Getting Pregnant After 40: Difficulty, Risks, and How to Conceive

by Nov 25, 2020

Most of us have heard about our so-called “biological clocks.” For those of you ages 40 and older, perhaps you have already felt yours ticking away… especially when your parents make pointed comments about when you are going to give them a grandchild already.

woman keeps a gift

But despite pressure from family and friends to have children while we are young, it is still possible to have a healthy pregnancy in your 40s. In fact, more and more women are waiting to have children until they are older, so they can move up the career ladder, travel the world, or achieve other goals before starting a family.

There is no right or wrong time to have a baby – all that matters is what is right or wrong for you and your partner. No matter if you are younger and still in the planning phase, or in your 40s and trying to conceive, here is what you need to know about pursuing pregnancy after age 40.

What are your chances of getting pregnant after 40?

Getting pregnant in your 40s is absolutely possible — in fact, births to mothers ages 40 and older are on the rise, according to data from the Centers for Disease Control and Prevention (CDC). But just how likely are you to get pregnant after age 40?

It isn’t always easy to get pregnant at any age: even in their 20s, women only have a 25% chance of conceiving each month. But after age 40, getting pregnant becomes significantly harder, as your chances of conception decrease to less than 5% each month.

The older a woman gets, the fewer eggs she has and the worse quality her eggs become. Our chances of miscarriage also increase as we age. In a woman over age 40, the odds of miscarriage are between 40 and 50% for each pregnancy.

However, thanks to technological advances, getting pregnant in your 40s is easier than ever. Assisted reproductive technologies (ARTs) such as in-vitro fertilization (IVF) can significantly improve your odds of getting pregnant in your 40s. The following graph summarizes pregnancy and birth rates among women ages 40-44+ using ART:

ART data

Source: CDC; Advanced Fertility Center of Chicago

Understanding Your Fertility at 40

As a woman, your chances of conceiving — especially naturally — decrease as you age. Your chances of getting pregnant each month are 25% in your 20s. Research shows that fertility begins to decline after age 32 and that the decline rapidly increases after age 37. By age 40, your chances of getting pregnant each month are less than 5%.

Doctors estimate that about half of women in their 40s who try to conceive naturally will do so successfully. Using IVF, however, as many as 22% of women over 40 are able to conceive. Women who undergo IVF using donor eggs may have even higher success rates. Even so, the risk of miscarriage and stillbirth is higher in women over 40. There is also a higher risk of pregnancy complications in the mother and birth defects in the child.

Egg Quantity

One of the biggest reasons why getting pregnant becomes harder after 40 is decreased egg quantity. During puberty, the average woman has 300,000 to 500,000 eggs. By age 37, most women only have around 25,000 eggs — and by age 51, most women have fewer than 1,000. Unfortunately, because not all of these eggs will be healthy enough to support a pregnancy, the “true” number of viable eggs is much lower than that.

Egg Quality

All women, no matter their age, have some eggs that are genetically abnormal. Sometimes, this means that they will be unable to produce a viable pregnancy. Other times, this means that although the egg is fertilized, the baby will experience genetic health problems, such as Down syndrome. When you’re younger, some of her eggs will have genetic abnormalities, but most of them will be normal. However, by age 40, this ratio flip-flops, leaving women with more genetically abnormal eggs than normal ones. Experts estimate that after age 40, less than half of a woman’s eggs are considered “normal.”

Fertility and Sterility

Source: Fertility and Sterility, 2014

Because the quality of younger women’s eggs is better, using a donor egg from a younger woman to get pregnant using ART may improve a woman over 40’s odds of conceiving successfully, without genetic abnormalities in the infant. Even so, many women prefer not to use an egg donor when getting pregnant.

Benefits of Getting Pregnant After 40

Even though the odds of getting pregnant are lower after age 40, many women are still choosing to wait until they are in their 40s to pursue pregnancy. While getting pregnant may be more difficult at that age, there are also many benefits to waiting to conceive.

Financial Stability

While they may be at their most fertile, many women are not ready to get pregnant in their 20s. At this point, many women have not established their careers and do not have much money in savings. They may not be able to afford to buy a house, or even a car, let alone go to OB/GYN appointments and purchase supplies to support a baby. Even in your 30s, you may not have the same level of financial stability as a woman in her 40s.

