Biology Insights

Can a 44-Year-Old Get Pregnant? Risks & What to Expect

Considering pregnancy at 44? Learn about the biological landscape, explore modern fertility approaches, and prepare for the unique aspects of later-life conception.

By Abena Norris

A 44-year-old can get pregnant, but the chances are substantially lower than even a few years earlier, and the pregnancy carries higher risks for both mother and baby. At this age, natural conception rates drop to single digits per cycle, IVF with your own eggs produces live births in roughly 2% of attempts, and the miscarriage rate climbs above 50%. Those numbers are sobering, but they are not zero, and understanding the specific biology and risks involved can help you make informed decisions about whether and how to pursue pregnancy.

Why Fertility Falls So Steeply in the Early to Mid-Forties

The core issue is not just having fewer eggs left but that the remaining eggs are far more likely to carry chromosomal problems. Anti-Müllerian hormone, a blood marker that reflects the pool of viable follicles in the ovaries, declines steadily with age and serves as a reliable predictor of when menopause will arrive. In a study of premenopausal women with a mean age of about 41, those whose AMH had already dropped below very low levels were estimated to reach menopause within roughly six years if they were in the 45-to-48 age bracket. By 44, many women are nearing the end of their ovarian reserve, though there is real individual variation.

But egg quantity alone does not explain the fertility cliff. Egg quality matters even more. As women age, the cellular machinery responsible for sorting chromosomes during egg maturation becomes less reliable. Chromosomal errors follow what researchers describe as a U-shaped curve over the reproductive lifespan: high in very young girls, low in the twenties and early thirties, then climbing sharply as women approach their forties. The types of errors change with age too. In older eggs, the “glue” that holds chromosome pairs together during cell division weakens, leading to premature separation and misassignment of genetic material. This is why a 44-year-old’s eggs are far more likely to produce embryos with the wrong number of chromosomes, a condition that usually leads to either failed implantation, miscarriage, or, in rare cases, a live birth with a chromosomal condition.

The Miscarriage Numbers at 44

If you do conceive at 44, the odds of miscarriage are high. A large Danish population study found that the risk of spontaneous abortion reached about 75% in women aged 45 and over, compared with under 9% for women in their early twenties. A more recent Nordic registry study put the number at 53% for women 45 and older. Whether you land closer to 53% or 75% depends partly on the study population and how miscarriage was defined, but either way the message is the same: more than half of confirmed pregnancies at this age end in loss, overwhelmingly because of chromosomal abnormalities in the embryo. The earlier study also showed that high maternal age was a significant risk factor regardless of how many previous miscarriages a woman had experienced or whether she had given birth before.

This is emotionally important to understand upfront, because it reframes what “getting pregnant” means at 44. A positive pregnancy test is a real event, but it is not the same as a baby in your arms. Preparing for the possibility of loss is not pessimism; it is realistic planning that can help protect your mental health through the process.

IVF With Your Own Eggs at 44

In vitro fertilization improves the odds compared with natural conception, but the gains are modest at this age. A study of IVF outcomes in women 40 and older found live birth rates of about 2.4% at age 43, dropping to 2.1% at 44, and falling to under 1% at 45 and beyond. Among women 45 and older in the same study, the spontaneous abortion rate after IVF was close to 75%. Those numbers reflect the same underlying biology: even with hormone stimulation, the eggs retrieved from a 44-year-old’s ovaries are likely to carry chromosomal problems, and the embryos that form from them have a high failure rate.

Some clinics offer preimplantation genetic testing for aneuploidy, which screens embryos before transfer to identify those with the correct number of chromosomes. In women of advanced maternal age, this testing significantly reduced the rate of biochemical pregnancy loss in one study, from about 32% without testing to under 4% with it. However, the live birth rates per embryo transfer and per patient were not significantly higher than in the group that skipped the testing. The reason is straightforward: if very few embryos are chromosomally normal to begin with, testing helps you avoid transferring the abnormal ones, but it cannot create normal embryos that are not there. Still, reducing the emotional and physical toll of repeated miscarriages has real value for many patients.

The Donor Egg Option

This is where the picture changes dramatically. When a younger woman’s eggs are used, the age of the uterus matters much less than the age of the egg. An analysis of nearly 28,000 fresh donor-egg IVF cycles found that recipients aged 40 to 44 had implantation, clinical pregnancy, and live birth rates comparable to those of women under 40. It was only in the 45-to-49 group that outcomes started to drop significantly, and the decline steepened further for recipients 50 and older. A more recent study confirmed that live birth rates in donor-egg cycles were significantly lower in the 45-to-49 group compared with the 40-to-44 reference group.

What this means for a 44-year-old is that donor eggs offer substantially better odds than using your own eggs. You are right at the threshold where outcomes remain strong, but if you wait even a year or two, the uterine contribution to declining success starts to become measurable. The decision to use donor eggs is emotionally complex because the child will not share your genetic material, but from a purely medical standpoint, it is the single most effective way to increase success rates at this age.

Pregnancy Risks If You Do Conceive

Getting pregnant is only the first challenge. Carrying a pregnancy to term at 44 comes with elevated medical risks compared with younger pregnancies, even when the conception is straightforward.

When gestational diabetes is present, the complications compound. Among pregnant women with gestational diabetes aged 40 to 44, rates of preeclampsia, preterm birth, and placenta previa were all highest compared with younger age groups in a large multicenter study. None of these risks makes pregnancy at 44 impossible, but they do mean you should expect closer monitoring, more frequent appointments, and a higher likelihood of medical intervention during delivery.

