Many people are now waiting until their 40s to have a baby. Having a baby after 40 may give couples the chance to wait until they are more emotionally and financially prepared for parenthood.
However, it can make it more difficult to get pregnant, as fertility declines with age. For women, in particular, fertility dramatically declines over the age of 40.
In this article, we look at the possible benefits and health risks of having a baby later in life, as well as what to expect during pregnancy and delivery.
Women in the United States are having fewer babies, except for one group — those in their late 30s and early 40s.
According to the Pew Research Center, women are more likely to have children now than they were a decade ago, but many are waiting until later in life. The average age at which a woman has her first child has, therefore, risen from 23 in 1994 to 26 in 2018.
This change may be partly due to the fact that many women are delaying marriage, pursuing further education, and participating more in the labor force.
Men are also having children later in life. The average age of a first time father has increased from 27.4 in 1972 to 30.9 in 2015.
While fertility rates are rising among older parents, infertility remains a problem. According to the American College of Obstetricians and Gynecologists, women’s fertility starts to decrease gradually but significantly from the age of 32 and then reduces more rapidly from the age of 37.
Male fertility also declines with age, but the drop is more gradual. Most men remain fertile into their 60s and even their 70s, although the rate of birth abnormalities increases as the male partner ages.
There are no direct health benefits of having a baby after 40. However, delaying pregnancy may have several results that could improve a woman’s mental and emotional well-being.
People who wait until they have a good job with health insurance may also be able to afford higher quality medical care.
People with paid leave or their own company may be able to take longer parental leave, which may allow them more time to bond with the baby and heal from giving birth.
Greater stability in a person’s job, life, or marriage may also promote better health. A new parent who worries less about money may experience less stress.
Age increases the risk of infertility because egg quality declines. The risk of medical conditions that have an association with infertility also increases. These include:
The rate of birth abnormalities or genetic conditions in the baby also increases. At a maternal age of 40, the chance of having a child with Down syndrome is about 1 in 100, and by 45, it rises to 1 in 30.
Historically, research on age-related pregnancy and fertility complications has focused on women. However, emerging research shows that infertility increases with age for both men and women.
A 2019 study found that:
- Older fathers have higher rates of infertility, even when their partner is under 25.
- The partners of men over 45 have a higher risk of preeclampsia, preterm birth, and gestational diabetes.
- Men over 45 are more likely to father children with birth abnormalities, low birth weight, and a low Apgar score — a measure of the baby’s general health at birth.
The success rate of infertility treatments declines with age, as well. After 40, women have about a 5% chance of pregnancy per intrauterine insemination (IUI) cycle. The success rate per in vitro fertilization (IVF) cycle is less than 20%.
For healthy women over 40, advanced age does not necessarily change how the pregnancy feels or progresses.
Most women experience a range of symptoms during the first trimester, including morning sickness. There is no evidence that these symptoms are worse or different in women over 40.
The first trimester may be more stressful for other reasons, though. Older age carries a higher risk of pregnancy loss, especially for women who have previously had miscarriages.
A 2019 study found that the risk of pregnancy loss was 53% in women over 45, compared with 10% in women aged 25–29.
As the pregnancy progresses, women 45 years or over have an increased risk of experiencing pregnancy-related complications, such as:
- gestational diabetes
- high blood pressure
- preterm delivery
For this reason, a doctor or midwife may recommend increased medical monitoring. This monitoring may include additional prenatal appointments or tests.
Some women may also choose genetic testing to assess the chance of having a baby with a birth abnormality.
Despite these increased risks, women over 40 can and do have healthy pregnancies. A 2015 study found no increased risk of pregnancy complications in healthy women aged 40 or over with quality prenatal care.
Merely being over 40 does not necessarily affect delivery. In fact, research has shown that pregnancy and birth outcomes over 40 do not differ significantly from those of younger women, as long as a woman over 40:
- has quality prenatal care
- does not have chronic medical conditions
- attends regular prenatal appointments
- maintains a healthful lifestyle
- has the baby in a prenatal center
This means that, for healthy women, conceiving after 40 may be no more dangerous than conceiving earlier in life. However, the rate of cesarean deliveries was higher among women over 40.
Other research has shown that rates of complications in women over 40 are higher, though. A 2017 study in Berlin that compared the outcome of women delivering over the age of 45 to that of 29-year-old women found that:
- The younger women needed fertility treatments at a rate of 3%, compared with 34% in the older group.
- 28% of older women, compared with 11% of younger women, had a preterm delivery.
- 59% of older women had a cesarean delivery, compared with 29% of younger women.
Cesarean deliveries may have an increased risk of additional complications, particularly for older women. A 2019 study linked cesarean deliveries to a higher risk of severe complications, such as stroke, embolism, and hemorrhage.
While cesarean deliveries can be lifesaving, pregnant women should discuss the potential complications with their healthcare provider. Avoiding elective cesareans may help reduce birth complications.
The process of conceiving after 40 is no different for many people. For heterosexual couples to conceive, the couple must have intercourse during the woman’s fertile window. This window includes the days leading up to ovulation and the day of ovulation.
Using ovulation predictor tests can help pinpoint the release of eggs. Monitoring basal body temperature can help a person check whether they have ovulated. Doing this is important as a woman ages, as some women stop ovulating or do not ovulate as frequently.
To monitor basal body temperature, people can take their temperature at the same time each morning as soon as they wake up. It is important to do this immediately in the morning, after at least 3–4 hours of sleep, and using a digital thermometer.
After ovulation, the average temperature rises slightly by 0.5–1°F and remains elevated until a woman gets her period. The temperature then returns to baseline.
Basal body temperature is not always an accurate measure of ovulation. Several factors, such as stress and alcohol consumption, can affect the measurements.
Women who are single or in a same-sex relationship may choose fertility treatments such as IUI or IVF. These treatments are also an option if one person in a relationship has infertility.
If either partner has any preexisting conditions, such as diabetes or polycystic ovary syndrome (PCOS), they should see a doctor for testing before trying to get pregnant.
If a woman believes that she is not ovulating, she can see her doctor to check.
Most doctors recommend that women over 35 see a fertility expert after trying for a baby for longer than 6 months with no results.
People in their 40s may find that seeking fertility treatment as soon as possible can help them have a successful pregnancy.
Many people over 40 are able to have healthy, safe pregnancies, and are glad that they waited. With the right healthcare and a healthful lifestyle, people can have positive outcomes.