How To Get Pregnant at 40: Tips From a Fertility Doctor

trying to get pregnant at age 40 and older [Music] hi friends i am dr natalie crawford i'm a board certified ob gyn and rei i'm a fertility doctor and today today this video is getting released it's my birthday so happy birthday to me i am turning 40. so i think it's super timely to talk about what if you are trying to start your family or grow your family and you are 40 and older what do i want you to know first of all this channel exists to spread knowledge about your body and your fertility please subscribe if you want to learn more can women get pregnant at age 40 and more absolutely they definitely can do you have a lower chance of getting pregnant per month also yes i think it's very important in the circumstance to realize that your time is your most valuable commodity and you want to be educated so that you are using your time wisely the chromosomes inside a normal egg are 46xx inside the egg i want you to imagine that the chromosomes are lined up in the middle and held apart by these little myotic spindles of proteins when you ovulate part of the job is to separate these chromosomes apart half of them go into a polar body which is considered trash and half of them are in the oocyte or the egg that can be fertilized this is the half of the genetics that's coming from the maternal side however as we get older these chromosomes start to split abnormally at an increased prevalence this is largely because the proteins about symbiotic spindles start breaking down our eggs take on the wear and tear of our life and over time things are just going to disintegrate and there's very little you can do about it although there is some and we will review that at the end so the first thing you want to know is just in a natural fertility cohort what happens when women who are older start trying to conceive there was a fabulous study done by one of my fellowship mentors and i did a ton of research on this cohort the cohort was called time to conceive it was a large population-based cohort in north carolina and this study is called the impact of female age and null gravity on fecundity and an older reproductive age cohort this cohort followed people who'd been trying to get pregnant for less than or equal to three months and watch their cycle pattern history tracking ovulation and just reported a pregnancy there was no intervention beyond just cycle tracking everybody in the study was age 30 and older so the comparison groups as people who were in their early 30s not people who were younger than 30. there were 960 people who were in the study with over 3593 cycles for evaluation for women who were under 38 the average time to pregnancy was three months for people who were 40 to 41 the average time to pregnancy was eight months and for people who were 42 and older the average time to pregnancy was greater than 12 months compared to the reference group who was under age 34 women who were 40 to 41 had a 53 reduction in chance of pregnancy per month and women who were 42 to 44 had a 59 reduction per month we broke this down in a little bit different way to look at it what was your chance of getting pregnant in one month what was your chance per month overall and what percentage of people got pregnant from the age of 8 40 to 41 6.2 of people got pregnant the first cycle trying after 12 cycles 54 of the age group was pregnant with a monthly chance of being pregnant of 8.6 however in the age of 42 to 44 what we saw was that no people got pregnant in the first cycle overall though at 12 months 48 were pregnant and the average chance per pregnancy was 6.6 per month can people 40 and older get pregnant absolutely in this study almost 50 percent of people who were trying to get pregnant did get pregnant and this is of people who just first started trying to get pregnant trying for approximately a year now if you compare that to the younger age groups in the same study people who were 35 and younger 80 to 90 of them were pregnant a year so you can see there's a much higher chance of infertility as you got older however where this data becomes really important is stratified by people who've been pregnant in the past versus people who've never been pregnant so people who had never been pregnant who were 40 to 41 had a 2.9 chance of pregnancy per month and an overall cumulative chance of pregnancy by the end of 12 months of 25 if you compare that exact same group so age 40 to 41 who'd had history of a prior pregnancy their chance of being pregnant per month was 9.8 and their overall cumulative chance of being pregnant was 56 by the end of 12 months so there's a huge difference in the people who've never had a pregnancy before and so this should be number one the first thing that you're looking at if you're starting to try to get pregnant at age 40 is have you achieved success in the past are you trying to add to your family or is this your first attempt at having a family there's a brother effect of this change that we're seeing is due to abnormal chromosome numbers there was a great study published in fertility and severality also that is effects of maternal age on euploidy rates and large cohort of embryos analyzed with 24 chromosome single nucleotide polymorphism-based pre-implantation genetic screening essentially in the study what they did is they did pgs or screening of embryos prior to implantation to look at the percentage that was euploid across different ages this graph is joining us right here but there's a steady decrease in the percentage of euploid embryos after age 35 and at age 40 the approximation of normal embryos is around 25 to 30 percent dropping significantly as you get older than that to be around 10 at age 44 to 45. okay so this state is scary and as somebody who is in this age range it is actually scary this is what advanced maternal ages so being age 35 and older is considered advanced maternal age solely because you have an increased prevalence of chromosome abnormality this previously before we could test embryos or do any of this stuff this would be detected on your prenatal screening once you are pregnant screening tests for down syndrome trisomy's 13 and 18. those are some of the more common chromosome abnormalities that can be detected in babies now a lot of these chromosome abnormalities do not fertilize implant and that's why we're seeing lower pregnancy rates in this group right if all of these chromosome abnormalities led to becoming babies we would see this consistent pregnancy rate we would just see a huge drop off afterwards so the fact that we're seeing a lower chance of pregnancy overall is telling us that this is the number one reason why so what are you gonna do with this information