Sexual Reproduction and Menopause
The Red Hot Mamas website has received a significant number of e-mails and bulletin board posts on the topic of sexual reproduction related to menopause. More women are attempting to start a family after the age of 40. They want to establish a strong foundation for bringing a new life into the world, so they decide to start later. Many different factors including relationship issues, career demands, waiting until the first house is purchased, and monetary setbacks can delay the age when you even start to think about children. Women can become frustrated, angry and upset when finally, everything is in place, they are ready to get pregnant, and nothing happens.
Many people do not realize that fertility in women declines with age. According to the American Society for Reproductive Medicine (ASRM), there is a strong association between an increase in age and decrease in fertility1. A woman’s ovarian production of eggs slows down. The chance of getting pregnant begins to decrease in a woman’s early 30s, declines more rapidly after 35, and progressively declines through perimenopause. When a woman reaches menopause, it is no longer possible for her to become pregnant with her own eggs because she has none left. Surgery, chemotherapy or radiation therapy are other causes of running out of eggs and can cause premature menopause. Women are often surprised to find out they can no longer have children.
Perimenopause and Sexual Reproduction
Often times, women in their thirties are shocked when they begin having trouble becoming pregnant and find out their fertility is declining or they are in the perimenopause transition. Ovarian problems begin during this stage in a woman’s life. Women are not only getting older, their eggs are also. All of a woman’s eggs are produced in her ovaries before she is born. After puberty, one egg is produced each month of a woman’s life. If there is a defect in that egg, there is less chance for fertilization and an increased chance of a miscarriage. The frequency of egg defects also increases as we age. When a woman ovulates (produces an egg), the hormone progesterone is needed to sustain the embryo. If the follicle from the egg does not produce enough progesterone within two weeks following ovulation (the luteal phase), the embryo is not able to implant in the uterus and results in a miscarriage. Blood tests can measure progesterone levels in the body and can reveal the presence of a luteal phase deficiency.
To enhance your chance of becoming pregnant, your doctor may prescribe a fertility enhancing drug to help you produce more than one egg per month or to optimize your ovulation. Assisted reproductive technologies (ARTs) are available as well. A common ART is invitro fertilization (IVF). Your egg is removed with a needle inserted into your ovary through the back wall of your vagina. The fertilization takes place in a lab. The fertilized egg(s) is then placed in a woman’s uterus. Intracytoplasmic sperm injection (ICSI) is another common ART that injects a single sperm into an egg then places the egg into the uterus. If a woman is in menopause, these methods don’t work and success rates for women in the perimenopause are less than 5%. When fertility enhancing drugs and assisted reproductive technologies don’t work, an egg donor can be considered which involves IVF using the egg from a younger woman. Adoption is always another option.
Natural menopause and reproduction
If you are having difficulty conceiving, one of the first things your doctor will do is check to see if you are capable of ovulating. In order to ovulate, you need to have eggs that can respond to the hormone that stimulates ovulation. That hormone is called FSH or follicle stimulating hormone. A follicle is the name given to the small cyst that surrounds an egg each month as it develops. During the menopause transition, your eggs become more resistant to FSH and blood levels of the hormone rise. The FSH test is often used to see if you are in menopause. The higher the level is over normal, the fewer eggs you have lest. There is no absolute number that diagnoses menopause.
Premature Menopause
Menopause before age 40 is called premature menopause. It can occur after surgery, chemotherapy or radiation therapy or in some cases, naturally. This can cause a woman to feel as though the change in life came too early. They find themselves traumatized by losing the ability to have children earlier in their lives than expected.
Surgical menopause
Surgical menopause refers to menopause induced by surgery. Removal of both ovaries results in immediate menopause. It is a form of permanent sterilization. You will no longer have the ability to become pregnant.
Medical menopause
Medical menopause is induced by chemotherapy or radiation therapy. These treatments can cause a “pause” in the body’s normal menstrual cycle that is permanent, but once the treatments are completed, periods may return.
Your Choices
Some of the women writing us had the desire to have a family and discovered their dream for a family would not be a reality due to menopause. They became very sad, emotional and distressed over their loss of their fertility due to menopause.
Red Hot Mamas wanted to address this important issue because coping with infertility during the holiday season is especially stressful, particularly when there are family gatherings with many children around (especially at Thanksgiving, Christmas and of course, Mother’s Day and Father’s Day). It is during this holiday time that many women are reminded of their desire to have a child.
November is National Adoption Month which is designated as a national recruitment campaign to encourage families to “ensure the safety, permanency, and well-being of our children”2. If you have always wanted to start a family, but have reached a time in your life when it is biologically not possible, consider adoption. There are many children, of all ages, races and nationalities, waiting to become part of a family and be loved. The National Adoption Information Clearinghouse provides an online directory of support services with state-by-state contact information3. If you’re longing for a child is deep within your heart, learn more about the different options and ways to adopt. The National Adoption Information Clearinghouse provides an online directory of support groups with state-by-state contact information4.
Seek advice
Your healthcare provider can help you address all of your concerns specific to your situation.
Discuss with your doctor the different ways to tell if you are fertile. Discuss whether you are capable of ovulating and have your doctor take a dipstick on your hormone levels. If you are having problems becoming pregnant, seek the help from your gynecologist or a fertility specialist. The earlier you start, the greater your chances are for success.
Take time and share your feelings with your partner. By doing so, you will be better able to help each other through this difficult time. Reach out to your family and friends - not looking to them to fix things, just support you.
Coming to terms with the situation can feel impossible but requires support from your partner, friends and family. Seek the help of a professional counselor if you are experiencing grief or depression for long periods of time. If these feelings are interfering with your day-to-day life and relationships, get the help you need. You can start feeling better about yourself today.
