When To Talk To Your Doctor
Getting pregnant after 40 is possible without fertility treatment, but your chances of having trouble conceiving are higher. After the age of 45, its not likely that you’ll be able to get pregnant with your own eggs.
If you’re over 40 and wish to conceive, ACOG recommends that you see your gynecologist right away for an evaluation, which may include basic fertility testing. A simple blood test can check your hormone levels, and an antral follicle count ultrasound can assess your risk for infertility.
If you have any symptoms or risk factors for infertility, make sure you discuss them with your provider before you start trying to get pregnant. You can also ask them if there is anything you can do to increase your odds of conceiving.
How Does Pregnancy Happen
Before we get into the ways you can increase your chances of getting pregnant, lets find out exactly what takes place on the road to conception.
The journey to pregnancy begins with ovulation. This is when your ovaries release an egg in anticipation of fertilization. Your uterus also prepares its inner lining, called the endometrium, for the fertilized egg to attach. All this happens over a monthly sequence your menstrual cycle. When no sperm is available within 1224 hours of the egg being released, it degrades and you get your period.
However, when you have sex around the time of ovulation, sperm makes its way up your vagina, through your cervix, and into the uterus.
Usually one sperm fertilizes one egg, resulting in one baby. When sperm fertilizes an egg, and the resulting embryo splits into two, you get monozygotic twins. Sometimes two eggs are fertilized, and dizygotic twins are formed.
After fertilization, a thick coat, known as the zona pellucida, forms around the egg and denies entry to the other sperm cells. This fertilized egg will begin splitting into many cells and stays in the fallopian tube for around three or four days.
It will then begin to descend into the uterus, where it implants into the inner lining. You will sometimes experience some spotting when this happens. Your body will then flood your system with a number of hormones to maintain a healthy pregnancy.
Can You Get Pregnant With Secondary Infertility
The short answer is yes, you can get pregnant with secondary infertility, but you may need to seek out the assistance of a fertility doctor, and heres why.
While women over the age of 35 still have eggs left, it becomes more difficult to get pregnant because the eggs are of lower quality.
Research performed by doctors at RMA showed that a womans age impacts the viability of the embryos created from her eggs.
Namely, the older a woman, the more likely it is that her eggs have a chromosomal error which will, in turn, result in embryos being aneuploid, or chromosomally abnormal.
For example, in her mid-to-late 20s, the rate of aneuploidy in a womans eggs is a little more than 20 percent, rises to the mid-30s by age 35, is about 50 percent by age 40, and is nearly 90 percent by age 42 and 43.
This means that while about 20 percent of the embryos a woman creates may be abnormal in her late 20s, almost 90 percent could be abnormal by her early 40s. That is a significant change in a little over a decade.
Planning A Pregnancy After 40
Lori and Kevin Miller climbed the corporate ladder for nearly 20 years before starting a family.
We were very focused on our careers and kept waiting for the right time to have kids, Lori said. Then, age kind of snuck up on us.
Lori was on the verge of turning 40, an age when, in the past, most women were sending kids to grade school rather than trying to conceive them. But Lori represents a new normal. According to National Center for Health Statistics data, birth rates in women over 40 are on the rise.
Fast-forward to today: The Millers, who live in Columbia, are now a family of four. Isabella, their daughter, was born when Lori was 40, and Rhett, their son, was born when Lori was 43
MU Health Care obstetrician Karen Thies, DO, cared for Lori throughout her second pregnancy. She has practiced medicine for 15 years, but has only recently noticed increasing numbers of women over 40 coming in for family planning and prenatal care.
As the decades have passed, women have become more educated and professionally active, resulting in them getting married and starting families later in life, Thies said. Ten years ago, it was fairly uncommon to see women in their 40s having children. Decades ago, it was extremely rare.
What Type Of Treatment Is Available For Women With Secondary Infertility
Secondary infertility is treatable, and many women diagnosed with it go on to have successful subsequent pregnancies.
There are various treatment options based on the womans specific fertility profile, including Intrauterine Insemination , where sperm is inserted into a womans uterus at the time of ovulation.
In Vitro Fertilization is another option, where sperm and egg are fertilized outside the womans body and a resulting embryo is transferred back into the womans uterus in hopes of implantation.
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Understanding Your Odds Of Pregnancy By Age
From your doctor asking if youre thinking about getting pregnant soon to nosy relatives asking when youre going to settle down, you may have felt your biological clock counting down already. With all the pressure placed on women to have a baby by a certain age, it can be easy to feel like your fertility is a ticking time bomb.
Thankfully, age does not necessarily limit your fertility as much as you may think. More and more women are choosing to wait until their 30s and 40s to have a child for reasons like pursuing career goals, traveling the world, or finding the right partner.
