How to Increase the Chance of Pregnancy at Advanced Maternal Age?

Many women decide to get pregnant at a relatively advanced age for various reasons. Since female fertility decreases with age, one of the main concerns of women is how to preserve their fertility and overcome possible fertility problems.

It should be said that pregnancy at an advanced maternal age increases reproductive risks such as female infertility or birth defects. It may also lead to complications for mothers and babies. Read on to learn about the factors that can help with a successful pregnancy at an advanced age.

When Is the Best Age to Get Pregnant?

Actually, the best age to get pregnant is when the couple is ready. However, since women have different reproductive powers at different stages of their lives, they may face challenges to get pregnant as they age.

Girls have a certain number of eggs when they are born, known as ovarian reserve. With aging, the follicles containing eggs are destroyed and decreased over time due to menstruation and other natural interactions of the female body.

Why Does the Chance of Pregnancy Decrease with Age?

Different factors can cause female infertility, the most important of which is aging. Female aging can lead to the following risk factors:

• Reduced vaginal discharge and thinned endometrium lining;
• Short and irregular menstrual cycle;
• Diminished ovarian reserve;
• Increased risk of chronic diseases and reproductive problems such as polycystic ovary syndrome, chlamydia, and endometriosis.

What Age Is the Advanced Maternal Age?

As said above, it is not possible to determine the threshold of advanced maternal age accurately; however, it is considered to be 35. Even with the development of assisted reproductive technologies such as egg freezing and embryo freezing through IVF, it is still not possible to be safe from the risks of pregnancy at an advanced age such as multiple births.

According to research, the chances of pregnancy drops by age 40. Although, this does not mean that women over 40 are infertile. However, they are at a higher risk of pregnancy-related complications than women at younger ages.

How much Is Female Fertility in Different Life Stages?

Female ability to get pregnant begins from the first period cycle and continues until menopause (end of menstruation). The chance of a successful pregnancy is 30% in a monthly cycle in fertile couples under normal conditions. However, pregnancy-related risks are not the same at all ages and may be associated with a higher risk at certain times.

According to OB-GYNs' advice, the best time to get pregnant for women is their 20th. The reason is that they have enough physical ability to endure the pregnancy in this decade. On the other hand, from their 30th, women's ability to have children decreases. Female reproductive ability falls drastically after the age of 37.

Read on to learn some important information about pregnancy at an advanced age:

Pregnancy in the 30th (30 to 39 years old)

Women's ability to get pregnant gradually decreases after 32. This reduction rate gets faster after the age of 35 and after the age of 37, only 25,000 eggs will remain in the woman's body. Therefore, the chance of pregnancy by the age of 35 and after 3 months of trying will be about 12%. 

The risk of birth defects and miscarriage will also increase after 35. Therefore, it is recommended that over-35-year-old pregnant women be under the supervision of a doctor and perform more tests regarding the health of the mother and the baby.

Pregnancy in the 40th (40 to 49 years old)

According to statistics, the chance of pregnancy is around 7% by age 40 and after 3 months of trying. It drops to 5% by age 42 and 2% by age 44. Furthermore, since the quality and quantity of eggs decrease at these ages, the risk of birth defects will increase. 

Women aged between 40 to 50 years old are at higher pregnancy-related risks as follows:

• Premature birth;
• Forced C-section;
• Ectopic pregnancy;
• Stillbirth;
• Low birthweight;
• Chromosomal conditions, such as Down syndrome;
• Miscarriages.

Although, pregnancy at an advanced age may have disadvantages, it brings some advantages as well. Children who are raised after the age of 40 can spend more time with their parents as they are less busy.

What Are the Risks and Complications of Pregnancy at an Advanced Age?

As same as pregnancy at other ages, pregnancy at an advanced age requires special care. However, the risks and complications of geriatric pregnancy will be more than other ages. 

The complications of pregnancy at an advanced age on mothers:

• More overweight;
• Fatigue and weakness;
• Stretch marks;
• Saggy breasts;
• Sarcopenia (loss of muscle strength and function);
• Preeclampsia (High blood pressure);
• Cesarean section due to placenta formation and cervical stenosis;
• Occurrence of various types of bleeding, especially during the first trimester of pregnancy, due to placenta previa or placental abruption;
• Increased risk of gestational diabetes;
• Premature birth.

