On Getting Pregnant After 40
As a new mom the second time around, I walked into my postpartum OB appointment feeling relatively calm and collected. I was confident and had just a hint of “been there done that” to my step. I was lucky enough to have an uncomplicated delivery this time. And our healthy baby was hitting all their benchmarks at the pediatrician’s office. As a result, I had very few questions as we worked our way through the standard post-delivery checklist which covered everything from postpartum depression symptoms (none), to post-delivery healing (ouch), and my recent sleep habits (do new moms ever really sleep?).
As we neared the end of the appointment, I had one lingering question: how should we consider family planning if we hoped to have another baby? I had turned 35 half way through my last pregnancy. And knew I was considered to be of (gasp) “advanced maternal age,” but I wasn’t sure how that might affect future pregnancies. Would I need additional prenatal supplements? Should I seek help or interventions earlier if it took us longer to conceive next time around, or could we just wait and see? Though I shouldn’t have been surprised, my doctor’s answer still shocked me: “I’d like you to be done having babies by the time you’re 40.”
Having experienced two miscarriages in my early 30s before carrying my last two pregnancies to term, the thought of having such a short time to complete our family felt overwhelming. Short of satisfying my initial curiosity, my doctor’s answer had in fact given rise to a dozen new questions. While I still didn’t know what our plans for possible future pregnancies might be, I did know I needed more information.
Let’s Talk About Getting Pregnant After 40
To ease my mind about what felt like an impossible timeline to meet, I reached out to Brittanny Jo Keeler, DO and Board-Certified OB-GYN based in Western New York for additional clarity and perspective.
What exactly is “advanced maternal age” and why does it matter?
“Your OB is not wrong,” Dr. Keeler said, when I shared that my doctor hoped I would be done having babies by 40.
“It’s not necessarily to scare you, or dictate your life, or tell you what to do. Really, we want you to have the most information you can to make the best choices for you and your family.”
According to the American College of Obstetrics and Gynecology (ACOG), the designation I had received of “advanced maternal age (AMA)” applies to all women experiencing pregnancies that will reach full term at or after the age of 35.
After this age, pregnancy becomes much more difficult because not only do women have a decreasing number of eggs, but they also have a decreasing number of healthy eggs lacking genetic mutations. After the age of 35 the risks of miscarriage and stillbirth rise significantly, as does the risk of carrying a pregnancy with aneuploidies or other genetic abnormalities.
35 is also a statistically significant age for a woman trying to conceive, as it marks the age at which any individual is at a higher risk for hypertensive disorders, gestational diabetes, and preterm delivery. For these risks to enter into the equation, Dr. Keeler emphasized that even the healthiest individuals are at a disadvantage.
“Even if you’re completely healthy and have no medical problems whatsoever, your age is still your biggest risk factor when it comes to those [complications],” she said.
For many women in their 30s, such statistics can act as a starting point for how they think about family planning—or begin to think about family planning differently.
What is missing from the education around women’s fertility
Erin Smith is a first-time mom who gave birth at age 39. She remembers considering the daunting statistics of trying to conceive without assistance after age 35, and wondering if time was against her.
“Especially as someone who trusts and believes in science, you can’t help but hear those numbers,” Smith said. “The risk of chromosomal defects increases, the risk of never being able to get pregnant at all […] I always heard those statistics and I knew that’s real math, that’s real science, that’s real data.”
Smith, now 40, says though starting to have children later in life has changed how she envisions her future family, she also found comfort in the increased focus in the medical community on studying advanced maternal age.
In the end she feels more informed than intimidated—she knows that while the numbers pointed to the fact that getting pregnant might be more difficult, it wasn’t an impossibility.
“I also looked at those numbers and knew that that’s the law of averages, that’s statistics. It’s not everybody,” she said.
I also looked at those numbers and knew that that’s the law of averages, that’s statistics. It’s not everybody.
Beyond the considerations of maternal health and fertility, cultural trends also affect how some women consider family planning. Dr. Keeler remembers growing up in the ’90s, she often felt encouraged to focus on career first when she was younger, with the unspoken message that a family could wait. Similar messaging is often reflected in the overly optimistic timeline some of her patients have for conception. She wishes we had more education surrounding fertility and the preservation of fertility for women who may want to delay having a family. “I don’t want to say that women have been fed a lie,” she said, “But it’s a misconception that it’s going to be there when you’re ready for it, and that’s not always the case.”
