Dr. Meike Uhler, a physician board-certified in both obstetrics and gynecology and reproductive endocrinology and infertility, shares answers to the top questions she hears about conception and pregnancy over 40.
How does age impact a woman's fertility potential?
Fertility is most affected by age and age is the single determining factor for the likelihood of a patient achieving pregnancy. Age is so important because the egg is so important. With increasing age, the chance of pregnancy decreases while the chance of miscarriage increases and the chance of having a baby with a chromosomal abnormality increases. All three factors are related to the age of the female patient.
Are there some DIY tips that can help women assess their fertility?
One of the steps a patient can take is to check to see if she is ovulating. An easy way to do this is to buy one an over-the-counter ovulation predictor kit in the drugstore that measures the hormone LH, or luteinizing hormone, which rises right before ovulation. It’s a simple test - you urinate on the stick and it will change color (or not) within five minutes. This helps establish whether the woman is releasing her eggs during ovulation. If she doesn't want to do that, she can track her basal body temperature or check cervical mucus.
How long should women try to conceive on their own before seeking help?
The definition of infertility is trying to get pregnant with one year of no success for a woman under the age of 35. And that time is shortened to six months at over age 35. And I think that's important because the older the woman is, we want to more quickly ascertain if there's a problem and then potentially start treatment if needed.
Are there any reasons why a woman should see a specialist sooner than that?
Yes, depending upon the situation. For example, a woman with very irregular cycles may be many, many weeks between cycles and there is probably a problem. Perhaps she knows that she has had a problem with her fallopian tubes in the past or endometriosis in the past. If a patient thinks that she has a problem, she should trust herself. It's better to see a doctor earlier than later.
What are the chances of conception each month at 40 and above?
Approximately 5% per month or less. So it does get harder at age 40 and above.
Once pregnancy occurs, should women over 40 visit an OB-GYN sooner due to risk?
It's a good idea so that the OB-GYN can monitor the patient more closely. Sometimes, blood tests are needed or an early ultrasound. I think it's prudent.
What are some of the risks associated with pregnancy later in life?
Some of the risks include an increased risk for cesarean section, increased risk of high blood pressure in pregnancy, diabetes in pregnancy. So these are some of the other things that can be associated with a pregnancy that happens at age 40 or older. It is important to have a good doctor with a good rapport that understands these potential problems.
How can women mitigate some of those risks?
I think these all have to do with lifestyle changes. So if the woman is smoking, then we of course encourage her to stop. If the body mass index is high, then it would be nice to try and lose weight before pregnancy, if possible. It is important to only use medication that is acceptable in pregnancy. These are things that can be done ahead of time to try and optimize pregnancy outcomes.
Is there an increased chance of twins or multiples with age?
Yes, because as women age, their follicle-stimulating hormone levels are higher and sometimes this can release more than one egg, which then can increase the risk of twins.
How does age factor into pregnancy loss?
Unfortunately, an increase in age is accompanied by an increase in miscarriages. The quality of the eggs is the main factor, because the older the woman is, the less of the good quality eggs remain. All women are born with as many eggs as they will have for the rest of their life. When all those eggs are used through menstruating every month and releasing an egg, then at approximately age 50, all women will undergo menopause. In which case, there will be no eggs left. So it makes sense that the better quality eggs are released first and then towards the end of the reproductive life, those eggs are lower quality and eventually, there will be no eggs left. That is the definition of menopause.
Is there anything women can do to improve the health of their eggs?
There are some vitamins that can be taken to help improve egg quality. We also support complementary medicines such as acupuncture, which can increase blood flow to the ovaries, or other forms of treatments such as yoga. Lifestyle changes help as well - stopping smoking, being moderate in alcohol and caffeine intake and, of course, no other drug use unless prescribed by a physician for a particular medical illness.
At what point should someone consider donor eggs?
That is a good and a hard question. Usually, if a woman has undergone several cycles of IVF and the egg quantity and/or quality has been low, then it makes sense to consider potentially going to donor eggs. The success rates are very good with donor eggs. The donors are usually between 21 and 30 years old. And the average age of the recipient, which is the woman receiving these eggs, is in the 40s. The pregnancy rates are quite good because of the egg quantity and the egg quality of the donors.
What fertility treatment is commonly done for women over 40?
Generally, we recommend in vitro fertilization. We can try and have the woman produce as many eggs as possible, take them out, put them together with sperm in a test tube and then transfer the embryo back a few days later or do genetic testing of the embryos so we can transfer back a normal chromosomal embryo. Other treatments such as intrauterine insemination or mild fertility drugs are less successful. And therefore, we do want to prescribe the best treatment for a woman who is 40 or older.
What should couples know about genetic disease in relation to aging?
This comes back to the question about age and its effect on eggs. It is possible that if a woman were to do in vitro fertilization, we can take out her eggs and fertilize them with her husband's sperm. When the embryo develops to what we call the blastocyst stage, which is about five days after the initial retrieval of the eggs, then these embryos can be tested for chromosomal abnormalities, and we can optimize pregnancy outcome by transferring back an embryo that we know has normal chromosomes.
While conception and pregnancy can be harder with age, we want people to know that the odds are in their favor. Can you share some positive statistics with us?
If we can transfer back one embryo that we know has normal chromosomes, then that substantially increases the chance of pregnancy in women over 40 to approximately 60 to 65%. That would be a very, very good statistic for transferring back a normal embryo.
What would you say to someone who's trying to conceive and is nervous or afraid to seek help?
There are many people in the same situation. You may or may not know about it, but there really are, according to all the statistics. And the doctor, her OB-GYN, is very familiar with infertility over 40, so please go and ask for a referral. Talk to your friends. Go see an infertility doctor. There is no reason to be nervous. And if you are nervous, then I'm sure the doctor can put you at ease. In our practice, we have clinical psychologists who help patients who need extra coping and extra help along the way from an emotional point of view. There is a lot of assistance throughout this process. It can be time-consuming and it can be emotionally draining, but we feel that we have the resources to help patients through it.
Can you share some words of hope with our listeners?
The most important thing to know is that you are not alone. We have many women in the same situation and there is help. Science has advanced considerably in the last few years and more and more advances are being made every day. So take advantage of the fact that we have excellent technology to help. And please seek out help because chances are there is help for you.
Dr. Meike Uhler is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.