By their 40s, most women have established a stable career, have purchased assets like a house and a car, and have saved a reasonable amount of money, allowing them to give their child a better life.

Better Healthcare

More and more women in their 20s are not being offered health benefits through their jobs. Some companies do not purchase health insurance for employees at all, while others require employees to work at the same company for a number of years before they become eligible for benefits.

Young women without health benefits may need to choose public healthcare options that do not offer the same level of healthcare as private health insurance plans. By their 40s, most women have access to better health insurance options through their jobs or partners, including maternity benefits.

Stronger Relationship

We’re writing this in 2020 and more and more women are waiting longer to commit to marriage. Taking extra time to find your Mr. or Mrs. Right, and to make sure you are with the right person before having a baby, benefits you and your future child.

Having a stable relationship sets a positive example for your child and allows them to grow up feeling mentally healthy and well-adjusted. Most of all, waiting to get pregnant allows you to spend plenty of time with your spouse after getting married, so you can invest time into making your marriage the strongest it can be before adding the stress of a newborn baby into the mix.

Healthier Lifestyle

In their 20s, many women assume that their lifestyle choices will have little bearing on their future health and that they have plenty of time to get healthy before having a baby. As a result, they might drink more, eat lots of processed and fast food, or forgo exercise.

Unfortunately, the negative habits we build in early adulthood can take lots of time to unlearn. You might end up spending most of your 30s trying to correct the damage you did to your health and develop better routines. The good news, however, is that by your 40s, you are likely to be much more health-conscious and have established a healthy lifestyle. This means that if you’re trying to get pregnant as a 40-something, your body is much better primed to support a pregnancy than a young woman who is drinking heavily and maintaining poor dietary and exercise habits.

Risks of Getting Pregnant After 40

Financial stability, better healthcare, a stronger relationship, and a healthier lifestyle: all of these things sound wonderful, but the benefits of pursuing pregnancy after age 40 must still be weighed against the risks. For years, the recommendation was to get pregnant before age 35 to avoid the risks of pregnancy after age 40.

Thankfully, improved technology is making it easier to get pregnant in your 40s and mitigate the risks — but that does not mean that there are no potential problems associated with pregnancy after 40.

Preeclampsia

Giving birth to a baby after age 40 raises your risk of developing high blood pressure and/or preeclampsia during pregnancy, especially if it is the first time they have given birth.  Preeclampsia is a syndrome combining high blood pressure with signs of kidney and liver damage during pregnancy. Most often, these changes occur after the 20th week of pregnancy, but rarely, they can occur within 48 hours of delivery. Some women with preeclampsia go on to develop eclampsia, which is characterized by preeclampsia and seizures.

Birth Defects

There are many types of birth defects that can affect infants. Most occur when there are genetic abnormalities in the egg that becomes fertilized — which, as we mentioned earlier, are more common in the eggs of women over age 40. Birth defects may affect the heart, lungs, esophagus, genitals, and skull, among other anatomical structures and organs.

Some of the most common birth defects result from abnormalities in the chromosomes. One of the most well known is Down syndrome, which results from having three copies of chromosome 21 (as opposed to the usual number of two copies). By the age of 40, your odds of giving birth to a baby with Down syndrome are 1 in 70; by age 45, the odds increase to 1 in 19.

Miscarriage

The risk of miscarriage in a woman over age 40 is nearly 50%, more than triple that of a woman in her 20s. Most miscarriages occur because of abnormalities in the fetus, many of which are genetic. It’s estimated that half of all miscarriages are caused by extra or missing chromosomes.

These problems usually occur due to errors that occur by chance during the duplication of cells as the fetus grows, rather than genetic abnormalities inherited from a parent. Unfortunately, these errors appear to become more common as women age and egg quality declines.

