Pregnancy After 35: Glade Curtis, MD

Last Editorial Review: 3/24/2004

By Glade Curtis
WebMD Live Events Transcript

Are you pregnant in your 30s or 40s? You're not alone. More and more women are waiting until their 20s are behind them to have children. Your chances of a healthy pregnancy are excellent, but conceiving after 35 does come with some special circumstances. Your Pregnancy After 35 co-author, Glade Curtis, MD, was our guest on Tuesday, April 30, 2002.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live. Our guest today is Glade Curtis, MD, co-author of Your Pregnancy after 35.

Your appearance on WebMD is well timed, Dr. Curtis. An article in my newspaper today says London researchers (Bristol University) have found that fertility, in men and women both, declines at an earlier rate than previously thought. Should your book be renamed Your Pregnancy after 27?

Curtis: I don't think so. The focus of the book is for people at an older age when they get pregnant. It's hard to decide where to draw the line on that. We've all been aware that as we get older, there can be increased risks and problems for the older couple. With a study like the one you refer to, it's interesting to take note of the information, but I would like to see more information and more studies. So we won't change the title of the book just yet!

Moderator: So this news should not be a source of too much worry for 30-year-olds who thought they were still in their prime?

Curtis: I don't think it's a source of concern. But it's always wise for those planning families to be aware as they get older that it may be more difficult to get pregnant. The number 35 is not magical but it seems to be the age where we start talking about these problems. But I certainly don't think those who are 27 need to panic and change their plans. It could be a reminder for those who are in their early 30s and contemplating a family or childbearing that they might want to move up their schedule.

Member: I am 32 years old and nowhere close to having children. I have heard that fertility drops 50% after 35. Is that true? If so, is there anything I can do to help my chances of conceiving in the future?

Curtis: I look at fertility after 30 not as a precipitous drop at a certain age, but more a gradual decline. The question you asked is very complicated because of numerous factors. A part of the question, can you do anything to improve your fertility -- the obvious answer is to be aware that the longer you put off the decision that your chance of success will go down.

A suggestion that's been given in the past has been use of birth control pills to try and help prevent endometriosis while you are waiting to have children. Endometriosis has been one of the problems for the older woman who is trying to get pregnant. The hormones in birth control pills can help protect you against the development of endometriosis even if you don't need the hormones or birth control pills for contraception.

Another area of precaution is with regard to infection. Using a condom to help prevent infection such as chlamydia or gonorrhea would be a good safeguard in trying to protect your fertility.

The other suggestion I would have would be general healthy living in watching your weight, eating right, and exercising, because most of us find as we get older these things become more challenging and they can have an effect on your ability to conceive and carry a pregnancy. This would include things such as smoking, alcohol, or drug intake.

Member: Is there any evidence that being on the pill reduces fertility?

Curtis: That's an excellent question, and one that doctors hear often. My experience is, and my belief is, that the birth control pill has more positive effects related to conception in the future and it does not do anything to make it difficult to get pregnant. I mentioned endometriosis. We often use the birth control pill as a first-line treatment for endometriosis. We use the birth control pill to help prevent ovarian cysts. I have seen many women over the years that took the birth control pill to prevent the formation of cysts and I believe this has been key in maintaining and preserving their fertility.

I advised my own daughters to take birth control pills. When the time was right I wanted them to have children and therefore grandchildren for me. The positives outweigh any negatives with the birth control pill and I would advise its use.

Member: If you're on the pill, does that extend the life of your eggs?

Curtis: Taking the pill prevents you from ovulating. It may mean that you have a little later menopause and therefore could extend your ability to ovulate. I think the biggest factor is the hormonal regulation from the pill. A problem that many women 30 and older have is irregular ovulation because of changing hormone levels. The pill takes care of this. I believe this is part of the benefit of taking the pill in preserving your ability to get pregnant.

Member: What about HPV [human papillomavirus]? Is that a risk factor for endometriosis or other fertility problems?

Curtis: Our knowledge right now indicates HPV is not a risk factor for endometriosis.

HPV does have a very strong link to abnormal pap smears, cervical dysplasia, and even cervical cancer. I have seen situations where a very young woman had abnormal pap smears making it necessary for her to have biopsies on her cervix, treatments for cancer and precancer, and these things can make a difference for future fertility.

