about my fertility, I now worry about paying for child care and getting three children to bed on time. These are good problems to have.

Yet the memory of my abject terror about age-related infertility still lingers. Every time I tried to get pregnant, I was consumed by anxiety that my age meant doom. I was not alone. Women on Internet message boards write of scaling back their careers or having fewer children than they’d like to, because they can’t bear the thought of trying to get pregnant after 35. Those who have already passed the dreaded birthday ask for tips on how to stay calm when trying to get pregnant, constantly worrying—just as I did—that they will never have a child. “I’m scared because I am 35 and everyone keeps reminding me that my ‘clock is ticking.’ My grandmother even reminded me of this at my wedding reception,” one newly married woman wrote to me after reading my 2012 advice book, The Impatient Woman’s Guide to Getting Pregnant, based in part on my own experience. It’s not just grandmothers sounding this note. “What science tells us about the aging parental body should alarm us more than it does,” wrote the journalist Judith Shulevitz in a New Republic cover story late last year that focused, laser-like, on the downsides of delayed parenthood.

How did the baby panic happen in the first place? And why hasn’t there been more public pushback from fertility experts?

One possibility is the “availability heuristic”: when making judgments, people rely on what’s right in front of them. Fertility doctors see the effects of age on the success rate of fertility treatment every day. That’s particularly true for in vitro fertilization, which relies on the extraction of a large number of eggs from the ovaries, because some eggs are lost at every stage of the difficult process. Younger women’s ovaries respond better to the drugs used to extract the eggs, and younger women’s eggs are more likely to be chromosomally normal. As a result, younger women’s IVF success rates are indeed much higher—about 42 percent of those younger than 35 will give birth to a live baby after one IVF cycle, versus 27 percent for those ages 35 to 40, and just 12 percent for those ages 41 to 42. Many studies have examined how IVF success declines with age, and these statistics are cited in many research articles and online forums.

Yet only about 1 percent of babies born each year in the U.S. are a result of IVF, and most of their mothers used the technique not because of their age, but to overcome blocked fallopian tubes, male infertility, or other issues: about 80 percent of IVF patients are 40 or younger. And the IVF statistics tell us very little about natural conception, which requires just one egg rather than a dozen or more, among other differences.

Studies of natural conception are surprisingly difficult to conduct—that’s one reason both IVF statistics and historical records play an outsize role in fertility reporting. Modern birth records are uninformative, because most women have their children in their 20s and then use birth control or sterilization surgery to prevent pregnancy during their 30s and 40s. Studies asking couples how long it took them to conceive or how long they have been trying to get pregnant are as unreliable as human memory. And finding and studying women who are trying to get pregnant is challenging, as there’s such a narrow window between when they start trying and when some will succeed.

Another problem looms even larger: women who are actively trying to get pregnant at age 35 or later might be less fertile than the average over-35 woman. Some highly fertile women will get pregnant accidentally when they are younger, and others will get pregnant quickly whenever they try, completing their families at a younger age. Those who are left are, disproportionately, the less fertile. Thus, “the observed lower fertility rates among older women presumably overestimate the effect of biological aging,” says Dr. Allen Wilcox, who leads the Reproductive Epidemiology Group at the National Institute of Environmental Health Sciences. “If we’re overestimating the biological decline of fertility with age, this will only be good news to women who have been most fastidious in their birth-control use, and may be more fertile at older ages, on average, than our data would lead them to expect.”

These modern-day research problems help explain why historical data from an age before birth control are so tempting. However, the downsides of a historical approach are numerous. Advanced medical care, antibiotics, and even a reliable food supply were unavailable hundreds of years ago. And the decline in fertility in the historical data may also stem from older couples’ having sex less often than younger ones. Less-frequent sex might have been especially likely if couples had been married for a long time, or had many children, or both. (Having more children of course makes it more difficult to fit in sex, and some couples surely realized—eureka!—that they could avoid having another mouth to feed by scaling back their nocturnal activities.) Some historical studies try to control for these problems in various ways—such as looking only at just-married couples—but many of the same issues remain.

