Dr. Shannon Brim discusses the challenges of becoming pregnant at 40 and how to increase your chances.
In the 1970s, the average age of first-time mothers in the United States was 21. By 2020, that average age had jumped to 26. Studies show this trend is mostly due to career goals and financial concerns – children aren’t cheap!
Unfortunately, evolution has not caught up with the newer preference of becoming pregnant later in life, and our bodies face some unique pregnancy challenges as we age.
Having a baby at 40 or older is not always easy even if you feel perfectly healthy and capable of carrying a baby.
As obstetricians and gynecologists, we’ve seen an increase in patients asking us questions about getting pregnant at 40.
We thought we would address a few of the most common questions and offer some tips for getting pregnant at 40 or later.
Is it possible to get pregnant naturally at 40?
YES! While fertility does decline naturally as we age, starting around age 30, it is possible to become pregnant without fertility treatments after age 40. (This is why we often recommend staying on birth control until menopause if pregnancy is undesired…if you are having periods, there is a chance you can get pregnant!)
However, women have a much lower chance of conceiving naturally after 40 than at a younger maternal age .
Fertility specialists quote approximately a 5% chance per menstrual cycle of getting pregnant naturally after age 40 vs. a 25% chance per cycle for women in their 20’s, which is when fertility typically peaks and you have the best chance of experiencing healthy pregnancies.
The reason for the decline in successful pregnancies after 40 is multifactorial, with risk of miscarriage being the biggest concern. The rate of miscarriage is about 40% after the age of 40.
This is due to many reasons, but the biggest is a higher chance of genetic abnormalities in each egg. Women’s ovarian reserve also decreases over time, meaning they have fewer eggs by age 40.
How many eggs does a woman have at 40?
When girls are born, their ovaries contain the total number of eggs they will ever have – about a million! This number declines as they age. Women lose about 30 immature eggs a DAY!
This means that by the time a woman reaches puberty her ovaries contain 300,000 eggs; by age 30 she’s down to 100,000. Estimates say that by age 40 women only have about 20,000 eggs remaining.
Ovarian reserve can be tested by a physician with a blood test called the Anti-Mullerian Hormone. AMH is a hormone produced by the follicles in a woman’s ovaries where egg cells develop, and it declines through a woman’s reproductive lifespan. The lower a woman’s AMH number, the fewer eggs remain in her ovarian reserve.
However, it’s important to remember that a woman’s AMH test results are just one piece of data that her doctor will look at when discussing her fertility health. They don’t tell anything about the quality of her remaining eggs and their chances of resulting in a successful pregnancy.
Are my eggs bad after 40?
All women have a percentage of eggs that are genetically abnormal. This means that even if those eggs are fertilized, the pregnancy will not end in a live or genetically normal baby. The percentage of normal eggs a woman has decreases as she ages.
At age 25, a woman has approximately 75% normal eggs. By age 35, that number drops to around 45%, and by 40, it’s around 20-30%. This is one reason why most physicians recommend genetic testing for conditions such as Trisomy 21 in a pregnancy over age 35.
Is Having a Baby at 40 Too Old?
Even beyond simply wondering if you’re too old to conceive, a lot of patients will ask us if we think that 40 is too old to have a baby and raise a child. We simply say, do what feels right. If you want to get pregnant at 40, we will do our best to help you reach that goal and have the healthiest pregnancy possible.
We also want you to be aware that there are more challenges involved with pregnancy at 40 and older. Dr. Allison Giles discusses some of the risks for both mother and baby in her blog post, Odds and Risks of Pregnancy After 40. We encourage you to schedule a preconception visit with your doctor to discuss your personal risk and what you can do to minimize it even before you become pregnant.
How long does it take to get pregnant at 40?
At peak fertility (in their 20’s), the chance of a fertile couple conceiving in any one month is about 20-25%. After a year of unprotected intercourse, approximately 85-90% of those couples will conceive. This is why OB/GYNs generally recommend fertility testing for couples under 35 who have not become pregnant in one year of trying.
By age 35, the chance of a successful natural pregnancy drops to 10-15% per cycle, and by 40, the chances hover around 5%. This does not mean that getting pregnant after 40 is impossible, just that it will likely take longer. That’s why the recommendation for considering fertility testing after 40 is only 6 months.
How do I improve fertility after age 40?
There are many ways to improve fertility in general, and they become especially important after age 40.
Besides naturally declining fertility, another challenge women over 40 face is that many will have been diagnosed with other conditions which can cause pregnancy complications and/or more difficulties getting pregnant. Examples are obesity, high blood pressure, diabetes, thyroid disorders, fibroids, and endometriosis.
Women with other medical conditions should make sure that their physicians know that they are trying to conceive so that they can optimize their health to prepare for the pregnancy.
This may mean changing medications, working on eating healthy, exercising, and weight loss (see Dr. Pound’s 4 Tips for Becoming Pregnant in 2022), or being more aggressive in controlling some conditions like diabetes.
A preconception counseling appointment with your regular gynecologist can help pinpoint areas for improvement and give you personalized recommendations.
It is important to take a prenatal vitamin daily when trying to conceive. They help you get the nutrients needed for healthy development of a fetus if you do become pregnant – even before you know it. Some reproductive endocrinologists also recommend supplementing with CoQ10 to help with egg quality. Learn more in Dr. Dogal’s blog post, Everything You Want to Know About Prenatal Vitamins (Whether You’re Pregnant or Not)
Here are some tips for getting pregnant at 40 or older:
Try More Frequently During Your Fertile Window
One of the simplest ways to increase your chances of getting pregnant as an older mother is to try more often during the times in your menstrual cycle when you are most fertile. Track your cycle and look for ovulation indicators to understand when your fertile window will occur if you want to increase your chances.
Eat Right
Obesity and a poor diet high intrans fats and processed foods can decrease your chances of getting pregnant. If you’re struggling to control your weight, talk to your doctor about some of the things you can do. Dr. Stephen Pound has some great tips.
Ditch Drinking and Smoking
If you’re drinking or smoking while trying to get pregnant, it’s recommended that you stop. Drinking alcohol and smokingwill hurt not only your chances of conceiving but also of having a healthy, successful pregnancy.
Is there help if I haven’t gotten pregnant after 40?
YES! Reproductive endocrinologists specialize in assisting women with fertility issues. After age 40, we recommend having a consultation with a specialist if you haven’t become pregnant within 6 months of trying.
There are many options for how to proceed depending on a woman’s age and health history, her partner’s age and health history, etc. You can go over these options together and figure out the best plan for you and your partner. We wish you the best of luck!
To schedule a preconception consultation with a VPFW provider, call us at 804-897-2100 or set an appointment online.
