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Getting Pregnant After 40

By CNY Fertility Published on

It’s pretty well known that a woman’s chances of getting pregnant begin to decline with age. The cruel irony being you spend much of your 20s (when you’re most fertile) trying to avoid getting pregnant, only to spend your mid to late 30s and early 40s desperately praying for that little pink + sign to appear on a home pregnancy test.

Getting pregnant isn’t a slam dunk for any woman at any age. Even the youngest, healthiest, most fertile women among us only have a 25% chance of getting pregnant each month because of the narrow fertilization window and egg abnormalities that naturally occur at any age. So, for those trying to conceive after age 40, is it possible? What are the chances? What’s it going to take? Let’s dig in.

Chances of Getting Pregnant After 40

For comparison, a 30-year old woman has about a 20% chance of getting pregnant each month. At 40, that same woman has a less than 5% chance, and the likelihood of miscarriage and other fertility challenges is quite high.

Chance of Successful Natural Pregnancy Each Month

Chance of successful natural pregnancy each month by age chart

The important take away here is that it’s still possible to get pregnant at 40. It just might take longer for it to happen, and it may not happen on its own.

Getting Pregnant After 40 Naturally

Getting pregnant naturally after age 40 is not as easy as getting pregnant at age 25 or even 35, but it can happen. Why is it more challenging? In short, declining egg count and egg quality.  As women approach menopause, egg quality and their number of remaining eggs begin to naturally decline making conception less likely.

Egg Count:

Ovarian reserve is a term used to describe the ability of the ovaries to provide egg cells that are capable of fertilization and that will result in a healthy and successful pregnancy. In other words:  your egg supply. 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 ovarian reserve. From this point on, it’s on the decline.

Around age 35-37, egg reserve takes a precipitous nosedive. At age 40, 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 this stage. 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

Doctors have a way to measure ovarian reserve. They use a common 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 lower your egg count.

While egg count varies widely from woman to woman, declining egg quality is a foregone conclusion and well documented in women as they age.

Egg Quality:

There’s no way to test egg quality besides actually fertilizing the egg. We can’t run bloodwork or do a sonogram to determine if you have genetically normal eggs. We do know that the older you are, the higher your percentage of genetically abnormal eggs. Egg quality actually refers to the proportion of eggs we can expect to be genetically normal. Even women in their 20s have some genetically abnormal eggs, but when women reach their 40s, the ratio of normal to abnormal eggs flip-flops. At 40, less than half of a woman’s eggs will be normal.

Percentage of Genetically Abnormal Embryos by Age

Egg quality - percentage of genetically abnormal embryos by age

What does this mean for natural conception? Fertility is directly connected to egg quality. If the ovulated egg is not genetically normal, it will likely fail to fertilize, fail to implant, or result in a miscarriage.  Because it’s much more likely that the one egg released each month will be abnormal, natural fertility declines with age resulting in an inability to conceive (aka infertility), miscarriage, and a higher likelihood of genetic disorders in the embryos of women over 35.

Since time is not your friend when it comes to fertility, it’s important to seek help from a reproductive endocrinologist if you’ve been trying to conceive for 6 months without success.  While many women think fertility treatment is the cure-all for age-related infertility, the truth is that fertility treatment is less successful with age. And as you get older, your odds of success with less aggressive treatment options like IUI also decline, so it’s important not to delay setting up an appointment for a fertility consultation with a reliable clinic.

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

Although there’s nothing you can do to prevent the regular loss of eggs as you age, you can improve your chances of getting pregnant by improving egg quality, reducing inflammation and stress, and improving your general health and wellness. CNY Fertility recommends the following methods for boosting female fertility:

  • Take supplements to improve egg quality, reduce inflammation, and improve implantation. Key nutrients include co-q10/ubiquinol, DHEA (avoid if you have PCOS), inositol, Vitamin D and more. CBD can be helpful in improving blood flow to the uterus and ovaries and as an anti-inflammatory.
  • Eat a high fat, low carb diet such as Kiltz’s Keto Diet to reduce inflammation and improve hormone function.
  • Consider additional surgical treatments that can improve the uterine lining and boost odds of conception and implantation: laparoscopy, hysteroscopy, LIT, ERA, and PRP-Therapy.
  • Limit high intensity exercise which can cause heat and inflammation and take away blood flow from your core. Instead focus on yoga, Tai Chi, light weights and stretching, or walking with a friend.
  • Certain prescription medications can further reduce inflammation beyond what changes to your diet and lifestyle can accomplish. If you’ve been diagnosed with PCOS or endometriosis, there are several drugs that are helpful in balancing hormones. If you have an overactive immune system, LDN, IVIG, and Tacrolimus can help dial it back. Infertility can be a result of other pre-existing conditions that can be treated to improve your chances of conception.
  • Egg Freezing. If you’re still in your 30s and just looking ahead, egg freezing is another option to consider.  Freezing eggs effectively ‘stops the clock’ on the eggs you’ve frozen even though egg quantity and quality continue to decline as you age. By freezing your eggs in your 30s and using them in your 40s, your chances of having a child are all based on the age of the eggs you’re using, not your biological age at the time you use them.

After 6 months of trying (if age >35), if you are unable to get pregnant, it’s time to check in with a reputable reproductive endocrinologist for some basic fertility testing. Most likely, he or she will recommend some form of fertility treatment that can range from very basic to advanced reproductive assistance. The older the patient, the more likely your fertility doctor is to skip over less aggressive fertility treatments like timed intercourse and progress to treatments like IVF that have higher success rates since time is of the essence.

Getting Pregnant After 40 with Fertility Treatment

Getting pregnant after 40 may take some time, and it can require a little assistance. What might that include?  Anything from medication to help you ovulate to drugs that help you produce extra eggs and injectables that tell your body it’s time to release those eggs. It can even mean using an egg donor if egg quality is an issue. For every patient, the continuum of care looks a little different based on their individual health and unique situation. A good fertility doctor will review results from your fertility testing and your and your partner’s (if you have one) medical history to assess what treatments you’ll be a good candidate for and which ones aren’t worth wasting precious time. IUI is generally a good starting point for most women without tubal disease or endometriosis using donor sperm or whose male partners do not have severe male factor infertility, however, it is not usually recommended for women over 40.

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.

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 After 40 & 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 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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