The best way to assess fertility might be to measure “cycle viability,” or the chance of getting pregnant if a couple has sex on the most fertile day of the woman’s cycle. Studies based on cycle viability use a prospective rather than retrospective design—monitoring couples as they attempt to get pregnant instead of asking couples to recall how long it took them to get pregnant or how long they tried. Cycle-viability studies also eliminate the need to account for older couples’ less active sex lives. David Dunson’s analysis revealed that intercourse two days before ovulation resulted in pregnancy 29 percent of the time for 35-to-39-year-old women, compared with about 42 percent for 27-to-29-year-olds. So, by this measure, fertility falls by about a third from a woman’s late 20s to her late 30s. However, a 35-to-39-year-old’s fertility two days before ovulation was the same as a 19-to-26-year-old’s fertility three days before ovulation: according to Dunson’s data, older couples who time sex just one day better than younger ones will effectively eliminate the age difference.

Don’t these numbers contradict the statistics you sometimes see in the popular press that only 20 percent of 30-year-old women and 5 percent of 40-year-old women get pregnant per cycle? They do, but no journal article I could locate contained these numbers, and none of the experts I contacted could tell me what data set they were based on. The American Society for Reproductive Medicine’s guide provides no citation for these statistics; when I contacted the association’s press office asking where they came from, a representative said they were simplified for a popular audience, and did not provide a specific citation.

Dunson, a biostatistics professor, thought the lower numbers might be averages across many cycles rather than the chances of getting pregnant during the first cycle of trying. More women will get pregnant during the first cycle than in each subsequent one because the most fertile will conceive quickly, and those left will have lower fertility on average.

Most fertility problems are not the result of female age. Blocked tubes and endometriosis (a condition in which the cells lining the uterus also grow outside it) strike both younger and older women. Almost half of infertility problems trace back to the man, and these seem to be more common among older men, although research suggests that men’s fertility declines only gradually with age.

Fertility problems unrelated to female age may also explain why, in many studies, fertility at older ages is considerably higher among women who have been pregnant before. Among couples who haven’t had an accidental pregnancy—who, as Dr. Steiner put it, “have never had an ‘oops’ ”—sperm issues and blocked tubes may be more likely. Thus, the data from women who already have a child may give a more accurate picture of the fertility decline due to “ovarian aging.” In Kenneth Rothman’s study of the Danish women, among those who’d given birth at least once previously, the chance of getting pregnant at age 40 was similar to that at age 20.

Older women’s fears, of course, extend beyond the ability to get pregnant. The rates of miscarriages and birth defects rise with age, and worries over both have been well ventilated in the popular press. But how much do these risks actually rise? Many miscarriage statistics come from—you guessed it—women who undergo IVF or other fertility treatment, who may have a higher miscarriage risk regardless of age. Nonetheless, the National Vital Statistics Reports, which draw data from the general population, find that 15 percent of women ages 20 to 34, 27 percent of women 35 to 39, and 26 percent of women 40 to 44 report having had a miscarriage. These increases are hardly insignificant, and the true rate of miscarriages is higher, since many miscarriages occur extremely early in a pregnancy—before a missed period or pregnancy test. Yet it should be noted that even for older women, the likelihood of a pregnancy’s continuing is nearly three times that of having a known miscarriage.

What about birth defects? The risk of chromosomal abnormalities such as Down syndrome does rise with a woman’s age—such abnormalities are the source of many of those very early, undetected miscarriages. However, the probability of having a child with a chromosomal abnormality remains extremely low. Even at early fetal testing (known as chorionic villus sampling), 99 percent of fetuses are chromosomally normal among 35-year-old pregnant women, and 97 percent among 40-year-olds. At 45, when most women can no longer get pregnant, 87 percent of fetuses are still normal. (Many of those that are not will later be miscarried.) In the near future, fetal genetic testing will be done with a simple blood test, making it even easier than it is today for women to get early information about possible genetic issues.

What does all this mean for a woman trying to decide when to have children? More specifically, how long can she safely wait?

