Episode 75: Motherhood Over Age 40, Miscarriages, and the Impact of COVID-19 on Fertility.
In this episode, Dr Bahijja Raimi-Abraham talks about motherhood over 40, miscarriages and the impact of COVID19 on fertility with Dr Zeynep Gurtin (also featured in episode 74), a Lecturer in Women’s Health at the Institute for Women’s Health at University College London (UCL), and holds an Affiliate Lectureship at the University of Cambridge Sociology Department.
Pregnancy Over Age 40
Dr Bahijja: Motherhood after 40 seems to be a growing reality for a number of people. Previously, I have heard the term “geriatric pregnancy” used for pregnancies over age 35, is this term still used?
Dr Zeynep: It’s still used, although most clinicians are now more sensitive towards patients. Depending on where you live in the country as well, such as in central London, pregnancies over 35 are far more common as well. At UCLH, for example, it’s honestly rare to see women under 35, and it is more normal now. Is is not as common everywhere in the UK or the world, but its becoming more common, especially in urban areas.
Dr Bahijja: Are there any risks for women having children over 35 and more specifically over 40?
Dr Zeynep: I don’t have firm data off the top of my head, however, there are risks that increase as you get older. For example, risk of infertility and risk of miscarriage increases. The risk of gestational diabetes, pre-eclampsia, etc. also increase with age. However, there are many women over 35+ who do not experience any complications, so increased risk doesn’t necessarily mean each patient with experience all, some, or any risks.
Dr Bahijja: What are the differences in the experience of being pregnant over 35, over 40 compared to those who are pregnant younger?
Dr Zeynep: Anxiety in pregnancy is often more common in pregnancies in those over 35+, however, this really depends on the individual. For example, many individuals may have had prior miscarriages, or failure to conceive for an extended period of time, or infertility and this can cause a lot of stress. That situation will, of course, increase anxiety if they eventually do become pregnant.
Dr Bahijja: Is there as much focus on men and parenthood over 40? Are there any risks there?
Dr Zeynep: That’s a really important point, and we really cannot leave men out of the question. While my research focuses on women, we really do need more information on this. There is less research on this area, however, researchers have also found it is much harder to recruit men into studies on fertility. Even when we try really hard to get men involved, its just harder as they perceive these as “feminine” issues.
One thing to note, is in recent years we have seen a huge decline in male fertility (or an increase in low sperm count) and an decrease in quality of sperm (meaning the function of the individual sperm). At the moment, with heterosexual couples, around 50% of the time the issue will be men’s infertility.
Dr Bahijja: What are common misconceptions about pregnancy over 40? What can be done to de-stigmatise pregnancy over 40?
Dr Zeynep: The main misconception is that these are women who are selfish, that they are career women who prioritise their job’s over family and have left things too late. In the media theres this misconception as if these women want to “have their cake and eat it”, as if there [is someone wrong with wanting both a fulfilling career and children]. This is just so far from the truth. Oftentimes I hear that these women focused on their careers because they didn’t have a family, simply because they never met the right person and never had the opportunity to settle down. Oftentimes, its just a matter of not finding the right relationship or even fertility concerns. […]
Miscarriages and Stigma
Dr Bahijja: In November 2020, The Duchess of Sussex revealed that she had suffered a miscarriage of her second pregnancy. You say in the article you wrote in the Guardian that:
Although miscarriages are surprisingly common and “ experienced by approximately one in four women” there continue to be pervasive taboos around the subject. This is partly because around 85% of miscarriages occur within the first trimester, before most women publicly announce their pregnancies.
So, why are miscarriages still so difficult for society, for people and for women to process and also to accept as being common?
Dr Zeynep: It’s actually incredibly sad, as it is a terrible experience for people to go through. It is even more difficult due to the stigma, as people have to go through it all on their own. That is why there is a general 12 week social rule, where people typically do not share their pregnancy. If a person then miscarries, they are expected to just deal with it, [as if there wasn’t just a potentially traumatic situation]. How attached a women might be to a baby has nothing to do with how long a pregnancy has been going on. […]
Impact of COVID-19 and Lockdown on Fertility
Dr Bahijja: COVID-19 has affected almost every part of life. How has it affected the fertility landscape?
Dr Zeynep: So this current pandemic will have reverberations for some time. In regard to fertility, it has had several effects. For single people looking for partners, it has made things very difficult in terms of finding a new partner. Single women who previously wanted to settle down are experiencing a lot of anxiety related to this. People undergoing IVF also experienced issues, as fertility clinics have been closed during some lockdowns, and there is now a backlog creating delays. Capacity has also been reduced. […]
Dr Bahijja: How COVID-19 impacted reproductive anxiety, if so how/why?
Dr Zeynep: Many fertility patients have felt really anxious about the disruptions in the treatments, but some people I’ve spoken to noted that they kind of welcomed the forced break. In some cases, people mentioned that it was beneficial to their relationships. In the survey we did of 501 couples, many noted it made them feel more relaxed about reproduction and two of them even naturally conceived during the lockdown, even with the disruptions to the IVF treatment. […]
Dr Bahijja: There was an assumption that there would be a lot of “lockdown babies” but I’ve seen a few articles suggesting that the UK has seen the lowest number of births since records were predicted. What are your thoughts on this?
Dr Zeynep: From there beginning there were these comments about the “lockdown baby boom”, but we really haven’t seen this in the numbers. It was a bit weird that people assumed a lockdown would be this sudden aphrodisiac, despite all of the pain that many people have experienced. Many women have also felt left out, as this doesn’t reflect their experience at all and they really feel excluded.
Dr Bahijja: There has also been misinformation spread that the COVID-19 vaccines have an effect on fertility. Though a recent guidance published by the Association of Reproductive and Clinical Scientists and the British Fertility Society has confirmed that absolutely no evidence that covid-19 vaccines can affect the fertility of women or men.
Dr Zeynep: There have been so many inaccuracies and scaremonerging occuring surrounding the vaccine — these rumours have been entirely baseless. But of course, as fertility is a concern for many people at the moment, even just hearing these rumours can lead to increased vaccine hesitancy and a growing concern. [It’s important to really share the information and data — showing that it is safe and doesn’t effect fertility — so that we can combat vaccine hesitancy.]
Dr Bahijja: Are there differences in attitudes across different cultures with respect to fertility treatments?
Dr Zeynep: This is a growing area of research amoung reproductive sociologists and archaeologists. Reproduction is so important within our societies that it makes up a huge portion of our cultures. Unsurprisingly then, there are many different ideas of fertility across cultures. Preferences of fertility, [indicators of fertility, views of fertility treatments and what those treatments are — these are all things that vary immensely accross different cultures]. Of course, most cultures if not all promote healthy fertility and relationships, but the rules, regulations and acceptance of fertility treatments varies extensively.
Dr Bahijja: What is the future of fertility and Women’s Health? What are the future needs?
Dr Zeynep: I think most research is in one of two camps — one camp feels that we now have increased technology, proliferation of technology and lots of different options. They might argue that the technological aspect will increase and become more sophisticated, [providing more fertility options for a wider variety of people]. I think the other camp would argue that there is a pendulum swinging — they think that the generation below [Millennials] will start having children earlier. This would result in less of a dependance on technological intervention.
The amazing aspect, however, of fertility treatments, is how they have enabled so many different families — same sex couples, single women, or people with genetic risk factors, to have children when they may have otherwise been unable to.
Did you know? There is an experimental IVF technology called “Egg Blending” or merging in which the eggs of two separate donors are combined and then fertilised, providing an option for same sex partners who would like a child that is their genetic offspring.
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