Having babies later in life is a growing phenomenon, but it’s not always the easiest path to take.
Having babies later in life is a growing phenomenon, but it’s not always the easiest path to take. Being well informed is the first step
Although we’re at our most fertile in our 20s, statistics show the number of women giving birth in their 40s has almost tripled in recent years. As more women spend their younger years building a career, or struggle to meet the right partner, an increasing number are holding off on having babies until a time when they might also be approaching menopause.
While some might think delaying for that long is too big a risk, there’s often sound reasoning for waiting until you’re ready to be happily pregnant, says Melbourne obstetrician, gynaecologist and fertility specialist Dr Joseph Sgroi.
“Many couples want to be socially, emotionally and financially prepared before they start a family and some want to enjoy themselves before they take on the responsibility of parenthood,” he explains.
The passage of time, however, does mean that getting pregnant and staying pregnant is a lot trickier for older women, he adds. So if you’re thinking of having a baby in your 40s. here’s what you need to know.
YOUR EGGS ARE OLDER
The number of eggs in your ovaries declines rapidly at age 35 and because the quality of remaining eggs is also compromised, the chance of conceiving each month drops from 20 per cent at age 30 to five per cent at age 40. Because of this, some unsuccessful midlife pregnancies are thanks to donor eggs from younger women.
MISCARRIAGE IS MORE LIKELY
The risk of miscarriage increases with age, being five times higher at about 42 than it is at 30. At 40, about three quarters of your eggs are chromosomally abnormal. Because of this, pregnancy loss often happens early, when a genetic abnormality prevents the embryo from developing beyond two or three cells.
EXPECT THE UNEXPECTED
Unexpected pregnancies can come as a shock to women who thought their eggs had reached their use-by date. Even if your cycle has always been regular as clockwork, ovulation can occur at odd times during perimenopause, the natural progression towards the release of your final egg. This can be a game-changer, flinging open the narrow window of opportunity for conception when you might not be expecting it.
Also, the chance of having twins increases in your 40s because as you get closer to menopause, your hormones fluctuate, including FSH (follicle stimulating hormone), which tells your ovaries how many eggs to release in any given ovulation cycle. This can sometimes result in two eggs being released.
WEIGHT MATTERS
Overweight Singaporean women contribute to 28.6 per cent of the population while obese women form 7.9 per cent. This affects their chances of getting pregnant and having a healthy baby.
Infertility rates are higher and live birth rates are lower for women who fall into this category – and this particularly affects women in their 40s. But even moderate weight loss – seven per cent of your body weight – can boost fertility and improve your chances of having a healthy baby.
Weight gain and fertility problems are also common features of a hormonal condition called polycystic ovary syndrome (PCOS).
BEING FIT AND HEALTHY HELPS
There’s not much you can do about your older eggs, but age is not the only impediment to making babies. Talk with your doctor about the fact that you want to get pregnant – they will help you rule out conditions like PCOS, diabetes, thyroid disorders and endometriosis, all of which can impact your chances of getting pregnant.
Daily moderate-to-vigorous exercise boosts fertility at any age, even for overweight or obese women with PCOS. And avoiding exposure to tobacco smoke is important – even second-hand smoke can make it harder for you to conceive.
Women who are pregnant or trying to conceive are advised to eat a healthy diet, and limit or eliminate drinks that have caffeine, and alcohol, either of which can impair fertility or increase miscarriage risk.
“Remember for weight loss to be achieved, it is essential to nourish your body with a variety of fresh foods in sensible portions,” says Dr Sgroi.
DON’T RELY ON IVF
In Singapore, IVF is only applicable for married couples. Women above 45 are not allowed to undergo IVF unless they have permission granted from the Ministry of Health and are not entitled to government subsidies for IVF pregnancy once they are above 40. In order to take part in the clinical trial for embryo screenings, she must be 35 years or older, or have experienced at least two failed pregnancies or implants.
Your chances of getting pregnant within three IVF cycles is 34 per cent if you are aged 36 to 40, and this drops dramatically to about five per cent if you’re 40 or older. So IVF doesn’t give you a solid guarantee, especially if you plan on using your own eggs. If you use an egg from a younger donor, your chances of success are the same as if you were the same age as the donor (53 per cent for donors younger than 30).
It might still be worth seeing a fertility specialist sooner rather than later if you’ve been trying to get pregnant for six months with no results.
CONSIDER THE HEALTH OF YOUR BABY
The chances of Down syndrome increase from one in 350 at age 35 to one in 100 at age 40. There is a non-invasive test to check for the disorder that’s offered to all expectant mothers, not just older mothers.
