If 40 is the new 30, it's no wonder so many women are keeping up with all the activities from their third decade, including being able to conceive. Planned pregnancies among 40-year-olds are more prevalent than ever in the U.S.; the birth rate among women age 40 to 44 increased from 10.2 to 10.3 per 1,000 births in 2011, according to the Centers For Diseases Control and Prevention.
Despite how youthful forty-something women seem on the outside, there are certain biological realities they have to face. "It's harder to get pregnant at 40 and very hard after 45, but in the real world it does happen sometimes," says Alice Domar, Ph.D., executive director of the Domar Center for Mind/Body Health at Boston IVF, and associate professor of obstetrics, gynecology, and reproductive Biology at Harvard Medical School. At age 40, you have about a 5 percent chance of becoming pregnant over the course of any given menstrual cycle, compared to a 20 percent chance for women under 30.
Regardless of the challenges, there are some smart steps you can take to make the most of your fertility after 40.
It's a good idea for women of every age to map out a pregnancy plan with their doctors in advance. "Some medical conditions or medications can be detrimental to a future pregnancy. Also, learning about your family history may identify certain risks for a future offspring and undergoing genetic testing or seeing a genetic counselor should be done before you start trying," says Steven R. Bayer, M.D., a reproductive endocrinologist at Boston IVF fertility clinic in Boston, Massachusetts.
Conventional wisdom says that your best chances of getting pregnant are on days 12 to 14 of a standard 28-day menstrual cycle. That may not apply when you hit 40, though. "Women who approach 40 often start ovulating earlier and earlier in their cycle," says Alan Copperman, M.D., director of the Division of Reproductive Endocrinology and Infertility at Mount Sinai Medical Center in New York City and co-director of Reproductive Medicine Associates of New York. "It could be day 12, day 10, day 9, so they may not even be having sex at the right time."
To make sure your rhythm isn't off, track your menstrual cycle and figure out exactly when you're ovulating each month. Once you determine when your period is due, figuring out the timing of ovulation is actually easy. Simply count back 14 days before your next period is scheduled to start -- that's the day you're supposed to ovulate. You can double check when you're ovulating by using a basal body temperature chart, monitoring your cervical mucus, using an over-the-counter ovulation kit, or all of the above. When you've got it down, have sex every other day a few days before and after you're due to ovulate. "Sperm stays in your system for multiple days after you have intercourse and an egg stays in your system for a good five days after you ovulate," says Angela Chaudhari, M.D., a gynecologic surgeon and assistant professor at Northwestern University Feinberg School of Medicine in Chicago. "It's really a much longer window than you may think."
Although an impeccable facade may not reflect the state of your ovaries, it's critical to try to get your body into peak shape. "The older you are, the more you have to work at lifestyle stuff," says Jill Blakeway, a licensed acupuncturist, co-owner of The YinOva Center in New York City, and co-author of Making Babies: A Proven 3-Month Program for Maximum Fertility. "You can get away with being badly behaved at 22 and still get pregnant. Every egg isn't a winner when you're older, so that's the time to eat right and avoid caffeine and alcohol." Thirty minutes of cardiovascular exercise most days of the week is recommended, as is maintaining a healthy weight. Straying too far on either side of your ideal can mess with hormone function, cause estrogen levels to go out of whack, and impede your chances of conceiving.
In addition to taking a high quality prenatal multivitamin and 400 micrograms of folic acid daily, consider adding coenzyme Q10 (CoQ10) to your routine. Animal studies show that this natural enzyme could be a wonder supplement for fertility, actually reversing age-related reproductive decline. "If you give CoQ10 to perimenopausal mice, they turn into young, hot babe mice in terms of their egg quality," Dr. Domar says. Research on humans has just begun, but the preliminary results are looking good. "In the meantime." Dr. Domar adds, "I'm advising all my patients to take Co Q10. There doesn't seem to be a downside, so why not see if it can make an impact?"
"When you're in your early forties, you're very aware of the biological clock ticking, loudly," says Andrea Braverman, Ph.D., a clinical psychologist in the Department of OB/Gyn at Jefferson Medical College in Philadelphia. "You need to make sure you don't psych yourself out and add to already high stress levels." Mind-body behavioral techniques such as yoga or tai chi can help, as can cognitive behavioral therapy. Acupuncture may also be beneficial: Practitioners say it can increase blood supply to the uterus and help with hormones, and physicians generally accept its relaxation properties.
It you've been trying for three or more months without any luck, it's a good idea to see your doc to rule out correctable issues such as blocked tubes or ovulatory dysfunction. The doctor will also look at hormone levels to assess the quantity and quality of your eggs ("the ovarian reserve") if early menopause is a factor. (The average age of onset varies from 40 to 60.)
If you're diagnosed as sub-fertile, you may choose to look into intrauterine insemination (IUI) or in vitro fertilization (IVF). Success rates decline steadily, and tend to be quite low after the age of 44.
The reality is that many women in their forties won?t be able to conceive with their own eggs, especially after the age of 44. But if you?re set on carrying your own child, there?s another way to make it happen. ?The option of donor eggs is spectacular because it still affords a woman or couple the opportunity to have a biologic child,? says David Ryley, M.D., a reproductive endocrinologist at Boston IVF fertility clinic and clinical instructor at Harvard Medical School. "The egg donor is no different from a sperm donor. It's the carrier's uterus, and it's her blood and her placenta going through those babies veins." New research shows that moms have a big influence on how the baby develops genetically. "The environment that you nurture the baby in matters with regard to the way genes are turned on and turned off -- you actually make the baby more like you," says Jani Jensen, M.D., a reproductive endocrinologist and assistant professor at the Mayo Clinic in Rochester, Minnesota.
Egg donation has a success rate of about 60 to 70 percent per cycle for a woman in her for forties, affording many women more time to conceive on their schedule. (Use of embryos, in which neither of the parents' genetic material is used, has about the same success rate.) It can be an incredible rewarding experience, but not one taken lightly or done to halt the pain of infertility. "I tell patients I never want them to move on to egg donation until they let go of this dream of a genetic child between them and their partner," Dr. Domar says. "Otherwise it's not fair to the child because the odds are you're going to get pregnant." Once you go down that path, you may find you're so close to the child you completely forget about the lack of genetic ties. "Patients who have used egg donations tell me, 'I'm unable to love a child more than I love this one," Dr. Domar says. "As one woman put it, 'This baby is 50 percent my husband and 50 percent the donor, but he's 100 percent mine.'"
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