Speaking with other women may improve your outlook. There are many resources for women looking for solace and a place to share their feelings with others. A number of forums are available through the International Council on Infertility Information Dissemination, Inc. (INCD): http://www.inclid.rg/index.php?page=forums. For other forums on women’s health, log onto www.redhotmamas.org bulletin board, part of the Vibrance Network that includes www.newshe.com; www.ourgyn.com; and www.hisandherhealth.com. Resolve and the American Fertility Association are patient forums that focus on fertility issues. The American Society for Reproductive Medicine (ASRM.org) can help you find a qualified physician to help you.
If you don’t find a specific post regarding your concern, create your own post. Chances are there will be women out there who would like to share with you their similar concerns.
Remember the basics
It is important to have an understanding of the menopause transition and it’s affect on fertility and beyond. Before trying to conceive, be as healthy as possible. Eat a healthy diet, exercise regularly; rid yourself of stress, get plenty of rest and plan to have regular sexual activities to enhance your chances of becoming pregnant. There is hope and there may be a solution to resolve your problem if it focuses on a strong desire to have children.
Feelings of loss are common at menopause. It is ok to be angry, confused and upset at the fact you can no longer have children. There are others out there just like you. Find a way to take control of these feelings and channel them in a positive way. If you are longing for a child deep within your heart, learn more about the different options and ways to adopt.
References:
1 American Society of Reproductive Medicine Journal of Sexuality Reproduction and Menopause, Volume 3, Issue 1, pp.12-17, “Understanding the menopausal transition, and managing its clinical challenges”: http://www.srmjournal.org/article/PIIS1546250105000022/fulltext#section
2 Journal of Sexuality, Reproduction and Menopause articles:
“Sex and Menopause: the sizzle and the fizzle” by Karen Giblin:
“Sex and Menopause: from red hot to red hot mama” by Dr. Machelle Seibel:
3 National Adoption Month information: http://naic.acf.hhs.gov/general/adoptmonth/about_adopt_month.cfm
4 The National Adoption Information Clearinghouse adoption directory search: http://naic.acf.hhs.gov/general/nad/index.cfm
THE STORY OF A MIDDLE AGE MAMA
By Barbara Lorenzo
When I was a young woman focused on my career, I believed the hype about “you can have it all”. I could build the career and then late in life get pregnant and have children. Well, I built my career. I went to graduate school and became a Clinical Social Worker. I went through years of clinical training and built my practice.
Along the way, I met a wonderful man. We married, built a house and then decided that we wanted to have children. By this time I was in my forties. Oh well, no problem as “I could have it all”. Right? Wrong! A funny thing happened on the way to deciding to have children. My body aged. Sad to say, it began its journey toward menopause and nothing was going to change that.
I tried very powerful and high doses of Fertility drugs. I tried Artificial Insemination, GIFT and IVF. There were so many VF’s and I tried them all. I was labeled everything, including a “Poor Responder to Hard Eggs”. Many, many thousands of dollars and years later, I was told the news. You’re too old! I was devastated. We could not believe it. Why did they not tell us this earlier?
As the reality set in, life without children became very painful. Coming from a large family I was in constant contact with family members becoming pregnant and having children. My neighbors across the street had twins. While I was happy for them, I was devastated! Being around children became very painful and I found myself pushing back my emotions. I felt like such a failure. I thought of myself as one big hard egg!
Fortunately, my loving husband was always very supportive. He felt that he could remain “child free” but I didn’t. I knew I had to do something. Several years later, when I was 46, I began to hear about international adoption. A woman where I worked adopted a sweet little baby boy from Russia. She and I spoke and I followed her progress with the adoption.
Through my relationship with her and what I learned on my own, I decided that maybe there was hope for us. Being a social worker, I’ve spent years of studying and learning systems. If it is one thing I knew, it was how to work with a governmental system. So, Russia became not just a possibility but a reality.
In 2002, after many years of heartache and searching, my dear husband and I embarked on a journey to Russia to adopt two brothers. Given our ages (48), we felt that we would skip the infant stage and adopt younger children. On November 13, 2002, my husband and I stood in front of a Russian judge in the state of Vladimir, Russia and vowed to love, cherish and raise two little brothers Alexander and Nikita. This was the best day of our lives.
Fast forward to 2005 and a very happy family! My life is now filled with Sponge Bob, Power Rangers, Cub Scouts, camping, PTA and all of the things important to raising little boys. Gone is the hurt and anger. Gone is the “Old Egg Feeling”. What is now important are wedgies, how far I can spit and the color of bug guts!
Sure I am in perimenopause and there are those days that my family begs me to turn down the air conditioner. However, I’m a mom, I feel young and I love it! My boys are happy, healthy and we are all secure in a loving family.
I have also made a career change. I started my own adoption agency and these days, I help singles and couples realize their dream of a family through international adoption. To learn more about international adoption, visit my website: http://www.adopthomestudyserv.com.
It really doesn't matter what age you are, your hormonal level, stage of menopause or the condition of your eggs. If you want to have a family you can. You just need to open your arms and open your heart to other possibilities!
Barbara has many years of experience withassisting individuals and couples explore and pursueadoption as the means to build or expand their family. She holds a Masters Degree in Clinical Social Work and is an experienced clinician and educator. Many families and organizations call upon her for her knowledge of the adoption process and her experience withcouples who are not able to have children biologically. Home Studies and Services, Inc. is a full service adoption agency licensed in Pennsylvania but able to provide services nationwide.
Barbara Lorenzo, LCSW,is a licensed clinical social worker, the founderand the Executive Director of Adoption Home Studies and Services, Inc. She is also an adoptive parent to two sons from Russia.
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