How to Talk to Your Doctor About Your Fertility If You’re Over 40
Talking about your fertility when you’re over 40 is not easy, but I want women to stop apologizing for desiring a family. Times have changed. It’s okay to want a baby over 40. It’s not crazy, nor selfish.
My approach is for all of my patients to be given their best chance at a healthy pregnancy in the shortest period of time.
How do we do this?
It starts by not believing everything you read. There’s an international headline I saw recently on BBC news that fertility doctors are exploiting older women and “dealing false hope”.
Do I believe that fertility doctors deliver false hope? No way! I do not.
Do I believe that it’s imperative to get a diagnosis before treatment, regardless of who you are and your age? Yes! Diagnosis before treatment. Please!
I want my patients over 40 to understand their follicle count. Then I want them to decide if moving forward with treatment using their own eggs is the best path forward. There are so many ways to have a baby if your own body is not making it happen there are other creative paths to explore. Egg and embryo donation and adoption are a few examples.
How are 49-year-old women having babies?
We used to think to have a baby at 40 was a big deal, but once Janet Jackson had her baby at over 50 then people started calling me from all over. People wanted the same treatment she had. I wish I had some sort of superpower, but I don’t.
All I can do is to work with the DNA that you bring me. If you have eggs left I will certainly do my best to try and grow an embryo. I have tried to help women at 49, 50, and even 51 to have a healthy pregnancy with their own eggs. I will tell you, however, that they are not as successful in reaching a healthy full-term pregnancy. However, this is part of their journey and process so I support them in the path they want to take.
Alternatively, I have had many patients also in their late 40s and early 50s deliver healthy babies, but by using other creative options.
I imagine in ten years or now I will be able to tell you about having many, many women over the age of 46 having healthy pregnancies with their own eggs. The reason for this is they will be patients that have frozen their healthy and young eggs when they were in their 30s!
Every pregnancy is natural and precious. Where that egg comes from is nobody’s business, but yours. It’s not something you have to explain to anyone.
I have to educate people that the chance of a healthy pregnancy using your own eggs after the age of 46 is close to zero. It’s misleading when people see celebrities that have babies and are led to believe the same can be true for them. We have to keep in mind that we don’t always know the full story. Nor is it a person’s duty to share it.
I’m hopeful that in the future there will be scientific breakthroughs that make pregnancy at a later age easier, but for now, I want to ensure all women are aware of the option to freeze their eggs younger, getting pregnant younger, and looking out for the signs of DOR.
WTF is DOR?
Decreased Ovarian Reserve. If you’re over 40 that’s kind of what happens, and it’s what’s supposed to happen. Our healthy eggs go away for most of us when we’re 40 and most of us by the time we’re 43.
I don’t like to label patients. I like to be transparent with patients, but also positive. As long as I’m not harming someone physically or emotionally then I will do what a patient wants to help them get to that next step and to take the route they wish to take.
Do I have the option to use my own eggs in your clinic?
This sounds like a funny question to me. There are clinics out there that will not treat you unless you’ll use donated eggs or embryos over a certain age. If it’s really important to you to use your own eggs then make sure you set up an appointment with a doctor like me, one that sees you as a fertile person.
What are the chances of getting pregnant based on your fertility levels?
I hear stories from friends of doctors telling them they are too old to get pregnant. You can’t make that claim without getting your levels checked. Get your levels checked before even going to the clinic. There is one really important thing to realize; age, when over 40, is more predictive of your pregnancy success than your fertility levels. Before you even go in, I often ask patients to have their fertility levels checked so we review things in concrete terms during their first appointment. Ask your doctor, “what are the chances based on these levels?
Am I more likely to have twins or triplets with an older pregnancy?
This isn’t a silly question as there are things online that suggest this. If you look at natural twin rates they are higher in 40-year-olds than women in their 20s. The reason for this is that when the FSH levels go up sometimes more than one egg ovulates and sometimes two are genetically normal and you can get twins. The chances of this happening are low, but it is still a possibility.
One out of ten eggs will be genetically normal for a woman over 40. The chance that you’ll have two normal eggs in a batch over 40 is low. Less than 5 women have had two or more normal embryos in a batch at 43. In general, the number of pregnancies you have through IVF is directly related to the number of embryos you put in.
Should I wait 3 months to see if my levels improve?
Eggs aren’t like sperm cells. They don’t necessarily get better over time. However, there are lifestyle factors that can make treatment timing better. But I hear patients tell me that they really want to exercise and get in shape and then come back to me as then their egg quality should be better. Or that their FSH level will be better after acupuncture. I wish that were true, but waiting for months will not change things regardless of your diet, exercise or acupuncture. As long as you’re a healthy person you don’t have to wait three months to be a better you. Hopefully, you’ll be able to achieve your goals regardless of your age.
