Why It’s Not So Rare to Get Pregnant after 45

Hope for Older Women Trying for Healthy Babies

Current conversations about fertility are failing the millions of women world-wide who are over 40 and trying to get pregnant. When we talk about the best time to conceive or  how much fertility declines with age, we talk past a huge community of women who are hoping to become mothers after 40.

I remember the recurrent sorrow and crazy-making frustration of trying to get pregnant, starting when I was first ready to become a mother—not until I was 41—and lasting until I was lucky enough to conceive my first child at age 45. She was born when I was 46 and she is, I’m incredibly grateful to report, now a healthy, happy 4 and a half year old. I also remember how unhelpful much of the discussion around fertility and age was, during those years when I was trying and failing to get pregnant or to carry a pregnancy to term, a time I’ve written about in my book, The Good Shufu.

Because here’s the thing: Women like these, and like I once was, are not in the position of deciding when to have a baby or whether they should try before reaching “advanced” or “very advanced maternal age.” The ship has sailed on that one. The reality is, they are already in their 40s, and the teeth-aching desire to meet and hold their baby has not declined with age.

Surprisingly, for women over 40 who want to conceive, the most relevant—and most hopeful—information isn’t even found where people usually look during discussions of fertility. Instead of focusing on studies comparing fertility at various ages or surveys of ART successes and failures, we should look to US census data on births and, perhaps paradoxically, to statistics on abortion, menopause, and sterility.

To be clear: I’m not arguing women should wait. I’m not arguing they shouldn’t. I’m saying that if a woman happens to be in her 40s and trying to conceive, she should know there actually is some hope, tempered though it may be. The chances are certainly smaller than when she was 25, and even 35. But that’s immaterial now. And it doesn’t by any stretch mean there is no chance. This point bears stressing and examining in the absence of comparisons with younger women.

Besides having given birth to a healthy baby conceive naturally when I was 45, I’ve also been unusually lucky to have heard from almost 1,000 women, aged 40+ who are trying to conceive or who are already pregnant and who have found me through this blog, then gone to my book’s website to contact me. I love hearing from all of you and am grateful to be privy to some of the uncensored thoughts, concerns, questions, and emotions being shared among this population.

Especially for those women 42 and older who get in touch, I hear frequently that they’ve either heard or just feel they have “no chance,” a “0%” likelihood of becoming mothers with their own eggs. A significant number also tell me they feel ashamed, have been told they’re “crazy” for thinking they might have a shot. These are the women I’m writing this for now. (And you go, ladies, for trying!)

Overlooked Stats Show Hope for Women 40+

Census statistics on live births & medical abortions

https://www.cdc.gov/nchs/data/vsrr/report002.pdf: According to the Center for Disease Control and Prevention, in 2016, there were 111,848 births, (1.1% of population) to women 40-44. This covers all births, not just births to women who were trying to conceive, suggesting that if all 40-44 year olds in 2016 tried to conceive every month, the percentage of women in this age group who’d had babies would be considerably higher. To women between 45-54 (with the great majority falling between 45-49), 9,025 babies were born.

Combining these stats with those on abortion in 2015 for the 40-44 age group, (20,962)–the latest age group and last year in which statistics were collected–and then dividing this number by 3 (accounting for expected 33% miscarriage rate in this age group), we could expect to add around 7,000 babies, totaling close to 120,000 births. This number would actually be a low estimate, since many miscarriages occur before scheduled abortion dates.

All together, we could expect between 125,000-130,000 live births in 2016 to women 40-49. Put into context, that’s a population of babies likely greater than the total population of most of our hometowns.

Perhaps most significantly, these statistics hold steady or decline only somewhat when viewing births before egg donation was available in the US (See births 1933-1998 @ https://www.cdc.gov/nchs/data/natality/mage33tr.pdf.)

Sterility & menopause

https://www.ncbi.nlm.nih.gov/pubmed/12268772: According to a review of the literature pertaining to declining fertility with age, the likelihood of permanent sterility at age 40 is about 40% and at age 45 is about 80%, meaning one of out every five 45 year olds should be able to become pregnant at some point during their 45th year.

http://www.healthline.com/health/menopause/pregnancy#1: As explained by executive director emeritus of the North American Menopause Society Dr. Marjory Gass, pregnancy even in the mid-to-late 40s is not impossible for most women. “Never assume, ‘Oh, I’m too old to get pregnant,’” Gass has said. “Unless you have gone a year without a period–the technical definition of menopause—pregnancy remains a possibility.”

Birth defects & miscarriage

I get a lot of questions over email and on this blog about whether getting pregnant in the 40s, especially in the mid-40s, guarantees a miscarriage or a child with a genetic abnormality. Many women, myself included, field questions from family members about whether it’s even wise to get pregnant or hope for a positive outcome given the dire statistics on Downs, etc., for older mothers.

