Planning a Pregnancy After 40

miller family

Lori and Kevin Miller climbed the corporate ladder for nearly 20 years before starting a family.

By then, the couple had achieved considerable success in their professional lives. Lori was a project manager, and Kevin was an insurance company executive.

“We were very focused on our careers and kept waiting for the right time to have kids,” Lori said. “Then, age kind of snuck up on us.”

Lori was on the verge of turning 40, an age when, in the past, most women were sending kids to grade school rather than trying to conceive them. But Lori represents a new normal. According to National Center for Health Statistics data, birth rates in women over 40 are on the rise.

Fast-forward to today: The Millers, who live in Columbia, are now a family of four. Isabella, their daughter, was born when Lori was 40, and Rhett, their son, was born when Lori was 43

MU Health Care obstetrician Karen Thies, DO, cared for Lori throughout her second pregnancy. She has practiced medicine for 15 years, but has only recently noticed increasing numbers of women over 40 coming in for family planning and prenatal care.

“As the decades have passed, women have become more educated and professionally active, resulting in them getting married and starting families later in life,” Thies said. “Ten years ago, it was fairly uncommon to see women in their 40s having children. Decades ago, it was extremely rare.”

Preparing for Pregnancy

Karen Thies, DO
Karen Thies, DO

Pregnancy is physically demanding at any age, but it can be especially challenging for women over 40.

“Everything hurts more with age,” Thies said. “You will feel exhausted. Dinner parties will put you to sleep, and if you don’t have a house cleaner, you will seek one out at any cost.”

On the bright side, Thies said women who conceive later in life possess a distinct advantage over their younger counterparts.

“With age comes wisdom and tolerance,” she said. “And both of these attributes are essential when dealing with the aches and pains of pregnancy.”

Thies said women over 40 also face an increased risk of miscarriage and stillbirth, and their children are slightly more likely to have chromosome anomalies such as Down syndrome.

The Millers made it a point to discuss these risk factors before trying to conceive, and Lori underwent genetic testing during pregnancy to ensure she knew what to expect every step of the way.

“Almost all of my patients who are over 40 check for chromosome anomalies because they want to be psychologically prepared,” Thies said. “The first test can occur as early as the first trimester of the pregnancy, and if a potential anomaly is detected, confirmatory tests can take place after 16 weeks.”

During preconception appointments, Thies encourages all couples to explore all of the challenges, changes and sacrifices that come along with parenthood. She said it is impossible to be over-prepared for pregnancy.

Finding Fertility

Thies said a woman’s fertility can be boiled down to two main factors: her ovarian function and her overall health. At any age, a healthy woman who ovulates regularly and has good eggs can likely get pregnant through intercourse within a year.

However, it is important for couples over 40 to visit a doctor early in the process to assess their fertility.  

“We can test your ovarian function, run a semen analysis on your partner and know right away whether you have a solid chance of conceiving in a timely fashion,” Thies said.

During this preconception counseling appointment, the doctor also will assess health and lifestyle factors that could be impacting the woman’s fertility, such as her weight, diet and exercise habits.

If both partners are deemed fertile and healthy, Thies will instruct them to try what is called “the gunshot method.” That means intercourse every other day during the mid-third of the woman’s menstrual cycle. She said doctors can help couples identify this ideal time window.

“Some couples think they need to have sex every day in order to get pregnant, but the male partner simply won’t produce enough sperm for that to work,” Thies said. “With the gunshot method, you will always have an appropriate amount of sperm looking for the woman’s egg.”

Lori said she got pregnant “almost immediately” after Thies steered her toward the gunshot method. However, Thies said this will not always be the case. She typically has couples try the gunshot method for six months before referring them to a MU Health Care reproductive specialist. From there, the couple can explore options such as in-vitro fertilization.

Today, with two healthy children in tow, Lori serves as encouragement for women who choose to start families later in life.

“If women feel strongly about pursing their careers and achieving certain things before becoming a parent, then by all means go for it,” she said. “Just keep in mind that as you age, everything is harder on your body. Make sure you are eating well, exercising and keeping yourself as healthy as possible when you decide to start your family.”

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