A 45-year-old woman can become pregnant, though it involves significant considerations compared to earlier reproductive years. The increasing trend of women delaying childbearing has led to more pregnancies in this age group, with approximately 10,500 births annually in the United States occurring to women over 45. Achieving a healthy outcome often requires navigating the natural decline in fertility and increased medical support.
Natural Conception Possibility
Female fertility naturally declines with age, a process that accelerates significantly after age 35. Women are born with all their eggs, and both their quantity and quality diminish over time. By age 40, only about 3% of a woman’s maximum pre-birth egg supply remains.
The decline in egg quality is a considerable factor, as older eggs are more susceptible to chromosomal abnormalities due to errors during cell division. This heightened risk of genetic errors impacts egg viability, making natural conception more challenging and increasing the likelihood of miscarriage or genetic conditions.
Consequently, the chance of natural conception at 45 is considerably low for most women. The probability of getting pregnant naturally per menstrual cycle at this age can be as low as 3-4%.
Assisted Reproductive Technologies
Given the challenges of natural conception at 45, assisted reproductive technologies (ART) offer viable pathways to pregnancy. In vitro fertilization (IVF) is a common ART, but success rates using a woman’s own eggs at 45 are very low, often approaching zero live births per cycle. For women 43 and above, success with their own eggs is very limited. Due to the increased risk of chromosomal abnormalities in older eggs, preimplantation genetic testing (PGT-A) of embryos is often recommended during IVF cycles.
Egg donation significantly improves pregnancy prospects for women in this age group. With donor eggs, success rates can range from 50% to 70% per cycle, and cumulative success rates over multiple cycles can reach 75-95%. This higher success is because egg quality is determined by the younger donor, largely mitigating the recipient’s age-related decline.
Some fertility clinics may have age limits for recipients, with some not accepting patients over 52. Other options for family building include donor embryos or adoption.
Health Considerations and Risks
Pregnancy at age 45 is categorized as high-risk, necessitating close medical supervision for both mother and baby. Women in this age group face increased maternal health complications, including gestational diabetes, preeclampsia, and high blood pressure.
The likelihood of requiring a Cesarean section (C-section) is higher for mothers aged 45, as are risks of placental complications, such as placenta previa. Miscarriage risk increases substantially with maternal age, reaching approximately 53% for women over 45. Ectopic pregnancy risk also rises with advancing age.
For the baby, there is a greater risk of chromosomal abnormalities, such as Down syndrome. At 45, the risk of Down syndrome is approximately 1 in 30 to 1 in 35. Babies born to older mothers also have a higher risk of prematurity, low birth weight, and congenital disabilities.
Preparing for a Healthy Pregnancy
Proactive steps optimize health before and during pregnancy at age 45. A pre-conception check-up with an OB-GYN or maternal-fetal medicine physician is recommended to assess overall health, medical history, diet, exercise, and manage existing chronic conditions like high blood pressure. Fertility testing often follows this initial consultation.
Adopting a healthy lifestyle is important. This includes maintaining a healthy weight, consuming a balanced diet, staying well-hydrated, avoiding harmful substances such as smoking, recreational drugs, and alcohol, and taking necessary supplements like folic acid for fetal development.
Throughout pregnancy, expect more frequent medical visits, including regular blood pressure checks, ultrasounds to monitor the baby’s growth, and genetic carrier screening. These measures help ensure the best possible outcome for both mother and baby.