How to Prepare for Pregnancy After 40

Many women decide to have children later in life, but pregnancy after 40 can pose additional risks and complications to the mother and baby. Although a healthy pregnancy after 40 is very likely, preparing yourself before you become pregnant can help you get your body in optimum condition for a successful pregnancy. Women who want to conceive after 40 also need to prepare for a higher risk of complications during the birth, difficulty conceiving, and the greater likelihood that their babies may experience Down syndrome or other chromosomal birth defects.

·        Schedule a physical or pre-conception consultation with your primary caregiver or gynecologist. 

As people age, the likelihood of suffering from common health conditions such as high blood pressure and diabetes increases, and older women may also be more likely to have conditions that impair fertility such as polycystic ovary syndrome or endometriosis. A doctor can help you identify health problems.

·         Make sure you tell your doctor you want to conceive. Ask for a realistic time frame in which you can resolve or manage any existing health issues before trying to conceive.

·         Discuss whether you will be able to continue using any medications you are currently taking while you try to conceive and while pregnant or breastfeeding. Ask your doctor about alternate therapies or medications safe during pregnancy, and be realistic about whether you can manage your health problems without medication if that is the only option for a safe pregnancy.

·         Evaluate with your doctor which health problems are most important for you to address before pregnancy. Because fertility begins to decline after 35 years in most women, many women preparing for pregnancy after 40 are balancing the need to manage health problems with a rapidly diminishing fertile period.

·         Get any immunizations your doctor recommends. Your doctor may perform blood work to check for immunity to diseases such as rubella and chickenpox--wait 1 month to try conceiving after you get a vaccine.

·        Manage any existing health problems before conceiving. 

Health issues that have a mild effect on your everyday life currently may become major complications once you are pregnant. For example, unmanaged diabetes can greatly increase your risk for miscarriage and moderate high blood pressure can quickly worsen.

·         Get treatment for sexually transmitted infections and diseases immediately as these can lead to infertility.

·         Work on getting to a healthy weight. Overweight and underweight can both cause significant problems while pregnant or trying to conceive. For example, women with unhealthily low weights can have anovulatory cycles making it impossible for them to conceive.

·        Improve your nutrition. 

Good nutrition is especially important during the preconception period as healthy levels of folic acid and other vitamins can help prevent certain birth defects.

·         Although vitamin supplements are available, try to increase your intake of foods naturally containing folate including citrus fruit, legumes, and dark leafy greens. Folate can help prevent anemia and birth defects.

·         Eat whole grain, complex carbohydrates and cut down on the amount of refined carbohydrates you consume.

·         Get protein from lean meats and fatty fish rich in omega-3 such as salmon, eggs, and low-fat dairy.

·        Reduce the amount of sugar you eat.

Begin exercising or increase your activity level. 

Exercise can help you maintain a healthy weight and may allow you to have a more comfortable pregnancy and labor.

·         Include both aerobic and resistance training in your exercise program.

·        Stop smoking and avoid secondhand smoke. 

Smoking can lower fertility, even leading to early menopause, and causes a number of complications during pregnancy such as low birth weight and increased rates of respiratory distress in infants.

·         Talk to your partner about quitting-secondhand smoke is also harmful, and men who smoke have lower fertility than their non-smoking counterparts.

·        Consider the risk of chromosomal birth defects. 

Although many older women have healthy pregnancies, the reality is that the rate of chromosomal birth defects is much higher in infants born to women over 40. One out of 100 women who are 40 years old will have a baby with Down syndrome, and the risk increases with age, rising to 1 in 30 women at age 45.

·         Discuss the possibility of birth defects with your partner and/or family. Decide whether you want to take the risk, and plan out how you would cope with a diagnosis.

·         Research the additional diagnostic tests available during pregnancy. You may be interested in amniocentesis or chronic villus sampling (CVS), but both tests do carry a slight risk for miscarriage.

·        Take into account the higher rate of pregnancy loss. 

The estimated miscarriage rate for women between 40 and 45 is 35 percent and this rises to over 50 percent for women over 45. Older women also experience a rate of stillbirth 2 to 3 times higher than that for women in their 20s. Stillbirth is death of the fetus after 20 weeks. Evaluate whether you feel emotionally prepared to experience pregnancy loss, possibly multiple times, while trying to have a baby.

·        Make an appointment with a genetic counselor. 

If you are especially concerned with the risk for birth defects or other health problems for the infant, a genetic counselor can help you assess the likelihood of problems.

·         Gather together information on maternal and paternal family members including any illnesses, health conditions or reproductive issues. The counselor will review your family history as part of the assessment.

·        Follow up with your doctor while trying to conceive. 

Since the probability of fertility problems is so much higher for women over 40, you should consult a doctor if you do not conceive within 6 months of trying to conceive. Waiting longer may diminish your chances of conceiving, as your fertility may be declining and alternate treatments also become less successful as you age.

Happy 50 years old mom

"There was a time when I thought I would never want children. Now, I can’t imagine a life without the two beautiful boys I had in my 40′s. When I was younger, I didn’t expect to need help conceiving. I started trying at 28, but after a year nothing had happened. My husband and I went for all of the necessary testing and I was finally diagnosed as having “unexplained infertility”.

