I remember way back 20 years or so ago, walking through the Port Authority bus station in New York City seeing the cover of a magazine hanging up at a newsstand with the headline “Ma Ma Madonna.” The big news of the day was that superstar Madonna had given birth—after age 40.
Nowadays, it seems like everyone’s doing it. Janet Jackson, Alyssa Milano, Julianne Moore, and Maya Rudolph are just a few celebrity women who have given birth after the age of 40. And why not? Today, many women are more career focused in their 20s and 30s. Some don’t find the right partner until after 40. Some decide to go ahead without any partner at all.
Whatever the reason, pregnancy in the over 40s is the largest-growing group of women having babies. While women in their 20s and 30s show a decline in birth rates, women over 40 are coming in strong showing a stark increase. But it may be harder to conceive in your 40s, so if you’re over 40 and you’ve been trying for a while, you may want to consult with your doctor—pronto! You know how they say “time equals money?” Well in this case time equals whether or not you may be able to get pregnant. It’s no secret that fertility declines as women age. But why?
Diminished Ovarian Reserve
When a female is born, she is born with all the eggs she’ll ever have. (That’s why a grandmother’s lifestyle may affect her as yet unborn grandchild.) By the time she’s 40, that woman is starting to run a little low on her egg supply. Physicians call this diminished ovarian reserve, or DOR. DOR is the most common cause of infertility in women over the age of 40. Despite age-related decline in ovarian reserve, some women over age 40 can still conceive without the help of a fertility doctor.
Yet, many other women over 40 have difficulty conceiving.
If you are one of these women, your doctor will do blood tests that measure follicle stimulating hormone (FSH), estradiol, and anti-Müllerian hormone (AMH). If you are suspected to have DOR, depending on how your numbers look, you may benefit from assistive reproductive technology (ART), like in vitro fertilization (IVF).
What are the ‘numbers’ my doctor is talking about?
Most likely, your doctor is referring to measurements of the amounts of FSH and AMH your body is making. Because your ovaries are producing fewer eggs, the amount of FSH (which stimulates egg production) will be elevated compared to someone in their 20s. For the same reason, AMH (which is secreted by the eggs) will be lower than someone in their 20s. Having a high FSH or a low AMH is not diagnostic of having diminished ovarian reserve, but it indicates that may be the case. Nor does a high FSH or low AMH mean that you will not get pregnant, either with your partner or with IVF.
What about an egg donor?
Women over age 45 who are trying to get pregnant will likely require an egg donor. An egg donor is a woman in her 20s or early 30s that receives medication to stimulate follicle (egg) production in her ovaries. You, as the recipient, will also receive injections to stimulate growth of the lining of your uterus to make for a healthy pregnancy environment. The eggs from the donor are retrieved and then fertilized using your partner’s or donor sperm, then implanted in your uterus in a process that resembles IVF.
Unfortunately, pregnancy after age 40 comes with some risks. First, a woman over age 40 is more likely to have some health problems that should be taken care of before she becomes pregnant. Because pregnancy places a burden on all of your organ systems, some health problems can get worse (though some, like rheumatoid arthritis, tend to get a little better during pregnancy). Second, the risks of developing high blood pressure or diabetes are higher as is the progression to preeclampsia—a life-threatening complication of pregnancy. Additionally, pregnant women over age 40 are more at risk for heart attack or stroke.
Women who are pregnant over 40 are more likely to miscarry, more likely to give birth to a low-birthweight or premature baby, and more likely to have a baby with a chromosomal abnormality like Down Syndrome.
For these reasons, a pregnant woman over 40 will likely be followed by an obstetrician who specializes in high-risk pregnancies. And you will be offered tests like a chorionic villus sampling or amniocentesis to check for chromosomal abnormalities.
Things to keep in mind if you’re trying to get pregnant after age 40
- You may need to use assisted reproductive technology (ART), like IVF.
- IVF has a higher success rate than IUI (intrauterine insemination) after age 40.
- If you live in a state that mandates insurance pay for infertility treatments, that payment may be capped at age 40.
- You may have to use a donor egg to get pregnant (especially if you’re over 45).
- Your risk for pregnancy complications is increased.
What’s the good news?
Although birthrates are declining for women in their 20s, birth rates for women over age 40 are on the rise. One thing to remember: every woman is unique. Some women over 40 will have no problem whatsoever getting pregnant. Others may go through round after round of IVF with no success. One woman I spoke to went through multiple rounds of IVF, ran out of money, tried IUI because it was less than 1/10 the cost and had a successful pregnancy.
Whether you find success without medical intervention, with IUI or IVF, by using a donor egg, or (if you were forward-thinking enough in your 20s or early 30s) by using your own cryogenically preserved eggs, having a healthy pregnancy after age 40 is definitely possible, especially with proper medical management.