How age affects fertility

Your age affects your fertility, with a gradual decline in the ability to get pregnant starting at age 34.

If you decide to have a baby later in life it’s very likely you will do so without having problems. However, it might take longer to get pregnant and some people may need medical help, which is called assisted conception.

Your age is not something you can control. Many women are having babies later in life for very valid reasons such as not feeling stable enough to support a child (for example, with money or housing), not wanting to have a child before or not having a partner to have a child with.

However, as women get older, it becomes more difficult to become pregnant and the risk of miscarriage increases. Men’s fertility also decreases with age, though to a lesser extent.

Why does age affect my fertility?

Fertility decreases with age, particularly after the age of 35 because both the number and quality of eggs gets lower.

An egg is sent from your ovaries to your womb every month from when you hit puberty to the menopause. When the egg binds with sperm in the womb you get pregnant. Although it may seem like your body is making a new egg every month, this is not the case. Women are born with all the eggs they ever have and they are stored in the ovaries. As you get older your eggs get older too.

How long it takes to get pregnant depending on age

More than 8 out of 10 of couples where the woman is under 40 will get pregnant naturally within a year of having regular unprotected sex (having sex every 2 to 3 days without using contraception).

One study found that for couples having regular unprotected sex:

  • around 7 out of 10 women aged 30 will conceive within one year
  • around 6 out of 10 women aged 35 will conceive within one year
  • around 4 out of 10 women aged 40 will conceive within one year.

There are several causes for fertility problems, but sometimes an exact cause can’t be found. This is called ‘unexplained infertility’. Unexplained infertility is rare when the woman is in her 20s but becomes the most common cause of infertility in women over 35 years of age.

There are treatments such as IVF (in vitro fertilisation) that can help you to conceive if you are struggling. You should see your GP if you haven’t conceived after a year of trying or within six months of trying to conceive if you are over 36.

If you know you have any other health concerns related to fertility, such as endometriosis, polycystic ovary syndrome (PCOS) or thyroid problems you should also make an earlier appointment with your doctor.

Remember that age is not the only thing that may affect your fertility. Smoking alcohol and drug use, obesity and sexually transmitted diseases can also have an impact on your ability to get pregnant.

If you are thinking about having a baby later in life, try not to get too stressed about the impact of age on your fertility. According to the Office for National Statistics, the conception rate for women aged 35 to 39 years and 40 and over in England and Wales has more than doubled since 1990.

Your age and free IVF on the NHS

Fertility treatments such as IVF can help women conceive. But as with natural conception, IVF is less successful as women get older because, unless you use donor eggs, the quality of your eggs also gets worse with age.[4] For this reason some areas in the UK will only offer free NHS treatment before you have reached a certain age.  If you do have IVF, the clinic will discuss with you what your likelihood of success in relation to your age.

NICE is the body that makes recommendations to your NHS Trust about what treatment it should offer. According to NICE, women under 40 should be offered 3 cycles of IVF treatment free of charge on the NHS if:

  • tests show that IVF is the only treatment likely to help you get pregnant.
  • you have not become pregnant with regular unprotected sex for 2 years
  • you have not become pregnant after 12 cycles of artificial insemination

NICE also says that women aged 40 to 42 should be offered 1 cycle of IVF free of charge on the NHS if:

  • you’ve been trying to get pregnant through regular unprotected sex for 2 years, or haven't been able to get pregnant after 12 cycles of artificial insemination
  • you’ve never had IVF treatment before
  • you show no evidence of low ovarian reserve (where eggs in your ovaries are low in number or quality).

Again, if tests show IVF is the only treatment likely to help you get pregnant, you should be referred straight away.

Not all trusts offer the amount of IVF cycles described above. In spite of NICE guidelines, some NHS Trusts (who run your local health services) do not all follow the guideline above. Some may also ask for other criteria, such as that you:

  • do not having any children already
  • are a healthy weight
  • do not smoke
  • are under a certain age.

In some cases, only 1 cycle of IVF may be offered, instead of the 3.