Chromosomal Risks for the Baby

Down syndrome is the chromosomal condition most associated with advanced maternal age in the public imagination, and the risk is genuinely elevated. A study examining live births in women 45 and over estimated an average Down syndrome risk of about 34 per 1,000 births, or roughly 1 in 29. At 44, the risk is somewhat lower than that but still considerably higher than the roughly 1 in 350 chance at age 35 that most people have heard cited. It is worth noting that Down syndrome is only one of several trisomies that become more common with maternal age; others, like Edwards syndrome and Patau syndrome, also increase but are much rarer and usually not compatible with live birth.

Modern screening has transformed how these risks are managed. Cell-free DNA testing, often called NIPT, can detect Down syndrome with roughly 99% sensitivity and over 99.9% specificity from a simple maternal blood draw as early as 10 weeks of pregnancy. However, NIPT is a screening test, not a diagnostic one. A positive result still needs confirmation through amniocentesis or chorionic villus sampling. And for rarer chromosomal abnormalities beyond the common trisomies, combining NIPT with detailed ultrasound substantially improves detection accuracy.

The Perimenopause Overlap

At 44, many women are already experiencing perimenopause, the transitional years leading to menopause during which hormone levels fluctuate unpredictably. Estrogen levels can actually average significantly higher than normal during this phase and swing erratically, sometimes mimicking early pregnancy symptoms. Ovulation becomes irregular but does not stop all at once, which means unplanned pregnancy is possible even when periods seem to be winding down. This creates a confusing situation: symptoms of perimenopause and symptoms of early pregnancy can look almost identical, including missed or irregular periods, breast tenderness, fatigue, and mood changes.

If you are actively trying to conceive, tracking ovulation becomes harder during perimenopause because the hormonal signals are less predictable. Working with a reproductive endocrinologist rather than trying to time things on your own can save months of uncertainty.

Does the Father’s Age Matter Too?

Conversations about age-related fertility risks tend to focus almost exclusively on the woman, but the father’s age matters as well. A comprehensive review of the literature found a direct correlation between paternal age and decreased sperm quality and testicular function. Advancing paternal age has been linked to increased DNA mutations, chromosomal abnormalities in sperm, and epigenetic changes that can silence important genes. It also affects assisted reproduction outcomes, reducing success rates in IVF and related procedures and increasing the rate of premature birth. If both partners are in their mid-forties, the combined effect on fertility and offspring health is greater than either partner’s age alone would suggest.

What If You Froze Eggs Earlier?

Women who froze eggs in their thirties sometimes return to use them in their early to mid-forties, and this can meaningfully change the equation. The frozen eggs retain the chromosomal quality of the age at which they were collected. In a large U.S. study of elective egg freezing, about 39% of women who froze eggs between ages 27 and 44 (most between 35 and 40) had at least one child from those eggs. A small number who froze at 41 to 43 also succeeded. That said, age at the time of freezing matters enormously. National data shows that the ratio of thawed eggs needed per live birth jumps from about 41 for women who froze before 35 to over 122 for those who froze after 41. If you froze at 35 and are now 44, your frozen eggs likely give you much better odds than your current eggs. If you froze at 42, the improvement is real but more modest.

The Financial Reality

Fertility treatment at 44 is expensive and often requires multiple cycles. A modeling study comparing different strategies for women of advanced maternal age found that standard IVF with your own eggs had the lowest cumulative live birth rate, dropping to about 1.6% by age 45. Adding preimplantation genetic testing or switching to donor eggs both raised cumulative success rates and were estimated to be more cost-effective per live birth, but they also cost substantially more per cycle. The study noted that higher out-of-pocket costs could prevent many patients from accessing these better-performing strategies. Insurance coverage for fertility treatment varies dramatically by state and country, and many plans cap coverage at a certain number of cycles or exclude women over a certain age. Before committing to a treatment plan, getting a clear picture of costs per cycle, expected number of cycles, and what your insurance will and will not cover is as important as the medical conversation itself.

Preconception Health at 44

Regardless of whether you conceive naturally or through assisted reproduction, the health of a pregnancy at 44 depends partly on your baseline health before it begins. The concept of preconception care recognizes that some interventions available before conception are not possible once pregnancy starts. At 44, this means managing blood pressure if it runs high, optimizing blood sugar control, reaching a healthy weight, and screening for thyroid disorders or other chronic conditions that could complicate pregnancy. Given the elevated risks of gestational diabetes and hypertensive disorders already discussed, starting from the best possible metabolic baseline gives you the most room to absorb the physiological demands of pregnancy.

Your provider will likely want to check your cardiovascular health more carefully than they would for a younger patient. A baseline echocardiogram or cardiac workup is not unusual for pregnancies at this age, because the cardiovascular system has to handle a roughly 50% increase in blood volume during pregnancy. If there are underlying issues, identifying them before conception allows for treatment decisions that protect both you and a future pregnancy.

When Donor Eggs or Adoption Make Sense

For many 44-year-olds, the honest conversation with a reproductive endocrinologist will include a recommendation to consider donor eggs, embryo donation, or gestational surrogacy with a younger egg source. This is not because pregnancy is impossible with your own eggs but because the per-cycle success rate is so low that the emotional, physical, and financial cost of repeated failures can be devastating. Some women start with one or two IVF cycles using their own eggs and set a clear stopping point before switching to donor eggs, which is a reasonable and increasingly common approach.

Adoption and foster care are sometimes framed as consolation prizes in fertility discussions, which does them a disservice. They are distinct paths to parenthood with their own timelines, costs, and emotional landscapes. At 44, one practical consideration is that domestic infant adoption wait times can stretch to several years, which means starting the process while simultaneously pursuing fertility treatment is worth considering if both paths interest you. International adoption policies vary by country, and some set maternal age limits that become relevant in the mid-forties.

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