How Easy Is It (Really) To Get Pregnant After 40?

Lots of women are delaying having children until their late 30s — but Dr. Danielle Martin says we need to talk more openly about the risks.
By Dr. Danielle Martin
Image of a positive pregnancy test - is it easier to get pregnant in your 40s than in your 20s?

Q: A recent report out of the U.S. found that more women are having babies in their 40s than in their 20s. Does that mean it’s easier to have a baby at 40 now?

Here’s the tricky thing about pregnancy at 40: The best time to consider whether it’s right for you is when you’re 30. Too often, women wait to consider the pros and cons until the only two choices available to them are pregnancy at 40 or not at all.

As a health care provider, I struggle with this: I want to support women’s choices in their careers and their desire to wait for the “right moment,” but the biological reality is that fertility drops steeply starting at age 35, and quite precipitously at 40 — so the chances of being unable to get pregnant naturally (or even at all) and the risk of miscarriage are much higher.

A review of fertility clinics in the U.S., by the Centers for Disease Control and Prevention, found that by age 45, live birth success rates with in vitro fertilization drop to 1 percent. The risk of chromosomal abnormalities rises with age, as does that of other complications: gestational diabetes and high blood pressure, for example, which carry risks for both the fetus and the long-term health of the woman.


And these are conditions you can’t avoid simply by being fit — they are independent risk factors that have to do with how the placenta functions in someone of “advanced maternal age.”

These are facts that no amount of financial or relationship stability can erase. Trying to get pregnant at 30 and trying to get pregnant at 40 are not equivalent scenarios.

If your goal is to avoid these risks, one way to reckon with the idea of having a baby earlier in life is to ask yourself this: If you were to get pregnant by accident tomorrow, what choice would you make about your pregnancy? If the answer is “There’s absolutely no way I could handle it. I would terminate the pregnancy,” then it’s clearly not the right time. But if the answer is “Well, it’s not ideal, but I’d figure it out and wouldn’t terminate the pregnancy,” then you should consider whether you can make the leap earlier.

Having said all that, of course it’s possible to have a healthy pregnancy at 40. But we need to be honest about how much harder that road is. We need to make changes socially that support women, so they can have kids when it’s less biologically risky to do so. That means more generous parental leave policies, support for breastfeeding and affordable child care. It also means workplaces support time out for parenting.

Women should be able to make a choice at age 32 to have a kid, rather than feeling that if they do, they’re opting out of their career success.


Danielle Martin is a family physician and vice-president, medical affairs and health system solutions, at Women’s College Hospital in Toronto.


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