Low Birth Weight

1 in 12 babies in the United States is born with low birth weight, which is defined as a birth weight of fewer than five pounds, eight ounces. The most common causes of low birth weight are premature birth (birth before 37 weeks gestation) and fetal growth restriction. Fetal growth restriction occurs when a baby does not gain as much weight as they should throughout gestation. Because there are health risks associated with low birth weight, babies with low birth weights may need medical treatment, including time spent in the neonatal intensive care unit (NICU). You are at a significantly higher risk of giving birth to a baby with a low birth weight if you are age 40 or older.

Ectopic Pregnancy

Ectopic pregnancy is a pregnancy that implants outside the uterus. Most often, ectopic pregnancies implant in the fallopian tubes. The egg is fertilized while it is still traveling down the fallopian tubes. If it does not move down the fallopian tube and into the uterus as it is supposed to, the pregnancy may implant in the fallopian tube instead.

Because the embryo does not have room to grow in the fallopian tube, an ectopic pregnancy is not viable and must be removed via surgery. Ectopic pregnancy can cause severe, stabbing abdominal pain and abnormal uterine bleeding. Sometimes, it may even threaten the mother’s life, especially if the fallopian tube ruptures. Women over 40 are at the highest risk of having an ectopic pregnancy when compared to women in other demographics.

Gestational Diabetes

Gestational diabetes is new-onset diabetes occurring during pregnancy. Compared with women ages 20 to 29, women in their 40s are three to six times more likely to develop gestational diabetes.

Women with gestational diabetes have high blood sugar. Usually, their blood sugar goes back to normal after delivery but having gestational diabetes does increase the likelihood of developing type II diabetes later in life, which is a risk factor for heart disease, kidney disease, and many more conditions. If left untreated, gestational diabetes can lead to complications in the infant, including stillbirth.

Advice for Getting Pregnant After 40

If you are looking to conceive after 40 there are several things you can do to increase your chances of conceiving naturally:

  • Consult your doctor before trying to conceive for health screening and genetic testing
  • Use an advanced fertility tracker like Mira to measure hormone concentrations
  • Time intercourse with your fertile window and ovulation
  • Stop smoking, drinking alcohol, and using drugs
  • Maintain a healthy lifestyle, including diet and exercise routines

If you do become pregnant, it will most likely be a completely different experience than if you were younger. Your pregnancy may be more difficult after age 40. You may experience more complications, ranging from minor aches and fatigue to more serious problems like preeclampsia and gestational diabetes.

Stay in touch with your doctor and follow their advice for the healthiest pregnancy possible. You should also work with your OB/GYN to create a plan for delivery. Vaginal delivery may not always be possible after age 40, meaning you may need to schedule a C-section.

When to Seek Help Getting Pregnant After 40

Women over 35 should see a fertility doctor if they have been unsuccessful in conceiving after six months of trying naturally. Some options for fertility treatment after age 40 include:

  • Fertility drugs like Clomid, which are used to stimulate follicle development and ovulation
  • In-vitro fertilization (IVF), which can be used in combination with medications
  • IVF with donated eggs from a younger woman
✔️ Medically Reviewed by Banafsheh Kashani, MD, FACOG

Banafsheh Kashani, MD, FACOGBanafsheh Kashani, M.D., FACOG is a board-certified OB/GYN and specialist in reproductive endocrinology and infertility at Eden Fertility Centers, and has been treating couples and individuals with infertility since 2014. Prior to joining Eden Centers for Advanced Fertility, she was practicing as a top fertility specialist at Kaiser Permanente in Orange County and Reproductive Fertility Center. Dr. Kashani has received numerous awards throughout her years of study and medical training. 

Dr. Kashani has conducted extensive research in female reproduction, with a specific focus on the endometrium and implantation. Additionally, Dr. Kashani has authored papers in the areas of fertility preservation, and fertility in women with PCOS and Turners syndrome. She also was part of a large SART-CORS study evaluating the trend in frozen embryo transfers and success rates.

Dr. Kashani is a fellow of the American Congress of Obstetricians and Gynecologists. In addition, she is a diplomat of the American Board of Obstetrics and Gynecology and an active member of the American Society of Reproductive Medicine (ASRM) and Pacific Coast Reproductive Society (PCRS). She is also a member of the Society of Reproductive Endocrinology and Infertility (SREI).

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