Getting Pregnant After 40

Getting pregnant after 40 comes with a host of challenges.  This likely comes as no surprise as the difficulties of getting pregnant after 40 are well documented in scientific literature and in mainstream culture. 

While it comes with its challenges, getting pregnant in your 40s isn’t near the dead-end in your family-building journey you might have been lead to believe. 

In this article, we will review the chances of getting pregnant after 40, why this decline in fertility happens, what you can do to naturally counteract this decline and boost your egg quality, and cover a host of fertility treatments that you could encounter on your journey to get pregnant in your 40s.

Fast Facts

  • The odds of getting pregnant naturally at 40 is roughly 5% and decline further into your forties. 
  • The main reason it is difficult for a female to achieve a live birth in their 40s is due to poor egg quality, or more specifically, high odds of genetic abnormalities in their eggs which leads to a failure to fertilize or implant as well as higher odds of pregnancy loss if implantation occurs.
  • There is a lot you can do to naturally increase your fertility at 40 and beyond including dietary changes as well as supplementation with CoQ10 (in either Ubiquinone or Ubiquinol form).
  • It’s highly recommended that even with changes to your diet and supplement regimen that you contact a reproductive endocrinologist as quickly as possible so that you are ready to seek more advanced treatments like IVF if necessary
  • Some women may need to turn to donor eggs.

Chances of Getting Pregnant After 40

Let’s start with the basics. Under normal circumstances, a 40-year-old woman has approximately a 4-5% chance of conceiving naturally each month.  Unfortunately, these numbers continue to decline the further you go into your 40s.  For comparison, a 30-year old woman has about a 20% chance of getting pregnant each month.  

 

Chance of Successful Natural Pregnancy Each Month

Chance of successful natural pregnancy each month by age chart

This of course comes with a HUGE caveat. All numbers regarding the odds of getting pregnant by age are based on large population statistics and there are significant individual differences. Some women may in fact find it quite easy to achieve pregnancy in their 40s and even have multiple births past 40; for others it will be a challenge to see even one positive pregnancy test.

The important takeaway here is that it’s still possible to get pregnant after 40. It will likely take longer for it to happen and come with a bit more effort but it can certainly happen. 

Why is Getting Pregnant in Your 40s Difficult

As women age into their 40s, both the number of eggs they have and their quality decline. Fortunately, uterine quality does not decline nearly to the extent that egg quality and count do.

Egg Count in the 40s

Ovarian reserve is a term used to describe the number of eggs you have left in your ovaries.  Declining ovarian reserve is an unavoidable consequence of normal aging. A woman’s ovarian reserve is actually at its peak before she’s even born.  Female fetuses 6 months in age have their lifetime maximum eggs in their ovarian reserve. From this point on, it’s on the decline with a female losing roughly 1,000 eggs per month.

After 40 or so years of this monthly detrition, the amount of eggs left in a woman’s ovarian reserve is considerably low and will keep on diminishing until menopause between ages 45-55. Most women have about 5,000 eggs in reserve at the age of 40. That number can be further reduced by other factors such as endometriosis, tubal disease, prior ovarian surgery, pelvic infection, chemotherapy/radiation, smoking, autoimmune disorders, illness such as mumps, and genetic abnormalities like Fragile X Syndrome.  By comparison, a healthy 25-year old has approximately 100,000+ eggs in reserve.

Ovarian Reserve by Age

Ovarian Reserve by Age

While the number of eggs you have doesn’t play a huge role in your odds of getting pregnant each month, you will eventually run out of eggs. 

Fortunately, doctors have a way to measure ovarian reserve which can help you say informed and make the best decisions. They use a blood test called the Anti-Müllerian Hormone (or AMH) test.  AMH is a hormone that’s produced by the cells inside a woman’s follicles—the round, cellular structures in the ovaries that contain eggs. Eggs mature inside the follicle until they are eventually mature enough to be released during ovulation.  Therefore, the number of follicles a woman has directly correlates to the number of eggs “on deck”, and the level of AMH created by these follicles reflects that reserve. The higher your AMH level, the more eggs you have in reserve. The lower your AMH, the fewer eggs left in your reserve.

So, if you’re trying to get pregnant after 40, it’s a good idea to get your AMH levels tested so you know about how long you have left.

Egg Quality in the 40s

Egg quality plays a huge factor in your ability to get pregnant with your own eggs after 40. Unfortunately, there’s no real way to test egg quality besides actually fertilizing an egg and seeing what happens. While there are indeed visual grading systems used by embryologists, those grades are given based on a quick visual analysis and known to be quite unreliable.

