What are the chances of getting pregnant after 45?

Women are born with a fixed number of eggs, (about one million) and at puberty, only about half of these are viable or destined to make a baby. According to Dr Franklin Wasswa, a general practitioner, the older you get, the more your remaining eggs become less viable to be fertilised. 

Therefore, at 45 years of age, the largely considered start of menopause, a woman’s chances of conception are limited. However, the menopause age varies with individuals. 

“One can predict their age of menopause by looking at the age of their mother’s onset of menopause. Therefore, chances of one conceiving reduce as they age and highest between ages 25 to 30. Infertility can, thereafter, kick in and this is defined as failure to conceive after consistent attempts for 12 months,” Dr Wasswa shares. 

Dr Spire Kiggundu, a gynaecologist and obstetrician, says one percent of women ovulate past 40 years, and this could be tagged to good lifestyle choices such as exercising and eating healthy foods. Diets rich in processed foods lead to obesity, a major challenge to ovulation and conception. 

“Additionally, someone with a body mass index (BMI) above 24 ages faster, which also affects reproduction. Another reason for ability to ovulate past 40 is genetics,” he says.

Possibility of conception
Dr Wasswa says the general rule of thumb is that if a woman reaches 45 years of age, even the probability that In vitro fertilisation (IVF) will work is one percent. 

“India has the highest success rates, most probably because they have a number of fertility clinics with less stringent laws on the procedure unlike in the EU or North America where a number of laws govern IVF. As such, there are many post-menopausal pregnancies,” he says.

“However, if a woman has no more viable eggs, her organs cannot handle pregnancy or the man’s sperm is of low quality, there are other options such as surrogacy or a donated sperm or egg,” he says.

Risks 
That said, Dr Kiggundu says there are still risks associated with this including:

Incompetent embryos: Aged eggs usually have poor DNA, as is the case for women in menopause and either such eggs will fail to fertilise or the baby will have abnormalities such as Down’s syndrome among others. Dr Wasswa emphasises that as men age, their sperm quality also reduces and this can play a role in infertility.

High miscarriage rates: Even in a normal pregnancy, Dr Kiggundu says, chances of a miscarriage are high owing to low hormone count. “Progesterone and oestrogen counts reduce as one ages yet these are responsible for reproduction among women,” he says.

Failure to attach: The inner lining of the womb is also not well prepared, which is also due to low hormone count. “That way, the uterus cannot hold the foetus well,” Dr Kiggundu shares.

Ailments: Diseases such as diabetes, hypertension, and pre-eclampsia are more likely to arise during pregnancy, which is life threatening.

Slow labour: Women in this age bracket suffer because labour does not progress easily. “Often times, the preferred birth method is a caesarean section,” Dr Kiggundu shares.
Chronic diseases: Even when one takes care of themselves well, Dr Kiggundu says, some have chronic illness such as diabetes, and high blood pressure, sometimes owing to genetics and these make the pregnancy very problematic.

Downside of IVF

While IVF is a safer and quicker option for such women, Dr Wasswa says the challenge is the number of injections one has to take to prepare the ovaries and uterus, which may not be pleasant. 

“They alter mood, psychology, and body physiology just like pregnancy does. Once there is a successful conception, because of the menopausal age, all the risks of pregnancy are up a notch. However, we have come to notice that it is not any different for a regular pregnancy. The only difference is that in this case, the couple do not want to risk anything. Otherwise, IVF has come so far that it has become cheaper and we do not have to implant multiple eggs to increase chances (where applicable) because that leads to more pregnancy complications such as miscarriages, preterm labour,” he explains.

Dr Wasswa adds that unless there are pregnancy complications, children born by IVF are normal since the process does not alter the egg in any way. 

“IVF does not leave any complications for the mother because it is like any other pregnancy attempt,” he adds.

Special care 

By the time a woman starts IVF, they are having fertility issues. Therefore, it is advisable to continually seek help and advice from a professional. 

“That ensures that all goes smoothly and you achieve a good result. IVF can also be used to get donor eggs as well as once stored eggs for later use. Even then, one needs some extra attention to make sure the whole process is smooth,” Dr Wasswa highlights.

Full pregnancy
While the possibility for miscarriage is undeniable, as a rule, it is better for any pregnancy to reach term as that makes it good for the baby’s development in and later outside the womb. 

“However, for some reason, under professional care, we can deliver the baby earlier. For example, in situations where we have many eggs in the uterus for better conception chances, we get multiple pregnancies (twins or quad), and that may lead to preterm deliveries. Also, when IVF is the conception method, you will need to have a professional to walk with you all the way,” Dr Wasswa mentions.

Benefits of having a baby after 40
Having a baby while you are older may come with various challenges. However, it also presents some unique benefits:
● You are more emotionally prepared for parenthood.
● You might be more financially stable; hence, you might not feel the financial pinch of raising a child.
● You are more prepared to focus on family, having checked off many life goals, including career, travel, and education. You are more settled and prepared to make solid decisions concerning the upbringing of your child.