Nicky, a forty-year-old social worker, had been trying to become pregnant for two years without success. Her gynecologist was baffled. There was no good medical reason for Nicky's infertility. She was in good health and her husband Leon, a forty-nine-year-old lawyer, had an excellent sperm count.
After extensive tests, the Weill Cornell team told them they were among the group of "unexplained" infertility, and suggested they opt for IVF. Their first try failed, and so they tried again. This time the procedure worked, and Nicky gave birth to a girl, Olivia.
Women in their forties are a lot healthier than they were even a generation ago, making pregnancy a viable—and achievable—option for these women. However, the risk of birth defects is a growing concern. Older eggs are more likely to have chromosomal abnormalities in their embryos. At age forty, the chances that a fetus will have Down syndrome is one in one hundred, and at age forty-five the chance is one in thirty. Due to these higher risks, it is essential that prenatal genetic tests be performed.
What's more, first-time mothers over forty are more likely to develop high blood pressure and diabetes during pregnancy than mothers in their twenties. And they are more likely to suffer placenta previa, a condition in which the placenta is implanted low in the uterus, which can impede delivery. This condition can cause complications, but these can often be prevented with a cesarean delivery.
If you're over forty and trying to conceive, you're in good company. Technological advances such as better IVF techniques now make it easier for women in their forties to have babies. With the extension of life expectancy for older women, the benefits of hormonal replacement therapy, and general improvement of the health and living conditions of older women, very late childbearing has become more socially acceptable. However, the chance of becoming pregnant with one's own eggs is very difficult after the age of forty-two or forty-three. Many women in this age group must turn to egg donation.
Some women who seek to conceive after age forty have no difficulty in achieving a pregnancy as long as they have a prompt, thorough evaluation and undergo aggressive treatments.
One simple blood test—measuring the level of follicle-stimulating hormone (FSH) in your blood on day 3 of your menstrual cycle—is important to assess the ovarian reserve, a term used to describe the number of eggs remaining in a woman's ovary. The pituitary gland produces FSH, which is responsible for the development each month of an ovarian follicle, which contains an egg. When the ovaries have very few eggs remaining, the pituitary gland senses this and begins to produce and release higher and higher amounts of FSH in an effort to stimulate the ovary. For example, women who have gone through menopause and have few or no eggs remaining in their ovaries have exceedingly high levels of FSH in their blood. Young women who have had an accelerated decline in the number of eggs can also have high FSH levels. FSH is probably more an indirect measure of egg quantity than an indicator of quality.
If the blood test shows that your FSH levels are consistently elevated, you have a much lower chance of conceiving and carrying to term; if your FSH levels are slightly above normal, these baseline levels suggest that you have a lower chance of achieving a pregnancy.