Still, that does not mean that your fertility is an unlimited reserve. While its becoming more common and, thanks to modern medical technology, safer to have children at an older age, your fertility still changes significantly as you get older. Heres what you need to know to understand your odds of pregnancy by age.
Do I Need Infertility Treatment
If youre having trouble conceiving, an infertility specialist may be able to help. The first step after 12 months of trying to conceive is to schedule an infertility evaluation. This multipart assessment includes:
- Physical examination
- Semen analysis
- Evaluation of the uterus and fallopian tubes
If you or your partner have a known medical condition that affects the uterus, fallopian tubes, sperm or ovulation, talk to your doctor to see if you should be evaluated sooner. For example, if you know that both of your fallopian tubes are blocked, youll need to see an infertility specialist even before trying to get pregnant.
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Fertility Treatments After 40
Research has shown that assisted reproductive technology is less effective after age 40, and the rate continues to fall as you get older. For example, intrauterine insemination success rates can be as low as 5% for women in their 40s.
In vitro fertilization has slightly better success rates for older peopleabout 15% per cycle. Still, this rate is not as good as it is for younger people.
Egg donation may offer the best chance for someone who wants to get pregnant after the age of 40. In this process, a person can become pregnant using a donated egg that has been inseminated with the sperm of their partner or a donor.
The success rates for IVF using a donor egg can be upwards of 35% in cases of diminished ovarian reserve . While the success rates are encouraging, using an egg donor means that the person who becomes pregnant won’t have a genetic connection to their child.
The decision to use an egg donor can be difficult to make. Some people will consider the option and decide it’s not the right choice for them.
The process can also be costly. The price tag may prevent some people from using egg donation services to become pregnant.
When To Seek Help Getting Pregnant After 40
Women over 35 should see a fertility doctor if they have been unsuccessful in conceiving after six months of trying naturally. Some options for fertility treatment after age 40 include:
- Fertility drugs like Clomid, which are used to stimulate follicle development and ovulation
- In-vitro fertilization , which can be used in combination with medications
- IVF with donated eggs from a younger woman
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What Prenatal Tests Will You Need If Youre Pregnant At 45 Will There Be More Than Usual
Youll likely get poked and prodded more than your younger-mom counterparts, but you may find the additional testing and extra attention reassuring.
Youll also be closely monitored for high blood pressure and preeclampsia, which also crop up more often in older pregnancies. And you may have additional ultrasounds to monitor the babys growth, since low birth weight is another pregnancy complication that is more common in older expectant moms.
Because the rates of Down syndrome and other chromosomal conditions are greater in babies of older moms-to-be, youll likely be encouraged to undergo chorionic villus sampling between 10 and 13 weeks of pregnancy or amniocentesis, which is done between weeks 15 and 20 of pregnancy and most often between 16 and 18 weeks.
If you conceive with a donor egg or your own eggs that were previously frozen, the risk of chromosomal abnormalities in your baby would be based on the age of the donor or your age when your eggs were frozen. It’s a good idea to inform your doctor of those details so he or she can provide an accurate assessment of that risk.
What Will Pregnancy Be Like
Just as its statistically more difficult to conceive after the age of 40, pregnancy itself can also be more challenging as you age.
You may have more aches and pains due to joints and bones that are already starting to lose mass with age. You might also be more susceptible to high blood pressure and gestational diabetes. Pregnancy-related fatigue may be more pronounced as you get older, too.
Its important to talk to your OB-GYN about what else you can expect during your pregnancy based on your age and overall health.
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Age Is A Major Factor For Women
Youve probably heard the phrase your biological clock is ticking. This phrase refers to your fertile window. Women cant conceive after their menstrual cycles stop, usually sometime in your 40s or 50s. Men produce sperm throughout their lives, but women are born with a set number of eggs that decreases as you age.
At birth you have about two million eggs but naturally lose hundreds of thousands of them by the time you reach puberty, says Cross. Your body continues to lose eggs no matter what you do. And the rate at which women lose eggs accelerates around the age of 37.
The quality of eggs stored in the ovaries also declines over time. The eggs youre born with are naturally paused in the process of dividing their DNA, Cross explains. They complete that process, or ripen, when you ovulate them 20 to 40 years later. The longer eggs are stuck in the mid-division stage, the more likely that process will go wrong creating eggs with the wrong number of chromosomes. That results in not becoming pregnant, experiencing miscarriages or having babies with genetic syndromes due to chromosomal abnormalities.
The bottom line: The quality and number of eggs a woman has decreases throughout her lifetime and egg loss accelerates around the age of 37, which makes it more difficult to become pregnant.
Getting Pregnant At : Faqs And Tips For Optimizing Your Fertility Health
Dr. Shannon Brim discusses the challenges of becoming pregnant at 40 and how to increase your chances.