The complications of pregnancy at an advanced age on babies:

• Higher birth weight - more than 4 kg - or fetal macrosomia due to maternal gestational diabetes that can lead to C-section or birth injuries;
• Fetal growth restriction;
• Chromosomal conditions caused by reduced number and quality of eggs and frequent miscarriages;
• Down syndrome.

What Are the Complications of Pregnancy at an Advanced Age on Childbirth?

Pregnancy at an advanced age may cause negative and sometimes serious effects on childbirth such as stillbirth and forced cesarean section. Although, it does not affect breastfeeding.

A stillbirth occurs when a baby dies after 28 weeks of pregnancy due to the placental dysfunction that prevents the delivery of nutrients and oxygen to the baby. This can make the pressure of childbirth unbearable for the baby and will result in fetal death. The forced cesarean section can also happen due to inadequate uterine contractions at an advanced age.

How to Increase the Chances of a Healthy Pregnancy at an Advanced Age?

In order to increase the chances of a successful and healthy pregnancy at an advanced age, it is recommended that older women take some measures before and even during reproductive technologies, the most important of which are as follows:

Doing Pre-pregnancy examinations

Performing pre-pregnancy checkups and getting gynecology consultations about pregnancy at an advanced age are one of the most important measures that help women identify any physical problems and disabilities in having children. They also will have an accurate and effective plan for a healthy pregnancy.

Performing regular and timely examinations

Women can improve the chances of a healthy pregnancy and reduce pregnancy-related risks at an advanced age by taking timely examinations and checkups. Performing regular tests, ultrasounds, and physical examinations during the first 8 weeks of pregnancy can lead to early diagnosis and treatment of complications such as gestational diabetes and preeclampsia.

Having a healthy diet

Eating a healthy diet containing vitamin D and iron before and during pregnancy is one of the most effective factors for a successful pregnancy that can make pregnancy easier.

Getting regular physical activity

It is recommended that older mothers do regular physical activities and have a proper exercise program under the supervision of a doctor in order to strengthen their general health, prevent pain, increase their body energy, and strengthen their muscles.

Taking essential vitamins during pregnancy

It is very important to take adequate amounts of folic acid during the first trimester of pregnancy and even before pregnancy. It will help prevent birth defects in the baby's spinal cord and brain. It should be said that due to the increased risk of birth defects in pregnancy at an advanced age, taking folic acid is more important in older mothers.

Maintaining a healthy weight 

Maintaining a healthy weight at any age, especially at an advanced age, can reduce the pregnancy-related risks and increase the chance of having a healthy baby. This can also help preserve the mother's health.

Avoid smoking and drinking alcohol

Since consuming alcohol, drugs, and tobacco is forbidden during pregnancy, pregnant women should inform their doctor before taking any medicine or supplement.

Following a healthy lifestyle

Having a healthy lifestyle such as getting good-quality and adequate sleep and avoiding heavy activities during pregnancy can lead to an easy advanced-age pregnancy. Also, controlling blood sugar through dietary modifications, physical activity, or certain medicine is another factor that plays an important role in a healthy and easy pregnancy.

What Infertility Treatments Can Help pregnancy in an Advanced Age? 

Woman have two choices when deciding to get pregnant: either to get pregnant naturally at a younger age or use assisted reproductive technologies at an advanced age.

Assisted reproductive technologies can help women to get pregnant until menopause (usually 51 years old). Although, as it was said, success rate of these technologies is very low in women over 40 years old.

Assisted reproductive technologies (ART) at an advanced age include using fertility drugs as well as some in-vitro techniques as follows:

Egg Freezing

Egg freezing is one of the common methods that help women preserve their eggs in the younger age for future use. This method can be used by women who are not yet married or intend to postpone pregnancy.

During egg freezing, women receive stimulation ovulation drugs to release an egg and then the released egg is stored. This egg can be thawed at the desired time and transferred to the uterus after being fertilized with sperm. 

It should be noted that although egg freezing can help with having healthy eggs, sometimes other problems such as PCOS and uterine disorders may prevent successful pregnancy.

In-vitro Fertilization or IVF

IVF is another helpful infertility technique that can be used with egg freezing or without it. In this method, egg and sperm are fertilized together in the laboratory and then the resulted embryo is transferred to the woman's uterus. The IVF method is also very useful in cases where the infertility is caused by male-factor and sperm weakness.

IVF with Donor Egg 

Although egg donation should be the final solution, it is a good way to get high-quality eggs and try to have children. During egg donation, the donor egg is fertilized with sperm in the laboratory and the resulted embryo is transferred into the uterus.

