Pregnant After 35 | by Julie Dugdale


Posted on Mon, Apr 9, 2018

What to know about conceiving later in life.

Today, more and more women are asking their biological clocks to tick for longer, but getting — and staying — pregnant after 35 can be complicated. Here, Colorado reproductive experts weigh in on what women over 35 should know before and during pregnancy.

Take Patty, a Denverite, who knew she wanted a family since she was a little girl but reached a turning point when she was in her 30s and still single: “At 38, I decided to freeze my eggs because I hadn’t met my husband,” she says. When she did get married the following year, she got pregnant naturally, but lost the baby due to chromosomal abnormalities.

Then there’s Stacey Brophy, a certified nurse midwife, who suffered six miscarriages between the births of her first and second children, who were born when Brophy was 37 and 42 years old.

Dr. Althea O’Shaughnessy, a reproductive endocrinologist, ConceptionsThey are not unusual. The American Pregnancy Association reports that pregnant women between the ages of 35 and 45 have a 20 to 35 percent chance of miscarrying, compared to a 15 percent chance for women under 35.

Biological Challenges

A woman’s ovarian reserve, or the number of eggs that can potentially be fertilized into embryos, diminishes with age. “You are born with all the eggs you’ll ever have,” says Dr. Althea O’Shaughnessy, a reproductive endocrinologist at Presbyterian/St. Luke’s Medical Center. “Genetics may impact that number and the rate of attrition over time.”

Even more than quantity, deteriorating egg quality can thwart a pregnancy. “Egg quality is, without a doubt, related to age,” O’Shaughnessy says. “You have a much higher number of chromosomally abnormal eggs as you get older.”

Dr. Althea O’Shaughnessy

The majority of miscarriages, most of which occur in the first trimester, are due to chromosomal abnormalities. 

Prepping for Pregnancy

“When you’re getting ready to get pregnant, you should look at it like training for a marathon,” O’Shaughnessy says. If you’ve been trying unsuccessfully for six months — as opposed to one year, if you’re under 35 — you should consider consulting a fertility specialist to evaluate your eggs, health and options.

Checking your ovarian reserve is a good place to start. O’Shaughnessy says this can be done via blood testing and transvaginal ultrasound to see and count the small antral follicles (cysts where the eggs grow).

And to help with healthy egg development, studies show that supplements such as DHEA and CoQ10, in addition to prenatal vitamins, may be good for women trying to get pregnant. (Consult your physician before taking any supplements.)

O’Shaughnessy recommends that women also check their thyroid levels since the thyroid hormone can impact fertility and is essential in healthy development of a baby.

If timing is an issue, some women, like Patty, extend their window for pregnancy by freezing their eggs — preserving their quality — to be fertilized at a later point. Note: Costs for this and other fertility treatments vary based on clinic policies, packages, and insurance coverage.

Fertility Treatments

Conceiving later in lifeProtocols will vary based on the results of a complete infertility workup, O’Shaughnessy says. Some of the most common recommendations include: injections of fertility hormones such as Clomid to regulate ovulation; artificial insemination, which can be done in multiple ways — one of which is intrauterine insemination (IUI), where the sperm is placed inside the uterus at exactly the right time and location; and, often after three unsuccessful IUI attempts, in vitro fertilization (IVF). Through IVF, eggs are retrieved — or thawed if previously frozen — and the highest quality egg is manually combined with sperm for fertilization outside the body, then re-inserted into the uterus as an embryo.

Genetic Testing

Women undergoing IVF can get their embryos genetically tested for abnormalities before they’re transferred to the uterus, O’Shaughnessy says, in a procedure called pre-implantation genetic screening (PGS) or diagnosis (PGD).

If already pregnant, many older women opt for the relatively new and non-invasive cell-free fetal DNA test, which can identify chromosomal abnormalities in the baby. It just requires a blood draw from the mother. However, O’Shaughnessy points out, the test is a screening tool; it does not provide a definitive diagnosis. If results are positive, she says, the more invasive amniocentesis — where a fluid sample from the amniotic sac is collected via needle — can provide results that may help parents make important reproductive decisions.

Dr. Shan Shan Jiang, an OB/GYN with Consultants in Obstetrics and GynecologyO’Shaughnessy also encourages women to consider getting a carrier screening test, regardless of age, since it determines whether you carry genes associated with disorders such as cystic fibrosis, spinal muscular atrophy and fragile X syndrome.

Once You’re Pregnant

After 35, women are at higher risk for certain conditions and labor problems, says Dr. Shan Shan Jiang, an OB/GYN with Consultants in Obstetrics and Gynecology at Presbyterian/St. Luke’s Medical Center, including:

  • Dr. Shan Shan Jiang, OB/GYN

    Dr. Shan Shan Jiang

    Gestational diabetes – a woman without diabetes can develop high blood sugar levels during pregnancy; an early glucose screening is commonly done once prenatal care is established.

  • Intrauterine growth restriction – refers to when the baby is underweight for gestational age.
  • Preeclampsia – a pregnancy complication marked by suddenly high blood pressure and damage to other organ systems such as the kidney, liver and blood vessels, which can be due to declining vascular quality. It may lead to premature delivery for the safety of the mother.
  • Labor complications – “They’re more likely to encounter issues during labor that require a C-section, such as fetal intolerance of labor or arrest of descent, or failure of the baby to descend properly down the birth canal,” Jiang says. “The C-section itself doesn’t become more technically challenging with age, but it does take a little longer to heal.”

To help mitigate some of these risks (not genetics), Jiang says, “Being active, eating right, making healthy choices — these will improve pregnancy outcomes at any age.” But, being healthy won’t necessarily make it easier to get pregnant once you pass 35.

Moving Forward

Today, Patty is 44, and she and her husband have a healthy baby girl. Rather than trying to conceive naturally again after her miscarriage and running the risk of chromosomal abnormalities a second time, they opted to thaw her frozen eggs for IVF so they could take advantage of genetic testing and select the healthiest embryo.

As Jiang points out, the risks are real, but that shouldn’t discourage women in their late 30s or early 40s from exploring options.

“I see a lot of women who come in for pre-conception counseling because of their age,” she says. “My primary goal in these conversations is reassurance. We get so bogged down with all the risks. Most end up having healthy, normal pregnancies.

Presbyterian St. Lukes Leap Frog hospital performance

 Presbyterian/St. Luke’s Medical Center obstetric and Rocky Mountain Hospital for Children

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