Getting pregnant at 40 or older can be more challenging than when you were younger, but it is still possible for many women. Success rates vary based on individual circumstances. Here is an overview of fertility and some tips that may help increase your chances of getting pregnant in your 40s.
What are the chances of getting pregnant at 40?
A woman’s fertility gradually declines as she ages, mostly due to reduced egg quality and quantity. By age 40:
- A woman’s chance of conceiving within a year is about 40-50% each menstrual cycle.
- The miscarriage rate is over 50%.
- Only about 5% of a 40-year-old woman’s eggs are genetically normal.
Compared to younger women:
| Age | Chance of conceiving within a year |
|---|---|
| 30 | 75-80% |
| 35 | 60-70% |
| 40 | 40-50% |
As you can see, fertility drops significantly between ages 35 and 40. However, 40 is not a fertility cliff. Many women in their 40s do get pregnant naturally.
Why is getting pregnant harder after 40?
There are a few reasons why fertility declines with age:
- Fewer eggs: Women are born with all the eggs they will ever have. By age 40, the number of remaining eggs is significantly lower.
- Egg quality: Not only are there fewer eggs, but their quality also declines. Chromosomal abnormalities become more common, lowering the chance each egg will fertilize and develop normally.
- Hormone changes: The hormones that control ovulation and pregnancy – estrogen, progesterone, and FSH – decrease and fluctuate more as you near menopause.
- Health conditions: Conditions like endometriosis and uterine fibroids become more common. Pelvic health issues can interfere with conception and pregnancy.
In your 20s and 30s, you have a surplus of healthy eggs and hormones are at optimal levels. Small irregularities often don’t cause issues. After 40, your reproductive system has less wiggle room, so problems are more likely to impact fertility.
What fertility treatments are available?
If you don’t conceive after 6 months of trying, see a fertility specialist. They can discuss treatment options based on your unique situation. Some common fertility treatments include:
- Ovulation induction medications – Clomiphene and letrozole tablets stimulate ovulation.
- Intrauterine insemination (IUI) – Sperm is inserted directly into the uterus around the time of ovulation.
- In vitro fertilization (IVF) – Eggs are retrieved and fertilized with sperm in a lab to create embryos that are then transferred into the uterus.
- Donor eggs – IVF using another woman’s younger, healthier eggs can increase success rates.
Talk to your doctor to determine if you are a good candidate for any of these options based on tests to check your ovarian reserve and other factors.
Does egg or sperm quality impact fertility more after 40?
Usually the woman’s age has a greater impact. Here’s why:
- Men produce new sperm constantly, so sperm quality does not decline nearly as much as egg quality with age.
- Women are born with a set number of eggs that cannot be replenished.
- Eggs carry the chromosomes; abnormal chromosomes in eggs are the leading cause of miscarriage and birth defects.
However, men over 40 may experience some fertility declines, including:
- Lower sperm counts.
- More sperm morphology and motility issues.
- Declining testosterone levels.
A man’s age can negatively impact fertility too, just usually not to the same extent as a woman over 40.
Does getting pregnant get harder each year after 40?
Yes, fertility gradually continues to decline each year as you get closer to menopause. Here is how the chance of conception changes annually:
| Age | Chance of conceiving within a year |
|---|---|
| 40 | 40-50% |
| 41 | 38-48% |
| 42 | 35-45% |
| 43 | 30-40% |
| 44 | 25-35% |
| 45 | 15-25% |
| 46 | 10-15% |
| 47 | 5-10% |
| 48 | 1-5% |
| 49 | <1% |
As illustrated, the decline accelerates significantly after 43. At 46, chances are quite slim without medical intervention. Your fertility specialist can administer tests to evaluate your ovarian reserve and help project your conceiving capabilities over the next few years.
What lifestyle changes may improve fertility after 40?
You can optimize your fertility potential through lifestyle adjustments like:
- Take a prenatal vitamin – Ensure you get enough folic acid, iron, and other vitamins essential for pregnancy.
- Eat nutritious foods – Focus on getting plenty of antioxidants from fruits, veggies, and whole grains.
- Exercise regularly – Moderate activity improves circulation and manages stress.
- Achieve a healthy BMI – Carrying too much body fat can disrupt ovulation.
- Quit smoking – Smoking damages eggs and lowers IVF success rates.
- Limit alcohol – Heavy drinking can make conception difficult.
- Reduce stress – Mental health impacts hormone function.
- Get preconception screening – Check for potential health risks beforehand.
Making positive lifestyle adjustments maximizes egg, sperm, and uterine health to support conception.
Should you consider donor eggs?
Using another woman’s eggs can greatly improve the chances of successful conception and pregnancy after 40. With donor eggs:
- The live birth rate per IVF cycle is about 50-60% with donor eggs, versus 15-25% with a woman’s own eggs at 40.
- Miscarriage rates are much lower.
- The risk of chromosomal abnormalities is extremely low.
If your ovarian reserve is very low or IVF with your own eggs has failed, donor eggs are usually the next best step. Consider finding an egg donor in her 20s or early 30s to maximize your odds.
What are the risks of pregnancy after 40?
Women over 40 face higher risks during pregnancy, including:
- Gestational diabetes – Risk is 2 to 4 times higher.