number one you're gonna expedite a workout number two you're going to do everything you can to impact your egg quality the best possible and number three you're gonna make most of your months trying to conceive i always tell my patients who are older that there's no reason for us to suddenly just start seeing what happens you know if it happens it happens if it doesn't it doesn't we need to take a more proactive approach that we can have the family that we want to have number one your history if you've ever been pregnant in the past you overall have a higher chance of getting pregnant right now so that should be a reassuring sign if you have never been pregnant you need to be paying close attention to your cycles and get an evaluation sooner honestly i tell everybody if you're 40 and you're starting your family i would love to see you at the very beginning do a basic fertility evaluation if it's all normal we might choose to let you go try to get pregnant naturally for a period of time however if it's abnormal then you have not wasted your time because the sooner we get moving on treatments the higher chance of success we're going to have so what do i mean by that number one is your period pattern regular are your periods coming at regular predictable intervals if they are great if they are not go see a reproductive endocrinologist for the beginning we want to check to see auger fallopian tubes open do you have any history of prior abdominal surgery history of infections like gonorrhea or chlamydia history of endometriosis or suspicion of that in those circumstances there's a higher pretest probability that you might have a blocked fallopian tube either way you need to have open tubes in a normal uterus any history of uterine fibroids or polyps intrauterine surgery or medical terminations those are other reasons why we would want to look inside the uterus so anatomy looking at the inside of the uterus and the fallopian tubes this can usually either be done with an hsg test which is a hysterosalpingogram a dye test we put dye into the uterus to look at the uterus and the fallopian tubes that's what's called a film view also known as the bubble test it's a combination of a saline ulcer sound and then pushing air and water bubbles through the fallopian tubes or even going to surgery with a laparoscopy and hysteroscopy camera in the belly button and camera in the uterus it's obviously a much more invasive approach i'm not currently recommended for diagnostic testing anymore the next thing is a semen analysis so checking sperm if you've got a partner with sperm we want to make sure there's good volume of the sample the concentration is normal the sperm is moving well and of normal shapes abnormalities in these parameters can impact our pregnancy rates so if somebody who is older comes to me that's the basic fertility testing getting a good period tracking history checking anatomy checking sperm counts the other factor that we like to consider is checking your ovarian reserve please note i'm only talking about your reproductive chances per month i didn't mention one time running out of eggs everybody does run out of eggs and my favorite analogy is to imagine that you have a vault inside your ovary and that's where all your eggs are kept when you're born the vault is full and throughout your life eggs come out of the vault and when the vault is empty you're in menopause the number of eggs decrease in the vault over time and when the vault is less full fewer eggs come out when the vault is more full more eggs come out on a month-to-month basis when you're trying naturally that doesn't matter because the number of eggs outside the vault is only important in understanding our timeline or if we're doing ivf the number of eggs outside the vault is just how many die so if you have 12 eggs outside the vault or four in both circumstances the body is going to want one egg to ovulate the differences are you having 11 eggs or three that are dying off that month amh is a blood test essentially it's a hormone that is made from the cells surrounding all of the eggs that are outside the ball so when you have more eggs in the ball more come out higher emh fewer eggs level fewer come out lower amh lower amh values are not reflective of abnormal focusability or chance of getting pregnant naturally however it's putting a fire under our feet because we have less time to achieve our goals if we want to have more than one kid super important now because we need to be pregnant in the future and is changing our ivf outcomes on a cycle basis meaning those with a lower amh often will need more cycles to get to the same outcome as somebody who has a higher amh therefore you want to get started on those cycles faster before your amh is even lower because those eggs outside the vault the eggs that you can get in an ivf cycle so one person can get 12 eggs in one cycle one person could get four they could have the same outcome but this person needs to get four eggs from one month four eggs from the next month four eggs from the third month in order to have the same egg number as a peer so this is part of understanding the strategy and the urgency for the timeline so that is going to be ovarian reserve one of the biggest advantages to considering ivf in a patient group that is older is that you can test the chromosomes of the embryos before you implant them inside and you can get a higher life birth rate per transfer than if you don't so when you look at ivf statistics you have to understand is that a euploid or a genetically normal embryo that underwent genetic testing or is this an embryo that hasn't had genetic testing when you transfer a euploid embryo you have the same chance of pregnancy which is about 65 to 70 chance of live birth versus if you're looking at just ivf outcomes overall using untested embryos so one of the advantages in an older group of going to ivf is you can get a higher efficiency to pregnancy and get pregnant faster because we're ruling out the number one thing that's sitting your way also if you're 40 or older and you're just starting your family because you met your person later or you were chasing some amazing career dreams that's great too but we can give you the highest chance of having the family of your dreams by doing what we call embryo banking embryo banking means that you purposely get embryos to save for a future pregnancy typically in the mass equation we like to have two embryos in the bank for a future pregnancy so if you told me you wanted two kids and you were 41 i'd want to make sure we have at least four embryos before we start transferring so you might go through multiple months of cycles getting eggs from one month and then the next in order to