When viewed from the perspective of high the risks are compared to pregnancy at 25, the numbers do look grim. But when viewed from the perspective solely of the chances for a healthy baby at various ages throughout the 40s, the numbers are much more hopeful (and again, relevant):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071156/: “For women at 42 years of age, more than half of the intended pregnancies (54.5%) resulted in fetal loss…The risk of spontaneous abortion [was] 84.1% by the age of 48 years or older.” So yes, these are scary statistics, and they aren’t great, but they are better than many people fear and assume, especially if we look at them in reverse, from the perspective of a positive outcome rather than negative: a 45% chance of success for a 42-year old to carry a pregnancy to term, and even a 15% chance of success for a 48-year old.

https://www.ncbi.nlm.nih.gov/pubmed/6455611 & https://embryology.med.unsw.edu.au/embryology/index.php/Genetic_risk_maternal_age : The estimated rate of all clinically significant cytogenetic abnormalities at age 40 is 15.8 per 1000, meaning we can expect between 98-99% of all babies will be born genetically healthy. For age 45, it’s 53.7 per 1000, or between 94-95% of babies. Even for women giving birth at 49, only 12.5% of babies will carry a genetic abnormality, meaning 87 out of every hundred babies will be born genetically average.

So if you’re out there now and are trying to conceive in your 40s, please know that I’ll be keeping you in my thoughts and hoping you have the same good luck I—and almost 9,000 other women aged 45-49 in the U.S. last year—had. And please know that I and thousands of other women are out there, pulling for you.

Note: For more about trying to get pregnant, you can also see An Honest Take at Getting Pregnant Naturally at 45Getting Through to Getting Pregnant at 45 and On Delivering My First Child at 46, other blog posts I wrote in the hopes of supporting people slogging through infertility, although some of the content from these is reproduced in this post.  Based on requests in the comment section of this blog and through email, I’ve started a new online group, New Mothers at 45 and Up, and I welcome you to join us there. Finally, if you’re still interested in my path to motherhood later in life, the story of how I met and fell in love with my husband and then went through years of IVF and finally got pregnant naturally, is in my book The Good Shufu

Advertisements

118 thoughts on “Why It’s Not So Rare to Get Pregnant after 45

  1. I needed to read this today. Past few days have been a roller coaster and my hope has been wavering. We’ve been TTC since Jan 2017. First go round we had 3 miscarriages & 2 chemical pregnancies…so, we had a great conception rate that first year. Had a uterine fibroid removed last April and we had to wait at least 8 months. We started again as soon as we could on this second round of trying. I found out I was pregnant right before Mother’s Day, got my period, but was still getting positives on home tests, oddly enough. I had so much hope I had a little fighter. Blood tests revealed yesterday that hCG wasn’t doubling. It was very low to begin with and only went up by 1 point in 48 hrs. Needless to say, tears set in. “Chemical pregnancy”. I go in tomorrow for one more blood test to confirm the loss. My birthday is tomorrow, too. 44. Feels like extra salt in the wound with this happening around Mother’s Day and my birthday, which had originally given me a great sense of divine intervention. I had a few questions, given it was odd to have a positive test while on my period, so the doctor felt the need to remind me of miscarriage rates at my age…kinda already know that, definitely no need for the reminder…I think anyone, regardless of age, would have questions if they were pregnant while having a period. I knew the TTC journey would not be an easy one at my age. I never took that fact lightly. All the same, it does get hard to brush these losses off with the reasoning of “well, at least I know things are working ok; just need to find that golden egg.” I only tell the closest to me when I get pregnant, so I have some level of support. My husband, mom, and one of my best friends are wonderful. My brother is also great, even if the well-intentioned question of “are you going to keep trying?” stung in a way he can never understand. The half baked concern from my other best friend is, umm, transparent. I just really sense that she thinks I’m wasting my time. It hurts, so I should probably keep her out of my loop of TTC support going forward. It’s hard enough to stand for this dream at my age, but I think the hardest can be the doubt and judgement from others…the reminders they give you that play into your own fears of it not happening, the am i crazy, the what if my ship has sailed, the what makes me think I could be one of the lucky few. It’s hard having no one in my life that truly understands what this journey is like. So, yes, I really needed to read this post today. Thank you for this jolt of hope. I needed this reminder, to know there are others out there who really get it, to feel not so alone in my journey. Hold tight all of you out there still trying at our age. I hold all of you in my heart. It may not be like others’ journeys, but this is OUR journey. We have the right to have one of our own just like any 20- or 30-something year old. We’ve got this!

    Like

  2. This article was very inspiring. I recently was told by my gynecologist I have almost no chance of conceiving without some form of fertility treatment at my age (47). While do I understand why she told me this, it pains me to think my chances are slim to none to conceive on my own.

    After reading your article, I do have some hope. Although I understand the reality of what the statistics say for women my age, I want to maintain some glimmer of hope and optimism that I can do this using my own body’s resources. I feel and work hard at being healthy.

    Thank you for this article.

    Like

    1. Believe you can do it! Pun intended. Anyhow my grandmother had a natural baby at 47yrs old. I truly believe that some women’s eggs age later than others. Plus most people do not eat healthy or exercise in thier 40s, which affects eggs. I had my eggs frozen in my 30s but even then the doctor said my eggs tested in the range of a 21 yr old woman.

      Like

  3. My grandmother had her last child naturally at 47yrs old. And my aunt had her last child naturally at 46yrs old. Both were healthy. They were Foriegners. I believe the American diet of preservatives and freely taking birth control messes with fertility

    Like

  4. I just wanted to let everyone know there is hope. I had my 8th baby conceived naturally at 44 years old. I used systemic enzymes (Wobenzym) so I wouldn’t miscarry. I will be 46 soon and still breastfeeding.

    Like

Leave a Reply to sandra olson Cancel reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s