 Our fertility specialist suggested Intrauterine Insemination (IUI). Since we didn’t know the cause of our infertility, we figured it was a crap-shoot as to what would finally bring us a baby! While our first IUI was a success, it turned out to be a blighted ovum—a fertilized egg that implants but never turns into a baby. Devastated doesn’t begin to describe the feeling I felt when I received the news! We tried again…and again…and again. We must have blown through eight or nine more IUIs before I realized that I was turning 31 soon. At this point doctor suggested to go for an IVF consultation with a Reproductive Endocrinologist.

 After the consult, we decided we would proceed with an IVF. We were, like most newbie IVF’ers, positive it would work the first time! Well, it didn’t. The second attempt was a bust as well. This is when the doctor unceremoniously told me that my eggs were shot, and that I had to use donor eggs.

I just couldn’t fathom not using my own eggs, not seeing some part of me, or my family, in this wee little face. We decided to go to another attempts and two IVFs later I received the same news at the age of 33, though this time it was with a bit more compassion.

That’s when I made some life changes. I took a few months off from cycling just to wrap my head around everything that had transpired.

I rearranged my life, got a new job in a different field, and tried a few more IUIs just in case there happened to be that one stray good egg in there! But I was about to turn 36 years old—and labeled as “advanced maternal age”. To give birth to another child, I would have to accept and embrace the changes my body had gone through, and decide the best and most acceptable course of action. I was now filled with a new and exciting sense of hope!

We began our search online, and met with several donor agency coordinators. It was a difficult search, and finally we came upon a wonderful woman who seemed to fulfill everything we were looking for in a donor. She even looked a bit like me and had a similar background!

After the legalities, we started a cycle. She and I both followed every instruction from the clinic, and 3 months later, the phone rang, I nearly fell off my chair! It was the doctor with some wonderful news…I was pregnant!

I think I held my breath the entire nine months until my little baby came out healthy and beautiful! And I was 3 months into my 41st year!

But it wasn’t over yet. Three years later we decided to try for a sibling. We had a few frozen embryos left from the last cycle, and two had survived the thaw, so we had them transferred. Unfortunately they did not implant.

Worse, our first donor was now unavailable. It took a couple of years, and two more donors who failed the criteria, before we found the perfect donor who had passed all of her screening tests. With greatest fortune we conceived our second child when I was 49. He was born just 3 months shy of my 50th birthday!

It’s funny, but despite a fertility journey lasting more than two decades, I can’t imagine anything I would do differently! It took all of those experiences to become the mom that I am today! I am so filled with love for my beautiful family—calm, collected, and fulfilled".

Surrogacy as the last throw of the dice

Surrogacy is seldom the first choice on the journey to build a family. Often people come to surrogacy after trying and exhausting other options such as intrauterine insemination (IUI), in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). In some cases medical issues, such as absence of a uterus, impaired uterus, or a chronic health problem, make it impossible or unsafe for the intended mother to carry a child. Sharing a pregnancy with a carrier (the woman carrying the child) may be the right option for you if involvement with the pregnancy and prenatal care, genetics and being present for the birth of your child are important.

Until recently, stories in the popular press were about traditional surrogacy, where the surrogate is inseminated with sperm from the infertile woman’s husband, and the carrier is genetically linked to the child. Today, most couples who build their families through surrogacy choose gestational surrogacy, also known as gestational care. In gestational care, the intended mother or an egg donor provides the egg and the intended father or a sperm donor provides the sperm. The resulting embryo is transferred to the gestational carrier, who has no genetic connection to the child.

After three miscarriages and years of infertility, Sharon didn’t give up her dream of having children. Once it became clear that pregnancy wasn’t a viable option, she and her husband Dan became interested in surrogacy, where they could both be genetically connected to the child. They also investigated adoption and resolving without children.

Sharon: “All my life I expected that I would have children. After years of failed infertility treatment, my husband and I had almost given up. We didn’t have the energy or emotional stamina to keep trying. I thought adoption was my only alternative until our doctor suggested that we consider gestational care. As hard as that was to hear, I realized I could have a genetic child and be very close to the pregnancy even if I wasn’t carrying the child myself. It was so exciting to be at that first ultrasound and see my child’s heartbeat! It has turned a very painful beginning into a very hopeful future.”

Dan: “What a nightmare this has been for both of us, especially for my wife. After each miscarriage, what we took for granted began to seem like it might not happen. I have seen the pain in my wife’s eyes as she has come to terms with the fact that she is unable to carry a baby. I have always supported my wife but have also realized my own deep desire to have a child who will carry on the traits of my family. It may sound selfish, but I wanted to have a child who might be blessed with my mom’s musical talents or have my dad’s sparkly eyes. For me, surrogacy is as close as we can come to having our child in the “usual” way.”

Before deciding to use a surrogate, you (and your partner) should consider the following questions:

Are you ready to move on from current infertility treatments?

How do you feel about someone else carrying your child?

Are both partners ready to do this?

How will you explain the pregnancy and birth to others and eventually to your child?

It is important that you and the carrier speak to a mental health professional specializing in infertility about these and other concerns. A mental health screening can help ensure that all parties have considered all matters. It will also help to determine if you and your carrier are compatible.