Ask your GP what the criteria for NHS-funded IVF treatment are in your area.

What if my reproductive partner is older?

Men’s ability to have a baby also declines with age, though not as much as women’s.

If the male partner is over 40, this can make it harder for the woman to get pregnant, especially if she is also over 40.

Other reasons why older men may have less chance of pregnancy:

  • less interest in sex
  • poor sperm quality
  • lower levels of male sex hormones.

How can my age affect my pregnancy?

Most women over the ‘ideal’ childbearing age have healthy pregnancies and babies, but complications in pregnancy such as miscarriage also increase with age.

The risk of miscarriage occurs in around:

  • 1 in 10 pregnancies in women younger than 30
  • 2 in 10 of pregnancies in women between 35–39
  • 1 in 5 of pregnancies in women older than 45.

Women over 40 are also at higher risk of problems in pregnancy including:

  • high blood pressure and diabetes In pregnancy (gestational diabetes )
  • having twins or triplets, which cause complications
  • having a baby with Down’s syndrome
  • pre-eclampsia, (a pregnancy condition that can be dangerous for mother and baby)
  • longer labour or caesarean section
  • stillbirth.

Will I get any extra care if I am pregnant and over 40?

Yes. If you are over 40 your midwife, GP, obstetrician or specialist teams may all be involved in your care during your pregnancy.

Because you are at a higher risk of complications you will probably be offered more tests to check that you and your baby are healthy as part of your antenatal care. For example, you will have extra scans, tests, and your blood pressure may be checked more often because of the higher risk of pre-eclampsia.

Your midwife will explain more about what your care plan will look like at your booking appointment. You’ll also have the chance to ask any questions or talk about any concerns you have.

It’s very important that you attend all your antenatal care appointments so that midwives can spot any problems early and treat them.

What can I do to make sure I have a healthy late pregnancy?

The best thing you can do if you are planning to have a baby at any age is to make sure you are healthy before you get pregnant. You can do this by:

  • being as close as you can to a health BMI
  • taking folic acid for at least 2 months before conception
  • doing regular physical activity
  • eating a healthy, balanced diet
  • stopping smoking
  • cutting caffeine down to under 200mg a day
  • avoiding alcohol and illegal drugs
  • talking to your doctor or specialist about any existing medical conditions and pregnancy
  • being tested for sexually transmitted diseases (STIs) if you have any reason to believe you may be at risk of having one
  • having a cervical screening within three years
  • making sure you have had the MMR vaccination.

Sources

1. Leridon H.(2004) Can assisted reproductive technology compensate for the natural decline in fertility with age? A model assessment. Human Reproduction 2004;19(7):1548.

2. Gnoth et al. (2003) Time to pregnancy: result of the German prospective study and impact on the management of infertility. Human Reproduction 2003 Sep;18(9):1959-66.

3. Office for National Statistics (accessed 01/05/2018) Conceptions in England and Wales: 2016 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/conceptionand
fertilityrates/bulletins
/conceptionstatistics/previousReleases

4. Bewley S, Ledger W, Nikolaou, editors. Consensus views arising from the 56th Study Group: Reproductive Ageing, Royal College of Obstetricians and Gynaecologists Royal College of Obstetricians and Gynaecologists Press, 2009; p353-6

5. NICE Guidelines (2017) Fertility problems: assessment and treatment National Institute for Health and Care Excellence

6. Royal College of Obstetricians & Gynaecologists (January 2011) Reproductive Ageing https://www.rcog.org.uk/en/guidelines-research-services/guidelines/sip24/

7. NICE Guideline (2013) Miscarriage National Institute for Health and Care Excellence

8. NHS Choices (accessed 01/06/2018) Your antenatal care, Page last reviewed: 01/11/2016 Next review due: 02/11/2018 https://www.nhs.uk/conditions/pregnancy-and-baby/antenatal-midwife-care-pregnant/

9. NICE Guideline (2017) Antenatal care for uncomplicated pregnancies National Institute for Health and Care Excellence 

 

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Last reviewed on June 5th, 2018. Next review date June 5th, 2021.

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