Pregnancy: What every woman in her 40's Should know

Perhaps you've put off pregnancy to concentrate on your career, or because it’s taken you a while to find the right partner. Or perhaps you've been trying for a baby for a while, and your 40th has come and gone. The burning question for you now is, "Have I left it too late?"

The answer is "no"! Many 40-plus women do conceive, although there's no denying that your odds of getting pregnant are a lot lower than just a few years ago.

What are my chances of getting pregnant naturally in my 40s?

It depends how far into your 40s you are. At 40, your chance of conceiving is about 20 per cent (based on the average annual rate of pregnancy per cycle), falling to less than five per cent by the mid-40s .

After 45, you're far less likely to fall pregnant naturally. As early as 15 years before you go through menopause, the number of your eggs begins to decline.

Your reduced fertility is not just about the number of eggs you have, though. It's also about their quality. By your 40s, the eggs that your ovaries release each month are more likely to have structural problems (chromosomal abnormalities).

Chromosomal abnormalities in your eggs can raise the risk of miscarriage and birth defects. This is why both these complications are more common in older women.

What are my chances of getting pregnant with fertility treatment?

There's never been a better time to try to get pregnant as an older mum, given the range of fertility treatments available. Treatments such as IVF and ICSI are being refined all the time.

In your early forties you have about a one in five to one in 10 chance of a live birth per treatment cycle . From age 43 onwards, success rates fall to around one to five live births for every 100 women . From 43 to 44 onwards, your chances of success using your own eggs really are minimal, because conception rates per cycle of IVF are so low.

You may wish to explore the idea of using donor eggs or frozen embryos to try to conceive, as it will increase your chances of having a baby .

The risk of miscarriage and chromosomal problems is consistent with the age of your egg donor, who will be in her 20s or 30s.

What are the pros and cons of having a baby in my 40s?

Pros

Probably the greatest advantage of waiting to have children in your 40s is that you are emotionally and financially ready for them. You've had time to see the world, and you're more likely to be secure financially and comfortable in your career.

If you've been with your partner for a while you will have had the chance to get to know each other in all sorts of circumstances. This will provide a solid foundation for raising a family.

As an older mum, you'll be in a good position to make wise parenting decisions. Your life experience means you'll feel pretty confident about your approach to child-rearing. You're also more likely to breastfeed, which is good for your health as well as your baby's.

Your income is likely to be higher, as you will have had time to establish yourself in your career. You'll probably go back to work more quickly, and at a higher level of pay than younger women. That's the case even if you go back to work part-time.

Being financially secure has its benefits. It's estimated to cost about £13,000 a year to care for a child between the ages of one and four.

By the time you reach your 40s, you may have a sense that you've been there, done that. You'll be less concerned with your own needs, and will be happy instead to focus on your child.

If you do get pregnant in your forties, you may achieve the family you want in one go! From your mid-40s, if you conceive naturally, you have a one in two chance of having twins.

As you approach the menopause, your hormones work harder to release an egg from your ovaries. This often results in two eggs being released at the time of ovulation. The two eggs can be fertilised and implant in your uterus, resulting in non-identical twins.

If you have assisted conception, the follicle-stimulating hormones you'll be given also increase your chances of conceiving more than one baby.

Cons

If you do conceive, you are more likely to need extra care during your pregnancy. So most of the cons below are to do with health rather than lifestyle.

If you do develop health problems, your doctor will classify your pregnancy as high risk. This may sound alarming. But what it means is you'll get the care you need to ensure you and your unborn baby stay as well as possible.

You're twice as likely as a younger woman to experience:

• gestational diabetes
• pre-eclampsia
• high blood pressure
• placenta praevia (low-lying placenta)
• placental abruption, where the placenta comes away from the uterus (womb) wall

The birth experience for women over 40 may be harder too. You're more likely to have:

• a caesarean section
• your baby presenting in an awkward position at birth
• your baby being born with a low birth weight
• your baby being born too soon

The odds of chromosomal problems also jump as you get older. About one in 200 babies born to women aged 40 or over have Down's syndrome. This compares with one in 700 babies born with mums aged 35 to 39, and one in 1,500 babies born to mums aged 20 to 24.

All women are offered screening tests in pregnancy for genetic conditions, such as Down's syndrome. Your age will be factored in to the result to give you a risk of your baby having a problem. So you may find that diagnostic tests, such as amniocentesis or chorionic villus sampling are suggested, to check for chromosomal problems.

Sadly, the increased change of chromosomal problems also increases the likelihood of miscarriage. Half of all pregnant women aged 42 experience miscarriage. This disheartening figure rises to three quarters for women aged 45 years or more.

It may seem like there's a long list of all the things that can worry you as a 40-plus mum-to-be. But keep in mind that there are plenty of women in their 40s who have trouble-free pregnancies and perfectly healthy babies.

What should I do if I want to get pregnant?

Age aside, there are steps you can take to give yourself the best chance for a normal pregnancy and a healthy baby. Read our tips to help you prepare for pregnancy.

You can make changes to your lifestyle to help your fertility. If you smoke, now's the time to stop. And staying fit, keeping a healthy weight and cutting back on alcohol are all advisable.

If you are in your 40s, and have been having unprotected sex two to three times a week for three months, without getting pregnant, see your GP. She will carry out some blood tests to see if there is a medical reason why you're not conceiving.

Some medical problems can make it harder to conceive. See your doctor before trying for a baby and if you have or have had:

• irregular periods
• polycystic ovary syndrome (PCOS)
• sexually transmitted diseases

You and your partner should also see your doctor straightaway if your partner has a known fertility problem.

You're likely to be referred to a fertility specialist sooner rather than later. Most specialists start with blood tests and investigations to check your fallopian tubes or your partner's sperm.