I’m often asked by women over the age of 40 my opinion on having a baby. Clearly it’s a personal decision by a woman and her partner. But I have gained a lot of wisdom and experience in this area, so here is my personal position statement on later motherhood that I would like to share with you.
The decision to have a baby at any age is a life affecting one, but deciding to have a baby after the age of 40 carries additional considerations. First there is the health of the mother. That’s why the first thing a woman choosing to have a baby after age 40 should do is to obtain accurate information about her chances to conceive (< 10%), how long it will take her to conceive (up to a year or more) and how long she should attempt conception (see below).
If she chooses to proceed, she should obtain a complete medical exam, begin taking folic acid, clear her house of potentially toxic substances such as lead paint, and establish a realistic time frame for conception to occur. She should also seek fertility guidance within three months if conception does not occur. I recommend mental health support as well. For those who attempt conception with assisted reproductive techniques such as in-vitro fertilization or donor egg, the vast majority of successes occur within three attempts (Seibel MM et al. In Vitro Fertilization: How Much is Enough? N Engl J Med 1989;321:15). If a surrogate mother is a consideration, begin with a good attorney who specializes in reproductive law.
The next consideration is the health of the baby. After the age of 40 there is a high rate of both miscarriage and of babies affected by genetic disease. Prenatal testing of the baby by methods such as amniocentesis is highly recommended. In order to increase the likelihood of the child having parents until at least the age of 18, I recommend that combined ages of the parents not exceed 100 at the time of conception (Seibel MM, Zilberstein M, Seibel SG. Becoming Parents after 100? Lancet 1994;43:603).
If adoption is a consideration, look into it early. This allows many of the waiting periods to pass so that in the event biologic parenting does not occur, months of waiting will have passed and not have to be endured at the end of fertility treatment.
There are many ways to successfully build a family. Being informed, getting the best help along the way and obtaining open dialogue with your partner and mental health professional helps ensure a gratifying outcome. Finally, living a child-free life is for some, one of the gratifying outcomes.
Click here for my video on why it’s important to see a fertility doctor early if you’re 40 or more.
