For women in their 40s, the possibilities in life may still seem endless. But even though so many doors remain open, conventional wisdom suggests at least one is slamming shut: childbearing. While it’s true that the odds of getting pregnant and having a baby after 40 are slimmer and there are more risks involved, it’s certainly possible for many women.
The fact is, many people delay having children because they’re focused on their career or other priorities. Some may have needed more time to settle down, feel ready, or find the right partner. Whatever your reason, if you’re older than 40 and hoping to get pregnant, it’s important to not only understand some of the challenges that may be involved, but also learn what you can do to improve your chances of having a healthy pregnancy.
Fertility wanes over time
You may have heard the old adage: “You’re only as old as you feel.” That may well be true for many things. But when it comes to reproduction, your chronological age really does matter. That’s because as you age, so do your eggs.
A woman’s prime reproductive years are between her late teens and 20s. After that, fertility tends to decline. Generally speaking, about 1 in 4 women in their 20s or early 30s will become pregnant during any one menstrual cycle. By age 40, a woman’s chance drops to less than 5 percent per cycle, according to the American Society for Reproductive Medicine. After the age of 45, getting pregnant naturally (or without the help of fertility treatments) is unlikely for most women.
Much of the decline in a woman’s fertility over time is associated with changes in her ovarian reserve—the quantity and quality of her eggs. A woman begins life with a fixed number of eggs in her ovaries. Aside from their quantity, the quality of these eggs also declines with advancing age.
“A woman’s ovarian reserve in her 40s is just not as hearty as it is when she is in her 20s or 30s,” explains Daren Watts, MD, an OBGYN at St. Mark’s Hospital in Salt Lake City, Utah. “This is the number one issue for women trying to get pregnant after age 40.”
This is why some younger women are choosing to freeze, or cryopreserve, their eggs—a minimally invasive procedure that involves harvesting unfertilized eggs from the ovaries and then freezing them for later use. This essentially halts the aging process for these eggs so they will have a lower risk for abnormalities later on when a woman decides she’s ready to conceive.
Low ovarian reserve, however, could also be related to other factors, including certain medical treatments, such as chemotherapy, or injuries. Women in their 40s may also be at higher risk for uterine fibroids, endometriosis and other health issues, which can affect their fertility.
A woman’s ability to get pregnant could also be affected by a man’s sperm quality. Men’s fertility also declines with age, though not as predictably as women’s ability to conceive.
More risks during pregnancy
Getting pregnant is just one hurdle, Dr. Watts points out. Once women are in their 40s, other risks associated with pregnancy also rise. Older mothers face greater odds of stillbirth, miscarriage, and other complications such as ectopic pregnancy (when an embryo implants somewhere other than the uterus) and placenta previa (when the placenta that feeds the fetus lies low in the uterus).
Additionally, women in their 40s are at higher risk for gestational diabetes and preeclampsia, or dangerous high blood pressure during pregnancy. They are also more likely to have babies with chromosomal abnormalities. Down syndrome, for example, is one of the most common genetic disorders associated with delayed childbearing.
Older moms are also more likely to have multiples, such as twins or triplets, since they are more likely to release more than one egg from their ovaries each month. Women in this age group may also be more likely to use fertility drugs, which increases the overall likelihood of having multiples.
Preparing for a healthy pregnancy
It may be harder to conceive once you’re in your 40s but you can increase your odds of success by taking certain steps, even before you start trying.
If you’re hoping to conceive later in life, schedule a “preconception” appointment with an OBGYN, particularly one that specializes in high-risk pregnancies. During this visit, your doctor will discuss genetic screening for you and your partner. You may also be advised to start taking prenatal vitamins, which have been shown to reduce the risk for certain birth defects when taken correctly both before and during pregnancy.
If you’re gearing up to get pregnant, it’s also important to shed excess weight and adopt healthy habits to prepare your body.
“It’s really important to lead a healthy lifestyle and be as fit as possible, as pregnancy does put strain on your body, and your body is capable of handling more strain when you are 20 than when you are 40,” Watts advises. If you smoke, quit, he adds. Getting a handle on any stress can also make a difference in your overall health.
Trying to conceive
Once your OBGYN gives you a “green light,” you may begin attempting to conceive naturally by making sure to schedule sex with ovulation. If you don’t get pregnant within a certain period of time, it may be time to consider an infertility evaluation.
Younger women often try to get pregnant for up to a year before considering fertility treatments, but women in their 40s may be offered these options sooner. “If you are over 40, we recommend six months of attempting to get pregnant naturally,” Watts says. “If you don’t succeed, we will do a full fertility workup.”
This workup may include a variety of tests, including an X-ray with dye or hysterosalpingography to confirm that your fallopian tubes (through which an egg travels from the ovaries to the uterus) are open. Your OB/GYN will also measure certain hormone levels and order tests that assess your ovarian reserve. In some cases, imaging tests can also give your doctor a better idea of the health of your reproductive organs. The quality of your partner’s sperm will also be evaluated during this process.
Based on the results of these tests, your doctor will develop a plan to help you achieve pregnancy, Watts says. Medications, or fertility drugs, may be used to help stimulate ovulation. “Advanced reproductive techniques and technologies may be necessary,” he says. For example, in vitro fertilization (IVF) involves combining sperm with a woman’s eggs in a laboratory and implanting the embryo in her uterus. If you chose to freeze your eggs, IVF is the technique that will be used to help you become pregnant.
If your ovarian reserve or your partner’s sperm quality is affecting your ability to conceive, you may also consider using a donor egg or sperm to improve your odds of becoming pregnant.
Ensuring a healthy pregnancy
All pregnant women should receive good prenatal care. This is especially true if you’re in your 40s. In fact, depending on your age, other health issues and medical history, you may need to undergo additional tests and have more frequent checkups throughout your pregnancy.
Early and routine monitoring by your OBGYN will help ensure that you have the best possible outcome. During each visit, your health and the health of your baby will be assessed.
Your doctor may recommend screening tests to make sure that your baby is developing properly. This includes a blood test in the first trimester plus an ultrasound of the fetus to assess risk for specific chromosomal abnormalities. This test, which is typically performed between the 11th and 13th week of pregnancy, could indicate the need for further testing.
Other diagnostic tests such as amniocentesis, which tests amniotic fluid, or chorionic villus sampling (CVS), which tests tissue from the placenta, can provide more definitive results. These tests do confer a higher risk of miscarriage, which is already higher in women older than 40.
“A newer blood test that analyzes bits of fetal DNA that leaked in the mother’s bloodstream is less risky,” Watts says. “This is much less invasive and can be done as early as nine weeks.” Together with your OBGYN, you should determine the most appropriate screening plan for your pregnancy.
It’s important to remember that pregnancy after 40 is less likely—but it is increasingly possible thanks to advancements in fertility and reproductive medicine. If you are expecting later in life, you can improve your chances of having a healthy pregnancy by establishing a game plan early on. That means getting regular prenatal care, adopting a healthy lifestyle—including stress reduction, regular physical activity, a nutritious diet, and adequate sleep—and having open communication with your healthcare team.
Sourcing: The American College of Gynecologists, National Institutes of Health, Rogel Cancer Center, The American Cancer Society