Pregnancy after 40

Pregnancy after 40

‘Age is just a number’ – good to hear and quite soothing & satisfying to the souls, particularly for the ones under the age bracket of 30 and above. Subsequently, age does hold an intriguing impact on one’s life, mind and body; and age is gender neutral. It marks its territory on all without bias, whether men or women. So planning pregnancy after 40 does need you to be considerate to make the decision.

As women age, their fertility rates, concerning the number and quality of eggs, decline due to several factors. The risk of infertility increases significantly for women over 35, and after 40, the pregnancy rates naturally drop to less than 5% per month. However, with the advancement of medical technology, fertility treatments have become more accessible to women of all ages, reciprocating the age to be merely a number.

Herein, we shall discuss fertility treatment options and the age factor’s relevance to having a child after 40.

The truth behind the decline in fertility rate after 35 and 40 years of age

Women bear a finite number of eggs, which decreases over time. With age 35+, the number and quality of oocytes gradually decline, reducing fertility rates due to the upsurge of the predominance of spontaneous abortions and genetic anomalies. Besides, even men may experience a significant increase in DNA damage in their sperm. Their semen parameters also fall by degrees with age resulting in a decline in motility and viability. Thus, by the age of 40, fertility rates are significantly reduced.

As more women delay childbearing for various reasons, such as career or financial stability and sometimes medical inability, the demand for fertility treatments in older women has increased. Therefore, understanding the benefits and risks of late pregnancy is essential to make informed decisions about starting a family later in life.

Fertility Treatment Options at Advanced Age

Assisted reproductive technology (ART) ART refers to various medical procedures that help individuals or couples struggling with infertility to conceive. ART treatments include:

  • In-vitro fertilization (IVF) involves retrieving eggs from the ovaries, fertilizing them with sperm in a lab and implanting the fertilized embryos in the uterus.
  • Intracytoplasmic sperm injection (ICSI) involves the injection of a single sperm into an egg.
  • Egg donation involves using a donor egg from a younger woman to fertilize it in a lab and implant it in the uterus. It has also rescued several women struggling with infertility due to conditions such as polycystic ovary syndrome (PCOS).

Pregnancy with IVF/ICSI

The IVF procedure entails the female being on medications to stimulate ovaries to produce more eggs surgically harvested and combined with sperm in a laboratory; then, the embryo is implanted back into the woman’s uterus. IVF successfully addresses the challenges regarding blocked fallopian tubes, reduced number of eggs or premature ovarian failure with age in women and reduced sperm count in men, and other various issues that impact the capability of fertilization of eggs.

It is the most popular and prudent option for women over 40, as the IVF procedure, besides embryo biopsy, ensures that only viable healthy embryos free of chromosomal issues are implanted in the uterus, posing little to no risk of giving birth to children with genetic abnormalities.

Success Rates of ART at Advanced Age

Factors affecting success rates of ART in older women Factors such as age, underlying medical conditions, the quality of eggs, sperm and embryo, the endometrial development and luteal phase post-transfer can affect the success rates of ART in older women.

According to the Centers for Disease Control and Prevention (CDC), the success rates of IVF decline with age, from 41% in women under 35 to 5% in women over 43. However, with the use of donor eggs, the success rates increase to 56%.

Success rates may vary depending on individual & lifestyle factors. However, a few advanced medical techniques are revolutionizing the medical sector with regard to ART. In addition to, ICSI, like assisted hatching, pooling of embryos, Blastocyst transfer, Pregenetic testing, and Intraovarian PRP, have been successfully adopted clinically. However, the one gaining the most traction is freezing the embryos to increase the success rate considerably.

Freezing eggs at a young age to have a healthy baby with the frozen eggs and experience and enjoy motherhood has been increasingly trending. It is an option for women who want to delay pregnancy while preserving fertility. The procedure involves stimulating the ovaries to produce numerous eggs harvested and frozen for later use. It allows women to delay pregnancy until they are emotionally, financially, and personally ready.

Even though there are several risks and complications associated with becoming pregnant after age 40, medical advancements designed to manage these risks have made it possible for a woman to have a safe and healthy pregnancy.

Benefits of Late Pregnancy

  1. Emotional Maturity Women who decide to have children later in life often have the advantage of emotional maturity. They may have had more time to establish their careers, relationships, and personal goals, giving them a sense of stability and confidence. This emotional maturity can make them better prepared to handle the responsibilities of parenthood.
  2. Financial Stability Women considering late pregnancy may have more time to save money and establish their careers, making them better equipped to support a child financially. Additionally, they may have had more time to pay off debts, such as student loans, which can free up more money for child-rearing expenses.
  3. Sense of Fulfillment Having a child later in life can provide a sense of fulfilment for women waiting for the right time to start a family. It can be a joyous and rewarding experience to see their children grow and develop, knowing they have had the time and resources to provide for them.

Risks of Late Pregnancy

  1. Increased Risk of Complications One of the significant risks associated with late pregnancy is an increased risk of complications during pregnancy and childbirth. As women age, their bodies become less resilient and may be more susceptible to conditions such as gestational diabetes, hypertension, and preeclampsia. The risk of miscarriage and stillbirth also increases with age.
  2. Chromosomal Abnormalities Another significant risk of late pregnancy is the increased risk of chromosomal abnormalities in the developing fetus. As women age, their eggs are more likely to have genetic mutations or chromosomal abnormalities that can cause conditions such as Down syndrome. This risk increases significantly after the age of 35.
  3. Increased Risk of Cesarean Delivery Women who have children later in life also has an increased risk of having a cesarean delivery. As women age, their uterine muscles become less toned, making delivering a baby naturally arduous. Additionally, women who have had multiple pregnancies may have scarring or other issues that make it more challenging to deliver a baby vaginally.

When deciding on late pregnancy, it is essential to consider all the benefits and risks. Women should discuss their individual health and fertility with a healthcare provider to understand their chances of a successful pregnancy and to discuss any potential complications. Women should also consider their personal goals and lifestyle factors when making a decision about late pregnancy. With careful consideration and the guidance of a healthcare provider, women can make informed decisions for themselves and their families.

Dr. Ila Gupta

Director & Senior Consultant in Reproductive Medicine at Ferticity Fertility & IVF Hospital in Delhi. She has more than 28 years of experience in Reproductive Medicine. She is special interested in treating patients with Repeated failed cycles of IVF and Cases with Recurrent Abortions and has treated them with successful pregnancies.

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