We do know that the older you are, the higher percentage of genetically abnormal eggs you will make. In fact, most fertility specialists agree that egg quality is nearly synonymous with how genetically normal the egg is (which in turn correlated to higher odds of a live birth).

While all women, even those in their 20s have some genetically abnormal eggs, the ratio of abnormal eggs skyrockets from the age of 35 to the mid-40s.  At 40, approximately 40% of eggs will be genetically normal. By the age of 44, as little as 10-20% may be normal.

Percentage of Genetically Abnormal Embryos by Age

Egg quality - percentage of genetically abnormal embryos by age

Genetically abnormal eggs are less likely to fertilize or implant in the uterine lining. If they do implant they are more likely to result in a pregnancy loss.  This is the main reason that fertility declines as a woman ages into their 40.

It’s important to note here that while we have discussed this egg quality decline as it is inevitable, research shows that it is at least partially fixable. We will discuss this further in the following section on how to increase your chances of getting pregnant after 40.

Uterine Quality

Egg quality is critical, but equally important is having a healthy uterus to nourish and support your baby as it grows and develops during pregnancy. A well-developed uterine lining is essential for implantation. While egg quality is in steep decline for women after 40, fortunately, the uterine environment is usually good for much longer. The chronological age of your uterus does not impact implantation rates. This is one of the reasons we see IVF success with women over 40 using donor eggs and carrying to term.

A study of 869 IVF cycles that used chromosomal screening to control egg quality found that uterine aging does not contribute to the age-related decline in fertility and that implantation rates are not affected by the chronological age of the carrier’s uterus.

How to Increase Your Chances of Getting Pregnant After 40

Before we dive into specific actions that can be taken to improve the odds of getting pregnant after 40, it’s important we set the stage properly.  Females are born with all the eggs they will ever have. For most of a female’s life, these eggs simply sit in a waiting pool in an immature stage until it is their turn to be recruited and developed with the chance of being ovulated. 

For a long while, it was assumed that these eggs in the waiting pool degrade as a woman aged. [6] [7]   By the time a woman reached 40, these eggs had been slowly withering away for 40+ years and substantially degraded. So, when they were recruited out of their waiting pool they were destined for failure.  However, reproductive endocrinologists now believe eggs remain in excellent condition as long as they remain in the waiting pool.

On the other hand, a woman’s hormonal and thus ovarian environment indeed deteriorate quite noticeably as a woman ages. This environment and the hormones inside the ovary are critical for proper egg development. If a healthy immature egg is recruited into this poor ovarian environment it is unable to develop properly. They end up being poor quality by the time ovulation occurs because they enter a poor ovarian environment for development. [8]

This suggests the following formula: Fix the ovarian environment -> fix egg quality -> improve reproductive outcomes. So, what can you do to fix the ovarian environment. Here we will cover three easy changes you can make to your life.

Eat a High Fat Diet

When we’re talking about things to do to help you get pregnant after 40, we’re not talking about eating loads of french fries. We’re talking about eating fats typically found in a high-quality ketogenic diet.  Fats are well known to reduce inflammation and synthesis and balance hormones key reproductive hormones .  Inflammation may not sound too important, but inflammation has been shown wreak havoc upon the reproductive system.

We won’t go too deep into fats role in hormone production, but long story short, several of the most important reproductive hormones including Estrogen, Progesterone, and Testosterone are all derived from cholesterol, a type of fat . Cholesterol is also a critical component of Vitamin D, a nutrient that similarly plays a very important role in fertility .

Take Co-Q10

CoQ10 is found in every cell of the human body in both its oxidized (ubiquinone) and reduced and active form (ubiquinol). The biomolecule is used in all cells and plays a critical role in energy production. As eggs are rapidly growing and developing cells that have high energetic requirements CoQ10 has long been looked at for its potential role in egg and embryo quality.

As with many things, CoQ10 levels naturally decline in the 30s and appear to co-occur with the age-related fertility declines and increased rates of embryo genetic defects.

Many animal studies have demonstrated that CoQ10 protects ovarian reserve, counteracts ovarian aging by restoring mitochondrial and energy production functionality, and thus increases the rate of quality embryo formation.

Clinically speaking, CoQ10 supplementation on humans has shown to improve fertility as well including fertilization rates, the percentage of genetically normal embryos, as well as pregnancy and live birth rates. One study showed that Co-Q10 supplementation reduced the odds of genetically abnormal embryos with the treated group of 35-43-year-old women experiencing a defect rate of 46% vs the placebo group who experienced a 63% genetic defect rate. Another random placebo-controlled human study showed 20% higher fertilization rates and 15% higher live birth rates for those who supplemented with CoQ10.

