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Planning a Family

Family Planning

WebMD Feature

As Jeanne Meyers was growing up, she always assumed she'd have children someday. But when she got married in her 30s, at a time when both she and her husband had successful careers, they decided to postpone starting a family for a couple more years. A family, they felt, could wait a little while longer.

But before long, their plan of having children was turned upside down. In her mid-30s, when Jeanne and her husband had finally made the decision to become parents, she had difficulty becoming pregnant, month after disappointing month. Finally, a reproductive specialist broke the news that had seemed inconceivable to Jeanne earlier in her life: Her eggs had deteriorated in quality as she had aged, presenting a major obstacle to pregnancy.

"We tried in vitro fertilization (IVF) when I was 37, and while I did get pregnant, I miscarried, probably due to the egg quality," says Jeanne (whose last name has been changed in this article at her request). "I used to work as a nurse in the fertility field, but I never thought I'd be on the other side. I never imagined that I'd have difficulty having children myself."

Jeanne, who now does medical-legal consulting in Atlanta, says that she and her husband faced the facts: While she could probably get pregnant again through IVF, the odds were good that she would miscarry. So they stepped back, and decided to adopt children. Today, at age 40, she and her husband have two sons who were born in the Ukraine.

For millions of Americans like Jeanne, the family life they've given birth to isn't exactly the one they may have envisioned years earlier. In fact, in America today, terms like "family planning" have taken on new meaning, with couples often moving in unanticipated directions as they respond to the hand they've been dealt.

Waiting Too Long?

As part of their family planning, more women than ever are choosing to postpone childbearing into their late 30s and early 40s, due to careers and late marriages. But as with Jeanne, many may have miscalculated their ability to become pregnant. According to the American Society for Reproductive Medicine, a startling two-thirds of women will not be able to conceive spontaneously by age 40 due to factors such as changes in their eggs and the way their ovaries function.

"Ultimately, age matters," says Ruth Fretts, MD, obstetrician/gynecologist at Harvard Medical School and Brigham and Women's Hospital in Boston. "Women tend to not want to hear this. But the large, well-designed studies show that women who delay significantly are going to have an increased risk of infertility. Biology is sexist," adds Fretts. "Biology just doesn't care."

At New York University Medical Center, obstetrician/gynecologist Steven Goldstein, MD, says career women often come into his office at age 38 or 39, perhaps having just gotten married, and announce that they plan to wait a couple more years before having a baby. "I find myself gulping," he says. "Particularly in women over age 40, physicians are nervous as hell that these women are flirting with disaster by having waited. They may not get pregnant when they want to, not because they aren't ovulating, but because the quality of their eggs has diminished."

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