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

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Navigating a Safe Pregnancy in Your 40s

I’m so touched by all the emails I get from women trying to conceive in their 40s and from people interested in pregnancy at a later age. One person I loved hearing from through this blog is reporter Kristine Crane, who writes about women and health for US News & World Report‘s Wellness section. Her latest piece is “Navigating a Safe Pregnancy in Your 40s,” and it starts with our story, then goes on to look at those of other women, couples, and doctors involved in later-life pregnancies and the quest to conceive in your 40s:

At age 45, Tracy Slater, an American expat writer living in Osaka, Japan, resigned herself to the fact that she might never be a mother. After a few years of failed fertility treatments and two miscarriages, she and her husband continued trying to have a baby – but shifted their focus to Slater’s husband’s dying father.

So when Slater developed what they assumed was a stomach bug, they figured she had picked it up at the hospital while visiting him. But it turned out she was seven weeks pregnant. “They already saw a heartbeat,” Slater says. “And I’d been drinking one or two glasses of wine a night, and a cup of coffee everyday.” In addition to drinking alcohol and caffeine – not advised for women trying to conceive – Slater was also overwhelmingly stressed over the prospect of losing her beloved father-in-law.

In other words, she was not in ideal fertile conditions – and yet, she had become pregnant with her daughter. “I still have dreams they made a mistake. I still can’t believe I carried to term this healthy child,” says Slater, author of “The Good Shufu.”

While Slater’s outcome is certainly not the norm, and one she attributes to good luck, it’s increasingly common to see women in their 40s have successful pregnancies – through IVF, egg freezing, donor eggs or more rarely, as in Slater’s case, natural conception.

According to the Centers for Disease Control and Prevention, pregnancies among women in their 40s has increased by about 2 percent per year since 2000. In 2014, there were 10.6 pregnancies per 1,000 women in this age group.

Read the full article here at US News & World Report

 

The fastest way to get in touch with Tracy is here.

(Note: For more about trying to get pregnant, you can also see An Honest Take on How I Got Pregnant Naturally at 45,  Getting 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. I’ve also gotten quite a few questions about my pregnancy and birth experience, and I’ve written a bit more about those in the Washington Post online and in Brain, Child Magazine online — although please note that the picture in this latter article is not my daughter! It’s a stock photo the magazine used. In any case, I will continue to keep you all in my thoughts. Finally, if you’re *still* interested in my story [bless you for your patience if so!], 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.)

The Draconian Midwife

Before I got pregnant, I’d heard from my Western friends in Osaka that Japanese midwives and doctors are very strict about weight-gain for expectant mothers. Pregnant women in America are told that “normal weight gain” falls between 25 – 35 pounds. In Japan, it tops out at 10kg, or 22 pounds.

At 5’5″ and 118lbs when I conceived, I figured weight-gain in pregnancy wouldn’t be a big concern for me. After-all, I’ll be 46 next month and had gotten pregnant naturally at 45 and 1/2, against all expectations. Weight gain, when I learned I was actually knocked up and not sick with the stomach flu, was the last thing on my mind.

Apparently, the midwife at my maternity hospital here would like to disabuse me of my laissez-faire attitude towards my growing belly.

At my last appointment, I was about 1.5 kg over target. In addition, the baby’s heart was still beating and the chromosomal screenings came back all-clear. I couldn’t have been happier. Until that draconian midwife beckoned my husband and me into her office.

In Japanese with my husband translating, she informed us that I was already entirely too fat. She admonished that Americans like juice, and I needed to stop drinking juice right away. Although I asked my husband to explain that I don’t drink juice, she remained unmoved. She encouraged me to weigh myself every night and every morning, so I could remember how fat I was getting. Then, despite it still being late summer, she brought up the holidays. December was around the corner, she warned, and then she switched into broken English, seemingly for emphasis: “So please don’t enjoy!”

In my own broken Japanese, I tried to explain that I didn’t celebrate the holidays. “Why not?” she wanted to know.

I couldn’t remember the Japanese word for Jewish, so I asked my husband to translate again. A brief conversation between the two of them ensued about what “Jewish” meant, and it seemed to distract her for a moment. Veering off course from my apparently egregiously ample belly, she inquired about what I celebrated in December, if not Christmas.  Next followed a rough explanation of Chanukah, although, I explained, adults don’t usually celebrate it, since it’s mostly a holiday for kids.

She mulled this information over for a few moments, uncharacteristically silent. “Well,” she finally told me in Japanese, “You’ll still probably be too fat in December!”

After my husband translated this last bit for me, we both couldn’t help but giggle. And I still can’t get worked up about her distress. If I end up becoming much more than 1.5 kilos over the Japanese target, if I develop high-blood pressure or gestational diabetes, if I stop being able to eat healthily and start scarfing down sweets, then I’ll start taking her diatribes more seriously. As I said, I’m still in shock over my luck that, if all continues to go well, I’ll turn 46 in about 3 weeks and be 24 weeks pregnant. I don’t have any room in my psyche for distress over 1.5 extra kilos. In fact, as I reach the 21-week mark now, I think I’ll celebrate with a fresh glass of juice.