For many modern young women the question is not whether to have a child, but when. When their 30th birthday rolls around, pregnancy might be the furthest thing from the mind of someone who is still studying for her doctorate while maternity leave might sound like just another way to take a steep dive off the top of the corporate ladder. The whole question itself could be a moot point if she hasn’t found someone she’d like to make the father of her children.

Many women are certain they want children – eventually – but it’s a decision that needs to be carefully evaluated. On their side are huge advances in medicine and treatments that can boost fertility for both men and women. Working against them is simple biology – the older you get, the harder getting pregnant becomes. Simultaneously, the risk of genetic defects in the foetus rises steeply, says Dr. Nalinda Rodrigo, Consultant Obstetrician and Gynaecologist.

A woman is at her most fertile between the ages of 18 – 24, says Dr. Rodrigo. From that point on, fertility begins to decrease. This deterioration in reproductive capacity is more acute in women than in men – in fact in one gender it grinds to a complete halt with the onset of menopause. This becomes particularly noticeable once a woman crosses the age of 35. In an ideal world, women could make their choices based on their own personal and professional context, but the biological clock never stops ticking. “When you postpone it you have to recognize that there’s an age related problem,” says Dr. Rodrigo emphasising the practical concerns.

For a couple attempting to get pregnant, it’s important to remember that the window of opportunity is surprisingly small. The optimal time of the month for ovulation is 14 days after the first day of the woman’s last menstrual period. If you’ve tried for at least a year without success, it might be time to seek your doctor’s advice on what type of treatment to pursue.
Options include medicines that can boost fertility, surgical interventions and assisted conception. Drugs may be prescribed to either partner and if they don’t work, couples can look at more serious options. A woman’s fallopian tubes may have blocked or scarred as a result of conditions like pelvic inflammatory disease (PID) which requires surgery to repair the tubes or laparoscopic surgery could be used to help treat women with endometriosis who have parts of their womb lining start growing outside of the womb.

Laparoscopic ovarian drilling can help women with PCOS (Polycystic Ovarian Syndrome) if medication hasn’t worked. Depending on the underlying cause, a woman’s partner might be the one who requires treatment. Assisted conception refers primarily to intrauterine insemination or IUI (where the best sperm are directly inserted into the womb through a plastic tube) and in-vitro fertilisation or IVF (where the egg is fertilised outside a woman’s body and only then inserted into the womb). While plenty of success stories exist, the process can be long drawn out, frustrating and expensive, cautions Dr. Rodrigo.
As women age, both they and their babies must run the gamut of more pregnancy-related complications. Changes in the reproductive system and general health problems associated with aging are the culprits, says Dr. Rodrigo, adding that their presence might mean a higher risk of miscarriage.

He lists some of his concerns with older patients, including greater risk of general maternal health problems, such as heart disease, cholesterol, high blood pressure and diabetes. Problems with the reproductive system such as fibroids in the womb as well as ovarian inactivity could be a cause for concern.

For couples who have been through fertility treatments, there’s a greater possibility of having twins or triplets, which in itself can lead to further complications An increased risk of pre-eclampsia and most heartbreakingly, an ever higher possibility that the child might be born with Down’s Syndrome, must also be taken into consideration. An extra chromosome 21 causes Down syndrome but many other chromosomal abnormalities are so severe they can lead to miscarriage. “The chances of the genetic abnormalities increase proportionately according to the woman’s age,” says Dr. Rodrigo. It might be 1 in 2,500 early on, but by the time a woman is 40, it’s 1 in 75 and when she’s 48, it’s 1 in 10.

He also voices concern about the social dimension of choosing to delay pregnancy. Elderly parents might struggle to raise a teenager or find themselves dealing with serious illness when they have to put their child through college, he says. It can also be a growing financial strain, hitting hardest just when you’re thinking about retiring.

However, some of these problems can be dealt with by just planning carefully ahead. Many women become happy mothers in their late thirties and a few precautions can improve their chances of having a smooth pregnancy and a healthy baby. For those who have access to the information, finding about their family history of genetic disorders might help them make a smarter decision, as will using any screening tests available. A woman should start taking her folic acid as well as vitamin supplements when she begins trying for a child.

These may help prevent genetic disorders. She should check to make sure her immunizations are up to date to lower the risk of infection while pregnant. For those with medical conditions such as high blood pressure and diabetes, bringing them under strict control is crucial. In essence, a woman needs to be as healthy as she can be prior to pregnancy – this may mean maintaining a healthy weight and eating a balanced diet as well as exercising regularly, limiting alcohol intake and not smoking.

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