Ask Nurse Darby: When You're Over 40 and Want a Baby

Posted by Customer Care on Mar 21, 2019

Q: Unlike many of my friends, I married later in life. I was 35 and at the time didn’t think I wanted to have children. Now, six years later, my husband and I are seriously considering the idea of a baby. I know that pregnancy related risks increase with age. I also think I may be starting to experience some signs of menopause because my menstrual cycles are sometimes irregular now. What are some risks that are more commonly associated with older expectant mothers? Also, are there any specific questions I should ask my doctor while we are trying to decide if pregnancy is a good choice for us?

A: Believe it or not, these are very common questions. The way society views families and careers has evolved so much over the past several decades. There was a time when women wed very young and became homemakers and mothers. Today, we seek higher education and set professional goals that make us feel like we may need to delay starting a family. Let me be clear, there is absolutely nothing wrong with this decision. No one knows what is best for you or at what time you should make changes in your plans -- No one but you!

What You Should Know

Many factors affect whether conception and a healthy pregnancy are possible for a woman. These factors become more of an issue as we age.

One of the most common issues that affects conception is ovulation. As women near perimenopause, ovulation becomes irregular, which makes conception more difficult. Additionally, while men produce new sperm throughout their lives, women are born with a certain number of eggs and will not produce any more. Usually by around the age of forty, a woman’s eggs have begun to experience the effects of aging.

These age-related changes can increase the chance of a baby being born with chromosomal abnormalities. Stanford Children’s Health reports “The chance of having a child affected by Down syndrome increases from about 1 in 1,250 for a woman who conceives at age 25, to about 1 in 100 for a woman who conceives at age 40.”

Unfortunately, there are other risks associated with pregnancy in older women, including hypertension (high blood pressure) and gestational diabetes.

What Are the Chances of Pregnancy After 40?

Women are most fertile in their twenties, but that does not mean that you cannot become pregnant and have a healthy pregnancy in later years. By the age of 30, women who are fertile have about a 20% chance of conceiving during any natural cycle. After the age of 31, the possibility of conceiving tends to decrease by 3-4% each year until the mid-thirties. Once a woman reaches the age of 35, the chances of conception decline even more rapidly. Women 40 or over have a 5% chance of getting pregnant per cycle. (avawomen.com)

It’s Time To Talk It Out

Whether you are a woman in your twenties or a woman in your forties, if you think that now, or in the future, you may want to have a baby, start learning NOW! I always strongly advise finding a women’s health practitioner that you feel comfortable with, someone that you can ask the uncomfortable questions. Ask your general practitioner to recommend an OB/GYN if you don’t already have one. This is always a good idea because, if your GP recommends someone, chances are they already have a good working relationship which will benefit you in the long run. Ask your care providers if they have recommendations about vitamins that you should take before becoming pregnant, what kind of diet or exercise regimen they recommend, and any ways that they suggest to protect your chances of being able to conceive.

If you are married or in a relationship, talk early about the possibility of having children. It is always easier to plan for things early rather than having the, “By the way, I want a baby” talk.

When Getting Pregnant Is Difficult

Let’s face it. No matter how healthy or what age a woman is, sometimes getting pregnant is difficult. Most practitioners will recommend that women younger than 35 who have been actively trying to conceive for 12 months unsuccessfully should see their OB/GYN. Women over 35, on the other hand, are encouraged to see their doctor if they have not conceived within six months of actively trying.

Most physicians will recommend a few things before moving toward medically-assisted conception. Some of those things include:

· Keep a record of your menstrual cycle

· Monitor ovulation

· Strive to achieve and maintain a healthy body weight

· Take prenatal vitamins

Speaking of medically-assisted conception…... Many people have the misconception that IVF (in-vetro fertilization) is a quick fix after having chosen to postpone pregnancy. The truth is, although IVF can assist people with infertility issues, it does not alter the natural changes that happen as women and men age. If you are considering postponing pregnancy until a later age, it is important to understand that IVF may not help you later.

Take Care of YOU

Because fertility health declines so rapidly around the age of 40, it is important to prepare yourself for pregnancy BEFORE you conceive. This is called preconception health and has been proven to have great influence on a woman’s health during the stages from perimenopause to post menopause.

Hormonal symptoms, especially changes in the menstrual cycle, are one of the main reasons women seek advice from their healthcare providers for support when trying to conceive during the perimenopausal stage. It’s important to note that symptoms and severity of symptoms will vary, sometimes greatly, from one woman to another.

Some of the most common symptoms indicating perimenopause include:

Irregular menstrual cycles
Decreased libido (sex drive)
Breast tenderness
Hot flashes
Night sweats
Mood swings
Decreased energy

Because other health conditions can present with some of the same symptoms, if you have been trying to conceive with no success, and are 35 or older, it is a good idea to make an appointment with your doctor. This will help you rule out other conditions that may be present and allow you to address those issues, along with your fertility health.

One of the most important things doctors will tell someone who is hoping to conceive is to make sure you are eating a healthy diet. Although all doctors may not mention this, I have found some interesting information about what is called a fertility diet. Although I am WAY PASSED the point of having children, as a nurse, I can see how this could be beneficial to any woman, especially those who are still of child-bearing age.

A fertility diet is a diet that is rich in fresh leafy vegetables, whole grains, nuts and seeds, fiber, fruits, and moderate amounts of lean animal products. Fertility diets are believed to promote overall health of a woman wanting to conceive as well as the health of eggs and sperm. A Fertility Diet provides nutrients that are aimed at maintaining perimenopausal hormone balance and health. Some nutrients included in this type of diet are:

Calcium – to maintain bone strength and support bone growth (in perimenopause and pregnancy).

Essential Fatty Acids, EFAs, – the good fats – cholesterol from high-quality fats helps the body produce hormones, supports smooth muscle, brain and nervous system health, and impacts the health of every body system.

Hydration – Dehydration causes a decrease in circulation within the body, among other things. Drinking a minimum of eight 8oz. glasses of water every day is a deterrent to this negative effect. Also, if you add a bit of lemon to your water, it will also help support your liver.

Bioflavonoids – these are found mainly in citrus fruits and black currents and have been shown to reduce hot flashes, regulate moods and balance estrogen levels.

As with any diet, exercise regimen, or medication, it is always best to discuss your thoughts with your primary care provider before beginning any program.

The most important thing I could tell anyone who is considering pregnancy is, no one knows your body like you do. Speak up for yourself. Speak up for your partner, if you have one. Speak up for the baby that you may one day have. You do this by asking questions, reading, studying, and asking more questions. There is never too much education when it comes to the health and well-being of both you and your baby!

Nurse Darby has been a nurse and Allied Health educator for over twenty years. She has clinical experience in several specialty areas and has instructed nursing students at both community college and university levels. She has coached nursing graduates across the United States as they have prepared to take and pass the National Council Licensure Examination (NCLEX).

Darby loves to cook and spends much of her free time baking specialty wedding and birthday cakes. If you can’t find her writing or in the kitchen, it’s likely she is on a cruise, as this is her favorite get-away!

This blog provides general information and discussion about medicine, health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately-licensed physician or other health care worker.

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