Today, technology allows obstetricians to screen for other conditions too – they can monitor your pregnancy for chromosomal conditions or placental failure (where the placenta blocks the cervix or becomes detached).
If you are using IVF, pre-implantation genetic diagnosis (PGD) technology allows your fertility specialist to use healthy embryos.
BETTER LATE THAN NEVER
Two Singaporean women, who took a gamble on late motherhood – one who had her first baby at 40 and the other who went in for a second baby in her mid-40s – share their personal experiences
Phaik Ai Choo with threeyear- old George Kai Whittington.cond baby in her mid-40s – share their personal experiences
Phaik Ai Choo had her son George (now three years old) at age 40.
The business development executive of a technology start-up says she and her husband had been trying to have a baby ever since she was 37 years old (which, going by conventional standards, may be considered quite late already), but it took her longer to conceive than they expected.
So the couple did the next best thing, which was to keep themselves well informed of the likely challenges of late pregnancy, both by reading extensively on the subject and asking medical professionals the right questions.
“The mandatory tests did make me nervous, but we chose to put our trust in the wisdom of the healthcare professionals we worked with and the new technologies,” Ai Choo says, grateful that women today have the access to information.
On the personal front, she also became more aware of her body, “I became more active and took good care of myself before, during and after,” she says, although, having always lived an active lifestyle, she feels, went a long way in helping her body adjust to the changes.
Her experience has taught Ai Choo that there’s no age that’s too old to have babies. “But it does get lonely,” she says. “My peers are largely divided into two groups: Those who planned to start families early would have had older kids and those who chose not to have families at all. So in that sense I don’t have peers who have kids in the same age group as my son.” Having neighbours with children the same age as George did help make things easier, and since she and her husband are both young at heart, hanging out with much younger neighbours wasn’t too much of an issue as well.
While it is up to personal choice, Ai Choo believes that it needs to be a calculated risk on the part of the individual. Having George that late in life did influence the couple’s decision to not have any more children. “Start younger and have a bigger family,” is what she would do if she had to do it all over again.
Veronica Tan with Joshua, eight, and Jonathan, four.
"It was sad for us to see Joshua (her first-born) playing by himself. That’s what made us decide to try for our second baby."
Veronica Tan, on the other hand, made a conscious decision to have a second baby even though she was already in her mid- 40s. Jonathan, now four, was born just before her 45th birthday, to be precise. “At first, my husband and I felt that one was enough. Raising a child in Singapore is really expensive! Plus, being older, our parents are also older and not as able-bodied. They try their best, but this still means that our childcare support system is limited,” she says matter-of-factly.
But personal losses changed all that. When her father and father-in-law passed away a year after each other, Veronica saw how the two families rallied together to support each other. It made the couple realise the importance of siblings. “It was sad for us to see Joshua (her first-born) playing by himself. That’s what made us decide to try for our second baby.”
That was however, easier said than done. “The prognosis for my second pregnancy was a lot more negative,” she says, recalling how her first pregnancy was a challenging one for her health-wise. There was also the higher possibility of the child being born with Down Syndrome (DS) or other genetic/ chromosomal abnormalities.
Twelve weeks into her pregnancy, Veronica’s doctors predicted, based on her age, and blood test results, and the sonogram results, that there was a 97 per cent chance the baby would be born with DS. “We went for the amniocentesis (test involving the amniotic fluid) to confirm if he had any chromosomal abnormalities, got our pastor to pray for us, and praise God, our baby was in the clear!” she says. “But it was a very real scare. We had to consider the possibility of terminating the pregnancy because being older parents, we may not have been able to look after a child with DS for as long as is needed.”
Late childbirth did tell on her health as well – she had gestational diabetes and pregnancy-induced high blood pressure, while also dealing with complications that arose during her first pregnancy (she was diagnosed with sub-clinical hypothyroidism), for which she is on life-long medication.
“I tried to stay as active as possible. I think that being active and limber is important for the changes the body goes through during pregnancy and for childbirth (regardless of age),” she says.
“The older you get, the higher the risks and the less energy you have, that’s a fact. So be prepared to deal with whatever comes with it, and I don’t just mean the baby! Both Mummy and Daddy should try to stay or get fit too, because looking/running after kids and keeping them entertained day in day out takes a lot of energy,” she says. Her children don’t notice much of any difference between them and younger parents, except that “maybe that Mummy and Daddy don’t run around with them as much.”
