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Janet Jackson Is Expecting

Options for women over 40 trying to have babies


Due to the recent announcement that at 49 years old, Janet Jackson is pregnant, I have been flooded with questions about how women who are older can get pregnant.  Although it is common knowledge that it is harder to get pregnant as a woman gets older, a fact that has been emphasized recently due to the explosion in knowledge about egg freezing, many women still don’t have a great grasp on when it is just too late to get pregnant.  The advent of assisted reproductive technologies has changed the landscape of reproduction for older women, but has also led to confusion on when having a baby is no longer possible, and what limitations IVF can overcome.

How does our reproductive function age?

A woman is born with all the eggs she is ever going to have.  As she gets older the quantity and quality of eggs decrease.  When the number of eggs is miniscule then a woman enters menopause.  However there is a period of several years before menopause, when a woman still has eggs and is still ovulating but can no longer get pregnant.  Why is that?  The answer is simple, the quality of eggs is poor.  Eggs are cells just like any other cell in the body, and thus they age as a woman gets older.  I like to think of them like cars.  The first year you have a car it works great, but leave that car in your driveway for 15 years, even if you don’t drive it, by the time you start it up again something is going to breakdown.  Eggs go through the same aging process with time.  The biggest issue is that eggs go through the most important stages of their development, not when they are brand new eggs right after a woman is born, but during each month as the egg is ovulating and being fertilized by the sperm.  So for a woman who is 35, her egg is also 35 when it goes through those critical developmental stages.  For a woman is 45, her egg is also 45, and thus more likely to have a mechanical error during those crucial stages that lead to either errors in the amount of genetic material or other errors leading to failed implantation.  Therefore, for women over the age of 40, it is harder to get pregnant because it is just less likely that the egg will develop normally and lead to a healthy baby.

When is it too late?

A woman’s fertility starts to decline after the age of 30, with more significant changes after the age of 35.  However, the most dramatic decline occurs after the age of 37, and continues until the age of 45 when the likelihood of pregnancy is exceedingly rare.  This is hard concept for women to grasp, as they don’t feel old when they are 40, so it seems hard to believe that their eggs are so bad that pregnancy is unlikely and that the chance of conceiving is maybe only 1 in 5.  After the age of 40, not only does the chance of pregnancy decline precipitously each year, but the chance of miscarriage also rises significantly each year.  Even with the use of IVF, by the time a woman is 45 her chance of conceiving with one embryo is 1-2%, and her chance of miscarriage exceeds 50%.


Why can’t IVF overcome age?

IVF is not a total cure for infertility.  IVF can make more eggs be ovulated in one month and optimize fertilization, however IVF can not reverse the aging process.  We can’t make a 45 year old egg act like a 30 year old egg.  A 45 year old egg is a 45 year old egg, no matter if the woman is trying to conceive on her own or going through IVF.  With IVF we can cheat time, by making multiple eggs ovulate when they are younger, instead of letting one egg ovulate each month, and as each month the woman is getting older and older and the eggs are getting older and older.  That is helpful, but it doesn’t make the eggs younger.  One of the biggest constraints with IVF is that the number of eggs that can grow in response to the stimulation medication will decrease as a woman ages because the number of eggs that are available decreases with age.  So in a woman is 45, when you really need lots of eggs to compensate for their poor quality due to age, that is also the time when she doesn’t have a lot of eggs, so no matter what we do we can only get a few eggs to grow.  At some point, the ovary gets to a point when it just stops responding to medication and despite large amounts of drugs the ovary will make only one egg, so the benefit of the stimulation portion of IVF no longer exists.

What are options when your own eggs aren’t working?

The amazing thing about the female body is that although egg quality declines with age, the ability of the uterus to carry a pregnancy does not.  A woman can carry a pregnancy well into her late 40’s without any issue.  Over the age of 50 there does seem to be a rise in complications during pregnancy, with an increase in high blood pressure and diabetes in pregnancy, and an increased risk of preterm delivery and cesarean section.  Many fertility clinics have cut offs of age 50 or 53, at which point they  require patients to use a surrogate to carry the pregnancy.  So if the eggs aren’t working but the uterus is, what are the options?  In these situations, women can conceive and carry a pregnancy in one of two ways, they can use an egg from an egg donor or if they froze their eggs when they were younger they can use those.  Pregnancy rates are predicated on the age of the egg, so if the egg is young the pregnancy rates are good, no matter the age of the uterus.  This is why women who are menopausal can get pregnant.  They aren’t using their own eggs at the age of 50, they are using their own eggs from when they were younger or they are using someone else’s eggs who is in their 20’s.

Being Proactive

If you are 40 or older and want to get pregnant, it is best for you to have a fertility evaluation right away to assess the chance of conception.  Unlike women who are 30 who can try to conceive for a year without needing a fertility assessment, for women over 40, the clock is ticking and it is best to understand how the ovaries are doing right away.  The information gained in a fertility assessment can best serve to help with family planning by determining how long to try on your own right away, or identify those women that proceed with fertility treatments immediately.  Time is limited so you want to make the best use of it.  Understanding your fertility potential by having a consultation with a fertility specialist will arm you with the knowledge that helps you make educated decisions about your reproductive life and potential to have a baby.