Dr. Allison Giles discusses fertility rates, risks to mother and baby, and other considerations for women trying to conceive over age 40
Over the past century, the average age at which women have their first child has increased for many reasons. Many women are making personal decisions to hold off from getting pregnant based on career aspirations, financial concerns, and a general desire to wait to have children. This change in societal standards poses newer questions for a growing number of women:
- Is 40 too old to have a baby?
- How common is pregnancy at 40?
- Should I even try?
- Are my risks different from the risks younger women face?
- Will my baby be disabled?
- Is it advisable?
These questions are understandable, and we hear them often. They can be overwhelming, and we can empathize with what’s going through your head as you ponder starting or growing your family later in life. Let’s break each question down one at a time.
Is 40 too old to have a baby?
We live in a different world than our mothers and grandmothers. Many women today make the decision to focus on their careers, travel and get to a better place financially before they settle down and have children. In fact, according to a survey put together by online personal finance company SoFi and reproductive health company Modern Fertility, 60% of survey respondents said they’re waiting to have kids because of money, and 51% said they wanted to get to a higher salary bracket before growing a family becomes a consideration.
In terms of safety, technological advancements in health care related to fertility and pregnancy have made it increasingly possible to have a baby into your 40s. In the next question, we discuss fertility and give you a better understanding of the possibility of getting pregnant after 40.
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.
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.
Is it advisable?
This is a very personal question, and there’s no definitive answer. For many women, the first opportunity to have children comes about in her 40’s. For others, this is a time when decisions about expanding the family are made. Achieving a healthy pregnancy and birth over 40 requires a preconception visit with your OB/GYN. Here, you and your doctor can discuss your specific risks based on your own health and family history. At this time, you and your doctor can also sit down and develop a strategy for obtaining the best outcome in the healthiest possible way. Often, this will include the option of early genetic testing, meeting with a high-risk pregnancy specialist if appropriate, and more frequent visits with your OB/GYN.
While the journey may hold more challenges and difficult decisions, it is possible for women to conceive and maintain pregnancy over the age of 40. Making this decision can be an exciting, yet overwhelming time in your life. Should you choose to try to have your first child or grow your family after the age of 40, we’ll be here every step of the way.
For more information on how we can help you prepare for pregnancy after 40, visit our preconception visits page. If you’re ready to start the process, call us at 804-897-2100 to schedule an appointment for preconception counseling with one of our OB/GYNs. You can also set your appointment online. We look forward to hearing from you.