Getting pregnant at 40+

On average, women are fertile until the age of 41. While some women become infertile in their twenties, other women have a child at 43 or 44. Whether you can have a child over the age of 40 primarily depends on your ovarian reserve, your hormonal situation, and the presence of underlying diseases – and, of course, from your partner’s or sperm donor’s sperm quality.

Your pregnancy chances involve a lot of statistics, so I’ve put together some numbers from clinical studies and public health surveys for you.

How fertility develops approaching menopause

The menopausal transition refers to the eight- or nine-year-long phase before your very last menstrual period and the one or two years after that. This time is defined by a significant decrease in the number of eggs in your ovaries (ovarian reserve) and their quality. The chances of pregnancy drop, while the risk of miscarriage or unsuccessful in vitro fertilization (IVF) increases.

Phases of menopausal transition

Premenopause
Most women enter the premenopause in their late 30s to early 40s. Women with premature ovarian insufficiency enter premenopause as early as in their mid-20s.

At the beginning of the premenopause, ovulation becomes increasingly irregular, and pregnancy chances drop to less than 8 percent per cycle.

Your estrogen and progesterone levels decrease according to the decline in your ovarian reserve. This decrease, in turn, influences various bodily functions and is responsible for the typical symptoms associated with menopause, such as hot flashes, dry skin, sleep disorders, and low mood. In response to the decrease of estrogen levels, the body releases more follicle-stimulating hormone (FSH) to maintain the function of the ovaries for as long as possible. The lower the estrogen and the higher the FSH, the more diminished your ovarian reserve, and the closer you are to menopause. In Europe and the USA, the average age for a woman to reach menopause is 51.

fertility menopause hormones

Fig.: Decline of estrogen and progesterone during the menopausal transition.


Premenopause usually lasts eight to nine years. Toward the end of premenopause, your cycle becomes unpredictable, and your overall fertility leaves only a theoretical chance of pregnancy.

Perimenopause
Perimenopause is defined as the two years immediately before and after the last menstrual period. Because “menopause” is defined as having gone with a menstrual bleeding for twelve consecutive months, perimenopause is the last two years before menopause.

At the time of the menopause, only about 1,000 of the original millions of eggs in the ovaries are left. In the two years before and after your last period, your body adjusts to the new hormonal situation and tries to find a new balance. Pregnancy with your own eggs is now definitely no longer possible.

If you suspect you’re in perimenopause and would like to have a baby, please feel free to contact me. Egg donation might be a good option.

Postmenopause
Post-menopause succeeds perimenopause. Symptoms such as hot flashes, sleep disorders, and mood swings may increase at this stage; there is also an increased risk of osteoporosis and breast cancer.

Early menopause

About 2-3 percent of all women are affected by early menopause or premature ovarian insufficiency (POI). Early menopause is defined as infertility related to an exhausted ovarian reserve before the age of 30. In rare cases, women lose their fertility by the end of their 20s. This condition is largely hereditary; if your mother entered menopause very early, the chances are that you will too.

Women who receive chemotherapy as part of cancer treatment can also be affected by early menopause. For these women, egg freezing is a great way to preserve their fertility.

The most important marker for ovarian reserve and predicting menopause is the anti-Mullerian hormone (AMH). With the help of the AMH, you can find out how much longer you are able to have children and approximately when to expect menopause. After completing chemotherapy, AMH is also a good prognostic marker of whether the ovaries will recover.

Important: The AMH must always be interpreted in combination with age; for a 30-year-old woman, an AMH of 1.2ng/ml has a different meaning regarding her fertility than for a 40-year-old woman. Please contact me at silvia@fertinesse.com if you would like to find out what your AMH level means regarding your fertility journey!

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Sources:

Dewailly D et al. The physiology and clinical utility of anti-Mullerian hormone in women [published correction appears in Hum Reprod Update. 2014 Sep-Oct;20(5):804]. Hum Reprod Update. 2014;20(3):370‐385.

te Velde ER, Pearson PL: The variability of female reproductive ageing. Hum Reprod Update. 2002;8( 2):141‐154.


Spira A:The decline of fecundity with age. Maturitas. 1988; Suppl 1:15-22.

Bentzen JG, Forman JL, Larsen EC, et al. Maternal menopause as a predictor of anti-Mullerian hormone level and antral follicle count in daughters during reproductive age. Hum Reprod. 2013;28(1):247‐255.