Fertility Stats for Those Supplementing with Co-Q10

CoQ10 for Getting Pregnant over 40

CoQ10 comes in two forms, ubiquinone, and ubiquinol (the reduced, bioavailable, and bioactive form). While some studies show not much of a difference, it has been demonstrated that older individuals may have difficulty converting ubiquinone into its active ubiquinol form. Other studies have shown ubiquinol to have a serious advantage in improving blood levels over ubiquinone. While for most cases of infertility CoQ10 in either form should work, we recommend those over 40 to use ubiquinol.

We recommend Molecular Fertility’s Ovarian Bloom (which combined many key fertility nutrients) or their stand-alone VESIsorb® Ubiquinol.  Both products feature the patented VESIsorb® nutritional absorption technology shown to improve the absorption and bioavailability of Ubiquinol 600%.  If you are interested in using CoQ10 and would like to save a few bucks, their Ubiquinone CoQ10 is still a great choice!

While there are other things you can do to improve egg quality after 40, it’s generally a good idea to seek the assistance of a fertility specialist sooner than later when trying to get pregnant in your 40s.

Getting Pregnant After 40 with Fertility Treatment

After 6 months of trying naturally (or possibly even sooner), it’s time to check in with a reputable reproductive endocrinologist to conduct some basic fertility testing and hopefully get rolling with a treatment fairly quickly.  Since time is of the essence in your doctor is likely to skip over less aggressive treatments like IUI and straight into treatments like IVF that have higher odds of success. Here we will go over some of the most common treatments you may encounter at a fertility clinic.

Intrauterine Insemination (IUI):

Also known as artificial insemination, IUI can be used with and without fertility medications.  Sperm is collected, concentrated, and then using a catheter to pass through the cervix, deposited into a woman’s uterus. If and how much fertility medication is used is generally dependent on your personal preference, your medical history, and results from your fertility diagnostic testing.  Most often, you will be treated with medications that stimulate egg growth and help time your ovulation with insemination.

Few reproductive endocrinologists will recommend IUI to women in their 40s because of the low likelihood of success and the delay in treatment that would result. IUI has lower pregnancy rates than IVF with success rates of around 15-20% for ideal candidates under 35, about a 10% chance in women 35-40, and just 5% or lower for women in their 40s.

Most choosing to do IUI after the age of 40 would be overriding the medical recommendations of their doctors due to cost. Still, with the low chance of success IUI, the cost of the IUI treatment per live birth would likely exceed the cost of IVF or donor eggs.

In Vitro Fertilization (IVF):

If IUI is not recommended or was not successful after several cycles, your reproductive endocrinologists will likely recommend progressing to IVF.  IVF has become the gold standard of fertility care and boasts the highest success rates per cycle of any Assisted Reproductive Technology (ART).  It successfully eliminates many female and male factors that may be contributing to your inability to conceive.

Women who switch from IUI to IVF sooner or begin with IVF get pregnant quicker than those who stick or start with IUI.  found that undergoing immediate IVF resulted in superior pregnancy rates with fewer treatment cycles compared to those who did two rounds of IUI before switching to IVF.  While the immediate IVF group got pregnant quicker, the overall success after up to 6 IVF cycles was similar.

During an IVF cycle, eggs are removed from the female’s ovaries and fertilized using partner or donor sperm in a laboratory (or occasionally using an alternative method with INVOcell).  Embryos are allowed to develop for several days at which point, one embryo (or potentially two) is transferred back into the woman’s uterus.  IVF is used in conjunction with many different medication protocols to produce more eggs, higher quality sperm, embryos, and improve the uterine lining.

IVF success rates are higher than any other fertility treatment but vary from age group to age group with younger patients generally achieving better results. CDC data indicates IVF has an average success rate of 27.3% and results in live births 22.2% of the time. These numbers, of course, depend on many different variables such as age, embryo quality, sperm and egg quality, reasons for infertility, and clinic; rates can be both much higher and much lower. For women age 40 and up, the percentage of live births per IVF cycle is just 5.8% according to the . And it may take more than one IVF cycle to achieve pregnancy.

Therefore, if IVF is not successful after several cycles and egg quality is believed to be a likely cause, your reproductive endocrinologist will likely suggest using an egg donor.

Donor Egg IVF

Advanced maternal age, unfortunately, goes hand in hand with diminished ovarian reserve, declining egg quality, and lower odds of IVF success.  After 45, experts say it’s almost impossible to get pregnant using your own eggs. Using donor eggs can improve your odds. 

