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Are you too old to have a baby at 40 or in your late 30s?
Studies show that women’s ovarian reserve goes down significantly after 37 years old, and at the age of 40 your chances of conceiving are just over 20%, but there are many reasons why you might be trying for a baby at this age. You might be trying for your first baby or you might want to add an additional member to the family.
Sometimes it just can’t be planned and isn’t within your control — it could take a long time to find the right partner, you might have been trying to get pregnant for years with your first or you might be experiencing secondary infertility. Or perhaps you were prioritising your career or didn’t see having a baby as something that you wanted to do earlier. Feeling ready to have a baby is a deeply personal choice.
Don’t worry, you are not too late.
Many women over the age of 37 conceive and have healthy pregnancies. What changes after 37 are the odds of getting pregnant. The odds are lower than a few years before. After age 37 fertility begins to reduce rapidly and at age 40 your chances of conceiving are just over 20%. Many women think that when the menopause starts this will stop them from conceiving naturally so they have until then to conceive, but your number and quality of eggs can actually start to decline 15 years before the menopause starts.
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Here are the chances of conceiving at different ages for comparison. These percentages are the same for IVF as well as natural conception. The success rate of fertility treatments is affected by the woman’s age.
|40||Just over 20%|
|Mid 40s||About 10%|
|After 45||Less than 5%|
What are the chances of getting pregnant over 40?
However, it’s also about the quality of the eggs — not just the number of eggs. A woman is born with a certain number of eggs and the best quality eggs are used for ovulation each month. This means that the quantity and the quality decline as a woman grows older. In your 40s, chromosomal abnormalities are more common in the poorer quality eggs that your ovaries release and this means that the chance of your baby having birth defects – and also the chance of miscarriage – is greater. A woman of 45 years old has a 1/35 chance of a baby with Down’s Syndrome (as opposed to a 1/350 chance at 35 years old). The risk of miscarriage is around 40% to 50% in a 40 year old woman (as opposed to 15% to 20% in a woman under 30 years old. And these are all connected with poor quality eggs.
How common is pregnancy after 40?
Implicit in this question is the reality that fertility declines with age. The estimated rate of infertility in women aged 15 to 34 years of age is 7-9%. By contrast, for women 40-44 years of age, the rate is approximately 30%. This is a significant increase, but it also means that 70% of women in the latter age range are not infertile! In other words, as a woman in the age range of 40-44, the odds that you will be able to conceive spontaneously are in your favor.
However, due to the increased risk of infertility in this age range, we typically don’t advise this population of women to try as long before getting an infertility evaluation. For example, for women younger than age 35, we advise 12 months of trying to conceive before initiating assessment for infertility. For women 35-40, we reduce that period to six months. In addition, for women over the age of 40, while there is no strict guideline, we don’t usually recommend waiting a full six months.
Should I even try?
Of course – there’s no harm in practicing, but it’s important to understand your chances of conceiving based on your age. According to the American College of Obstetricians and Gynecologists, women aged 45 and older have the lowest chances of getting pregnant naturally based on fertility declination. Exploring other options for having a baby can benefit your mental state of being as you attempt to grow your family. Fertility drugs, Assisted Reproductive Technology, artificial insemination, and in vitro fertilization are other processes to consider that may increase your chances of conceiving. All of these options can be explored with your doctor or a fertility specialist.
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Are my risks different from the risks younger women face?
Yes. Older women experience first-trimester miscarriage with greater frequency than younger women. Ectopic pregnancy is a life-threatening condition in which an egg implants in a location other than the uterus, and it is more common with increasing age. After age 35, that risk is as high as 4-8 times that of younger populations. Also with age come higher rates of chronic illnesses such as obesity, high blood pressure, and diabetes. These disorders can exacerbate the already-increased risk involved with pregnancy after age 40.
