It seems that through choice or necessity, more women than ever are having children in their 40s. Fortunately, the science and technology behind assisted reproduction is moving forward all the time and there has never been a better chance of getting pregnant over 40 than in the present day. But what are your chances of getting pregnant and how can you maximise them?
The number of women having babies after the age of 40 has increased fourfold in the last 30 years, with 1 in 25 babies now born to mothers aged 40+. The reasons for this change are manifold, including increasing numbers of women attending university and pursuing careers, the rising cost of raising a family, and relationship instability. Advances in contraceptive and reproductive technology have given women greater control in planning their family, which means that for many women, delaying motherhood is an active and empowered choice. There may also be a ‘celebrity effect’, as women see and read about celebrities having children after 40, apparently effortlessly. However, a woman’s fertility does decrease dramatically after 40 and it is important to know the facts about conception at 40 and above.
The decline in fertility begins around the age of 32 and becomes more rapid at 35 until by age 40, fertility has fallen by half. While at 30 there is a 20% chance of falling pregnant per cycle, this has fallen to 5% by age 40 and 1% at age 45. This decline is down to a decrease in both the quantity and quality of eggs. Women are born with a finite number of follicles, and the number of these decreases throughout the fertile lifespan. At birth there are 1-2 million eggs; this has declined to 300,000 by the onset of puberty and this supply dwindles further every month with ovulation. At 40 there are around 10,000 eggs; 3% of the original supply. A woman’s ovary is like a warehouse, it contains a set amount of eggs which are used up over time. The remaining follicles also accumulate mutations over time, which is believed to be due to a breakdown of DNA repair mechanisms; this means that the rate of failed fertilisation, miscarriage and birth defect increase over time.
The good news is that there are various things that women over 40 can do to increase their chances of getting pregnant. There are some lifestyle changes that can be made which will help with conception. The first step is to make the body receptive to pregnancy. This can be achieved by maintaining a healthy lifestyle including a good diet (plenty of protein, fruit & veg and calcium), lots of exercise, giving up smoking and reducing alcohol and caffeine intake. Among other things, this will help to keep a normal BMI (ideally less than 25) which is important for conceiving. Professor Campbell, Consultant and Director of Ultrasound at CREATE suggests that: ‘maintaining a healthy BMI and giving up smoking are the two most important lifestyle changes that you can make to optimise your fertility potential’. You may like to take a folic acid supplement one month prior to attempting conception, as this reduces the chance of any resulting baby having Spina Bifida. Also important is to reduce stress levels as much as possible, as stress hormones can interact negatively with reproductive hormones.
If, with all of these healthy lifestyle changes in place, you have not fallen pregnant after 6 months of regular unprotected sex, it is important to get yourself and your partner checked out for any possible medical problems, as the faster the problem is detected, the better the outcome of any treatment. One test that we offer at CREATE Fertility is the one-stop fertility MOT. This is a comprehensive fertility analysis which uses advanced ultrasound to assess ovarian reserve, the blood flow to the follicles, ovaries and womb lining and whether there are any structural reasons why fertilisation/implantation cannot take place. We also offer general fertility advice about how to optimise your fertility. Also available at the clinic is the AMH blood test. AMH stands for Anti-Müllerian Hormone, which is a hormone given off by antral follicles in the ovaries. Measuring the level of this hormone will give an accurate picture of how many eggs are left in the ovaries.
For many women over the age of 40, their best chance of getting pregnant is with assisted reproductive technologies. If this is the case for you, then there are a range of different IVF treatments available to meet your circumstances and preferences. At CREATE Fertility we specialise in Natural and Mild IVF. In particular, our Natural and Modified Natural treatments are very successful in patients over the age of 40 who want to have a baby with their own eggs. According to Professor Campbell: ‘Natural IVF protocols are by far the best choice of treatment for patients over the age of 40’. Natural IVF relies on the principle of using the body’s natural selection mechanisms to obtain the highest quality egg. This is particularly important for older women, who have a lower reserve of eggs. We will track the development of the naturally selected follicle which usually contains the healthiest egg, and may gently encourage its growth before collection. Using a lot of stimulating drugs in this age group tends to be counterproductive, as there is not usually a very large supply of eggs to recruit from, and many will not be viable for fertilisation. Selecting the highest quality egg and using fewer drugs results in a higher chance of fertilisation of that egg, and a better environment in the womb for the embryo to implant. Using this technique we have made the record achievement of having the two oldest patients in the world who have managed to get pregnant using their own eggs, at the age of 48.
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