- Preeclampsia – Risk rises from 3.7% at age 20-39 to 5.1% at age 40-44.
- Placental abruption – More common as maternal age increases.
- C-sections – Nearly 50% of births to women 40-44 are C-sections.
- Stillbirth – Stillbirth rate rises from 0.5% at 20-29 to 0.9% at 40-44.
- Chromosomal issues – At 40, the Down’s syndrome risk is 1 in 100 versus 1 in 1,000 at age 25.
Work closely with your prenatal care provider to monitor and manage risks. Remaining as healthy as possible during pregnancy helps minimize complications.
Does getting pregnant get harder after 40 for natural vs IVF conceptions?
Both natural and IVF pregnancies decline with age, but IVF success rates tend to drop more sharply after 40. Here is a comparison:
| Age | Natural conception within a year | IVF live birth rate with own eggs |
|---|---|---|
| 35 | 60-70% | 40-42% |
| 40 | 40-50% | 15-25% |
| 43 | 30-40% | 6-15% |
| 44 | 25-35% | 4-10% |
| 45 | 15-25% | 1-5% |
IVF is more significantly affected because it relies on harvesting enough healthy eggs for fertilization. As the egg pool declines rapidly with age, IVF success rates drop substantially after 40 unless using donor eggs.
What tests help determine fertility potential at 40?
Here are some tests a fertility specialist may order to assess your reproductive health:
- Ovarian reserve testing – Blood tests for FSH, estradiol, and AMH levels indicate how many eggs remain.
- Antral follicle count – An ultrasound counts the number of immature follicles developing.
- Estradiol challenge test – Estradiol is taken to see if FSH suppresses normally.
- Clomid challenge test – Checks if Clomid causes estrogen to rise appropriately.
- Hysterosalpingogram – An X-ray checks for uterine abnormalities and fallopian tube blockages.
- Hysteroscopy – Looks inside the uterus for fibroids, polyps, or other structural issues.
These tests help determine if you can conceive naturally or if you’ll need fertility treatment. Testing the male partner’s sperm count and quality is important too.
What procedures improve chances of conception after 40?
Some procedures that may help increase odds of conception in your 40s include:
- Tubal flushing – Clears blocked fallopian tubes.
- Laparoscopy – Minor surgery that can remove fibroids and cysts, unblock tubes, or correct issues like endometriosis or adhesions.
- Hysteroscopy – Corrects uterine cavity abnormalities.
- Endometrial biopsy – Checks for issues that could prevent implantation.
- ICSI – Micro-injects sperm into eggs during IVF to maximize fertilization.
- Assisted hatching – Weakens the egg shell during IVF to promote embryo hatching and implantation.
Procedures can help create a healthy environment for conception and pregnancy. They may be done alone or in conjunction with fertility drugs or IVF.
Are miscarriage risks higher when getting pregnant at 40?
Yes, unfortunately miscarriage risks rise significantly after 40, mostly due to chromosomal abnormalities in older eggs. Here are the odds of miscarriage by maternal age:
- Under 35: 10-15%
- 35-39: 20-35%
- 40-44: Over 50%
- Over 45: Over 90%
Genetic screening tests like cell-free DNA analysis, chorionic villus sampling and amniocentesis can check for chromosomal problems. Talk to your doctor about recommended prenatal genetic testing based on your history and age.
What are signs of declining fertility in your 40s?
Signs your fertility may be declining in your 40s include:
- Periods become irregular or lighter
- Breast tenderness after ovulation lessens
- Bloating and discomfort during ovulation diminishes
- Cervical mucus changes and decreases
- Basal body temperature is erratic
- Ovulation tests show fewer/no LH surges
- Higher FSH levels on blood tests
- Hot flashes and night sweats begin perimenopause
Note that you can still ovulate and get pregnant even if these signs appear. But pay attention to changes in your menstrual cycle and fertility signals.
Can you get extra fertility help from your doctor after 40?
Your doctor may recommend additional assistance to boost conception chances after 40, such as:
- Fertility drugs – Clomiphene and gonadotropins can stimulate better ovulation.
- Trigger shot – HCG trigger shot can time ovulation more precisely.
- Progesterone – Supplement after ovulation to strengthen the uterine lining.
- Sperm testing – Check for potential sperm issues impacting fertility.
- HSG test – Ensure fallopian tubes are open.
- Hysteroscopy – Detect/remove uterine abnormalities.
- PrEP – Get preconception screenings and counseling.
Medical guidance can help you understand your fertility status and recommend appropriate assistance.
Conclusion
While fertility drops substantially in your 40s, getting pregnant is still possible with certain steps. Work with your doctor to understand your ovarian reserve. Try naturally for 6 months and then consider testing and procedures that may help. If needed, discuss IVF or donor eggs. 40 is not too late if you utilize resources and medical advancements now available.
With a proactive approach, a healthy lifestyle, and expert guidance, your chances of conceiving in your 40s can be optimized. Monitor your cycle, address health conditions, reduce stress, and communicate with your partner. Facing fertility challenges at 40 can be disheartening, but support is available – do not lose hope. Many women do successfully get pregnant in their 40s with the right approach.
