Pregnancy After 40 Is Doable, But Expensive as Hell
Janet Jackson is pregnant just shy of her 50th birthday, leaving us mortal women to wonder: Can we do that too?
“Can I do that, too?”
That’s what many women wonder when they hear about celebrities getting pregnant in their late 40s—like Janet Jackson, who recently announced her first pregnancy two weeks shy of her 50th birthday. Halle Berry, Laura Linney, Kelly Preston, and Cheryl Tiegs, among others, all had babies after they turned 45.
So what are the chances that the average woman over age 45 will get pregnant? Pretty good, but with a big catch: She will need to use donor eggs from a younger woman, a procedure that costs about $30,000—and is rarely, if ever, covered by health insurance.
In donor egg IVF, another woman provides the eggs, but the intended mother carries the baby and gives birth. The sperm usually comes from the woman’s husband, because men’s fertility typically doesn’t decline as much with age.
The good news is that donor egg IVF is often successful—54 percent of attempts end in the birth of a baby, or as high as 75 percent at the best fertility clinics. By comparison, IVF for women 43 and older using their own eggs results in a baby only about 4 percent of the time.
Why the big difference? An older woman is just as capable of carrying a baby, but her eggs are exponentially more likely to have chromosomal abnormalities, and an embryo with a chromosomal mistake can’t make a healthy baby. A recent study of 5-day embryos in IVF found that 77 percent of 30-year-old women’s embryos were normal, compared to 12 percent of 44-year-old women’s. Even this doesn’t capture the whole decline, since only about a third of eggs can become five-day embryos, and that rate declines with age, too.
What about natural conception in your 40s? Here’s the frustrating thing: No one really knows. As I found when I researched my book The Impatient Woman’s Guide to Getting Pregnant, no published study has examined modern women’s natural fertility after age 40.
A few studies have looked at historic birth records from the times before birth control, but of course those women differ in many ways from women today (among other things, we might want to get pregnant in our 40s, as opposed to the 17th century women who already had seven children and who were probably crossing their fingers when they had sex). One unpublished study looked at white women ages 40 to 43 who had already had at least one child, and found that 60 percent became pregnant in 6 months—but that’s a small study on a limited population. For women over age 45, there’s no data at all on natural conception in modern populations.
Most studies find that women’s fertility is fairly high until about age 39. In one study, 82 percent of women ages 35 to 39 were pregnant after a year, compared to 86 percent of women in their early 30s. The limited data available suggest that fertility falls quickly between age 40 and 45, so that somewhere in that range the average woman won’t be able to get pregnant anymore, naturally or with IVF, which helps the sperm and egg get together—but without donor eggs it does not solve the problem of more chromosomal abnormalities with age.
After 45, from the limited data out there from IVF and historical records, pregnancy with your own eggs is very, very rare. It happens—many of us know an example or two—but it’s not something you can count on with any certainty.
That leaves donor eggs. This is a difficult choice for many women. Should they become mothers, but without a primary genetic connection to the child? Some women use a relative as an egg donor, though doctors often discourage this due to the possibility for family drama. Most use an anonymous donor, usually choosing someone who physically resembles them.
But there are other considerations. Studies in psychology consistently find that personality traits and intelligence are about half determined by genetics—and barely budged by the environment of the family. Using a donor egg means raising a child with a different genetic legacy. Of course, that’s the same thing parents do when raising an adopted child, so many would consider donor eggs just another way of building a family. There’s also emerging research on epigenetics (the science of gene expression) suggesting that the mother who carries the child can have some influence on which genes are turned on and off.
In the future, techniques using ovarian stem cells or even skin cells might finally triumph over the age limit to women’s fertility. Women can also choose to freeze their eggs when they are young—a procedure that only became reliable recently, and not something that helps the over-40 woman who did not freeze her eggs earlier.
For now, the fertility picture for women looks like this:
Age 35-39 = a very good chance of pregnancy
40-44 = a chance of pregnancy, less and less with each year
45 and up = a very small chance of pregnancy; for most, donor eggs
So did Janet Jackson and the other famous late 40s mothers use donor eggs? The statistics suggest they did—and those who have twins almost certainly did—but we’ll never know for sure unless they speak out publicly. For those of us who want to have children in our 40s, we’re left with incomplete research and a limited set of options. For now, all we can do is make carefully informed choices and hope that the science will improve.