Updated on May 3, 2023.
For some people, their 40s may be the perfect time to start a family: Maybe they’ve settled into a loving, long-term relationship, or have saved up enough money to support a child on their own. It may be the best time to take a short—or long—parental leave at their job, or they may just finally be in the headspace to become a parent. Whatever the reason, being pregnant in your 40s can be a wonderful adventure, but can also be more of a challenge. The odds of becoming pregnant and giving birth after 40 become slimmer and there are more risks involved, but it’s certainly possible, especially if you work with your healthcare provider (HCP) to improve your chances of having a healthy pregnancy.
Fertility wanes over time
When it comes to fertility, chronological age does matter. That’s because as you age, so do your eggs. The prime reproductive years for women are late teens and 20s. After that, fertility tends to decline a little bit each year. Generally speaking, about 1 in 4 women in their 20s or early 30s will become pregnant during any one menstrual cycle. By age 40, the chance of pregnancy drops to less than 5 percent per cycle, according to the American Society for Reproductive Medicine. After the age of 45, getting pregnant without the help of fertility treatments is unlikely—though not impossible—for most women.
Much of the decline in fertility over time is associated with changes in ovarian reserve—the quantity and quality of eggs. Early in life, there are a fixed number of eggs in the ovaries. Aside from their quantity, the quality of these eggs also declines with increasing age.
“A woman’s ovarian reserve in her 40s is just not as hearty as it is when she is in her 20s or 30s,” explains Daren Watts, MD, an OBGYN at St. Mark’s Hospital in Salt Lake City, Utah. “This is the number one issue for women trying to get pregnant after age 40.”
This is why some younger people are choosing to freeze, or cryopreserve, their eggs—a minimally invasive procedure that involves harvesting unfertilized eggs from the ovaries and then freezing them for later use. This essentially halts the aging process for these eggs so they will have a lower risk for abnormalities later on when someone decides they’re ready to conceive.
Low ovarian reserve, however, could also be related to other factors, including injuries and certain medical treatments, such as chemotherapy. Women in their 40s may also be at higher risk for uterine fibroids, endometriosis, and other health issues that can affect their fertility.
And to be clear, this isn’t entirely about eggs: Men’s fertility also declines with age, though not as predictably as a woman’s ability to conceive.
More risks during pregnancy
Getting pregnant is just one hurdle, Dr. Watts points out. Once you are in your 40s, other risks associated with pregnancy also rise. Older pregnant people face greater odds of stillbirth, miscarriage, and other complications such as ectopic pregnancy (when an embryo implants somewhere other than the uterus) and placenta previa (when the placenta that supports and feeds the fetus lies low in the uterus).
Additionally, pregnant people in their 40s are at higher risk for gestational diabetes and preeclampsia, or dangerously high blood pressure during pregnancy. They are also more likely to have babies with chromosomal abnormalities. Down syndrome, for example, is one of the most common genetic conditions associated with delayed childbearing.
Older mothers are also more likely to have multiples, such as twins or triplets, since they are more likely to release more than one egg from their ovaries each month. The increase in multiples can also be due to the use of fertility drugs, which are often needed to achieve a midlife pregnancy.
Preparing for a healthy pregnancy
It may be harder to conceive once you’re in your 40s but you can increase your odds of success by taking certain steps, even before you start trying.
If you’re hoping to conceive later in life, schedule a “preconception” appointment with an OBGYN (you may want to look for one who specializes in high-risk pregnancies). During this visit, your HCP will discuss genetic screening. You may also be advised to start taking prenatal vitamins, which have been shown to reduce the risk for certain birth defects when taken correctly both before and during pregnancy.
As you’re preparing for pregnancy, it’s also important to maintain a healthy weight and adopt good habits to prepare your body.
“It’s really important to lead a healthy lifestyle and be as fit as possible, as pregnancy does put strain on your body,” says Watts, who adds, “your body was capable of handling more strain when you were 20 than when you are 40.” If you smoke, quit, he adds. Incorporating stress-relief methods can also make a difference in your overall health.
Trying to conceive
Once your OBGYN gives you a green light, you should begin tracking your ovulation and plan to have intercourse during your most fertile window. If you don’t get pregnant within a certain length of time, it may be time to consider an infertility evaluation.
Younger people often try to get pregnant for up to a year before considering fertility treatments, but those in their 40s may be offered these options sooner. “If you are over 40, we recommend six months of attempting to get pregnant naturally,” Watts says. “If you don't succeed, we will do a full fertility workup.”
This workup may include a variety of tests, including an X-ray with dye or hysterosalpingography to confirm that your fallopian tubes (through which an egg travels from the ovaries to the uterus) are open. Your OBGYN will also measure certain hormone levels and order tests that assess your ovarian reserve. In some cases, imaging tests can also give your provider a better idea of the health of your reproductive organs. The quality of your partner or donor’s sperm will also be evaluated during this process.
Based on the results of these tests, your provider will develop a plan to help you achieve pregnancy, Watts says. Medications, or fertility drugs, may be used to help stimulate ovulation. “Advanced reproductive techniques and technologies may be necessary,” he says. For example, in vitro fertilization (IVF) involves combining sperm with eggs in a laboratory and implanting the embryo in the uterus. If you chose to freeze your eggs, IVF will be used to help you become pregnant.
If your ovarian reserve or your partner’s sperm quality is affecting your ability to conceive, you may also consider using a donor egg or sperm to improve your odds of becoming pregnant.
Ensuring a healthy pregnancy
All pregnant people should receive prenatal care. This is especially true if you’re in your 40s. In fact, depending on your age, other health issues, and medical history, you may need to undergo additional tests and have more frequent checkups throughout your pregnancy than a younger parent-to-be.
Early and routine monitoring by your OBGYN will help ensure that you have the best possible outcome. During each visit, your health and the health of your fetus will be assessed.
Your provider may recommend screening tests to make sure that your fetus is developing properly. This includes a blood test in the first trimester plus an ultrasound to assess risk for specific chromosomal abnormalities. This test, which is typically performed between the 11th and 13th week of pregnancy, could indicate the need for further testing.
Other diagnostic tests, such as amniocentesis, which tests amniotic fluid, or chorionic villus sampling (CVS), which tests tissue from the placenta, can provide more definitive results. These tests do confer a higher risk of miscarriage, which is already higher in pregnant people older than 40.
“A newer blood test that analyzes bits of fetal DNA that leaked in the parent's bloodstream is less risky,” Watts says. “This is much less invasive and can be done as early as nine weeks.” Together with your OBGYN, you should determine the most appropriate screening plan for your pregnancy.
While pregnancy after 40 is more of a challenge, it is increasingly possible thanks to advancements in fertility and reproductive medicine. If you are expecting later in life, you can improve your chances of having a healthy pregnancy by establishing a gameplan early on. That means getting regular prenatal care, adopting a healthy lifestyle—including stress reduction, regular physical activity, a nutritious diet, and adequate sleep—and having open communication with your healthcare team.
