• • •
The best way to assess fertility might be to measure “cycle viability,” or the chance of getting pregnant if a couple has sex on the most fertile day of the woman’s cycle. Studies based on cycle viability use a prospective rather than retrospective design—monitoring couples as they attempt to get pregnant instead of asking couples to recall how long it took them to get pregnant or how long they tried. Cycle-viability studies also eliminate the need to account for older couples’ less active sex lives. David Dunson’s analysis revealed that intercourse two days before ovulation resulted in pregnancy 29 percent of the time for thirty-five-to-thirty-nine-year-old women, compared with about 42 percent for twenty-seven-to-twenty-nine-year-olds. So, by this measure, fertility falls by about a third from a woman’s late twenties to her late thirties. However, a thirty-five-to-thirty-nine-year-old’s fertility two days before ovulation was the same as a nineteen-to-twenty-six-year-old’s fertility three days before ovulation: according to Dunson’s data, older couples who time sex just one day better than younger ones will effectively eliminate the age difference.
Don’t these numbers contradict the statistics you sometimes see in the popular press that only 20 percent of thirty-year-old women and 5 percent of forty-year-old women get pregnant per cycle? They do, but no journal article I could locate contained these numbers, and none of the experts I contacted could tell me what data set they were based on. The American Society for Reproductive Medicine’s guide provides no citation for these statistics; when I contacted the association’s press office asking where they came from, a representative said they were simplified for a popular audience and did not provide a specific citation.
Dunson, a biostatistics professor, thought the lower numbers might be averages across many cycles rather than the chances of getting pregnant during the first cycle of trying. More women will get pregnant during the first cycle than in each subsequent one because the most fertile will conceive quickly and those left will have lower fertility on average.
Most fertility problems are not the result of female age. Blocked tubes and endometriosis (a condition in which the cells lining the uterus also grow outside it) strike both younger and older women. Almost half of infertility problems trace back to the man, and these seem to be more common among older men, although research suggests that men’s fertility declines only gradually with age.
Fertility problems unrelated to female age may also explain why, in many studies, fertility at older ages is considerably higher among women who have been pregnant before. Among couples who haven’t had an accidental pregnancy—who, as Dr. Steiner put it, “have never had an ‘oops’”—sperm issues and blocked tubes may be more likely. Thus, the data from women who already have a child may give a more accurate picture of the fertility decline due to “ovarian aging.” In Kenneth Rothman’s study of the Danish women, among those who’d given birth at least once previously, the chance of getting pregnant at age forty was similar to that at age twenty.
• • •
Older women’s fears, of course, extend beyond the ability to get pregnant. The rates of miscarriages and birth defects rise with age, and worries over both have been well ventilated in the popular press. But how much do these risks actually rise? Many miscarriage statistics come from—you guessed it—women who undergo IVF or other fertility treatment, who may have a higher miscarriage risk regardless of age. Nonetheless, the National Vital Statistics Reports, which draw data from the general population, find that 15 percent of women ages twenty to thirty-four, 27 percent of women thirty-five to thirty-nine, and 26 percent of women forty to forty-four report having had a miscarriage. These increases are hardly insignificant, and the true rate of miscarriages is higher, since many miscarriages occur extremely early in a pregnancy—before a missed period or pregnancy test. Yet it should be noted that even for older women, the likelihood of a pregnancy’s continuing is nearly three times that of having a known miscarriage.
What about birth defects? The risk of chromosomal abnormalities such as Down syndrome does rise with a woman’s age—such abnormalities are the source of many of those very early, undetected miscarriages. However, the probability of having a child with a chromosomal abnormality remains extremely low. Even at early fetal testing (known as chorionic villus sampling), 99 percent of fetuses are chromosomally normal among thirty-five-year-old pregnant women, and 97 percent among forty-year-olds. At forty-five, when most women can no longer get pregnant, 87 percent of fetuses are still normal. (Many of those that are not will later be miscarried.) In the near future, fetal genetic testing will be done with a simple blood test, making it even easier than it is today for women to get early information about possible genetic issues.