In an FAQ section specifically devoted to advanced maternal age, ACOG notes that of women in their 20s and 30s 1 in 4 will get pregnant any given cycle. While for women in their 40s that number decreases to 1 in 10. And that by age 45, getting pregnant naturally is even less likely.
In the United States, the number of women falling within the advanced maternal age designation is growing each year.
Many women are delaying pregnancy whether by choice or through circumstance—making education around fertility preservation and the possible complications faced by women of advanced maternal age more important than ever.
“By the time you’re ready [to start a family] things might be a lot more difficult than you imagined,” Dr. Keeler said. Her message to her patients of all ages is: “This is something you should be thinking about. If you don’t want to have kids until your mid to late 30s, then you just have to be prepared that it may be a little more challenging than you anticipated.”
The emotional toll of trying to conceive, no matter your age
Dr. Keeler knows there is an emotional toll to navigating conception and pregnancy in your 30s and 40s. And shares that no matter the starting point, these experiences can prove emotionally charged in a number of ways.
“Everybody cries in my office,” she shared. “No matter where you’re starting from, this is a very emotional topic. Any struggles with infertility are hard. Any struggles with pregnancy loss are hard. Those are horrible, awful, emotionally lonely, devastating things to go through.”
Dr. Keeler, who is pregnant and due in May, acknowledged that the process of trying to conceive can be emotionally exhausting at any age, and shares that she experienced a miscarriage before her current pregnancy.
Everybody cries in my office. No matter where you’re starting from, this is a very emotional topic.
“I think I went through what most people go through,” she shared about her experience with loss. “It’s a really lonely, tough thing to deal with,” she says, noting that the emotional toll doesn’t just affect those who have experienced pregnancy loss, but also those trying to conceive.
“As an OB-GYN you have to acknowledge [the mental health] part. You have to make sure your patient is healthy from top to bottom.”
Dr. Keeler regularly refers patients who are struggling with infertility or pregnancy loss to therapists and support groups so they can connect with other individuals who can help them to process what they’re going through.
How you can be proactive about preserving your fertility
While conception and pregnancy become more complicated after the age of 35, women fortunately have a variety of options for considering family planning proactively—whether now or in the future.
Smith knows that, for her, timing is everything if she wants to have another baby. So she started conversations about plans for her next pregnancy with her OB immediately following the birth of her daughter.
“Her [doctor’s] response was, ‘Oh! Wow! Another one!,’” Smith said. “But she also added ‘We have older moms than you. If you’re going to do it, don’t wait too long.’”
Dr. Keeler said that beyond considering the timing of pregnancies, there are a number of steps women hoping to conceive in their 30s and 40s can take to set themselves up for success, even before considering assisted reproductive technologies like in vitro fertilization (IVF).
At the top of the list of recommendations she often shares with patients who are hoping to become pregnant or preserve their fertility are many standard health considerations for women: eat a balanced diet, exercise regularly, and maintain a healthy weight. But women can also take additional steps like keeping tabs on their menstrual cycles and having any irregularities assessed by their doctor. She also noted that quitting smoking is important when trying to conceive, as is limiting alcohol intake as its consumption can have an adverse affect on fertility.
Another suggestion Dr. Keeler had for women trying to conceive is to consider testing to check their ovarian reserve. And to consider freezing their eggs if they have the financial resources to pursue that option. Even if you’re not ready to become pregnant at that time, the additional data can help you to make informed decisions about your fertility when the time comes.
It may feel like a long laundry list of to-dos, but in the end, Dr. Keeler believes knowledge–especially about your own body, and your family’s health and reproductive history–is power.
Knowledge–especially about your own body, and your family’s health and reproductive history–is power.
“Nothing is impossible,” said Dr. Keeler. “We have a lot of science that can help us out. One of the biggest things you’re up against is the unknown. You just don’t know until you get there. There are a lot of paths to happiness. There are a lot of paths to achieving a family, there is no one right way.”
“The more information you have the better the choices you can make for yourself,” Dr. Keeler said. “[To] come from a place of knowledge is empowering.”
While navigating an advanced maternal age diagnosis during pregnancy might feel overwhelming for some, Smith says in the end, for her, it’s worth it. When asked how she feels about coming to motherhood a little later than she might have imagined, she didn’t miss a beat.
“Without hesitation, it’s fantastic,” said Smith. “It’s hard. It’s really, really, really hard, but it’s definitely worth every sleepless second.”