Beyond age 45, there are even more risks. A recent study that looked at almost 37 million deliveries between 2006 and 2015 showed that women aged 45-54 years have the highest rates of preeclampsia, gestational diabetes, postpartum hemorrhage, and hysterectomy—as well as c-section deliveries.
Will my baby be disabled?
An over-40 pregnancy does come with increased chances of disability for the baby in addition to risks for the mother. The prevalence of chromosomal abnormalities (DNA irregularities) in babies increases with the increasing age of the mother. There are several theories as to why this may be, including a decreased number of normal oocytes (immature egg cells which eventually become eggs during ovulation) available, or accumulated stress on the DNA strands within eggs, to name just a couple. At the age of 33, the chance of your baby being diagnosed with trisomy 21 (Down syndrome) during pregnancy is approximately 1/400. At the age of 40, this chance increases to 1/70. By age 45, this chance is about 1/19.
So too does the chance of congenital disabilities increase with age. The U.S. National Birth Defects Prevention Study found that women greater than age 40 are at increased risk of having babies with multiple types of heart defects, genital abnormalities, skull deformities, and esophageal malformations.
How many eggs does a woman have at 40?
When girls are born, their ovaries contain all the eggs they will ever have – about a million in total! This number declines as they age. Women lose about 30 immature eggs a DAY! This means that by the time a woman reaches puberty her ovaries contain 300,000 eggs; by age 30 she’s down to 100,000. Estimates say that by age 40 women only have about 20,000 eggs remaining.
Ovarian reserve can be tested by a physician with a blood test called the Anti-Mullerian Hormone. AMH is a hormone produced by the follicles in a woman’s ovaries where egg cells develop, and it declines through a woman’s reproductive lifespan. The lower a woman’s AMH number, the fewer eggs remain in her ovarian reserve.
However, it’s important to remember that a woman’s AMH test results are just one piece of data that her doctor will look at when discussing her fertility health. They don’t tell anything about the quality of the remaining eggs.
Are my eggs bad after 40?
All women have a percentage of eggs that are genetically abnormal. This means that even if those eggs are fertilized, the pregnancy will not end in a live or genetically normal baby. The percentage of normal eggs a woman has decreases as she ages. At age 25, a woman has approximately 75% normal eggs. By age 35, that number drops to around 45%, and by 40, it’s around 20-30%. This is one reason why most physicians recommend genetic testing for conditions such as Trisomy 21 in a pregnancy over age 35.
How long does it take to get pregnant at 40?
At peak fertility (in their 20’s), the chance of a fertile couple conceiving in any one month is about 20-25%. After a year of unprotected intercourse, approximately 85-90% of those couples will conceive. This is why OB/GYNs generally recommend fertility testing for couples under 35 who have not become pregnant in one year of trying. By age 35, the chance of a successful natural pregnancy drops to 10-15% per cycle, and by 40, the chances hover around 5%. This does not mean conceiving after 40 is impossible, just that it will likely take longer. That’s why the recommendation for considering fertility testing after 40 is only 6 months.
How do I improve fertility after age 40?
There are many ways to improve fertility in general, and they become especially important after age 40. Besides naturally declining fertility, another challenge women over 40 face is that many will have been diagnosed with other conditions which can cause pregnancy complications and/or more difficulties getting pregnant. Examples are obesity, high blood pressure, diabetes, thyroid disorders, fibroids, and endometriosis.
Women with other medical conditions should make sure that their physicians know that they are trying to conceive so that they can optimize their health to prepare for the pregnancy. This may mean changing medications, working on eating healthy, exercising, and weight loss , or being more aggressive in controlling some conditions like diabetes. A preconception counseling appointment with your regular gynecologist can help pinpoint areas for improvement and give you personalized recommendations.
It is important to take a prenatal vitamin daily when trying to conceive. They help you get the nutrients needed for healthy development of a fetus if you do become pregnant – even before you know it. Some reproductive endocrinologists also recommend supplementation with CoQ10 to help with egg quality.