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By Robert Boostanfar, M.D., FACOG and, Wendy Shubin, MPAS, PA-C, Huntingdon Reproductive Center, CA.

Are you trying to have a baby after forty and seeing all these celebrities pregnant?  So why are you having so much trouble conceiving?

Well, the media is really good at showing us pictures of their beautiful babies, but their story of how they conceived is not always open to the public.   Here are the secrets of conception after forty. According to the American Society for Reproductive Medicine (ASRM), the chance of conceiving naturally after 40 years of age is only about 5 percent per month.

For women ages 40 to 44, 29 percent are infertile, compared to only 15 percent of women ages 30 to 34 and 7 percent of women ages 20 to 24.   Not only is it harder to get pregnant after forty, but it is also harder to stay pregnant.  Data from the ASRM suggests that miscarriage rates for women over forty is 34 – 53% compared to their younger counterparts at 10% (20- 24 years old) and 12% (30 – 34 years old).

We all know that 40 is the new 30, however, ovarian function continues to decline with age.  As we age, follicle stimulating hormone (FSH) level tends to rise and we are much more likely to have chromosomally abnormal eggs that results in lower pregnancy rates.  In fact, woman 40 years of age and older have a 1 in 106 chance of having a baby with Down Syndrome compared to a woman who is 35 who has a 1 in 378 chance.

It is important to get a full fertility work-up with a Reproductive Endocrinologist (RE) to find out your individual success rate if you are trying to conceive after 40.  Your work-up will include an ovarian function assessment test, including follicle stimulating hormone (FSH), estradiol and perhaps an Antimullerian Hormone (AMH) level.

FSH is produced by the anterior pituitary gland and binds to receptors on the ovary to produce an egg every month.  As an egg grows your ovary releases estradiol to thicken the uterine lining for implantation and tells your pituitary gland to stop producing FSH.  This is called a negative feedback system.  FSH levels are elevated when your FSH receptors on your ovary no longer bind to FSH thus inhibiting estradiol levels to rise.

AMH is expressed by cells (http://en NULL.wikipedia NULL.org/wiki/Granulosa_cells) in the ovary during the reproductive years, and controls the formation of eggs by inhibiting excessive follicular recruitment by FSH.  AMH levels start to decline starting at 25 years and will become undetectable at menopause. Your RE will also order a hysterosalpingogram (HSG) test to ensure that your fallopian tubes are open and your uterine cavity is normal.

An HSG test is an X-ray test that involves an injection of contrast medium (dye) through the cervix into uterus that flows through the fallopian tubes (if they are open) into the abdominal cavity.   A semen analysis on the male partner will also be required to make sure that the sperm is not impacting conception.

When is it time to entertain the idea of using an egg donor?  Every RE is different in their recommendation for using a donor.  This decision is made based on each patient’s individual needs, such as medical indication and emotional readiness.  If you have a significantly elevated FSH and poor ovarian reserve, then your RE will recommend you to think about using an egg donor.

If you feel you are ready to explore egg donation, your RE will refer you to a number egg donor agencies.  Once connected with an agency, you will be able to read about and view potential donors.  Egg donation is most commonly anonymous, but if you donor is willing; you may choose to meet each other.  You donor will undergo a rigorous screening with your RE to make sure she is healthy and fertile.

Legal contracts need to be signed between you and your donor and your donor must go through a psychological consult, physical exam and blood work.  After all this is completed, you and your donor will need to put on birth control to match up your menstrual cycles to start the process of making eggs and preparing your uterus for an embryo transfer.

It is important to have realistic expectations of how our reproductive function in both men and women perform as we become older.  Twenty to forty percent of women over 40 years of age are able to achieve pregnancy with help of assisted reproductive techniques (ART) using their own eggs.  Sixty to Eighty percent of women over 40 years of age are able achieve pregnancy with the help of ART using donor eggs.

Egg donation increases pregnancy rates and allows women to experience pregnancy and child birth. This process is a journey and ultimately it doesn’t matter how you get to your destination whether it be spontaneous pregnancy, ART, egg donation or adoption.  Best of luck to you and your partner on your journey!

Notes for this blog:

Dr. Boostanfar, MD., F.A.C.O.G., has special interests in assisted reproductive technologies and oocyte donation in women of advanced reproductive age, selective estrogen receptor modulator effects on infertility and extended release gonadotropin therapy for controlled ovarian hyperstimulation.

Currently practicing at HRC Fertility (http://www NULL.havingbabies NULL.com/) in California, Dr. Boostanfar graduated medical school from the University of Southern California in 1995, completing his residency in Obstetrics and Gynecology in 1999 and his fellowship in the Division of Reproductive Endocrinology and Infertility in 2002 at the University of Southern California, Los Angeles County Women’s and Children’s Hospital.

He is active in well-known professional organizations, including American Association of Gynecologic Laparoscopists, the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, as well as the Pacific Coast Reproductive Society

During Dr. Boostanfar’s time at HRC Fertility, he has made multiple television appearances including Good Morning America, CNN, The Learning Channel as the resident doctor on TLC’s “The Little Couple”, KTLA, CBS and has been featured in People Magazine.

11 Responses to The Secrets of Conception After Forty

  1. Fruitful Harvest (http://www NULL.ourfruitfulharvest NULL.blogspot NULL.com) says:

    I am 43 (44 in Sept). Hubby (48) had
    tried for 17 mo. to concieve starting when I was 41. I concieved finally in Dec 2010 then miscarried 8weeks later in Jan 2011.
    We have 6 kiddos together already all concieved with no problem.