• • •
What does all this mean for a woman trying to decide when to have children? More specifically, how long can she safely wait?
This question can’t be answered with absolutely certainty for two big reasons. First, while the data on natural fertility among modern women are proliferating, they are still sparse. Collectively, the three modern studies by Dunson, Rothman, and Steiner included only about 400 women thirty-five or older, and they might not be representative of all such women trying to conceive.
Second, statistics, of course, can tell us only about probabilities and averages—they offer no guarantees to any particular person. “Even if we had good estimates for the average biological decline in fertility with age, that is still of relatively limited use to individuals, given the large range of fertility found in healthy women,” says Allen Wilcox of the NIH.
So what is a woman—and her partner—to do?
The data, imperfect as they are, suggest two conclusions. No. 1: fertility declines with age. No. 2, and much more relevant: the vast majority of women in their late thirties will be able to get pregnant on their own. The bottom line for women, in my view, is: plan to have your last child by the time you turn forty. Beyond that, you’re rolling the dice, though they may still come up in your favor. “Fertility is relatively stable until the late thirties, with the inflection point somewhere around thirty-eight or thirty-nine,” Steiner told me. “Women in their early thirties can think about years, but in their late thirties, they need to be thinking about months.” That’s also why many experts advise that women older than thirty-five should see a fertility specialist if they haven’t conceived after six months—particularly if it’s been six months of sex during fertile times.
There is no single best time to have a child. Some women and couples will find that starting—and finishing—their families in their twenties is what’s best for them, all things considered. They just shouldn’t let alarmist rhetoric push them to become parents before they’re ready. Having children at a young age slightly lowers the risks of infertility and chromosomal abnormalities and moderately lowers the risk of miscarriage. But it also carries costs for relationships and careers. Literally: an analysis by one economist found that, on average, every year a woman postpones having children leads to a 10 percent increase in career earnings.
For women who aren’t ready for children in their early thirties but are still worried about waiting, new technologies—albeit imperfect ones—offer a third option. Some women choose to freeze their eggs, having a fertility doctor extract eggs when they are still young (say, early thirties) and cryogenically preserve them. Then, if they haven’t had children by their self-imposed deadline, they can thaw the eggs, fertilize them, and implant the embryos using IVF. Because the eggs will be younger, success rates are theoretically higher. The downsides are the expense—perhaps $10,000 for the egg freezing and an average of more than $12,000 per cycle for IVF—and having to use IVF to get pregnant. Women who already have a partner can, alternatively, freeze embryos, a more common procedure that also uses IVF technology.
At home, couples should recognize that having sex at the most fertile time of the cycle matters enormously, potentially making the difference between an easy conception in the bedr
oom and expensive fertility treatment in a clinic. Rothman’s study found that timing sex around ovulation narrowed the fertility gap between younger and older women. Women older than thirty-five who want to get pregnant should consider recapturing the glory of their twenty-something sex lives or learning to predict ovulation by charting their cycles or using a fertility monitor.
• • •
I wish I had known all this back in the spring of 2002, when the media coverage of age and infertility was deafening. I did, though, find some relief from the smart women of Saturday Night Live.
“According to author Sylvia Hewlett, career women shouldn’t wait to have babies, because our fertility takes a steep drop-off after age twenty-seven,” Tina Fey said during a “Weekend Update” sketch. “And Sylvia’s right; I definitely should have had a baby when I was twenty-seven, living in Chicago over a biker bar, pulling down a cool $12,000 a year. That would have worked out great.” Rachel Dratch said, “Yeah. Sylvia, um, thanks for reminding me that I have to hurry up and have a baby. Uh, me and my four cats will get right on that.”