My friend who is 41 just had a baby. I am 43. Why Can’t I?
There’s a huge change in the pregnancy rate between a 41 and a 43-year-old. It’s not the same as being 31 vs. 33. If you’re over forty and want to have a baby I strongly advise you to get your levels checked and meet with a fertility specialist.
My partner is also 45, what do I need to know?
So often I find that we look at patients and ignore the sperm part of the equation. Your full fertility picture includes the sperm component. Get a semen analysis for your partner. A sperm donor may be better for older eggs depending on the situation. Think about all of the options — maybe you don’t need an egg donor, it could be the sperm that you need to get donated. I’m just giving you something to think about. As always, get tested and get information about you and your partner so you can make the best decision as a team.
If I froze my eggs at 30, will my age at 45 play a role?
As long as you’re healthy and don’t have chronic medical problems then your chances should be just as good because your chances are related to the health of your eggs. You can be pregnant in menopause. Some women have menopause at 40, but in today’s time, a lot of women haven’t finished building their family at this age. So what can we do about that? Educate. Talk about egg and embryo freezing and help women understand their options earlier in their life. This is why I do this show.
There was a really interesting study published showing that many people thought ovulation happened during their period. I want people to ask more questions and talk about their body and fertility.
How do I know if I need a gestational carrier?
I talk to all of my patients over 45 about using a gestational carrier. I want my patients to be really healthy for their future family and to not have any pregnancy complications. It would be ridiculous for me to suggest pregnancy over 45 is easy. It is not. There are some clinics that have a limit on age and so you want to understand this prior to an appointment.
What are the signs that you are menopausal?
If your cycles are getting shorter and then get longer then we know you’re in transition to menopause. At that point, it gets really harder to get pregnant. FSH level will go to 40 and you won’t have periods for a very long time. You will feel like you’re going postal. You’ll have wild hormone swings. You may want to try fertility drugs to see if you can ovulate one more egg and get pregnant. This is something to talk to your doctor about.
I have never had a patient at 47 have a healthy pregnancy using their own eggs. I have had patients at 46 and 45, but not 47. If you’re this age and curious about your chances of getting pregnant then talk to your doctor. Just because your doctor doesn’t have a patient that’s 44, for instance, that’s gotten pregnant using their own eggs doesn’t mean they are a bad doctor. If your doctor has had patients over 44 get pregnant I’d suggest asking these follow up questions:
- Are my fertility indicators similar to the patients you saw that did get pregnant at over 43?
- If you were me, what would you do?
I want to educate my patients and offer compassionate care. I want to teach you everything that I know about this stuff and then allow you to make a decision that feels right for you. I hope you receive the same compassionate care from your doctor.
Age isn’t the only factor
You hear me say this all of the time; get your TUSHY checked!
Get your tubes checked, get an ultrasound of your uterus, get the sperm checked, get a full hormone panel done, and look at your carrier screen.
I also don’t want women over 40 to ignore other factors that may be impacting their fertility. If we’re JUST focused on age then we may encounter other barriers at the most inopportune times.
For example, imagine you’re over 40 and ready to use a donated egg and you find out that you have a big fibroid sitting in the middle of your uterus. That means you’ll need to get it removed and wait another six months to have a pregnancy…that’s really frustrating.
Or imagine you’re ready for a donor pregnancy and the sperm isn’t viable.
Get your diagnosis before treatment and don’t just focus on one thing. For example, if you’ve been told that all of your miscarriages have only been caused by age, my counsel is to still look at everything. It would be frustrating for you and your partner if you missed an opportunity to do something different. Learn more about your body. Ask questions. No question to your doctor is a dumb one.
Thank you for watching the show tonight. I hope it was helpful. I’ve put together a quick checklist. If you’re over 40 and you want to talk to a fertility doctor, these are the three things that I want you to do:
- Get your levels checked: Get the full picture of what your fertility hormone levels are, and understand how they change over time. Go to your first visit with an understanding of your levels so that your time spent with that fertility doctor is very efficient. You can then together strategize and come up with a plan and a calendar if needed.
- Don’t forget about getting your TUSHY checked
- Don’t be afraid if there are signs that you are close to menopause: You can have a pregnancy in menopause. The reason? Hormones. We use fertility drugs that mimic ovulation to help you get pregnant.
Figure out where you are — what your levels are and your diagnosis to make a decision and craft a path forward that feels right for you.
I hope this has been a helpful show and that this information is something you can take with you to your fertility doctor, wherever you live. I wish you all the best and that you’re able to build the family of your dreams.
As always please reach out if you have any questions or topic suggestions for future shows.
Send me a note: firstname.lastname@example.org
You can also catch more of me and topics like this through the Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!