I’m 46.5 yrs old and reviewing my life with some regrets, particularly in assuming I had time to choose to have a child. The decision to wait has always been governed by readiness – my own and my partner’s. Have I waited too long? Is it still possible for me to have a child?

Written by our medical expert Dr. Stephen Hudson, Director of the Victoria Fertility Centre in British Columbia, Canada.

In order to address this subject I think it is important to discuss some introductory biology.

Women are born with a finite number of eggs. This egg reserve declines as a woman ages. A woman ovulates (releases an egg) once a month – however the loss of eggs through ovulation only accounts for a fraction of the eggs lost every year through the physiological aging process.

On average most women only have about 10 – 20% of their original egg reserve by the age of 30, and about 5% by the age of 40.

It is also important to realize that there are only a percentage of eggs that are of a perfect quality. As a woman ages, the percentage of her remaining eggs that have the potential to produce a baby also declines.

In nature we see a wide variation in women’s fertility. Some women are “superfertile” – they get pregnant very easily, may stay fertile into their forties, and go through menopause only in their late fifties. Other women may have a lower pool of “fertile” eggs, have more trouble getting pregnant even at a younger age, also experience a higher number of miscarriages, and enter menopause in their early forties.

On “average”, the chance of a woman conceiving per month in her twenties is about 25 – 30%. The chance of a miscarriage is largely related to the quality of a woman’s eggs. The risk of miscarriage in the twenties is about  5 – 10%. Fast forward to age 40. Now the chance of pregnancy per month on average is about 10% and the incidence of miscarriage about 30%. Pregnancy rates decline to less than 5% per month at age 45, while the incidence of miscarriage rises to about 80 – 90%. The rates of having a child with Down Syndrome are 1 in 20 by age 45.

To get to the original question, regarding your age and fertility potential. First of all, there are many women at age 46 who are already in the menopause. Their chance of conceiving with their own eggs is zero. If you are still having regular periods, it means you are ovulating. However you will have only a very small number of eggs remaining with the potential to produce a healthy baby. The chance of miscarriage is also very high, as previously indicated. There may also be many other age related factors that affect fertility – but the most significant is the egg factor.

If you were a patient at our clinic, our approach would be as follows:

  1. Evaluate your overall health and determine whether you are ovulatory
  2. Check your uterus and ovaries using ultrasound
  3. Do blood tests to evaluate your hormone levels and assess your “ovarian reserve”
  4. Do tests to make sure your fallopian tubes are open
  5. Do a semen analysis on your partner

If all these tests are normal – then we would want to make sure that you are doing everything possible to maximize your chances for conception. In that regard, we would encourage you to take supplements such as folic acid, Co enzyme Q10, and Vitamin D.

The truth is that at age 46, even if you are ovulatory and otherwise healthy, the chances of getting pregnant, and carrying a pregnancy to term with your own eggs, and delivering a healthy baby, is very low.

However, with the advances in assisted reproductive technology (ART), there are other options to still become parents, including egg donation and IVF, embryo donation, or adoption. Using third party reproductive options (egg, sperm, or embryo donation, and surrogacy) we are able to help most patients build a family. It is important to realize that with egg donation, as long as you are healthy, the risk of miscarriage is more closely related to the age of the egg donor, not your chronological age.

My advice is that you consult with a fertility specialist as soon as possible for a full evaluation, so that you can discuss your options. I would also recommend that in tandem with doing this you seek counselling from a psychologist or counsellor specializing in reproductive medicine to help and guide you and your partner through the process.

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