Women learn about the biological clock from a young age. And shortly after, we hear about another scary image: the fertility cliff. This, we are informed, often repeatedly, happens somewhere around age 35. But does this fertility fear mongering have any truth to it? Yes and no.

“Thirty-five is often presented as a deadline for your fertility, but it is certainly not, the whole thing is a continuum,” explains Dr. Kelly Culwell an OBGYN and former medical officer at the World Health Organization. “As women get older, every year that goes by their fertility declines. But it’s not like it is great at 34 and then when you turn 35 it is done. It’s really more of a gradual downhill slope than a cliff.”

So, what is this downhill slope like? Here is what you should know.

What’s the big deal about age 35?
Historically 35 was the age when a fetus was more likely to have a genetic abnormality, and it was worth it to do otherwise risky tests. “We used to counsel women on the risk-benefit ratio and it was always at 35 when women were at greater risk of having a genetic abnormality,” says Dr. Culwell. “Now we have much less invasive testing, which can be done earlier. But that is where a lot of this age 35 stuff came from. Plus, when studies are reported they often make artificial cutoffs like ‘less than 35’ and ‘greater than 35.’ This may be where the idea that there is absolute cutoff came from.”

What is actually happening to your body?
As women age, they lose what is called their ovarian reserve, or the number of eggs left. The quality of eggs also declines with age, as well, which is why women have a higher risk for miscarriage and genetic abnormalities as they get older. There are also hormonal fluctuations that can begin 10 years before you go into menopause, and cause you to stop releasing eggs. This means that even if you have enough eggs, and your eggs are high-quality, you may not be getting pregnant for this reason. Older mothers are also more likely to develop certain complications such as pre-eclampsia, which is high blood pressure in pregnancy. “Other conditions like obesity, endometriosis, and fibroids that cause infertility also become more common as you get older,” says Dr. Culwell. “As we age we keep accumulating things that make it more difficult for us to become pregnant, stay pregnant, and then have a healthy baby.”

What options do you have?
Egg freezing is increasingly popular option for many women, however, this procedure is expensive, and there is no guarantee of a positive outcome. There are also a number of alternative reproductive therapies including IVF, egg donation, and surrogacy. “I would never tell someone that they should try to hurry up and get pregnant just because their fertility is declining,” Dr. Culwell says. “Becoming pregnant and choosing to have children is largely about your social situation. But I would say, if you want a pregnancy sometime in the next X number of years no time is better than the present.”

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