“Why Conceiving In Your 40s Is High Risk” - Medical Expert

 

More women are becoming pregnant and having babies in their 40s, however, fertility specialist, Dr Abayomi Ajayi, says conceiving after age 40 comes with higher health conditions that can impede fertility and pose risks to mother and baby.

Ajayi, who is the Medical Director, Nordica Fertility Centre, Lagos, Asaba & Abuja, says women in their 40s who are planning to get pregnant, should go for preconception counseling first. Excerpts:

Women in their 40s are getting pregnant more and more now. The office of the National Statistics of the United Kingdom actually shows that this is the only group in which pregnancy is increasing unlike before when teenage pregnancy was increasing, now as a result of contraception and other factors.

The reasons are obvious, women are getting more educated, having their own careers, and some are not finding the right partner until they are old enough to make some decisions.

It is possible to get pregnant naturally after age 40, but this wanes  much more after 45, by then it is almost impossible to get pregnant naturally without some form of help.

At 40 the chances of getting pregnant naturally are  reduced. Normally, a lady in her 30s has a 20-25 per cent chance of getting pregnant every month. If you are 40, the chance is reduced to 5 per cent, so it is not surprising that infertility is commoner in women above 40.

The reason is due to the quality and quantity of the eggs. For such women, the male partners are also likely to be in their 40s, so this is like a double jeopardy.

When you do get pregnant, the chances of losing the pregnancy are high, and the risk of miscarriage may be 40 per cent.

This is due to the reducing quality of the eggs, the embryo, and other medical complications, such as high blood pressure and diabetes. This is the general trend for fertility in women over 40.

In vitro fertilisation, IVF, can be done for them, but Intrauterine Insemination, IUI, is not particularly a good idea at this stage because of a low success rate of around 5 per cent, and so might not be worthwhile for women in their 40s.

Although IVF is recommended, it is less effective for these women, and the success rate of IVF is in the neighbourhood of about 15 per cent for women over 40, and so can be considered.

Some women may have to use donor eggs. This increases their chances to 40 per cent, although the viability of the egg depends on the age of the donor.

Egg donation might not be the first option because the women and baby are not genetically connected, but it enables them to carry the baby in their uterus and to breastfeed them. So, it is a nature versus nurture thing.

No matter how the woman gets pregnant, naturally or assisted, pregnancy in the 40s is usually high risk.

This term comes from the fact that many women have to check through prenatal screening to confirm if they have health issues of if the baby, they are carrying has congenital issues.

Now we do non-invasive prenatal screening, NIPT, for high-risk pregnancies. The NIPT cuts down the need for aminocentesis.

It might be a good idea to do preconception counselling. In up to 80 per cent of cases, women in their 40s develop complications such as high blood pressure and diabetes.

An elective Cesarean Section is often required for those that are getting pregnant for the first time, and it is helpful to know the risks they carry before the pregnancy. The good point to note is that these risks are surmountable.

It might be a good idea to do preconception counselling, and explain to the physician the health conditions that they may be nursing as some may become worse in pregnancy.

The risk of congenital abnormalities such as Down syndrome and neurocognitive disorders such as autism are higher in children born to older women.

These children also tend to have a higher incidence of cancer, so it is good to know some of these risks before getting pregnant.

Women in their 40s may get pregnant on their own or come to the clinic to get pregnant with donor eggs and Assisted Reproductive Techniques (ART).

The fact that you have been pregnant before without complications does not mean that you will not have problems subsequently or that your pregnancy will go the same way. Above 40, the muscles of the abdomen tend to be looser, and have lost tensile strength. Other complications during pregnancy includes abnormal presentation of babies and low-lying placenta.

If you are over 40 and planning to get pregnant, you need to do preconception counseling to detect any medical condition.

This is necessary because you do not have so much time to conceive naturally, so see your gynaecologist early. Begin investigations early.

There is a big gap between giving birth naturally at 40 and at 45. At 40, there is a 1 in 10 chance, at 45 it is almost zero chance for natural pregnancy.

At this period, it is important to do prenatal investigation, particularly when aiming for natural pregnancy. Get all medical issues controlled so that they do not get worse in pregnancy.

A woman in her 20s can preserve her eggs for later in life but this will not reduce the risk of pregnancy in the 40s. Because she is older, whether she is using her eggs or using donor eggs, the risks are the same, however the congenital risks may reduce.

It is always better to adopt positive lifestyle choices when you start your family are part of lifestyle choices. Freezing your eggs when you are younger might help so that you do not have to use donor eggs, but the stressful effect on the body will still be there.