This question can’t be answered with absolutely certainty, for two big reasons. First, while the data on natural fertility among modern women are proliferating, they are still sparse. Collectively, the three modern studies by Dunson, Rothman, and Steiner included only about 400 women 35 or older, and they might not be representative of all such women trying to conceive.

Second, statistics, of course, can tell us only about probabilities and averages—they offer no guarantees to any particular person. “Even if we had good estimates for the average biological decline in fertility with age, that is still of relatively limited use to individuals, given the large range of fertility found in healthy women,” says Allen Wilcox of the NIH.

So what is a woman—and her partner—to do?

The data, imperfect as they are, suggest two conclusions. No. 1: fertility declines with age. No. 2, and much more relevant: the vast majority of women in their late 30s will be able to get pregnant on their own. The bottom line for women, in my view, is: plan to have your last child by the time you turn 40. Beyond that, you’re rolling the dice, though they may still come up in your favor. “Fertility is relatively stable until the late 30s, with the inflection point somewhere around 38 or 39,” Steiner told me. “Women in their early 30s can think about years, but in their late 30s, they need to be thinking about months.” That’s also why many experts advise that women older than 35 should see a fertility specialist if they haven’t conceived after six months—particularly if it’s been six months of sex during fertile times.

There is no single best time to have a child. Some women and couples will find that starting—and finishing—their families in their 20s is what’s best for them, all things considered. They just shouldn’t let alarmist rhetoric push them to become parents before they’re ready. Having children at a young age slightly lowers the risks of infertility and chromosomal abnormalities, and moderately lowers the risk of miscarriage. But it also carries costs for relationships and careers. Literally: an analysis by one economist found that, on average, every year a woman postpones having children leads to a 10 percent increase in career earnings.

For women who aren’t ready for children in their early 30s but are still worried about waiting, new technologies—albeit imperfect ones—offer a third option. Some women choose to freeze their eggs, having a fertility doctor extract eggs when they are still young (say, early 30s) and cryogenically preserve them. Then, if they haven’t had children by their self-imposed deadline, they can thaw the eggs, fertilize them, and implant the embryos using IVF. Because the eggs will be younger, success rates are theoretically higher. The downsides are the expense—perhaps $10,000 for the egg freezing and an average of more than $12,000 per cycle for IVF—and having to use IVF to get pregnant. Women who already have a partner can, alternatively, freeze embryos, a more common procedure that also uses IVF technology.

At home, couples should recognize that having sex at the most fertile time of the cycle matters enormously, potentially making the difference between an easy conception in the bedroom and expensive fertility treatment in a clinic. Rothman’s study found that timing sex around ovulation narrowed the fertility gap between younger and older women. Women older than 35 who want to get pregnant should consider recapturing the glory of their 20‑something sex lives, or learning to predict ovulation by charting their cycles or using a fertility monitor.

I wish I had known all this back in the spring of 2002, when the media coverage of age and infertility was deafening. I did, though, find some relief from the smart women of Saturday Night Live.

“According to author Sylvia Hewlett, career women shouldn’t wait to have babies, because our fertility takes a steep drop-off after age 27,” Tina Fey said during a “Weekend Update” sketch. “And Sylvia’s right; I definitely should have had a baby when I was 27, living in Chicago over a biker bar, pulling down a cool $12,000 a year. That would have worked out great.” Rachel Dratch said, “Yeah. Sylvia, um, thanks for reminding me that I have to hurry up and have a baby. Uh, me and my four cats will get right on that.”

“My neighbor has this adorable, cute little Chinese baby that speaks Italian,” noted Amy Poehler. “So, you know, I’ll just buy one of those.” Maya Rudolph rounded out the rant: “Yeah, Sylvia, maybe your next book should tell men our age to stop playing Grand Theft Auto III and holding out for the chick from Alias.” (“You’re not gonna get the chick from Alias,” Fey advised.)

Eleven years later, these four women have eight children among them, all but one born when they were older than 35. It’s good to be right.