Glamour (South Africa)

Fertility over 40

Here’s why more women are choosing to have children later in life.

- Words by Shannon Manuel

rest assured, most healthy women who get pregnant after age 35 and into their 40s have healthy babies, but one of the barriers to pregnancy in your 40s is your fertility. While some women have no issues getting pregnant well into their 40s, statistica­lly speaking, you’re less likely to get pregnant and more likely to need fertility treatments the older you are when you’re trying to conceive. Here, Dr Nomathamsa­nqa Matebese, from the Cape Fertility Clinic, explains what these treatments entail and answers our burning questions about pregnancy over 40.

G: Introduce yourself to our readers. Dr Nomathamsa­nqa Matebese :

I qualified as a medical doctor in 1993, then as a general obstetrici­an and gynaecolog­ist in 2003. I completed a fellowship in Reproducti­ve Medicine (which included fertility treatment), and I registered as a reproducti­ve medicine specialist in 2006. I also have a Master of Medicine, and wrote my

dissertati­on on the psychosoci­al impact of Turner syndrome, which is a genetic condition that causes infertilit­y. I’m a mother to two beautiful children. I help couples experienci­ng infertilit­y.

G: What are women’s chances of falling pregnant naturally after the age of 40?

Dr NM: Less than 15%.

G: Are birth rates rising among women over 40?

Dr NM: Yes, due to an increase in the number of women who have access to assisted reproducti­ve techniques.

G: What are the risks of pregnancy after 40 for both mother and child? Dr NM: For the mother, these include an increased risk of medical conditions related to pregnancy, mainly preeclamps­ia, gestationa­l diabetes and preterm labour. There’s also an increased risk of miscarriag­e due to the increased incidence of chromosoma­l abnormalit­ies in their babies. Risks for the child include an increased chance of chromosoma­l abnormalit­ies such as Down’s Syndrome, and risks associated with prematurit­y, the most significan­t being neurologic­al abnormalit­ies.

G: At what age does pregnancy become extremely high-risk to both mother and child?

Dr NM: From age 50.

G: How does a woman’s age affect her fertility?

Dr NM: It decreases with age due to the fact she produces fewer eggs, of lower quality, from the age of 35 onwards.

G: Does it also affect labour and delivery?

Dr NM: The main risks are premature labour and preterm birth. Labour and birth tend to be more complicate­d in your 40s due to changes in your health. A woman who has a chronic condition is more likely to experience complicati­ons than a woman who doesn’t. Chronic conditions such as diabetes, high blood pressure or thyroid disease, can complicate your pregnancy and potentiall­y increase your risk of miscarriag­e and pregnancy loss, including stillbirth.

G: What options are available to parents struggling with infertilit­y? Dr NM: Your first port of call would be to visit a fertility specialist, who may prescribe treatments including ovulation induction, artificial inseminati­on, and In-vitro fertilisat­ion (IVF), using either your own eggs or ones from a donor. Surgical procedures to treat endometrio­sis or remove fibroids (non-cancerous growths that develop in or around the womb) may be necessary. The male partner may undergo a procedure to retrieve sperm directly from the testis (a testicular biopsy) if they have obstructiv­e azoospermi­a (when there’s no sperm in the ejaculate). Using donor sperm is another option. Genetic testing of embryos for known genetic conditions is also possible with IVF treatment.

G: Briefly describe the types of fertility testing do doctors perform. Dr NM: The female partner has a full pelvic examinatio­n, including a transvagin­al ultrasound scan, to exclude structural abnormalit­ies of the reproducti­ve organs. Blood tests for hormonal evaluation are performed, including one to assess ovulation. A valuable blood test is an Antimuller­ian hormone (takes care of the eggs), which helps doctors assess a woman’s ovarian reserve (egg numbers). Testing for fallopian tube

“I support women who wish to further their careers before starting a family”

patency is done either at a radiology department or via a laparoscop­ic surgical procedure (used to examine the organs inside the abdomen). The male partner has his semen analysed (sperm test). Other tests such as genetic ones may be required depending on the patient’s medical history.

G: Are fertility treatments and IVF safe for women over 40, and is there an age limit to IVF treatment?

Dr NM: Yes, it’s safe. The age limit for IVF treatment using a woman’s eggs is around 43, as, after the age of 43, her chances of success are much lower (less than 5%). Doctors don’t recommend IVF treatment, even with donor eggs, after the age of 50, due to the increase in pregnancy related risks.

G: Most women over the age of 45 can’t get pregnant naturally. Do you agree?

Dr NM: Yes, this is true, mainly due to lower egg quality after the age of 45.

G: How long should couples try to conceive before seeing a doctor Dr NM: If the woman’s over 35, she and her partner should see a fertility specialist after six months of trying.

G: Most women’s bodies have reminded them the clock’s ticking. Is there a prime fertility window?

Dr NM: You have less chance of getting pregnant after the age of 35. Doctors advise women who aren’t planning to fall pregnant by the age of 33 to consider freezing their eggs to ensure they have lots of good quality eggs should they struggle to conceive after the age of 35.

G: What can women do to ensure a safer pregnancy after the age of 40? Dr NM: Being overweight is strongly associated with pregnancy complicati­ons, which is why we encourage all women to have a normal BMI prior to pregnancy. You can achieve this by having a healthful diet and exercising regularly. Take folic acid at least six weeks prior to conception to prevent spinal birth defects in the baby.

G: Many women feel put off having children until later in life because society views it negatively.

Dr NM: Women have rights, and they should be allowed to decide when to start a family. I support women empowermen­t, and fully support women who wish to further their careers before starting a family. One of the main reasons gender-based violence exists is that women are financiall­y dependent on their male partners. Women must empower themselves to have financial independen­ce, and they deserve the same reproducti­ve freedom as men.

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