Dr Steven R. Goldstein is a Perimenopause Specialist NYC who has helped thousands of women navigate Perimenopause, the transitional phase to Menopause. From the late thirties to the late forties, women may enter Perimenopause, which is a preparatory stage for menopause, both biologically and symptomatically.
Women in their late thirties or forties who are not yet married often ask about the “Biological clock”. The term "biological clock" is more than just a phrase—it refers to the natural, age-related decline in fertility that women experience over time.
From a medical standpoint, a woman is born with all the eggs she will ever have—around 1 to 2 million at birth. By puberty, that number drops to about 300,000. With each menstrual cycle, a group of eggs begins to mature, but typically only one reaches ovulation. Over time, both the quantity and quality of these eggs diminish.
This decline becomes more noticeable in a woman’s mid-30s, and by the time she reaches her early 40s, fertility has significantly decreased. It's not just about getting pregnant—it's also about a higher risk of miscarriage, chromosomal abnormalities like Down syndrome, and complications during pregnancy. The "biological clock" isn’t meant to pressure or scare—it’s simply a biological reality.
Dr Steven R. Goldstein, a Perimenopause Specialist NYC says that a woman’s chance of conceiving naturally within a year over the age of forty is 25 to 30 percent. Still, midlife motherhood is definitely on the rise. Dr Goldstein has had patients in their late thirties and early forties who conceived the first time they had unprotected sex, merely by carefully charting their menstrual cycles and copulating on the appropriate days. However, it’s estimated that 75 percent of women over forty will need some help from technology to conceive.
What makes it so difficult to have a baby during Perimenopause? First and foremost, you may not ovulate every month, giving you fewer chances to become pregnant. Next, women simply have fewer and older, less viable eggs. By the time of Perimenopause, it is estimated that she has about ten thousand left. Less viable eggs are those that are harder for sperm to penetrate.
Some women have scar tissue that comes from the ovary having to repair itself after each ovulatory cycle. The more difficult a time the egg has navigating thru this scar tissue to the place where it can be released, the more difficult conception becomes. Scarring can also come from pelvic inflammatory disease, caused by sexually transmitted disease such as chlamydia. If it goes untreated for long, it can cause enough scarring to block the fallopian tubes or damage the ovaries. The fallopian tubes, which link the ovaries to the uterus, must be unobstructed for pregnancy to occur.
The cervix can also cause problems. If it is scarred from previous childbirths or narrowed for any reason, it can block the sperm from reaching the egg. In rare cases, a woman’s cervical mucosa contains substances that immobilize sperm.
Many women of Perimenopausal age have had gynecological surgery. If you’ve had a fibroid or some other benign growth removed, there may be scar tissue as a result.
Your body is probably still making estrogen in perimenopause – and progesterone when you ovulate. But how high are those levels? It’s not uncommon for women to find that they don’t secrete enough progesterone to prepare the endometrium for the fertilized egg. The egg can’t embed itself, and therefore no pregnancy ensues. This condition is sometimes called “luteal phase deficiency”.
If you are perimenopausal and the state of your fertility is important for you to know, the use of follicle stimulating hormone (FSH) measurements on day three of your cycle is the trick of the reproductive endocrinologist. It has been noted that if FSH on day three of the cycle is already climbing (20 or greater), then the patient’s chances of conceiving naturally are not very good.
If you are thirty five plus, have decided you want to pursue pregnancy, and you know that you are not ovulating regularly, see a specialist as soon as you can if you fail to get pregnant after six months of having intercourse the time of ovulation. You will need to pursue a structured plan to overcome fertility problems.
If you are perimenopausal and considering pregnancy, then perhaps a consultation with Dr Steven R. Goldstein, a Perimenopause Specialist NYC may be in order. Dr Goldstein is a past President of The Menopause Society and the International Menopause Society. He is also a Certified Menopause Practitioner and considered one of America’s top gynecologists.