How to Diagnose Chromosomal Disorders in Geriatric Pregnancies?

There is a number of invasive diagnostic tests and examinations that can measure and identify chromosomal problems in older pregnant women. With the help of such tests, it is possible to detect the possible birth defects or the risk of getting special diseases. These tests are as follows:

• Ultrasound or sonogram;

Ultrasound sends sound waves into the abdomen to produce a picture of the baby. It can detect cases like multiple fetuses, the baby sex, the health of the fetus, the amount of amniotic fluid around the fetus, and the location of the placenta.

• Amniocentesis;

Amniocentesis is a test that examines amniotic fluid with the help of a needle sampling technique in mothers over 35 years old. This test can diagnose disorders such as Down syndrome, Tay-Sachs (a genetic disorder caused by the absence of an enzyme), cystic fibrosis, anencephaly (a spinal disorder), muscular dystrophy, spina bifida (birth defect related to the spine and spinal cord), etc.  

• Blood test to check multiple birth;

This test checks for Down's syndrome by measuring blood hormones and determining the risk of chromosomal defects. It can also detect multiple births. This blood test should be done between 16 and 18 weeks of pregnancy to prevent low birth weight and premature birth.

• Chorionic villus sampling (CVS);

CVS is a prenatal test that can detect or predict fetal chromosomal diseases in pregnancies at an advanced age by taking a sample of the placenta tissue.

• Nuchal translucency scan.

NT scan is an important test that can diagnose the probability of Down syndrome in the baby by measuring and checking the fluid behind the fetal neck. This test is done during weeks 10-14 of geriatric pregnancy.

The Final Word

It is recommended that couples try for a baby at younger ages in order to easily experience the sweet feeling of being parents. The age range between 20s and early 30s is associated with the best outcomes and fewer pregnancy-related risks. Thus, a woman before her 35 may have more chance for giving birth to a healthier baby.

Frequently Asked Questions About Pregnancy at an Advanced Age

1) How to increase the chances of having a healthy pregnancy at an advanced age?

To have a healthy pregnancy at an advanced age, women should do regular medical check-ups, follow a healthy diet, get regular exercise, consume a proper dose of folic acid daily, avoid smoking and alcohol, maintain a healthy weight, and prevent overweight or obesity, avoid exposure to harmful substances, etc.

2) Is there a higher risk of twins and multiple births in pregnancy at an advanced age?

Aging does not increase the chance of having twins or multiples by itself. However, since many women use assisted reproductive techniques such as IVF or fertility drugs to get pregnant at an advanced age, there is an increased risk of having more than one embryos. It should also be noted that in twin or multiple pregnancy, there is usually a higher risk of premature birth.

3) Does the father's age also affect pregnancy?

So far, no research has not proven that the father's aging can cause pregnancy disorders and fetal problems. However, it seems that there is a higher risk of babies with Down syndrome in men over 55. Also, a group of researchers recommends that men try for a baby before 40. 

4) What do obstetrician-gynecologists recommend for pregnancy at an advanced age?

In case of pregnancy at an advanced age, the OB/GYNs will perform various examinations and tests to confirm the mother's physical health.

The doctors will tell the couples about the costs of assisted reproductive technologies such as IVF and egg donation and explain the risks of pregnancy at an advanced age with these methods. Tests such as the AMH test are usually performed to check ovarian reserve.

It should be noted that doctors do not usually recommend a specific time for pregnancy to couples, and this decision depends on the couple's preparation and their plans for the future. However, it is often recommended for women who intend to get pregnant at an advanced age to take necessary measures from the age of 20 onwards (such as medical examinations, ovarian reserve tests, and egg freezing).

5) Does egg quality affect IVF success at an advanced age?

Yes! The quality of women's egg plays an effective role in having a successful pregnancy. Aging on the other hand will cause diminished ovarian reserve and so low egg quality. Therefore, maternal aging can also affect the success of IVF. The reason is that to experience a successful IVF, it is necessary to have a sufficient number of mature and high-quality follicles in the egg retrieval procedure.

The tests that can check egg quality at an advanced age include antral follicle count (AFC) ultrasound, anti- Müllerian hormone (AMH) test, and follicle-stimulating hormone (FSH) levels test.

In conclusion, low-quality eggs can lead to risks such as miscarriage, difficult pregnancy, and IVF failure. Therefore, it is important to prevent these complications with techniques like egg freezing at a young age.