Motherhood: Forty Shades of Fertility and Resilience
Written by: Nida Khan
Motherhood: Forty Shades of Fertility and Resilience.
Discover how to make informed decisions about motherhood over forty by understanding fertility, the benefits and risks of later pregnancies, assisted reproductive technologies, and inspiring stories of hope within a supportive community.
One’s age can be daunting. That unseen yardstick hovers in the background, tracking you and determining what stage of life you’re in. The right age to graduate, settle down, establish a career, and so on can all put pressure on a person. If something doesn’t go according to plan, our mountain of expectations can begin to weigh us down. As women, many of us also grow up fearing the inevitable ticktock of our biological clock, that invisible, doomed hour when, all of a sudden, we are too old to have children. The “fertility cliff” after thirty-five, or the “advanced maternal age” as some experts call it, is enough to cause despair. But it’s important to differentiate between unvetted judgment and science-backed facts to make better, informed choices when it comes to the truth behind women’s fertility over forty.
The New Age of Motherhood
There has been a significant shift toward women choosing to have children later in life, including in their forties. According to the Centers for Disease Control and Prevention (CDC), this trend steadily grows at about 3 percent every year. Various factors, including societal changes, advancements in reproductive technology, and personal circumstances, influence the decision to have children later in life.
Things are looking up compared to the past when late motherhood was deeply frowned upon. The conversation surrounding fertility is ongoing, and it’s important to understand the pros and cons for women trying to conceive after forty.
Is age nothing but a number?
It's All About the Eggs
The CDC states that women over forty have a 5 percent chance of getting pregnant compared to 25 percent of women in their twenties and thirties who can get pregnant in a single ovulation cycle. The science is in the eggs. Women are born with millions of eggs, but the egg count decreases every year. Nearing the fourth decade, the number of eggs decreases to about 2.5 percent of the original number.
The quality of the egg also significantly drops by that time, leading to birth defects and other fatal health issues in women and children. According to Lorraine Kasaven, an obstetrician-gynecologist and clinical research fellow at Imperial College London, after thirty-five years of age, the decline in egg quality and quantity speeds up; however, the decline rate varies as per the individual and does not plummet as earlier studies falsely indicated.
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Risky Business or Not?
After a certain age, it gets difficult to become pregnant due to a shortage of eggs in the ovary. Conditions like endometriosis and uterine fibroids also make it hard to conceive. The rate of miscarriage or stillbirth is higher because of chromosomal issues or mutations in older eggs, along with changes in reproductive hormones. According to Dr. van Dis women between forty and forty-four have a 33 percent chance of miscarriage. Older women are also more susceptible to high blood pressure, gestational diabetes, and placenta previa, thus making it a risky pregnancy. By the age of forty, the chance of a child having Down syndrome increases up to one in eighty-five as compared to twenty years of age, when the chances are one in 480 children.
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The Power of Technology and Advancements in Reproductive Medicine
There’s no better time than now to get pregnant using Assisted Reproductive Procedures (ARPs). ARPs encompass a range of fertility treatments, each with different methods, side effects, and success rates. A recent study states that by the year 2100, 400 million people could be conceived with ARPs. But no method is foolproof, and age-related factors can still affect the results. Anyone planning to get pregnant after the age of thirty-five should consult a fertility specialist and focus on a healthy lifestyle. Here is a breakdown of some of the ARPs that exist today:
- In in vitro fertilization (IVF), doctors combine sperm and egg in a laboratory to grow an embryo. IVF specialists note that using younger eggs—whether frozen or donor—significantly improves live birth success rates in older women. Therefore, freezing eggs (oocyte cryopreservation) can be a good option for women wanting to preserve fertility, but timing is key. Freezing too early, such as in the twenties, might not be cost-effective, as many women will naturally conceive. Research suggests the most cost-effective age for egg freezing is around thirty-five.
- Clomiphene and gonadotropins, widely used fertility drugs, help regulate reproductive hormones and stimulate the release of one or more eggs during ovulation. Most women use them for three to six months before either conceiving or moving on to alternative treatments.
- In intrauterine insemination, sperm is inserted directly into the uterus during ovulation.
- Eggs can be donated and fertilized with sperm and implanted in the recipient’s uterus.
- In intracytoplasmic sperm injection, a single sperm is injected into an egg, which is then transferred to the uterus, like with IVF.
- Surrogacy is when a surrogate carries a pregnancy for another individual or couple.
To help counter the high risk of chromosomal abnormalities, pregnant women who are forty and over are offered detailed screenings such as noninvasive tests like cell-free fetal DNA blood tests, advanced ultrasound, and invasive tests such as chorionic villus sampling.
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Stay Strong to the Finish Line!
It is remarkable to see fertility awareness among women of all backgrounds. Celebrities continue to break the silence on this sensitive issue and share their stories of resilience to inspire women struggling with infertility. Tina Malone had her second child at fifty after multiple IVF attempts, defying age-related challenges. Jennifer Aniston spoke about her years of fertility treatments, including IVF, encouraging others to share their experiences despite not having children. Gabrielle Union openly shared her fertility struggles and multiple miscarriages before welcoming her daughter via surrogacy.
ARPs are generally costly and can take a toll on financial and mental health. However, with strong family support and personal motivation, women have achieved nothing short of miracles.
Susan, forty-three, shares her journey: “Fertility treatment is a marathon, where everyone knows what the finish line is, but no one can tell you how far you have left to run or how long it’ll take you to do it. Stay strong, ladies; your finish line is out there.”
Kelly’s journey to motherhood was marked by persistence and resilience. After enduring several ARPs, from artificial insemination to multiple rounds of IVF, Kelly and her partner faced immense physical, emotional, and financial challenges. Ultimately, Kelly decided to use eggs from an anonymous donor and, at the age of forty-three, fulfilled her dream of becoming a mother by giving birth to her son. Her story is a testament to the power of perseverance and the many paths to parenthood.
Reyhan Harmanci got pregnant with her first child at forty and did extensive research when initially struck by cynicism and hopelessness online. She was able to determine the scientific facts yet remain optimistic. Dr. James Grifo, director at the New York University Langone Fertility Center, shares hopeful words:
Stay going!
Hope, Science, and Choice
Many women face negativity, judgment, and even “older-mama” shaming when they embark on their fertility journeys after forty. But here’s the truth: no matter your age, the decision to conceive is yours. With an older pregnancy, being proactive and fully informed about fertility science, reproductive health, and treatment options is key to smart family planning. Stay connected to your tribe of supportive women and lean on them when you need strength. Remember, you won’t know what’s possible until you try. At the end of the day, it’s the journey that truly counts.
Take a deep breath—you’ve got this!
Nadia Khan
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