Pregnant at 40: What Do Women Need to Know?

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By Professor Geeta Nargund, Medical Director of CREATE Fertility and abc ivf

Today an increasing number of women are choosing to delay starting a family, opting to wait until the time is right for them. Indeed, the latest ONS data revealed that since the mid-1970s, the standardised mean age of a mother in England and Wales has been rising, and reached an all-time high in 2021 of 30.9 years.

There are a variety of reasons why this might be the case: from women choosing to pursue their careers and education before choosing to have children; the cost-of-living crisis increasing the financial cost of raising a child; to advancing science and medical technology behind assisted reproduction which can improve women’s chances to have children later in life. However, it is important that women fully understand the impact of age on fertility, so they are empowered to make informed choices about when they start a family.

The facts and figures

Whilst there are some examples of women who get pregnant naturally in their 40s, this is very rare, and it’s important to understand that fertility does decline with age. As women become older, the number of follicles (eggs) will naturally decrease, causing fertility to decline from the age of 35. A 40-year-old woman has around 10, 000 eggs, and while this might seem like a significant number, it is only 3% of the original 300, 000 present at the beginning of a woman’s puberty. Additionally, over time a woman’s follicles will experience a breakdown of DNA repair mechanisms, increasing the risk of unsuccessful fertilisation, miscarriage, and birth defects.

However, it is understandable that seeing and reading headlines announcing the next celebrity to be having children after the age of 40, can lead to the belief that conceiving at an older maternal age is easy. But, in reality, the chances of becoming pregnant naturally over the age of 40 are less than 5%. So, what are the options for older women, who do want to try and start a family a little later in life?

Improving your fertility health

For women of any age, when looking to get pregnant, it is important you are having unprotected sex at the correct time in your menstrual cycle. In addition to this, certain lifestyle factors that promote a healthy lifestyle such as eating a good diet, regular exercise, reducing stress, stopping smoking, and the consumption of alcohol can all help achieve conception.

While all of these changes can help to improve your overall fertility health, if women over the age of 40 are struggling to conceive and have not become pregnant in six months, they should seek advice from a medical professional. It is likely they may need further help in becoming pregnant, via assisted reproductive technologies.

Fertility treatments

For women who are struggling to conceive naturally over the age of 40, there are advanced assisted reproductive technologies such as IVF that can provide an improved chance of becoming pregnant. However, it must be noted that conventional IVF uses lots of stimulating drugs that will not help women of an older age, as they naturally have a lower supply of eggs.

Instead, Mild and Natural IVF can be the best route for success as this option works with a woman’s natural cycle and purely focuses on those eggs that need gentle help to mature and has been found to improve success rates for women over 40.

However, IVF is not a silver bullet solution, and while it can improve a woman’s chances of conceiving, success for those in their mid to late 40s is lower due to the fact that the quality and quantity of their eggs are reduced. Using donor eggs – or their own eggs which they had frozen when they were younger – can help improve chances to some extent.

Before trying to conceive, women should also understand the increased risk of pregnancy complications when having a baby at an older age. It is therefore important for women to seek medical advice on their unique situation, to understand what risks they personally need to be aware of, before trying to conceive.

For women and couples who are waiting until later in life to have children or just haven’t found the right partner, understanding the impact on their fertility health is key. Empowering women and young people with the knowledge of how to look after their natural fertility is vital in allowing them to make informed decisions about their future. It is advisable for women to get their fertility tested while they are younger, to find out the status of their egg reserves and understand the best options for them. Whilst women should not feel pressured to become mothers before they are ready, they should know the options on the table when it comes to fertility testing, IVF and egg freezing. This way, women can make the decision that is best for them.