Female Fertility After Forty

More women are choosing to have children later in life. When making the decision to postpone building a family beyond age 35, however, there are certain risks women should be aware of.
In this article, Dr Nomathamsanqa Matebese from Cape Fertility explains the effect of age on a woman’s fertility, what the risks of a pregnancy after age 40 are for both mom and baby, how to know if you are at risk and what treatments and options are available.

In today’s modern world, many women put off having children until later in life. This may be because they are building a career, or because of financial pressure, or even because society can view it negatively when a woman gives up a job or career to have a baby.

At Cape Fertility, we support women empowerment. It is a woman’s right to be allowed to decide when to start a family. Women must empower themselves with financial independence, because one of the main reasons gender-based violence exists is that women are financially dependent on their male partners.

Women who want to further their careers before starting a family can fully count on Cape Fertility’s support. We believe women deserve the same reproductive freedom as men.

However, when making this decision, women should also be fully aware of the impact of their age on their fertility, their pregnancy, labour and birth, as well as the treatment options that are available.

Age-related infertility

The reality is that women have a prime fertility window that extends to around age 35. One of the barriers to falling pregnant naturally in your 40s is infertility.

With increasing age, a woman’s fertility decreases. This is due to the fact that from the age of 35 onwards, women not only produce fewer eggs than at a younger age, but these few eggs produced are also of lower quality.

Of course, some women have no issues getting pregnant well into their 40s, and most healthy women who get pregnant after age 35 and even into their 40s have healthy babies.

But, statistically speaking, a woman is less likely to get pregnant and more likely to need fertility treatments the older she is when trying to conceive.

Certainly, women generally have less chance of getting pregnant after the age of 35. But the chances of falling pregnant naturally after the age of 40 is less than 15%. And most women over the age of 45 are unable get pregnant naturally. This is mainly due to the low quality of the eggs produced after the age of 45.

Risks of pregnancy after 40

In addition to the risk of advanced age to a women’s ability to fall pregnant, a pregnancy after the age of 40 also holds risks for both mother and child. For the mom, these include an increased risk of medical conditions related to pregnancy, mainly preeclampsia, gestational diabetes and preterm labour. Due to the increased incidence of chromosomal abnormalities in babies conceived by older women, there is also an increased risk of miscarriage during pregnancy.

Advanced age also affects labour and delivery. Due to changes in a woman’s health with age, labour and birth tend to be more complicated after age 40. The main risks are premature labour and preterm birth. However, a woman who has a chronic condition is more likely to experience complications than a woman who doesn’t. Chronic conditions such as diabetes, high blood pressure or thyroid disease, can complicate a pregnancy and potentially increase the risk of miscarriage and pregnancy loss, including stillbirth.

Risks for the baby include an increased chance of chromosomal abnormalities such as Down’s Syndrome, and risks associated with prematurity, the most significant being neurological abnormalities.

For a safer pregnancy after the age of 40, moms-to-be should watch their weight. Being overweight is strongly associated with pregnancy complications, so all women are encouraged to have a normal BMI (Body Mass Index) prior to pregnancy. Taking folic acid at least six weeks prior to conception can also help prevent spinal birth defects in the baby.

From age 50 pregnancy becomes extremely high-risk to both mother and child.

How to know if you are at risk?

Generally, where the female partner is older 35, couples should see a fertility specialist after six months of unsuccessfully trying to conceive. However, if a couple has any reason to be concerned about their fertility, they should visit a fertility specialist without delay, because in fertility matters time is of the essence after age 35.

A fertility specialist will perform different types of fertility testing depending on the couples’ specific conditions.

At Cape Fertility, the female partner undergoes a full pelvic examination, including a transvaginal ultrasound scan, to determine if abnormalities in the reproductive organs could be a cause of infertility. Blood tests are done to evaluate hormone levels, including a blood test to assess ovulation. A valuable blood test is an Anti Mullerian Hormone (AMH) test to assess a woman’s ovarian reserve or the estimated number of egg remaining. Testing the function of the fallopian tubes is done either at a radiology department or via a laparoscopic surgical procedure, which is used to examine the organs inside the abdomen.

The male partner has a sperm test during which the semen is analysed. Other tests such as genetic ones may be required depending on the patient’s medical history.

Fortunately, there are treatments and options available to couples struggling with infertility, including fertility challenges related to age. Due to an increase in the number of women who have access to these assisted reproductive techniques (ARTs), birth rates rising even among women over 40.

Treatments and options

Depending on the reason for a couple’s fertility challenges, a fertility specialist might prescribe treatments such as (among many others) ovulation induction, artificial insemination or in-vitro fertilisation (IVF) using either the couples’ own eggs and sperm or ones from donors. Surgical procedures may be necessary to, for example, treat endometriosis or to remove fibroids.

The male partner may undergo a testicular biopsy, a procedure to retrieve sperm directly from the testis in the case of obstructive azoospermia, when there is no sperm in the ejaculate. Using donor sperm is another option.

Genetic testing of embryos for known genetic conditions is also possible with IVF treatment.

Fertility treatments such as IVF are safe for healthy women over 40, but there is an age limit. The age limit is around 43 for IVF treatment using a woman’s own eggs, because after the age of 43, her chances of success are much lower – in fact, less than 5%.

Due to the increase in pregnancy related risks, IVF treatment is not recommended after the age of 50, not even with donor eggs.

Women who are not planning to fall pregnant by the age of 33 can also consider another option, which is freezing their eggs to ensure they have many good quality eggs should they struggle to conceive after the age of 35.

If you are concerned about the effect of your age on your fertility, we would like to invite you to speak to one of our fertility specialists at Cape Fertility. It is as simple as contacting us by clicking here

At Cape Fertility, we value each individual patient and we look forward to providing you with our signature individualised and personalised care.