In the 1970s, the average age of first-time mothers in the United States was 21. By 2020, that average age had jumped to 26. Studies show this trend is mostly due to career goals and financial concerns children arent cheap! Unfortunately, evolution has not caught up with the newer preference of becoming pregnant later in life, and our bodies face some unique pregnancy challenges as we age.
As OB/GYNs, weve seen the number of patients asking us questions about pregnancy over 40 rise as well. We thought we would address a few of the most common questions we get and offer some advice for those who are trying to conceive later in their reproductive lifespan.
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When Should I See A Doctor For Secondary Fertility
The guidelines on when you should see a fertility doctor for secondary infertility are exactly the same as for any woman trying to get pregnant.
You should seek the assistance of a reproductive endocrinologist if you are under 35 years old and trying to conceive for 12 months.
It is recommended that you seek help after just 6 months of trying if you are 35 years old or older.
Ways To Boost Fertility
Younger women might still have some bad habits left over from their high school or college days that can sabotage fertility. They may still subsist on a diet composed of a lot of fast food and alcohol, or they may not have lost the “Freshman 15.” The good news is that women in their 20s can still take steps to optimize their odds of getting pregnant. For instance, weight plays an important role in conception, but many young women tend to be very underweight or overweight, explains Raupp. “Maintaining a normal BMI and adopting a pre-conception plan of eating a nutrient-dense diet, limiting alcohol and caffeine, and avoiding cigarettes help a woman achieve her most optimal health prior to conception,” she says. “That way, she can more likely conceive with ease, have a healthy pregnancy, and bring a child into a healthy home.”
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Risks Of Getting Pregnant After 40
While every biological clock is different, conception after 40 is difficult due to your egg supply decreasing with age. In fact, by the age of 40, 90% of your eggs are chromosomally absorbed, making it increasingly harder to conceive via natural methods. In your early 40s, your uterine line also begins to thin making it more difficult for eggs to implant and your male partner may begin to suffer from decreased virility and fertility as well. Even so, you still have a variety of options to choose from to assist you in getting pregnant. Well talk more about those later.
Because your body is older, you do have a higher risk of pregnancy complications than younger mothers. You may develop high blood pressure, diabetes, and placental problems during a late pregnancy. Premature labor and the need for c-sections also become more common as you age.
For your baby, getting pregnant at an older age comes with an increased risk of premature birth, low birth weight, congenital birth defects, and stillbirth. Frequent doctors visits and proper care will help you manage pregnancy and reduce some of these risks. Your doctor may recommend extra testing and monitoring to help prevent and detect any issues.
The cost of getting pregnant over 40 can add up if your conception methods go beyond the traditional. While options such as in vitro fertilization , egg freezing, and egg donation can help you get pregnant, they come with a higher price tag that your insurance provider may not cover.
Why Does Fertility Decline With Age
Age does not absolutely define fertility and, of course, every woman is different. In general, fertility does decline over time, though it is not simply predicted by calendar years. In females from the age of 35 onwards, reproductive potential drops and after the age of 40 there is less than a 10% chance of becoming pregnant naturally in any given month. The reason for this declining fertility, which reduces the chances of pregnancy and inexorably continues to reduce even further the likelihood of becoming pregnant in your 40s, is all in the arithmetic.
Girls are born with all the eggs they will ever have. At birth, they number just over a million. By puberty, between 300,000 and 500,000 eggs remain in the ovaries. However, from this very prolific starting point, only around 300 eggs will be ever fully mature and be released during ovulation. So naturally as you age, the number of remaining eggs declines. And as menopause approaches, the ovaries become less responsive to the hormones responsible for triggering ovulation. This is why, although we may all have heard anecdotes about a friend of a friend who was surprised to be pregnant at 45, the odds are against this happening.
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More Years Behind You Dont Always Mean More Problems Ahead
Aside from a significantly longer wait to see two blue lines on a pregnancy test, I can honestly say that my 40-plus pregnancy was no different than my earlier ones. I was officially a woman of AMA at least they dont use the term geriatric mother anymore but I certainly wasnt treated any differently by the midwives who looked after me.
My only health issue was depression, which was an issue during my last pregnancy as well and certainly isnt related to age. In fact, I think my mental health was better during my most recent pregnancy. I have many more years of experience , and Im a lot more open about my illness than I was back then. Im far less likely to put on a brave face or bury my head in the sand.
Aside from my mental health, Im in better shape in other ways, too. When I got pregnant at 29, I was a party girl who drank too much and survived on takeout and ready meals. When I got pregnant at 31, I was only a part-time party girl and ate a lot more veggies, but I had an energetic toddler to look after.
On the other hand, when I got pregnant at 39, I was a teetotaler, ate all the right stuff, exercised regularly, and had school-age kids, meaning I could get those precious daytime pregnancy naps.
Age does matter when it comes to having a baby. Apart from taking longer, on average, to get pregnant in the first place, older moms are more likely to have a