As I scroll through my social media feed, I understand how my patients might be confused about the relationship between age and pregnancy. One headline implies that your ovaries turn to dust after 30, the next shows a 50-year-old celebrity having healthy twins.
So, how old is too old to get pregnant? The answer is complicated.
Falling fertility: A woman’s ability to get pregnant begins to decrease slightly at age 27, and then decreases significantly after the age of 37. The average healthy couple under the age of 30 has about 95% of conceiving within a year. Once you’re over 30, the chance of getting pregnant decreases by about 3% each year. After 40, the chance of conception drops to 5-10%, and by age 45, the chance plummets to less than 5%. Of course, these are the general statistics – there are always outliers. In the last week, I met with a 25-year-old struggling with infertility and a 46-year-old who found themselves unexpectedly pregnant despite contraception.
Rising risk: As age increases, so does the risk of miscarriage and pregnancy complications. While the rate of early pregnancy loss is around 15-20% for women under 30, it begins to increase at the age of 35, and by age 40, the miscarriage rate is 40-50%. The risk of a baby having Down syndrome and other chromosomal abnormalities is also directly related to the level of “maturity” of the mother. The risk rises gradually with age, until age 35, and then the risk increases more rapidly. At age 35, the risk of Down syndrome is 1/350 – but by 45, the risk approaches 1/35. We also see a slight increased incidence of preeclampsia, gestational diabetes, C-section, and stillbirth in moms over the age 40, so additional ultrasounds and testing are often ordered in older moms.
How much does being healthy help? My patients often assume that if they are super healthy, that will counteract the effects of aging. Sadly, your ovaries do not care if you are a vegan, gluten-free marathoner. Each woman is born with a finite number of eggs – and with age, both the number and quality of these eggs decreases. Obesity, high blood pressure, and diabetes can further impede your ability to get pregnant, increase the risk of miscarriage and cause complications during the pregnancy itself. Staying healthy is important to maximize your chances of conceiving and help you have a healthier pregnancy, but diet and exercise alone cannot fully overcome the effects of aging on the ovary.
You may be wondering – if these numbers are all doom and gloom, why does it seem like there are so many fabulous forty-somethings with babies at the playground? While a ten percent chance per year of conceiving seems low, there is a significant portion of the population in their forties, so there are still a lot of women getting pregnant and having normal healthy pregnancies in their forties. Another consideration is that a majority of women undergoing fertility treatments over the age of 40 use eggs from a younger ovary (egg donors). All the fertility and complication rates I painfully quoted before were tied to the age of the eggs, so if younger eggs were used then odds of healthy pregnancy go up significantly. This is performed through in vitro fertilization (IVF), which can be an expensive and exhausting process.
Medically, the perfect time to have a baby is between ages 20-24. But emotionally, financially, and relationship-wise, for many of us, the perfect time is likely much later in life. Dr. Christopher Montville, Practice Director of the Tennessee Fertility Institute, says, “Ideally, a couple should plan on starting their family before the female partner reaches the age of 37. That helps improve their chances that they will have at least one healthy baby before age-related changes in fertility makes starting a family more difficult” – but sometimes that doesn’t happen. When looking for alternate options, if you find yourself at 35 with no “Mr. Right” in the picture, he recommends considering freezing your eggs to improve your chances of future fertility. If you are trying to conceive over the age of 35, you should seek medical attention if not pregnant in 6 months of actively trying.
While many women in their late 30′s and early 40′s have normal healthy pregnancies, many others experience struggles, heartbreak, and loss. Having a baby in your mid 40’s is possible, but often requires expensive fertility treatments and is not without risks. As you plan your future, know that there is no perfect time to get pregnant, but if having a baby is important to you, than the earlier you start your family the better.