“My neighbor has this adorable, cute little Chinese baby that speaks Italian,” noted Amy Poehler. “So, you know, I’ll just buy one of those.” Maya Rudolph rounded out the rant: “Yeah, Sylvia, maybe your next book should tell men our age to stop playing Grand Theft Auto III and holding out for the chick from Alias.” (“You’re not gonna get the chick from Alias,” Fey advised.)
Eleven years later, these four women have eight children among them, all but one born when they were older than thirty-five. It’s good to be right.
ESPN the Magazine
FINALIST—FEATURE WRITING
The portrait of Michael Jordan that emerges from this story is that of a great athlete consumed by his own legend, a generous friend who can also be “self-centered, bullying, and cruel.” The National Magazine Award judges called it simply “one of the year’s most poignant and memorable stories.” Born and raised in the Mississippi Delta, Wright Thompson was a reporter for the New Orleans Times-Picayune and the Kansas City Star before joining ESPN.com in 2006. Writing for both ESPN.com and ESPN the Magazine, he has covered baseball, football, basketball, NASCAR, boxing, cricket, and, yes, bullfighting. Thompson now lives in Oxford, Mississippi. ESPN the Magazine won its first National Magazine Award in 1999. Since then the magazine has been nominated for eighteen more awards and won three.
Wright Thompson
Michael Jordan Has Not Left the Building
Five weeks before his fiftieth birthday, Michael Jordan sits behind his desk, overlooking a parking garage in downtown Charlotte. The cell phone in front of him buzzes with potential trades and league proposals about placing ads on jerseys. A rival wants his best players and wants to give him nothing in return. Jordan bristles. He holds a Cuban cigar in his hand. Smoking is allowed.
“Well, s———, being as I own the building,” he says, laughing.
Back in the office after his vacation on a 154-foot rented yacht named Mister Terrible, he feels that relaxation slipping away. He feels pulled inward, toward his own most valuable and destructive traits. Slights roll through his mind, eating at him: worst record ever, can’t build a team, absentee landlord. Jordan reads the things written about him, the fuel arriving in a packet of clips his staff prepares. He knows what people say. He needs to know, a needle for a hungry vein. There’s a palpable simmering whenever you’re around Jordan, as if Air Jordan is still in there, churning, trying to escape. It must be strange to be locked in combat with the ghost of your former self.
Smoke curls off the cigar. He wears slacks and a plain white dress shirt, monogrammed on the sleeve in white, understated. An ID badge hangs from one of those zip line cords on his belt, with his name on the bottom: Michael Jordan, just in case anyone didn’t recognize the owner of a struggling franchise who in another life was the touchstone for a generation. There’s a shudder in every child of the eighties and nineties who does the math and realizes that Michael Jordan is turning fifty. Where did the years go? Jordan has trouble believing it, difficulty admitting it to himself. But he’s in the mood for admissions today, and there’s a look on his face, a half-smile, as he considers how far to go.
“I … I always thought I would die young,” he says, leaning up to rap his knuckles on the rich, dark wood of his desk.
He has kept this fact a secret from most people. A fatalist obsession didn’t go with his public image and, well, it’s sort of strange. His mother would get angry with him when he’d talk to her about it. He just could never imagine being old. He seemed too powerful, too young, and death was more likely than a slow decline. The universe might take him, but it would not permit him to suffer the graceless loss and failure of aging. A tragic flaw could undo him but never anything as common as bad knees or failing eyesight.
Later that night, standing in his kitchen, he squints across his loft at the television. His friend Quinn Buckner catches him.
“You gonna need to get some glasses,” Buckner says.
“I can see,” Jordan says.
“Don’t be bulls———ing me,” Buckner says. “I can see you struggling.”
“I can see,” Jordan insists.
