Yes, a 45-year-old woman can get pregnant, but it presents significant challenges compared to earlier reproductive years. Advances in reproductive technology have made pregnancy at this age increasingly feasible. However, the biological landscape of fertility at age 45 is substantially different, requiring an understanding of both the natural limitations and the medical options available. Fertility rates decline steeply at this age, making professional guidance and proactive health management paramount for those hoping to conceive.
Understanding Ovarian Reserve and Egg Quality
The primary biological factor affecting fertility at age 45 is ovarian aging, which impacts both the quantity and quality of a woman’s eggs. A woman is born with all the ovarian follicles she will ever have. This supply, known as the ovarian reserve, steadily diminishes over time, leading to a severely reduced number of remaining follicles by age 45, often resulting in a diagnosis of diminished ovarian reserve (DOR).
More impactful than diminished quantity is the decline in egg quality. As eggs age, they become significantly more prone to chromosomal abnormalities, known as aneuploidy. For women over 44, the aneuploidy rate in embryos can exceed 90%. These chromosomal errors are the main reason for low conception rates, increased miscarriage risk, and higher incidence of conditions like Down syndrome. This biological reality means that even if ovulation occurs, the resulting egg is unlikely to develop into a viable pregnancy.
Realistic Chances of Natural Conception
The likelihood of natural conception for a 45-year-old woman is very low, reflecting the steep decline in egg quality and quantity. While a woman in her early twenties may have a 25% chance of getting pregnant in any given menstrual cycle, this probability drops precipitously with age.
By age 45, the chance of conceiving naturally in a single cycle is often cited as less than 5%, with some sources placing the monthly probability at 1–2%. The American College of Obstetricians and Gynecologists considers natural conception at this age to be unlikely for most women. The risk of early miscarriage is substantially elevated, rising to over 50% after age 45 due to the high rate of chromosomal abnormalities. Most women seeking pregnancy at this age will require assistance to achieve their goal.
Navigating Assisted Reproductive Options
When natural conception is improbable, assisted reproductive technologies offer viable pathways to pregnancy. The most common intervention is In Vitro Fertilization (IVF). However, the success of IVF using a patient’s own eggs at age 45 is limited, resulting in a live birth rate of less than 3–5% per cycle. This low success is a direct consequence of the high percentage of aneuploid eggs, which prevent the formation of a viable embryo.
For women undergoing IVF with their own eggs, Preimplantation Genetic Testing (PGT) can screen embryos for chromosomal issues before transfer. PGT helps identify the rare, chromosomally normal (euploid) embryo, which increases the per-transfer success rate. However, the overall chance of finding a euploid embryo remains low.
The use of donor eggs dramatically circumvents age-related issues of egg quality, as the success rate is based on the donor’s age, not the recipient’s. For a woman aged 45, success rates for IVF with donor eggs can range from 50% to over 70% cumulatively after several cycles. This option offers the highest probability of a live birth, since the uterine environment is generally receptive to a healthy embryo.
Maternal and Fetal Health Considerations
Once conception is achieved, the pregnancy is classified as one of advanced maternal age, necessitating closer medical monitoring. Women over 45 face an elevated risk of several complications. Maternal risks include a higher incidence of gestational hypertension, preeclampsia, and gestational diabetes, which can be managed with careful prenatal care.
Delivery outcomes show a higher rate of intervention, including an increased likelihood of requiring a C-section compared to younger mothers. Fetal risks include a higher chance of preterm birth and low birth weight. There is also an increased risk of miscarriage and stillbirth, particularly when using the woman’s own eggs. Close monitoring, including regular ultrasounds and blood pressure checks, is standard to mitigate these potential complications.