07.11.2014

Age and fertility getting pregnant in your 40s

Perhaps you've put off pregnancy to concentrate on your career, or because it’s taken you a while to find the right partner (Bewley et al 2009, Utting and Bewley 2011). Chromosomal abnormalities in your eggs can raise the risk of miscarriage and birth defects.
There's never been a better time to try to get pregnant as an older mum, given the range of fertility treatments available. In your early forties you have about a one in five to one in 10 chance of a live birth per treatment cycle (HFEA 2011, NCCWCH 2013). You may wish to explore the idea of using donor eggs or frozen embryos to try to conceive, as it will increase your chances of having a baby (Klipstein et al 2005, Serour et al 2010, Utting and Bewley 2011). The risk of miscarriage and chromosomal problems is consistent with the age of your egg donor, who will be in her 20s or 30s. Probably the greatest advantage of waiting to have children in your 40s is that you are emotionally and financially ready for them.
If you've been with your partner for a while you will have had the chance to get to know each other in all sorts of circumstances.
Your income is likely to be higher, as you will have had time to establish yourself in your career. By the time you reach your 40s, you may have a sense that you've been there, done that. As you approach the menopause, your hormones work harder to release an egg from your ovaries. If you have assisted conception, the follicle-stimulating hormones you'll be given also increase your chances of conceiving more than one baby (Utting and Bewley 2011).
If you do conceive, you are more likely to need extra care during your pregnancy (Franz and Husslein 2010, Montan 2007, Utting and Bewley 2011).
All women are offered screening tests in pregnancy for genetic conditions, such as Down's syndrome.
Age aside, there are steps you can take to give yourself the best chance for a normal pregnancy and a healthy baby.


If you are in your 40s, and have been having unprotected sex two to three times a week for three months, without getting pregnant, see your GP. Discover how to get a fertility test, find out the best time to have baby-making sex, or talk to others who are hoping to conceive in the Actively trying group of our friendly community. Join now to receive free weekly newsletters tracking your baby’s development and yours throughout your pregnancy. Many 40-plus women do conceive, although there's no denying that your odds of getting pregnant are a lot lower than just a few years ago.
At 40, your chance of conceiving is about 20 per cent (based on the average annual rate of pregnancy per cycle), falling to less than five per cent by the mid-40s (NCCWCH 2013:65). As early as 15 years before you go through menopause, the number of your eggs begins to decline.
This is why both these complications are more common in older women (Nybo Anderson et al 2000, ONS 2010, RCOG 2008). From age 43 onwards, success rates fall to around one to five live births for every 100 women (HFEA 2011, Klipstein et al 2005, Serour et al 2010, Utting and Bewley 2011). Your life experience means you'll feel pretty confident about your approach to child-rearing (Hansen and Joshi 2008).
You'll probably go back to work more quickly, and at a higher level of pay than younger women. It's estimated to cost about ?13,000 a year to care for a child between the ages of one and four (Liverpool Victoria 2010). You'll be less concerned with your own needs, and will be happy instead to focus on your child.
From your mid-40s, if you conceive naturally, you have a one in two chance of having twins (NHS Choices 2010a, Utting and Bewley 2011).
This often results in two eggs being released at the time of ovulation (Beemsterboer et al 2006, Utting and Bewley 2011). Your age will be factored in to the result to give you a risk of your baby having a problem.


But keep in mind that there are plenty of women in their 40s who have trouble-free pregnancies and perfectly healthy babies. Most specialists start with blood tests and investigations to check your fallopian tubes or your partner's sperm. By your 40s, the eggs that your ovaries release each month are more likely to have structural problems (chromosomal abnormalities). From 43 to 44 onwards, your chances of success using your own eggs really are minimal, because conception rates per cycle of IVF are so low. The two eggs can be fertilised and implant in your uterus, resulting in non-identical twins.
But what it means is you'll get the care you need to ensure you and your unborn baby stay as well as possible.
This compares with one in 700 babies born with mums aged 35 to 39, and one in 1,500 babies born to mums aged 20 to 24 (ONS 2010). This disheartening figure rises to three quarters for women aged 45 years or more (Nybo Anderson et al 2000, RCOG 2008, 2011). And staying fit, keeping a healthy weight and cutting back on alcohol are all advisable (Utting and Bewley 2011).
The paradox of declining fertility but increasing twinning rates with advancing maternal age.
One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above. A statistical review of notifications of congenital anomalies received as part of the England and Wales National Congenital Anomaly System, 2008.



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