MINNEAPOLIS - The Centers for Disease Control says one in five women now wait until they're 35 or older to have their first child.
It's a decision that often comes with anxiety about the ticking of their biological clock.
Psychologist Jean Twenge, a Winona native, made headlines this summer when her research contended women in their late 30s have more time than they think.
Twenge, now based in San Diego, married for the second time in her thirties and became worried about her fertility.
"So I was about 34 when we first decided we wanted to start a family. We knew we wanted at least two children," said Twenge. "When we were trying for our second and I was 37. I was really, really scared that we had waited too long and we would not be able to have another child."
So Twenge set out to find the facts behind fertility after age 35, and what she found filled a book, called "The Impatient Woman's Guide to Getting Pregnant."
"I saw a statistic over and over in books and online that said 1 out of 3 over 35 would not get pregnant after a year of trying. I found the original research article, published in a journal called Human Reproduction," said Twenge. "That statistic comes from a study of birth records from 1700s France. These birth records which are hundreds and hundreds of years old."
The find became a widely discussed article published this summer in The Atlantic magazine. Twenge wrote, "Millions of women are being told when to get pregnant based on statistics from a time before electricity, antibiotics or fertility treatment."
Twenge says more recent studies provide more hope to women conceiving later.
"As I was writing the article, there were more research articles and studies coming out," she said. "The statistics were much more encouraging. It was like 80 percent or more women in late 30s able to get pregnant after a year."
Twenge says a study published in Obstetrics & Gynecology in 2004 by David Dunson of Duke University tracked 770 European women. It found that with sex at least twice a week, 82 percent of 35 to 39 year old women conceive within a year, compared with 86 percent of 27 to 34 year olds.
She points to another study released March 2013 in Fertility and Sterility. Kenneth Rothman of Boston University followed nearly 3,000 Danish women as they tried to get pregnant where 78 percent of 35 to 40 year olds got pregnant within a year.
Lastly, Twenge says a study headed by University of North Carolina School of Medicine Professor Anne Steiner, found that among 38 and 39 year olds who had been pregnant before, 80 percent of Caucasian women of normal weight got pregnant naturally within six months.
FERTILITY STRUGGLES OVER 35
At the University of Minnesota's Reproductive Medicine Center, the average age of patient seeking fertility help is 34.5.
Dr. Mark Damario, RMC's reproductive endocrinologist, says the fertility decline at 35 is somewhat subtle, when women are considered to be of "advanced maternal age," but he warns of more significant decline not long after.
"At age 37, 38 we begin to see some hormonal indicators on a lot of patients that their fertility may be a little bit lower. The chance for miscarriage also starts to increase. I don't know if we should use the term geriatric because patients are definitely healthy and having healthy pregnancies at these types of ages," said Damario, a reproductive endocrinologist.
He reminds women they are born with all the eggs they ever have, and the number of eggs for women is taking a more dramatic drop at age 37 or 38. In general, Damario tells couples under 35 who haven't conceived within a year to seek help and for women over 35, turn to a doctor after six months of unsuccessful conception for a fertility evaluation.
Many who struggle turn to in vitro fertilization, or IVF, which he says has lower success rates of about 5 percent as women move into their 40s.
"Only a minority of women who move into their 40s are able to achieve pregnancy without assistance and have a family on their own," he said.
In Minnetonka, Shana and Jeff Ess beat those odds. Shana is expecting for the first time at age 43. The couple married in their late 30s after a whirlwind romance, but the journey to parenthood took much longer.
"It was a little shocking when month after month, it just didn't happen," said Shana Ess. "We would tell anybody who is determined to not get discouraged because emotionally it can be a train wreck."
The couple sought fertility help locally and after it proved to be unsuccessful, turned to the The Colorado Center for Reproductive Medicine to seek the help of Dr. William Schoolcraft. On their fifth IVF cycle, Shana became pregnant for the first time with a baby boy.
"I thank him all the time for being strong and blessing us," said Shana Ess. "We have had our careers and travels in our lives and done so much on our lives. We are so focused on now. This is the chapter we are writing. We have become more present, and we, I think, we will be better parents for it."
She says years focused on careers brought money needed to conceive. The American Society of Reproductive Medicine lists the average price of an IVF cycle in the U.S. to be $12,400.
The Ess' still don't have a diagnosis for why they struggled to conceive, and now are looking ahead. More importantly, Shana Ess says she waited for the right partner to be by her side, with the support to rise above heartache.
"I don't feel 43, so I think the age, just like the statistics, is just a number. Not to get attached to it necessarily but be mindful of it. I feel good, and there's no reason why a woman my age can't successfully carry a baby," said Shana.
Her baby boy is expected to make his debut in mid-November.
FERTILITY SUCCESS AFTER 35
In south Minneapolis, time is on the side of Sarah Longacre Ehlers, the owner of Blooma, a prenatal yoga and birthing center on Lyndale.
On a September morning, more than 50 percent of a prenatal yoga class consisted of mothers over age 35, including Longacre Ehlers.
Even though she's helped hundreds of babies come into the world as a doula, the reality of motherhood was uncertain after she spent many of her childbearing years birthing her business.
"My mother said to me, 'I think you need to think about getting your eggs frozen.' What are we going to do? The clock is ticking," said Longacre Ehlers. "I was given some pretty clear messages from midwives, from OBs, from family and friends saying, 'Don't be worried. It's gonna take you a long time," she said.
Longacre Ehlers married at 37, and she faced new anxieties when she conceived immediately.
"So one would think I would be elated, for me about the pregnancy and that life change, wondering if I could do it," she said. "I just wanted more time. I had a lot of guilt, I wasn't embracing it."
Nine months brought a change in both body and mind.
"I feel amazing. I love being pregnant. I have never felt better, at 37, going to be 38 in a few months," she said.
And in late September, after a 44-hour labor surrounded by her husband, family and doula, time brought perfect perspective.
"I feel like I have known her forever," she said, holding her newborn daughter. "Her name is Metta. Metta means loving kindness."
Her newest venture comes without regret.
"I needed to make my career my number one. I needed time to work on my relationships, looking back, not a moment. I truly feel younger now than I even did in my pregnancy. I feel humbled," said Longacre Ehlers. "I thought I would really regret it. I thought for a long time I would say, 'Why didn't I do this earlier?' But my years have taught me to calm down a little bit more."
Time is still precious and Twenge warns women not to wait too long for obvious risks of miscarriage and birth defects, which rise with age.
But looking at the scope of research, Twenge believes overall, women should consider a new deadline.
"I do think that 40 is the new deadline or at least should be based on the research. Given that we don't know a whole lot what happens after 40, and we do know fertility in a woman's late 30s is actually pretty good, that is as good a deadline as any. It's really after 40 I think women have to be more concerned," she said.