I think another important factor is that HPV is a venereal infection and if you are exposed to that infection, it could mean that you are exposed to other serious infections such as gonorrhea or chlamydia. The concern with venereal infections is the scar tissue and damage to the fallopian tubes [they can cause]. There have been theories proposed that endometriosis in some women is caused by infections. We don't know that this is true, but it could be an important consideration.

Member: Do you know what percentage of women have endometriosis and do the chances of getting it increase with age?

Curtis: I don't know the actual percentage, but it does increase with age. That is why this is such an important factor for the woman who is older and wants to get pregnant. Many studies have shown that by delaying pregnancy, women end up having endometriosis. We don't know if this is because pregnancy protects them or it is more years of having periods and endometriosis gradually developing. Some people think that endometriosis is caused by menstrual blood backflow out the tubes and into the abdomen, which kind of makes sense. Therefore, in the older woman who has not had a pregnancy, she has had more periods and more chance for this to occur.

I have seen many patients that are 30 or in their early 30s who have had a gradual increase in pelvic pain and painful periods, and we end up diagnosing endometriosis. Many times [we discover this] when they try to get pregnant and can't.

Moderator: You've touched on endometriosis, but could you give us a laundry list of other concerns or complications a woman over 35 might experience that a younger woman might not when trying to conceive and when pregnant?

Curtis: We have talked about a couple of things already. Endometriosis is one. Pelvic infections or damage to fallopian tubes is another. Another important area of concern for a woman would be her general health, and as we get older, it is more likely to have problems with general health concerns. The kind of things I'm talking about would be

Many of these types of illnesses have their highest percentage of cases in women in age groups over 30. We know that a woman who is pregnant and over 30 is more likely to have her pregnancy complicated by the things I mentioned. With an illness such as diabetes or lupus as an example, there are medications that must be taken that can affect pregnancy. We also know that pregnancy can affect these medical problems.

I think one of the things that we have not touched on is the impact for the fetus in an older pregnancy. We have talked about difficulty getting pregnant, risks to mom from pregnancy, but I think it's also important to realize the risks for the baby are increased as we get older. The risk of multiple pregnancy with twins or triplets is higher with advanced maternal age. The risk of Down syndrome is one that is often mentioned and we know that this risk increases as mom gets older. As an example, at age 30 the risk is one in 1,000. At 35, the risk is one in 350. At age 45, it is about one in 30.

Moderator: Is gestational diabetes more prevalent among older women because we are generally heavier at 35 than at 25? Or is something else involved?

Curtis: Gestational diabetes is more prevalent as a woman gets older. I believe it's a combination of factors including our nutrition, exercise, and weight gain. I have had some women tell me that when they were older, they were more organized and established and knew more about nutrition and exercise and could take care of themselves better and therefore prevent these problems. I think it's a very individual thing and the message for the pregnant woman is whether she's 25, 30, or 35, her health, her nutrition, exercise, and how she takes care of herself before and during the pregnancy will affect the health of her baby.

Member: Can you explain the correlation between being older and the higher likelihood of having twins or triplets?

Curtis: The association between multiple births and older age is probably related to the fact that when a woman is born she has all of the eggs she is ever going to have. The eggs that are ovulated at age 20 have been around for 20 years. The eggs ovulated at 35 have been around that much longer. They have been exposed to more in the way of medications and environmental things. This also is related to the increased risk of Down syndrome and other genetic problems in the older woman. Something is different about these eggs and that is probably a factor in the development of twins or multiple births.

Member: What are some of the recommended prenatal vitamins?

Curtis: I don't want to mention any specific names, but will give general guidelines. Prenatal vitamins have come a long way. There used to be very few choices. They were huge in the past, jokingly referred to as horse pills. Now, prenatal vitamins are available in several different forms. These include liquids, pills that you can chew and dissolve in your mouth, and smaller pills. I think this last type of pill (the ones you can chew) or the liquid pills are good for those women who either can't swallow pills or have problems with nausea or indigestion from prenatal vitamin pills.

