Getting pregnant after 40

Alison Woodcock wasn’t planning on holding off until her 40s to have kids. “I just didn’t meet the right partner until I was 40, so by the time we were ready to have a baby, I was 41,” she says.

The odds were not in her favour. According to OB/GYN and reproductive endocrinologist Beth Taylor of Olive Fertility Centre in Vancouver, only about 50 percent of women age 40 to 43 will be pregnant after a year of trying, compared to 80 percent of women under 40. “Your odds are certainly declining at 35, but by 40 they really start to plummet,” she says.

Fertility check-ups Woodcock got lucky: she conceived almost right away. But she didn’t leave it all to chance. As soon as she was ready to start trying, she made an appointment with her doctor to get a referral to a fertility clinic. “We really wanted to do this, and given where I was, age-wise, we knew we didn’t have time to waste,” says Woodcock. The general recommendation for women over 40 is to start trying and then call your doctor if you don’t conceive after three months. “The reality, though, is that in Canada most patients have to wait to see their physician, so it’s not unheard of for people to go to their doctor sooner to get things moving, since most know that time is of the essence,” says Taylor.

A routine fertility check-up involves checking the health of a woman’s uterus, ensuring fallopian tubes aren’t blocked, hormone testing to look at thyroid function and egg count, and if there’s a male partner, testing his sperm, too. The next step is timing intercourse, so that you’re having sex (without lubricant, which can interfere with sperm mobility), every second day during the middle of your cycle, when you think you’re ovulating.

Forty-three year-old Agnes Mann used an app that monitors your cycle and logs your body temperature (taken orally and recorded every morning) to alert her to her optimal days for conception. After eight months of using the app, she got pregnant. “Ovulation predictor tools are really helpful,” says Taylor. She recommends patients buy ovulation predictor kits online or at a pharmacy (they’re a strip or stick that you pee on, like a pregnancy test), to help get the timing right.

Boosting the chance of conception Some simple lifestyle modifications can also improve chances of conception for women of all ages, but may be even more important after age 40. Regular moderate exercise and maintaining a healthy BMI are important factors, says Taylor. She also asks patients to quit smoking, limit alcohol to two glasses a day and keep coffee consumption to no more than two cups per day (or a maximum of 200 mg per day). She also prescribes a daily prenatal vitamin, 600 mg of coenzyme Q10 and 2000 IU of vitamin D, to enhance egg quality. “Egg quantity and quality are the two main problems for women over 40,” says Heather Shapiro, an OBGYN at Mount Sinai Fertility in Toronto.

All women who are trying to conceive should also be taking 0.4 to 1 mg of folic acid daily, before you get pregnant. (A standard prenatal vitamin, taken daily at least three months prior to conception, should do the trick.)

But even all the lifestyle adjustments and perfectly-timed trying doesn’t always guarantee a pregnancy. Shannon Babcock, 43, tried to conceive the old-fashioned way for six months. By September 2016 she’d had three IUIs (intrauterine insemination) and two rounds of IVF (in vitro fertilization). “I also had a hysteroscopy followed by a polypectomy to remove polyps from my uterus, but it just wasn’t working,” she says. Babcock eventually got to a point where she wondered if pregnancy would happen at all. “I think I started to come to terms with the fact that having a baby just might not be the path for us,” she says. “And then, during a two-month break from fertility treatments, I got pregnant spontaneously,” she says. “We were happy but incredulous—I had to take two home tests because I couldn’t believe it.” Her baby is due in December.

Possible pregnancy complications Conception is only half the battle, though. The risk of complications during a pregnancy rise dramatically after age 40. For one thing—be warned!—your healthcare providers may classify your pregnancy as “geriatric” or refer to you as being of “advanced maternal age.” And because egg quality declines as you age, there’s greater chance of genetic disorders, like Down syndrome, and of miscarriage. (Woodcock and Babcock both also experienced chemical pregnancies—a term to describe a very early miscarriage that occurs before five weeks gestation). While women over 40 are often allowed to select midwifery care (instead of an OB/GYN), you might be switched to an OB for a consultation if any issues or atypical conditions arise.

Pregnancy complications also skyrocket after 40. The expectant mom’s blood pressure usually increases, and the chance of developing gestational diabetes jumps to about triple the risk of a younger woman, making the glucose screening test a must. All women over 35 are encouraged to have prenatal screening done at about 12 weeks to detect the risk of chromosomal abnormalities. If a pregnancy “screens positive” for elevated risk, there are options for additional testing which can include further blood testing or amniocentesis to pinpoint possible problems.

Risky delivery According to The Canadian Institute for Health Information, first-time moms over 40 have the highest rates of labour complications and interventions. Chances of placental abruption (a condition where the placenta partially or completely separates from the uterus before the baby is born) are 60 percent higher in first-time moms over 40. One in three babies delivered to moms over age 40 are delivered by Caesarean. This high C-section rate is partly due to the fact that moms over 40 are at increased risk of having a stillborn baby after 40 weeks. Women over age 40 are rarely allowed to go past their due dates and C-sections are often scheduled right at the 40-week mark, if the baby hasn’t arrived already.

“My doctor told me about this right away and said there was a chance she’d want to induce me, to be safe, but as it turned out, my son, Jacob, came on his own about two weeks early and I was able to have a vaginal birth,” says Woodcock.

Of course, many moms over age 40 successfully have healthy babies—but a textbook pregnancy and a birth plan that doesn’t go exactly as you’d hoped isn’t unusual in this age bracket.

“People are comforted by this false belief in the power of science to overcome age, and by seeing celebrities having babies at increasing ages,” says Taylor. But fertility treatments aren’t a guarantee, even for A-listers.

Shapiro agrees: “Assume anyone in Hollywood who’s having a baby after age 40 used someone else’s egg.” In other words: be aware of the risks, likelihood and viability of having babies later in life.

“The most important thing women should know, if they are planning to have children after 40, is to be prepared that it might not happen,” says Shapiro.

Read more: How long does it take to get pregnant? Being 40 and pregnant is the new normal Why advanced maternal age could make you a better mom