Many women are choosing to have children later in life. And as some find, waiting longer often makes it harder to become pregnant naturally, which is why methods like in vitro fertilization (IVF) are used more and more. According to doctors at Yale University, some women may not realize that once the clock has ticked, it’s virtually impossible to rewind it.

The typical reaction is, ‘What do you mean you cannot help me? I am healthy, I exercise, and I cannot have my own baby?’

Women over 43 were inquiring about assisted reproductive technologies (ART) more often, but were surprised when it didn’t work for them. “We are really seeing more and more patients ‘upset’ after failing in having their own biological child after age 43 so we had to report on this,” said study author Pasquale Patrizio in a university news release. “Their typical reaction is, ‘what do you mean you cannot help me? I am healthy, I exercise, and I cannot have my own baby?’”

Although women in their 40s are seeking AFT more frequently, its success rate is staying the same, which is why more women may be disappointed when it doesn’t work. For example, the Society for Assisted Reproductive Technologies reports that use of IVF in women over 41 increased 41% from 2003 to 2009. But the frequency with which IVF leads to pregnancy is still just about 9%. In contrast, for women between 35 and 37, it is 27%.

The misconceptions that women have about ART are “alarming,” according to the authors, since many assume that the effects of waiting can easily be reversed with IVF or other techniques.

Another important issue is that even when ART results in pregnancy, it doesn’t always mean it will be a healthy one: “If pregnancy is achieved at an older age, women then face higher risk of pregnancy loss, birth defects, and other complications.” Women may not always be aware of the risks to the fetus, aside from their own possible complications.

The authors argue that age-related infertility should be viewed as a healthcare problem, to be addressed by doctors and by society. In this way, there would be less confusion and less judgment associated with it. For example, waiting to have babies often has a stigma attached to it, the authors said: Women who opt to delay motherhood are seen as “being selfish and unconcerned about starting a family.” Treating the issues as a medical problem would help to diminish the stigma.

Freezing one’s eggs is still the best option for pregnancy later in life, and the authors encourage more women to consider it. Israel became the first country to consider freezing eggs preventive medicine, and perhaps more countries will follow. If you are interested in preserving your fertility, it may be worth talking to your doctors about preserving your eggs for future use.

Patrizio and his team are at Yale University, and published their article in Fertility and Sterility.