While the age of first-time moms has increased, so has the number of women having babies in their 40s. The frequency with which women between the ages of 40 and 44 became first-time moms started to climb in the 1980s. And this rate of increase has only accelerated. Between the years of 1990 to 2012, the number of first-time mothers over the age of 40 more than doubled in the United States.
Despite the fact that more women are entering motherhood past the age of 40, getting and staying pregnant in your 40s can be difficult.
If you’re one of these women considering welcoming a new family member while in her 40s, there are steps you can take before and during your pregnancy to increase the likelihood that your new baby is healthy and happy.
Preparing for Pregnancy in Your 40s
Seeing your gynecologist to prepare for pregnancy in your 40s is a wise first step. A medical professional can check your existing health and screen you for any conditions that might make getting and staying pregnant more difficult or that may increase your risk of health complications during pregnancy.
If your doctor finds a condition that could prevent pregnancy or hinder a healthy pregnancy, he or she can treat you prior to pregnancy attempts, potentially making the process easier and less stressful.
Women of any age who are planning to become pregnant can benefit from adopting healthy lifestyle habits and improving their overall health. Consider:
- Reaching and maintaining a healthy weight
- Eating a well-balanced diet
- Getting regular, moderate physical activity
- Quitting any unhealthy habits, like smoking
If you have any pre-existing conditions that may predispose you to pregnancy complications, like high blood pressure or diabetes, getting these in control before getting pregnant will improve your chances of having a healthy pregnancy and a health baby.
Talked with your doctor? Check. Feeling in good shape to get pregnant? Great. Let’s talk about your next steps.
Getting Pregnant in Your 40s
Is it possible?
The primary concern patients in their 40s have when coming to Shady Grove Fertility is, “Will I be able to get pregnant?” says Dr. Rebecca J. Chason of Shady Grove Fertility’s Annapolis, MD office.
A woman’s fertility naturally declines with age due to a loss in the number of eggs as well as a decline in the ability of remaining eggs to form a healthy pregnancy. “If you’re over 40, time is critical, and any delay may limit your options. Now is the time to be proactive about your path to pregnancy,” adds Chason. Seeking support from a fertility specialist early in the process can provide crucial information about your current reproductive status and maximize the chance of pregnancy.
What to Expect from Your Fertility Center
During your first visit, you’ll meet with your dedicated fertility specialist who will gather your and your partner’s (if applicable) medical history and advise you of the need to begin simple diagnostic testing.
For the woman, screening will include an ultrasound, blood test, and hysterosalpingogram (HSG).
During the ultrasound, your doctor will evaluate the structure of your reproductive organs, checking for:
- Uterus that appears normal
- Uterine cavity that appears normal
- Ovaries that appear normal
- Number of visible follicles (small cysts that house eggs) in the ovaries
While a woman of any age may experience uterine abnormalities or blocked Fallopian tubes, women who are older are a bit more likely to experience these complications, simply as a result of the fact that they have lived longer and have had more time to develop some of these issues.
When checking your blood, clinicians will look at general levels to assess your overall health. They will also assess your ovarian reserve, that is, the number of eggs that you currently have remaining.
As you age, the number of your eggs declines and the quality of your remaining eggs decreases. As a result, ovarian reserve levels are critical in determining the likelihood of achieving a pregnancy and deciding the appropriate treatment options for a woman in her 40s who wishes to become pregnant.
If you’re trying to conceive with a partner, he will undergo an assessment as well. He will need a semen analysis in which the motility (movement), morphology (shape), and count of his sperm will be determined.
Your doctor will also offer you genetic screening. Today, with advances in technology, prepregnancy genetic screening (also called carrier screening) is more affordable and accessible than ever. Shady Grove Fertility is an advocate of genetic screening when planning for pregnancy, and offers genetic screening for more than 100 different diseases and syndromes. The insights gained by testing both partners offer the ability to identify possible genetic diseases and syndromes that may be passed on to future offspring.
Following these assessments, your doctor will consider all patient-specific factors and advise you on the best course of action toward pregnancy. Visiting a fertility center like ours doesn’t necessarily mean you’ll end up needing more advanced treatment such as in vitro fertilization (IVF).
If, for example, you have an average or limited ovarian reserve, you may be prescribed medication that will cause you to release more than one egg per cycle. This can be done in conjunction with intrauterine insemination of your partner’s sperm or donor sperm, especially if any abnormalities are found during the male evaluation or if you do not have a partner.
The uterus itself is capable of sustaining a pregnancy long past the age of 40. But the lack of high-quality eggs presents the largest hurdle to pregnancy in your 40s.
If your ovarian reserve is very low or you don’t have any viable eggs remaining, you may still be able to achieve a pregnancy through the use of donor eggs or donor embryos along with IVF.
Ultimately, the key to successfully getting pregnant in your 40s is not spending too much time trying on your own without additional information and counseling from a specialist – because time is of the essence, moving quickly through the process and exploring all of your options is a must.
Staying Pregnant in Your 40s
Women in their 40s have a higher rate of miscarriage than pregnant women in their 20s or 30s. And, as women move further into their 40s, miscarriage rates increase.
Due in large part to issues with egg quality, women in their 40s are more likely to become pregnant with a baby with a chromosomal abnormality. Often, these abnormalities are so severe that they result in a miscarriage.
Some miscarriage risks can be mitigated with Preimplantation Genetic Testing for Aneuploidies (PGT-A). This process, which is only available to women who undergo IVF, allows our embryologists to test the embryos to determine if they have the proper number of chromosomes before transferring them back into the uterus. By transferring a healthy embryo, doctors can improve the likelihood of producing a viable pregnancy.
Maintaining a Healthy Pregnancy in Your 40s
As a pregnant woman in your 40s, you will be more likely to experience complications, including:
- High blood pressure
- Gestational diabetes
- Pre-eclampsia
- Placental issues
- Preterm delivery
No matter your age, you should have regular prenatal care throughout the course of your pregnancy. Properly preparing your body prior to pregnancy in addition to conscientious care throughout the duration of your pregnancy will not only improve the likelihood that you have a healthy pregnancy, but also improves your chances of taking home a healthy and happy baby.
Medical contribution by Rebecca J. Chason, M.D.
Rebecca J. Chason, M.D., FACOG, is board certified in obstetrics and gynecology and reproductive endocrinology and infertility. Dr. Chason serves on the women’s health council at Anne Arundel Medical Center and is a member of the Academic Affairs Committee for the department of OB/GYN’s and will serve as core faculty for the developing residency programs. She sees patients at SGF’s Annapolis, Maryland office.
Editor’s Note: This post was originally published in October 2019 and has been updated for accuracy and comprehensiveness as of October 2020.
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