Written by Rhiannon Davis. Reviewed by Dr. Phoebe Howells. 

When we think of late pregnancies, names like Janet Jackson, Halle Berry, and Nicole Kidman come to mind,  all becoming parents later in life. While having a baby at 40 or older is more common than ever, it’s important to understand the unique fertility challenges that come with this age.

The reality is, trying to conceive over 40 isn’t as straightforward as when you were in your 20s or early 30s. The good news? Pregnancy is still possible, and advances in fertility medicine mean that support is available. While many celebrities highlight what's possible, it’s worth noting that some late pregnancies involve fertility treatments or egg donation. Being aware of all the options helps you make informed choices.

How Does Fertility Change After 40?

By the time you’re over 40, your fertility has significantly declined compared to your younger years. Chances of conceiving naturally in a given month drop to around 5%, and the risk of miscarriage or atypical chromosomes also increases. At 30, the risk of miscarriage is 1 in 5 and over 40, the risk of miscarriage is 1 in 2. While these statistics may sound alarming, they don't mean pregnancy is out of reach. Understanding what’s happening in your body and how you can manage it will help you plan accordingly.

One of the biggest changes after 40 is a decline in the number and quality of eggs. As women and people are born with a finite number of eggs (follicles), fertility naturally declines over time as the number of eggs decreases. At the age of 40, people typically have about 3% of the eggs they had at the onset of puberty. It’s not just about egg numbers, egg quality also declines with age. Fewer eggs reach the stage where they can develop into healthy embryos. This is primarily due to hormonal shifts that start impacting fertility more noticeably around age 40.

💡 Expert Insight 💡

 "As you approach 40, the body begins to show signs of diminished ovarian reserve, and hormone levels like AMH and FSH become crucial indicators." says Dr. Phoebe, OVUM’s Chief Medical Officer.

Don’t forget about sperm health

Sperm health also declines with age, albeit more gradually. From around age 40, sperm quality (including motility and morphology) may decline, and there’s an increased risk of DNA fragmentation and chromosomal issues. Advancing paternal age is associated with a slightly higher risk of miscarriage and certain genetic conditions in offspring.

Understanding the Hormonal Changes After 40

After 40, there’s a significant drop in the hormone levels that govern ovulation. Two of the key hormones you’ll hear about during fertility testing are AMH (anti-Müllerian hormone) and FSH (follicle-stimulating hormone).

• AMH is a marker of ovarian reserve - how many eggs you have left. As you age, your AMH levels decrease, which is one of the key signs of reduced fertility.

• FSH rises as your body attempts to stimulate the ovaries to produce eggs, signalling a decline in fertility.

In addition to these, other hormones like oestrogen and progesterone may fluctuate, making it harder for you to predict ovulation. This is why tracking your cycle becomes even more important after 40.

Proactive Steps to Support Fertility After 40

If you’re trying to conceive at 40 or beyond, there are a few proactive measures that can help optimise your chances:

1. Fertility Testing. Hormone testing (AMH, FSH, and estradiol) is essential. These tests can provide a clearer picture of your ovarian reserve and help assess the chances of natural conception. Additionally, ultrasound can assess ovarian volume and antral follicle count (AFC), which helps estimate ovarian reserve; however, it cannot directly measure egg quality.

2. Testing for sperm health is equally important. A semen analysis can assess sperm count, motility, and morphology. If abnormalities are found, lifestyle changes or medical treatment may help improve sperm health.

3. Healthy Lifestyle Choices. Nutrition and physical activity are just as important in your 40s as they were in your 20s. A balanced diet rich in antioxidants, folate, and omega-3s, along with regular exercise, can improve overall health and egg quality. Avoiding smoking and limiting alcohol are also essential. Good sleep hygiene is another often overlooked factor. Poor sleep can impact hormonal balance, stress levels, and overall reproductive health.

4. Fertility Supplements. Supplements containing CoQ10 and other nutrients specifically designed to target egg quality can be beneficial. CoQ10, for example, has been shown to support mitochondrial function in eggs, which tends to decline with age.

5. Track Your Ovulation. Ovulation prediction kits and fertility apps can help you track your cycle more accurately. Knowing when you're ovulating gives you the best chance of conception. It may also help you recognise if your cycles become irregular.

6. Limit exposure to harmful chemicals. Every day chemicals found in plastics, household cleaners, and personal care products may impact both egg and sperm quality. Try switching to fragrance-free and phthalate-free products, and avoid heating food in plastic containers.
   
   

Fertility Treatments After 40: What to Consider

For some, conceiving naturally may take longer or be more difficult, but assisted reproductive technologies (ART) like IVF and IUI can be very effective. The success rates for IVF have improved, especially with the use of egg donors or embryo freezing, and these treatments offer a greater chance of pregnancy after 40. If you’re over 40, it's often recommended to explore treatment options sooner, as fertility declines quickly at this stage. Some clinics may recommend moving to IVF or egg donation earlier, depending on your test results.

However, IVF should be considered after thorough testing and consultation with a fertility specialist. It’s also important to note that while fertility treatments have advanced, they can be physically and emotionally demanding, and not all treatments work the first time.

Risks of Pregnancy After 40

There are some additional risks associated with pregnancy after 40. These include:

• Higher Risk of Miscarriage: The risk increases significantly after 40.

• Chromosomal Abnormalities: There is a higher chance of conditions like Down syndrome.

• Gestational Diabetes and High Blood Pressure: These conditions become more prevalent after the age of 40.

• Preterm Birth & Low Birth Weight: The risk of delivering prematurely or with low birth weight is higher.

While these risks are higher, prenatal screening tests like NIPT (non-invasive prenatal testing) and genetic screening have become more advanced, enabling earlier detection of potential issues and improved management of pregnancy health.

Age of the sperm provider also contributes to some of these risks. Studies suggest that children of older men and people may have a slightly higher risk of conditions such as autism or schizophrenia, though absolute risks remain low.

The Rise of Parenthood After 40

Increasingly, people are choosing to become parents later in life, often due to changes in their careers, personal goals, or waiting for the right partner. Statistics show that 50% of women aged 40-44 will conceive naturally within a year if they have regular intercourse, though timing and overall health are key factors. With medical advances and personalised fertility care, having a healthy pregnancy after 40 is more achievable than ever. If you’ve been trying for 6 months without success, fertility testing is recommended to avoid delays.