The television is built into the modern stone fireplace in his sprawling downtown condo, the windows around them overlooking Tryon Street. An open bottle of Pahlmeyer merlot sits on an end table. Buckner, a former NBA guard from near Chicago and a Pacers broadcaster, is in town for an upcoming game. They’ve been talking, about Jordan’s birthday and about the changes in his life, all seeming to happen at once. Jordan feels in transition. He moved out of his house in Chicago and is moving into a new one in Florida in three weeks. He’s engaged. Inside he’s dealing, finally, with the cost of his own competitive urges, asking himself difficult questions. To what must he say goodbye? What is there to look forward to? Catching an introspective Jordan is like finding a spotted owl, but here he is, considering himself. His fiancée, Yvette Prieto, and her friend Laura laugh over near the kitchen island. Jordan relights his cigar. It keeps going out.
“Listen,” Buckner says, “Father Time ain’t lost yet.”
The idea hangs in the air.
“Damn,” Buckner continues. “Fifty.”
He shakes his head.
“Can you believe it?” Jordan says quietly, and it sounds like he’s talking to himself.
• • •
A day before, Jordan had flown to Charlotte from Chicago, a trip he’s made many times. This flight was different from all the others. When his Gulfstream IV, which is painted to look like a sneaker, took off and turned south, he no longer lived in the city where he had moved in 1984. The past months had been consumed with a final flurry of packing, putting the first half of his life in boxes. He has felt many emotions in his fifty years: hope and anger, disappointment, joy and despair. But lately there’s been a feeling that would have disgusted the thirty-year-old version of himself: nostalgia.
The packing and cataloging started several years ago, after his divorce. One night at his suburban Chicago mansion, he sat on the floor of his closet with Estee Portnoy. She manages his business enterprises and, since the divorce, much of his personal life—his consigliere. It was one in the morning. They were flummoxed by a safe. Jordan hadn’t opened it in years, and he couldn’t remember the combination. Everything else stopped as this consumed him. After ten failed attempts, the safe would go into a security shutdown and need to be blown open. None of the usual numbers worked. Nine different combinations failed; they had one try left. Jordan focused. He decided it had to be a combination of his birthday, February 17, and old basketball numbers. He typed in six digits: 9, 2, 1, 7, 4, 5. Click. The heavy door swung open and he reached in, rediscovering his gold medal from the 1984 Olympics. It wasn’t really gold anymore. It looked tarnished, changed—a duller version of itself.
The memories came to him, how he felt then. “It was very pure, if I can say it right,” he’d explain later. “It was p
ure in 1984 … I was still dreaming.” During the Olympics, he was deep in negotiations with Nike for his first shoe contract. He traded pins with other athletes. Eight years later, when he was the most famous person in the world and the Dream Team was forced to stay outside the Olympic Village, he’d be disappointed when that separation kept him from swapping pins again.
Jordan tried on an old pair of shorts and didn’t fit in them. He found first-edition Air Jordans. In his cavernous Nike closet, he counted nearly 5,000 boxes of shoes, some of which he marked to keep, others to give to friends. There was his uniform for the Dream Team. An employee found a stack of letters he’d written his parents as a college student at North Carolina, and what struck her as she flipped through the pages was how normal he seemed. Despite all the things that had been gained in the years since, that person had been lost. The kid in the letters hadn’t yet been hardened by wealth and fame and pressure. He told his parents about grades and practice and the food in the dining hall. He always needed money. One letter ended: P.S. Please send stamps.
For a rage-filled day and a half, he thought he’d lost two of his Bulls championship rings, No. 3 and No. 5. He tore the house apart screaming, “Who stole my rings? Who stole No. 5?”
“You talk about a mad f———ing panic,” he says.
Following the final title, the Bulls presented him a case with room for all six rings, but Jordan had never put them together. Now as he found them spread around the house, he slipped each one into its slot. He began plotting amendments to his will that if the missing rings emerged for sale after his death, they should be returned immediately to his estate. Buying a duplicate wouldn’t be worth it because even if he didn’t tell anyone, he’d know. Finally the missing rings were found in a memorabilia room, and the set of six was complete. He could exhale and continue packing.
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