Donor egg IVF is like traditional IVF, but instead of using your own eggs, high-quality eggs from a young, fertile donor are used instead. This improves your odds of conception making them similar to that of your young, healthy donor. Donor eggs are also a necessary option for women born without ovaries or with non-functioning ovaries, cancer survivors who did not bank their eggs prior to treatment, and women who are carriers of a genetic disease.

Your egg donor can be a family member or friend or chosen by you from an egg bank. With donor egg IVF, the donor takes medications to stimulate egg production. Eggs are retrieved, fertilized, and may be transferred fresh or frozen. You’ll take medications to prepare your body and uterus to receive the embryo. Fresh transfers also require you to synchronize your cycle with your donor’s cycle.

Success Rates - IVF vs Donor Eggs

The high success rate of donor egg IVF confirms that egg quality associated with age is the primary barrier to pregnancy in older women. If you are over 40, your chance of successful pregnancy is much higher in IVF cycles using donor eggs, but many women in their early 40s will choose to accept lower pregnancy odds and use their own eggs. By age 43, the chance of becoming pregnant through IVF is less than 5%, and by age 45, use of donor eggs is the only reasonable alternative

Risks of Getting Pregnant In Your 40s – Is it Safe?

For most women, getting pregnant and delivering a baby after the age of 40 is safe, and it’s on the rise.  According to the U.S. Centers for Disease Control and Prevention, since the early 1980s, births among women ages 40-44 have continued to climb even as the overall birth rate in the U.S. has fallen to a record low. In fact, women 40-45 was the only age group not to decline. This trend reflects the cultural shift to women choosing to complete their education, build careers, and waiting to find the right partner before starting a family. It’s also a vote of confidence in the assisted reproductive techniques and fertility centers that are sometimes required to make childbearing at an “advanced maternal age” possible. Plenty of celebrity moms like Janet Jackson and Halle Berry have become the face of women who ignored and ultimately beat their biological clocks.

This is not to say that carrying a child later in life is easy or without risks. Older moms have an increased risk of pregnancy complications like gestational diabetes, preeclampsia (high blood pressure), and intrauterine growth restriction, which can cause premature delivery. They are also more likely to need a C-section because older uteruses sometimes don’t contract as well as needed for a vaginal delivery. There are also greater risks to an older mom after the child is born, including postpartum hemorrhage or excessive bleeding.

Miscarriage Risk

Pregnant women over 40 are also more likely to miscarry. While women of all ages face some miscarriage risk (believed to be around 10-15% in women who know they’re pregnant) , because older women have increased rates of chromosomal abnormalities in their eggs and embryos, their rate of miscarriage is much higher than their younger counterparts.  A large Danish study of 634,272 women of all ages and 1, 221,546 pregnancy outcomes found 13.5% of the pregnancies intended to be carried to term ended with fetal loss. There’s a sharp rise in pregnancy loss for women in their late 30s. By age 42, more than half of such pregnancies resulted in fetal loss. The risk of a spontaneous abortion was 8.9% in women aged 20-24 years and 74.7% in those aged 45 years or more.

Miscarriage Risk by Maternal Age

Aneuploid eggs and embryos are responsible for most of the decline in fertility and the low pregnancy success rates with IVF for women over 40.

Older eggs are more likely to be abnormal. Although in many cases, a woman carrying a fetus with an abnormal chromosome number miscarries, pregnancies that continue normally often result in a fetus with any number of physical abnormalities. Babies born to older moms are more likely to be born with an abnormal number of chromosomes (aneuploidy), which includes missing chromosomes (monosomy) or an extra chromosome (trisomy).  Turner Syndrome is an example of monosomy; Down Syndrome is a well-known example of trisomy.

Bottom Line on Getting Pregnant After 40

There’s no denying your odds of getting pregnant after 40 are now far lower than they were just a few years ago.  If you’re about to turn 40 or you’ve already spent a couple of years in your fourth decade and you’re interested in having a child, don’t wait! Schedule an appointment with a reputable fertility clinic posthaste. While pregnancy is a possibility, it’s not a probability without some fertility assistance. For older moms, IVF is statistically your best option and may or may not be possible using your own eggs. It’s important to have some basic fertility testing performed so you have a good understanding of what your personal chances of conceiving are and the necessary steps it’s likely going to require for you to bring home a baby.

The good news is that becoming an older mom has its advantages. You’ve had time to travel and build a career and the financial security needed to raise a child. You’re also more likely to make well-informed parenting decisions and to better appreciate all of the milestones child-rearing offers.

 

 

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