Average costs of common fertility treatment options in the United States:
Fertility assessment: $250 to $500
Semen analysis: $200 to $250
Base fee for one IVF cycle: $12,000 to $14,000
Injectable medications: $3,000 to $6,000
Donor sperm: $300 to $1,600
Intracytoplasmic sperm injection (ICSI): Up to $2,000
Genetic testing: $1,800 to $6,000
Frozen embryo transfer (FET): Up to $6,400
Medication for FET: $300 to $1,500
Frozen donor eggs base cycle fee: $14,000 to $20,000+
Fresh donor eggs base cycle fee: $27,000 to $47,000+
Gestational carrier or surrogate: $60,000 to $150,000+
Three Reflections on Trying to Get Pregnant in My 30s
1. I was inching toward a precipice. While I was in a committed relationship, and in my 32nd year, I was not yet engaged much less married. I decided to ask my doctor about it at my annual gynecologist visit. This doc was known for her rather blunt, no-nonsense delivery, which didn’t appeal to all women but which I personally appreciated. “Should I be worried?” was the crux of my inquiry.
“I didn’t even meet my husband until I was 35, and I had four kids,” she said, almost dismissively, dispelling my concern. Wow, four kids after 35? Great! What a relief. I left the appointment reasonably reassured that much of the talk swirling around women my age was just hype.
Fast forward a year and I was back in her office for my annual checkup. The nurse put me in a different exam room. This one featured a portrait on one wall, four small children dressed up and staged on a bench in some photographer’s studio. The white, wooden painted frame screamed early ‘90s. Clearly these were those four kids my GYN had had after 35. I examined the portrait while waiting. A clearly older child on one end, then two that looked like twins, and one that seemed slightly younger on the other end. I asked about the picture when the doctor came in, wondering if I was right about the twins.
“Nope, those three are triplets.”
‘You bitch,’ I thought. You had to know that was NOT what I thought you meant last year. So, you had four kids after 35 with the help of fertility treatment. Treatments for which you probably got some “professional courtesy” discount. Sure, maybe the first one came naturally. But I don’t believe for a second that you had a naturally occurring set of triplets past the age of 35. What are the odds of that? And more importantly, does this mean I do have reason to worry, assuming I’d prefer to avoid having to resort to expensive and arduous fertility treatments to have a family? I wondered these things, but I didn’t ask, didn’t call her on her half-truth.
By this point I was 33—it was around 2016 or so—and living in the DC area. It seemed like stories about “the fertility cliff” at 35, or “progressive” employers paying for egg freezing for their female employees were everywhere.
2. Cut to early 2017, I’m now 34 and engaged to be married in late March. I’m at an off-site team building event for work, and Peter, a member of our office’s senior management, has come down to give us all a pep talk. He stays to join the group for lunch. Peter takes a seat at my table, otherwise occupied exclusively by women. Among them are one of my managers, Amy, and at least two of my teammates who are also in their late 20s or mid-30s.
We make polite conversation, as you do when a higher up of another generation attempts to relate. Soon the topic turns to how his engaged daughter is pregnant and is postponing planning her wedding until after the baby is born. This is because, as he explains: “she’s in her mid-30s, so having this baby now is important.” He’s attempting to sound cool, but he’s clearly not thrilled that she’s put the cart before the horse. It seems obvious that he’s latched onto this “well, she’s in her mid-30s thus practically a dried-out spinster, so it’s probably best that she just has a baby first before it’s too late. Then she can worry about getting married,” narrative to make himself feel better about the order of operations. The phrase “because, you know, she’s in her mid-30s,” comes out of his mouth several more times in relaying this story to this table of women.
I must have caught my colleague Nadia’s eye with my own rolling one, because she fills the next conversational lull by offering up: “Mary’s getting married soon.” She’s teed me up and before I can think better of it, I grab the baton.
“Yeah, coming up in March. I’m also in my mid-30s. Still going to go ahead and get married first, hopefully I can manage to have some kids later.” I honestly don’t remember how Peter responded, probably because he didn’t know quite how to respond to that. Thankfully, lunch was soon over and it was time to start the afternoon’s sessions.
