Author Name: Dr. Sonali Gupta || Mentor Name: Dr. Rinoy Sreedharan on April 27, 2020

In today’s world more women are pursuing higher education and looking towards financial stability in their life. They have become career oriented which has helped them become independent. As a result more women are getting married around 35 years of age or later. Due to this, the mean age at first pregnancy is also slowly rising, with many women approaching Fertility Clinics for the first time at 40 years of age for help in conceiving.

Problems associated with pregnancy at 40

1. Postponing parenthood may result in difficulty in conceiving. With increasing age in females, the ovarian reserve or the number of eggs that a lady has, reduces drastically translating into decreased chances of natural pregnancy. Moreover there is a rapid decline in quality of eggs too due to which the chances of miscarriages also may increase.

Research has shown that a 40 year old female seeking fertility has only 25 % chance of pregnancy with own eggs and it decreases to 1.6% at age of 44. If she conceives, the risk of miscarriage is around 25% at 40 years and around 50% at 44 years.

2. At the age of 40 and above, the incidence of medical problems like Diabetes Mellitus, High Blood Pressure is more. These may get aggravated during the course of a pregnancy.
3. The incidence of placental abnormalities is higher .
4. If a lady gets pregnant with her own eggs at the age of 40, the chances of having genetic problems is more. This risk can be reduced by opting for donor eggs as these eggs are of a much younger lady.
5. The risk of preterm delivery is more.
6. The chances of delivering a low birth weight baby is increased.
7. Chances of having a Caesarean section are higher at this age.

What are the Tips and Tricks to get pregnant at the age of 40?

1. Do not wait too long for natural conception
Several studies have shown that the chances of conceiving naturally is as low as 5-10 % the age of 40. This can be attributed to the diminished quality of eggs at this age.
2. Approach a Fertility Consultant for guidance.
You should visit a good fertility consultant to understand the challenges of child bearing at this age, get necessary investigations done and to choose the right modality of treatment according to the reports of your tests.
3. Assisted Reproductive Technology- ART like IUI- Intrauterine Insemination and IVF- In Vitro Fertilisation should be opted for.
4. IUI – Intrauterine Insemination is a process where processed sperms are directly injected into the uterus around the time of ovulation. However, it has a success rate of less than 10% in this age group. So, one should never be over-dependent on this modality of treatment to get a positive result.

5. IVF- In Vitro Fertilisation is a process wherein the eggs in the ovaries of a female are collected after giving a course of injections and then fertilised with sperms in the laboratory, followed by culturing in advanced incubators for embryo formation. The embryos are then transferred back into the uterus of the lady. With your own eggs, you have a 20-25% chance of conceiving using IVF at this age. However with each passing year the success rate dips drastically.

6. Donor egg IVF- IVF with a lady’s own eggs may not be possible in all cases due to a very poor ovarian reserve or due to the lady being on the verge of menopause with hardly any eggs left in her ovaries. These ladies can opt for a Donor egg IVF cycle where eggs are borrowed from a healthy egg donor and fertilised with sperms in an IVF lab followed by embryo formation and transfer back into the uterus of the infertile lady. Donor egg IVF greatly enhances your chances of getting pregnant at 40 with almost double the chances of success as compared to using your own eggs.

7. Plan in advance
If you realise at any point earlier in life that you may have to delay child bearing till the age of 40- then it is a good decision to freeze your eggs. The advantage of this process is that you have a good chance of getting pregnant with your own eggs using IVF bat 40 also as the age of the eggs at the time of freezing was less than 40yrs.

8. Proper treatment of pre-existing medical illnesses Medical illnesses like diabetes and high blood pressure should be managed well before attempting to conceive.

9. Lifestyle Modification A healthy balanced diet, adequate sleep, exercise and hydration is vital for your overall health and an uneventful pregnancy.

Due to advancements in the field of infertility treatment, having a baby at 40 years is no more a dream. Keeping a positive mindset all through the process and discussing all issues with a fertility expert and following their instructions can help you attain the joy of motherhood.

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