An important factor with prenatal vitamins is your insurance coverage. Some insurance companies cover prenatal vitamins. Some don't. They may not cover the newer vitamins, and you may have to get permission to take those or in some cases have to pay for them yourself. There are also over-the-counter vitamins available now as good as most prescription vitamins that in some cases are cheaper than your co-pay. It is wise to ask your doctor in your specific case if a vitamin is different than the one prescribed. Just make sure it's OK to substitute. I think it's a good idea to take the vitamins and I recommend continuing them after pregnancy, particularly if you are breastfeeding.

Member: I've heard you could just take folic acid. What does that do?

Curtis: Folic acid has several benefits during pregnancy and before pregnancy. It has been shown to be very important in preventing anemia and I think it's OK to take folic acid, but would not take that alone or instead of prenatal vitamins. If your situation is unique, I would not make that change without discussing it with your doctor.

Member: What other problems, besides Down syndrome, are the fetus of a 35-plus woman more likely to experience?

Curtis: We have talked about a couple of the problems including Down syndrome, multiple pregnancy, and related to this is premature delivery, which can include low birth weight. Also more likely in the older woman is intrauterine growth restriction. A woman over 35 is more likely to have complications during labor, leading to the possibility of a C-section delivery. Other problems for the baby would be other genetic problems that are more likely to occur as a woman gets older.

So far we have talked about scary things -- complications and problems. It is important to realize, however, that most of these things don't happen very often. And more often, pregnancy is healthy, we deliver healthy, happy babies, and all is OK. It is important that when we talk about a risk of a 35-year-old having a Down syndrome child being one in 350, 349 times everything is going to be OK. I would emphasize being positive and expecting a good and happy result because that's what happens most of the time. Pregnancy is both an exciting and a scary proposition at any age.

Member: I am 42 and recently miscarried after one month of pregnancy. This was my first pregnancy. My husband and I had been trying to conceive for about a year and a half prior. Due to the age factor, should I consider seeing an infertility specialist?

Curtis: First of all, the positive part of a miscarriage is that you are able to get pregnant. If you are seeing a gynecologist, I don't think you need to see anyone more specialized than that. It would be worth asking the doctor if she or he is comfortable taking care of you or if you need a specialist. Good luck to you.

Member: I am planning to try for my first child. My husband and I are both 36. How long should we try before seeking help if nothing happens?

Curtis: The average couple trying to get pregnant without any contraception takes about eight months to a year. If you ask most doctors for help in getting pregnant, and you have not tried for a year, they will probably tell you to keep trying on your own. However, at age 36, I would not want to be wasting a lot of time. I think it would be OK to consider a few things such as keeping track of your temperature, or even doing home urine ovulation tests, if you can do these things without getting too anxious.

Another important factor is if your periods are normal. If your periods are normal and regular, then your chances are a lot better. If you don't have periods or they are very irregular, I would ask for help. If in the past you have had problems with some of the things we have talked about such as endometriosis or adhesions, I would discuss that with the doctor before waiting more than a few months.

Member: On Sunday I had a second miscarriage since the beginning of the year. I'm 35 and have been trying to conceive for eight months and can't seem to get pregnant. Do two miscarriages signal a problem or is it just nature's way?

Curtis: Two miscarriages is probably just bad luck. Again, the positive thing about miscarriage is that you were able to get pregnant. Most people don't consider it a bigger problem until you have had three miscarriages in a row. The medical term for this is habitual miscarriage or abortion. You don't qualify for that. I would certainly ask the doctor if there are things you need to consider or do, and if the answer is no, I would try again with confidence that it's going to work this time.

Moderator: Before we wrap up for today, do you have any final comments for us, Dr. Curtis?

Curtis: I would like to emphasize the positive. It always helps to have a positive attitude. Problems and complications work out. It's a great joy when they do, even though they become teenagers, eventually.

Moderator: We are out of time. Thanks to Glade Curtis, MD, for being our guest, and thank you members for joining us today.

The opinions expressed in this transcript are those of the health professional's and have not been medically verified by WebMD. If you have questions about your health, you should consult your personal physician.

©1996-2005 WebMD Inc. All rights reserved.

Health Solutions From Our Sponsors