    I then found out about the Crieghton Model of Fertility and NaPro Technology. I started charting and then had blood tests done.
    I have low progesterone and estrogen in the last half of my cycle. I can concieve but baby will not attach good there for a miscarriage would happen most every time.
    My NaPro Doc prescribed 4 HGC injections on peak+3,5,7 and 9. to stimulate my body to produce progesterone and estrogen. The first month was not high enough so Doc uped my daily dose and the 2nd month it worked!

    I am now pregnant with my 8th baby due June 2012!
    Once pregnant I started taking
    200mg of progesterone in pill form a day and testing my levels progesterone every 2 weeks.

    At about week 27 of my pregnancy my levels droped so I am now taking 400mg of progesterone a day.

    I will contiue to take the progesterone until I an 37weeks. (though my OB was surprised I did not stop taking it at 11weeks when the placenta is said to be making enough progesterone!) Goes to show you that OB’s that you trust and thing should know these things don’t!

    Dr. Hilgers in Omaha Nebraska at Crieghton
    has
    been studying hormone and the reproductive system for over 30 yrs.
    His methods are in doing things natrually
    and in following the biblical teachings.

    Pregnancy in your 40 is an interesting topic!

    Peace+
    Georgiann

  2. Carolyn says:

    Georgiann,

    Thanks for the informative story!

    Carolyn

  3. LeslieC says:

    Thank you doctor for spreading the word about the realities of getting, and staying, pg after 40. While there are some success stories, I’ve seen many more women over 42 who have used donor eggs. However when I was in an egg donor support group, there were MANY women in their mid-late 30s who had already found out they had diminished ovarian reserve. We need to spread the word that just because people in the public eye are having children at older ages, 99 percent of the time they are using donor eggs. At age 43 I was told that the chance of having a child with Down Syndrome was 1/25, which was pretty high, IMO. Although externally we may be staying younger longer, the biological clock still ticks away.

  4. Janeane says:

    I’m 44 and my husband is 33 but does not have any children of his own. We tried for a baby in March and got pregnant the very next month. Unfortunately i just miscarried at 6 weeks yesterday. I am going to try again right away as I really want a baby now more than ever. I just wish there was something that could improve my egg quality. I’ve heard about Clomid and Femara and wonder if I should take those. My husband already painted a room in our house for the nursery. I just don’t want to disappoint him and his family who have no grandchildren. Any advice would be greatly appreciated. —-praying with fingers crossed—–

  5. Mohamed Ali says:

    Dear Sir,
    I’m 31 years old and my wife in 43 years’ we are this kind of people who find love later, she can’t be pregnant, we tried a lot but its all about her egg, we tried Clomid, I have listen about egg donation, but I haven’t any idea how we can go through it, and if this will be expensive, I don’t like to divorce my lovely wife, but we need a child to complete our life, I’m asking for you advice sir, if there is any hope I’ll tack it.
    thanks for your time,
    God Bless you

  6. LCB says:

    After 6 yrs & 6 failed IVF cycles with donor eggs, we are done. Never had implantation even when all else was perfection. My 50th birthday was 3 days before the last transfer; time to put the dream away. Where are the support groups for those of us with shattered dreams?

  7. Ryan says:

    I just don’t understand how this article reveals the “secrets of conception over 40.” What are the “secrets” here? All this article does is provide dismal stats, explain a bit about a fertility “work-up” and provide options for what you can do if you are diagnosed as “infertile” (which is a term that is thrown around way too loosely). A better title would be “fertility 101″ since It’s little more than a Wikipedia article.

  8. Top Over-40 Mom Site Re-launches With Extreme Makeover « A Child After 40 (http://achildafter40 NULL.wordpress NULL.com/2012/11/13/top-over-40-mom-site-re-launches-as-achildafter40-com/) says:

    [...] or over 40 who are trying to conceive naturally or via assisted reproductive technologies [...]

  9. Robyn says:

    I think Ryan is confused, and feels mis-lead by the title of Dr. Boostanfar’s article. The “secrets” of Hollywood’s women of advanced maternal age are exactly what Dr. B said–egg donors, surrogates and unlimited finances to try IVF multiple times. We spent $30,000 on two rounds of IUI’s and one round of IVF. Apparently, one celebrity did IVF five times before achieving success. Most people don’t have that kind of money, It sounds like Ryan is angry, and if anyone understands, I do; however, it is not Dr. Boostanfar’s fault that there is no real secret beyond biology and economics. And as far as it being little more informative that Wikipedia, well obviously most don’t seem to have the basics of reproduction, or we wouldn’t be trying to conceive after 40 years of age now would we?

  10. Joan Price (http://www NULL.fertileheart NULL.com/does-a-low-amh-level-indicate-infertility/) says:

    Thanks for the share. I was diagnosed with low amh levels and I was curious if anyone could tell me how much this comes into play when trying to becoming pregnant. Any information would be much appreciated. Thanks :)

  11. Tania says:

    Im desperate to have a baby. Im tuning 44 in Feb and my husband is 56. I have endometrioses and have had a syst removed from one ovary.
    I wish I had a family. My husband has three children and 7 grandchildren from a previous marriage.
    What do I do???? I had an abortion at the age of 23 and wish I never made that decision. I was with my husband then.

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