I started across the compound on my own, but soon realized Amy was speed-walking to catch up with me. “Here it comes,” I thought. “I’m going to get a talking-to for mouthing off to a senior official.” But, drawing up alongside, she surprised me.
“Mary, I’m so sorry about that!” she began, shaking her head at Peter’s inability to read the room. As we walked, she shared some of her own story. She didn’t get married until she was 32. As soon as she’d turned 30, her mother would regularly call her to harp on how she hadn’t had kids yet and was running out of time. Yet, Amy had three of them, the last when she was 37.
I appreciated her words, and that she took the time to confide this. But underneath my sharp tongue with Peter was a very real sense of dread that I was getting a rather late start. Sure, Amy got married at 32 and had a family, but that was still a head start on me. I would turn the dreaded 35 six months after my wedding, thus guaranteeing that any children I had would be “geriatric pregnancies” in the parlance of obstetrics. Her words were reassuring, but my fear was just as real as my annoyance with Peter’s tone-deaf story.
3. Shortly after settling in Cincinnati in autumn of 2018, I was due for my annual gynecologist appointment. Weeks away from turning 36 at this point and still smarting from my DC doctor’s lie of omission, of course the “geriatric pregnancy” question came up. Flipping over my appointment form to get to a blank piece of paper, my new doctor started drawing a graph. The reason they picked 35 as this “magic number,” he explained, was because 35 is essentially the point on the chart where the risk of having a baby with Down syndrome intersects with the risk of a miscarriage caused by amniocentesis.
As he explained it, the risk of pregnancy loss from amniocentesis—a procedure typically done to confirm a Down’s diagnosis—is steady at about one in 270 cases. He drew a straight line across the chart representing this. The risk of having a baby with Down syndrome starts out quite low, at about one in 1,000 pregnancies around the age of 20. This became the bottom corner of his graph, where the x and y axes met. That risk increases slowly to start, then as he drew his line started to rise upward more steeply in the 30s, reaching about one in 100 by age 40. At 35, the risk is also about one in 270. Hence, where these two lines meet on the graph represents the point in one’s reproductive life where the risk-benefit analysis of losing a baby from an elective procedure, and having a baby that will live, but with a chromosomal abnormality, is even.
I suppose I can see the “logic” behind this calculation, but it still equates two things that in my mind shouldn’t be considered equally undesirable outcomes. My doctor used the graph to illustrate that there was no dramatic drop-off or “cliff” specifically associated with 35. It was basically an actuarial calculation. Thus, he didn’t treat pregnant patients over 35 any differently unless or until there was reason to do so. While at the time I found this reassuring, I would realize later that his explanation only addressed the likelihood of conceiving a baby that is chromosomally “normal.” It did not really address my more burning question, whether my “advanced age” affected my likelihood of conceiving a baby at all.
Reflecting on these three incidents that have stuck in my memory, there is a common theme of optimism. Of concerns being raised and then downplayed. Of societal or familial norms and expectations being proven wrong, or outdated. Of reassurance that there was no need to worry, no ticking clocks or cliffs to be avoided, it was just media hype. And at first, staring at a Clearblue Digital test unambiguously displaying the word “Pregnant” one February morning a few months after turning 36, that optimism seemed well-placed.
And yet, just weeks later that optimism would be snuffed out in an ultrasound suite, when no amount of transvaginal probing could locate a heartbeat. It would be nearly two years before “Not” would finally cease to precede “Pregnant” on a digital test, and it would require scientific assistance after all.
Looking back now from the other side, I offer these reflections as a cautionary tale. I found myself approaching my mid-thirties and having a baby (or four) was something I wanted. Yet I let others be reckless with my fertility or dismiss my concerns with an anecdote. It was easier to accept the optimistic reassurances and not dig deeper, not advocate for more thorough answers. And sure, a woman in her 30s may have no problems at all, but she might, and I did. And I deserved satisfactory answers to my questions and an honest assessment of my chances. I should have kept asking until I got them.
Mary Mathes
Mary Mathes is a native Nebraskan and former Washington D.C. resident currently living in Cincinnati, OH. When not writing, she is a market research consultant. Her work has previously appeared in Notre Dame Magazine.
Cosmic Double 