Pregnancy After the Age of 40
There are several reasons why women might plan a pregnancy around the age of 40. Sometimes, it’s a matter of choice— for instance, a woman may decide to start a family after finishing her education, building her career, and achieving financial stability, or she may simply want to expand her family at this point in her life. In other cases, a later pregnancy may be due to fertility challenges faced by the woman, the man, or both, related to age or other factors.
From the age of 35: decline in women’s fertility
Women’s fertility peaks in their 20’s. From the time they are in their 30s, women’s fertility begins to decline and as they approach 40, their chance of becoming pregnant during any menstrual cycle is only 5%.
More on the causes of the decline in fertility
Approximately 5% of 185,040 (live) births in 2021 were of women between the ages of 40-44, and 0.5% among women over the age of 45.
Professional literature, as well as women’s fertility specialists, report a natural decline in fertility after the age of 35, and at the same time, an increase in the risk of pregnancy and birth complications after this age. Accordingly, the Ministry of Health recommends performing a chorionic villus sampling or amniocentesis on women aged 35 and older. An amniocentesis for pregnant women above this age is included in the health services basket. At the same time, you should know that the Israel Society of Gynecology and Obstetrics addresses monitoring geriatric pregnancy for pregnant women from the age of 45. Experts and investigators all agree on one point: after the age of 45, spontaneous (natural) pregnancy is extremely difficult to achieve and occasionally, women of this age, or older, who want to become pregnant will need to use a donor egg.
Impact of age on male and female fertility
Every woman is born with a definite number of eggs in the ovary, between one and two million eggs. As a woman ages, two processes occur: the number of eggs gradually declines, and the eggs themselves age and their quality declines. The repository of eggs is not renewed at any time. The eggs run out and new ones do not form. As a result of these two processes, the chances of becoming pregnant decline while the risk of genetic mutations that may occur in aging eggs increases.
Furthermore, as a woman ages, there is a greater tendency to suffer from gynecological disorders and illnesses that hinder pregnancy, such as endometriosis, uterine myomas and chronic diseases such as diabetes and hypertension. Male fertility is now known to be affected by age as well, although to a lesser extent. More on sperm donations.
Declining fertility, advancing technology
If we have discussed only difficulties and risks until now, this is the time for encouraging news. As the fertility level of men and women rapidly declines with age, medical technology is becoming more sophisticated. Thanks to scientific and technological advancements, women today can become pregnant and giver birth after the age of 40. HMOs in Israel fund fertility treatments until the age of 45 for women who want to become pregnant with their own egg (up to two children) and until the age of 53 for women who want to become pregnant with donor egg.
Advantages and disadvantages of later life parenting
Many studies that investigated the impact of age on later life parenting styles found many advantages in motherhood and fatherhood at a later age: less feeling of missing due to a sense of lack of self-fulfillment, greater economic ability that provides financial security, a broad support network of family and friends. Life experience, acquired skills and struggles the parents have gone through for many years, can be an advantage and help them manage the challenges of parenting and raising children.
On the other hand, older mothers and fathers of young children face a larger generation gap. Parents occasionally are more tired than younger parents or have less patience. Occasionally, their own parents, who themselves are grandparents, are already too old and unable to help.
Risks and complications of pregnancy after the age of 40
Pregnancy is an exciting and special experience in a woman’s life and has a happy outcome. At the same time, pregnant women of any age, and particularly older women, should know the challenges of pregnancy they should expect and what they must do to lower the health risks to themselves and to the fetus.
There are ways to lower the risks
Pregnancy planning
Prenatal counseling by a gynecologist designed to assess the risk (if any) to the pregnancy. The physician will perform an anamnesis (assessment of medical history), ask the mother-to-be about habits, underlying diseases, drug treatment, and so on. The physician will also conduct a physical and gynecological examination and refer the woman for additional tests such as blood tests, including a hormonal profile.
It is possible to assess the ovarian reserve by testing the FSH level, a sonar scan for follicle count - AFC and an AMH blood test (which is done privately). Before any test, you should consult the attending physician to make a decision about the need for the tests and their implications.
Depending on the situation and following the assessment that is part of the the pregnancy planning, the physician will recommend ways that can help you get pregnant: taking folic acid, if there are chronic diseases - control and change in medication treatment that is suitable for pregnancy, adhering to a balanced and varied diet, recommended vaccinations that it is important you receive before pregnancy, supplementing nutritional deficiencies and more.
The physician will also recommend changing habits that hinder the chances of becoming pregnant such as smoking or drinking alcohol.
Pregnancy tests and check-ups
Meticulous pregnancy check-ups that will include ultrasounds and, in accordance with the Ministry of Health recommendation, genetic testing to detect any fetal genetic abnormality: amniocentesis or chorionic villus sampling (tests that are recommended for every woman after the age of 35). It is also important to undergo tests throughout the pregnancy as recommended by the attending physician.
A complete pregnancy check-up and adherence to tests at the recommended time will allow the attending physician to identify any complications or problems as they appear and to provide a solution. During the check-up, the physician may recommend greater frequency of visits to perform more frequent check-ups. In addition, and particularly during a first pregnancy, there should also be follow-up by a nurse.
You to know: preserving fertility
You to know: preserving fertility
Today, women in Israel have the option of preserving fertility by freezing eggs or freezing fetuses. According to the Egg Freezing Law, every woman (married, single, divorced, mother) between the ages of 30-41 can freeze eggs in an attempt to ensure that she has young eggs or fetuses in the future that she can use to try to become pregnant.
It is important to note that this type of fertility preservation is known as social preservation, and should be distinguished from fertility preservation performed at any age for health reasons (for example for oncologic patients).