What if you waited too long to have your first child?

At 25, you think you have plenty of time. At 30, you think you'll see later. At 35, the question sometimes becomes much more concrete: "Do I still have time?"

Between studies, career, relationships, finances and personal projects, there is obviously no universal age to become a mother.

But there is a biological reality that is sometimes discussed too late: female fertility declines with age.

So, what is the "right" age?

There is no perfect age.

At 28 or 30, not having children yet is absolutely not a sign of being behind the times. But it also doesn't mean that fertility will remain the same for the next ten or fifteen years.

Fertility begins to decline gradually with age, with a more pronounced acceleration in the mid-thirties. After 40, conceiving naturally becomes statistically much more difficult.

Therefore, 35 years old is not an expiration date. But 35 years old is also not biologically equivalent to 25 years old.

The problem isn't just getting pregnant

With age, it is primarily the oocytes that change.

The number of available oocytes gradually decreases and the proportion of oocytes with chromosomal abnormalities increases.

This can lead to:

• more difficulties in conceiving;

• an increased risk of miscarriage;

• an increased risk of chromosomal abnormalities, including trisomy 21.

This obviously does not mean that a woman of 38 or 40 years old cannot have a perfectly normal pregnancy.

This simply means that the probabilities change.

And what about fibroids? Will they necessarily appear or grow larger?

No.

Fibroids become more common with age, but a woman who is expecting a pregnancy after 35 will not automatically develop fibroids.

When they already exist, some can increase in size during pregnancy, especially in the early stages. Their impact depends mainly on their size, number, and location .

A small fibroid located away from the uterine cavity does not have the same consequences as a fibroid that deforms the cavity.

And what about endometriosis?

Here again, we need to distinguish between two things.

Endometriosis can affect fertility and is sometimes diagnosed after several years of symptoms.

But endometriosis does not mean that the disease will necessarily "get worse" simply because a woman reaches 35 years of age.

On the other hand, a woman with endometriosis may have two overlapping factors: a disease that can affect fertility and, at the same time, the physiological decline in fertility related to age.

This is one of the reasons why a pregnancy plan sometimes deserves to be discussed earlier.

"After 35, a cesarean section will inevitably be necessary."

No.

Maternal age alone is not an indication for cesarean section.

A woman aged 38, 40 or 42 can give birth vaginally if obstetric conditions permit.

However, there are more of certain obstetric complications with advancing age, including high blood pressure, preeclampsia, gestational diabetes and certain complications at the end of pregnancy.

This mainly means that the pregnancy may require appropriate monitoring , not that a cesarean section is automatically scheduled.

And what about Down syndrome?

This is probably one of the best-known age-related changes.

The risk of chromosomal abnormalities increases with maternal age.

This is why prenatal screening deserves to be clearly explained to every expectant mother: first trimester screening, cell-free DNA testing and, in certain situations, diagnostic tests such as chorionic villus sampling or amniocentesis.

The goal is not to frighten.

The goal is to know what the possibilities are and to be able to make an informed choice.

So, should you have your first child at 25?

Not necessarily.

And above all, a woman should not have a child simply because her family tells her that "it's time".

But it would be just as unfortunate to indefinitely postpone a plan for motherhood, thinking that fertility will be the same at 30, 35 and 40 years old.

The real question, therefore, is not:

"What is the perfect age to have a child?"

The question is rather:

"What is my life plan, and how much biological time do I have left to achieve it?"

And what if you are already 35, 38 or 40 years old?

Don't panic.

A pregnancy after 35 can perfectly well proceed normally.

But if you still wish to have a child, knowing your personal situation can be much more helpful than relying on the experiences of your friends or stories told around you.

A preconception consultation allows, in particular, for a review of medical history, cycles, possible endometriosis or fibroids, risk factors and the pregnancy plan.

Your age doesn't decide for you. But your age is one of the important pieces of information to know when deciding on your reproductive future.

And sometimes, the best question to ask is not:

"Am I still young?"

But simply:

"How many children do I want to have, and when would I ideally like to have them?"

Yours sincerely,

Dr. Sandra Yene Amougui