get to that goal so that we don't see that drop in pregnancy as time goes on or the fact that it might take you a year to get pregnant naturally and only 25 to 50 percent of patients that age range will actually achieve a pregnancy in that timeline what have you lost in that time and at what point are you no longer going to be able to get pregnant because all your eggs are the vast majority are genetically abnormal all of that said let's pretend we check everything everything comes out okay you want to try to get pregnant naturally we want to be as efficient as possible in getting pregnant so tracking your cycles is going to be key studies have shown including a study that i did looking at tracking your cycles whether you use the calendar method whether you use basal body temperature cervical mucus monitoring or ovulation predictor kits they were all better than nothing so using one of these methods of fertility awareness and cycle tracking was excellent i personally like opk's a lot and i have a whole video on it because i think they're pretty straightforward they are measuring lh which is a hormone secreted from the brain that triggers the body to ovulate some keys and using opk's is you typically want to start them around five or six days before you anticipate ovulating so for most people in an average cycle length this is going to be around cycle day nine i recommend using an ovulation predictor kit one time per day in the middle of the day sometime between 10 am to 2 pm so don't listen to what the box says this is because we're checking luteinizing hormone in the urine it's secreted from the brain in the early morning it's got to get through your kidneys and be in your urine so we can check it the day you get a positive is the day before you ovulate so you'd like to have intercourse on that day and the next don't keep checking opk's afterward because lh then fluctuates throughout the entire ludial phase as it stimulates the corpus luteum to make progesterone in pulsatile fashion and so it'll drive you bonkers save your money in case you're not pregnant and use those opks in the next month we also want to set you up for success so everything you can do to optimize your natural fertility is going to be the best so you want to track your cycles you want to time your intercourse you want to avoid lubrication if possible if needed then fertility-based lubricants like pre-seed or water-based are going to be preferable going to decrease stress i know that's easier said than done we got to think about the whole body and lifestyle factors and some so take care of yourself and would you be taking a prenatal vitamin with at least 400 micrograms of folic acid for three months before you want to start trying to get pregnant i'm recommending that my patients who are older also take an extra vitamin d supplement of around 2000 ius a day i took vitamin d levels so some people need a little bit more so it's ask your doctor i also like coenzyme q10 coq10 has been shown in some studies to increase the stability inside the oocytes the dose of coconut i like is 200 milligrams three times a day that way we can support those eggs with everything we need and i also recommend fatty acids so omega-3 fatty acids because those beneficial fatty acids really important in cell division and creation those may be in your prenatal or you may need to take a separate pill depending on your prenatal brand i get asked all the time which prenatal the one that your take is gonna be the best so what i say is look at those things i just said if you can find one that has those things in them fantastic if not you can piece it together but there's not one prenatal that's truly better than the other ones find one you can tolerate that doesn't make you too nauseous and that you can reliably stick to and take which is the most important thing optimizing your diet and your overall health is going to be really important so take this on seriously you want to avoid toxins in your life i recommend you stop smoking cigarettes and marijuana both male and female can impact sperm and egg health and quality look at environmental toxins like bpa and other factors reduce those from your environment have a diet that's full of fertility friendly foods like fruits vegetables whole grains healthy fats and you want to limit out processed foods sugars red meat exercise is going to be good for you so make sure you're getting out and you're moving your body it's a great way for stress relief you're undergoing fertility treatments ask your doctor specifics about vitamin supplements or exercise restrictions because depending on what you're doing your doctor may say something different the take-home message i hope you hear is that women over 40 can absolutely get pregnant but time is of the essence the last thing i want you to do is waste a month of your life trying to get pregnant while your egg quality is decreasing over time we also know that the miscarriage rate increases as you get older for the same reason these chromosome abnormalities so if you're getting pregnant but you're miscarrying please go see your doctor we recommend evaluation after two losses although age is the number one cause for those of us who are older there also can be other causes of recurrent pregnancy loss such as inherited chromosome abnormalities autoimmune thyroid disease diabetes clotting disorders and anatomical factors so if you're suffering from pregnancy losses please go seek help i hope you understand that your reproductive community of reis we're here for you if you are starting your family in an older age i want what's best for you the number one thing is to understand your goal what is your goal what is your goal now and in the future what does your whole family look like find an rei who you can trust and be honest with and go get an evaluation early the last thing you want to feel like is looking in the rearview mirror and wishing you hadn't wasted time or that you made a different choice if you know the information you can make an educated decision but can you get pregnant over 40 absolutely might you need help potentially but i don't want you to feel like all hope is lost which i see so often from so many people as always thank you so much friends i love your support as a birthday present subscribe to the channel if you don't that would just bring me so much happiness you can always follow along on instagram nataliecrawfordmd and listen to the as woman podcast for more fertility-related information [Music] you

Channel: Natalie Crawford, MD

Views: 571,967

Keywords: fertility, infertility, natalie crawford md, dr natalie crawford, as a woman podcast

Id: _XFoy5ZTto4

Length: 17min 21sec (1041 seconds)

Published: Fri Jan 21 2022