More and more women, especially in urban areas, are having their first babies in their 30s. Traditional and medical wisdom dictate that women should finish with having babies by the time they are 30 years old, for fertility levels in women drop substantially after that age. "These days, about one in five women in urban areas choose to have their babies after 30," says Dr Alka Kriplani, professor, gynecology and obstetrics, All India Institute of Medical Sciences (AIIMS), New Delhi.
"A number of women plan to achieve a certain level of professional goals and financial security before the baby comes. Others simply take longer to be mentally prepared for an addition to the family. More years of education, late marriages and withdrawal of parental pressure are also big reasons," believes Dr Sujata Sharma, clinical psychologist, Parivartan Centre, New Delhi.
For example, Mala Oberoi, a nutritionist, had her life planned out. "I had decided early on that I would reach some distance in my career and then take a break midway for the baby business. So I had my first baby when I was 33. And now I'm off work for a couple of years," she says.
With the change in attitude towards pregnancy and babies, women are also taking the necessary precautions. Women are now listening to their bodies. "There are things that women can do to keep their chances of conception healthy. It makes sense to start taking care of one's fertility early, even if one is not planning on having children for another 10 years," says Kriplani. "A number of women today read up on these matters to understand how they can keep their reproductive health at an optimum. There is also an increase in the number of women who consult gynecologists regularly," she adds.
There are many things that women who wish to maintain their fertility can do. "They could change their lifestyle, diet and nutritional supplements, get regular medical check-ups done and choose the right contraceptive. I advise women to ensure that their detrimental lifestyle choices do not create chronic problems later on," says Dr Neerja Bhatla, Additional Professor, Gynecology and Obstetrics, AIIMS.
Another important fact: Stress is bad for baby-making. So caring for your emotional health and keeping your stress levels down are essential for maintaining optimum fertility levels. "Stress hinders sex hormones. This can postpone ovulation or, worse, stop your cycle altogether," explains Dr Sushma Sinha, senior consultant gynecologist, Apollo Hospital, New Delhi.
"An anxious lifestyle affects the intrauterine environment and the quality of ova. So cultivating a calm attitude, not surprisingly, enhances fertility. Even taking a quiet five minutes off, just for you, free of all responsibilities, can bring big results if done frequently enough," is Sharma's suggestion. She also suggests taking up relaxation therapy such as yoga, meditation or going in for reflexology or acupuncture sessions.
"Watching weight helps. My advice is to aim for a Body Mass Index (BMI) between 20 and 25 - divide your weight (in kgs) by the square of your height (in metres). A BMI over 27 is associated with significantly reduced fertility levels. Also, excessive fat around the stomach interferes with hormonal balance," says Dr Shikha Sharma, obesity consultant. "But some amount of body fat is necessary, for body fat is closely related to estrogen levels. The theory is that if we do not have enough fat stores, our bodies think we are starving. It is not appropriate to become pregnant when food is short. Similarly, excess weight can actually put pressure on the ovaries and fallopian tubes, making it difficult to conceive," she explains.
"I have always been terribly underweight and, although I don't intend to have a baby for the next eight years, I know that I must get fit in the meantime. So I am taking professional help to get my eating habits sorted out," says Rachna Agarwal, a chartered accountant.
"To a certain extent, what you eat also impacts fertility levels. Recent studies show that women who drink more than four cups of coffee or six cups of tea a day, take three times longer to get pregnant than those who don't. Caffeine slows down the absorption of necessary nutrients and produces adrenaline. Adrenaline can affect the menstrual cycle and ovulation," explains Sharma.
The contraception used is equally important. "Condoms are chemical-free and protect against sexually transmitted infections (STIs), another factor that reduces fertility," says Sinha. "Procedures are now simpler and quicker, and it is a good idea to have regular check-ups even if you are not planning a baby yet. This helps in detecting symptom-less STIs like Chlamydia, which are a major cause of infertility and also uncover problems like pelvic inflammatory disease or polycystic ovaries, which might cause problems with conceiving," she says.
"Avoid drugs, alcohol, tobacco, coffee and over-the-counter or prescription drugs (except those you absolutely need). Your liver needs to be strong and so do your kidneys, so that you can conceive and gestate a child when you desire. Smoking is a big villain too. Studies have shown that smokers are three times as likely to miscarry as non-smokers," says Bhatla.
"Speaking realistically, for a woman who has always had regular periods and no irregular bleeding or pelvic pain, it is probably all right to wait until 35 before trying for a baby," says Bhatla. "However, women who have had gynecological problems or have a hormonal imbalance should start at least by the time they are 30. This also applies to women who are very overweight or underweight, who smoke heavily or are on medication that might affect their hormones or the quality of their eggs, such as steroids, anti-inflammatory or anti-cancer drugs."