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Conception problems in mid-life
Q: I’m 41, and I have a delightful 7-year-old daughter. My husband and I want to have a second child, and we have been trying to conceive for six months. Are there special concerns about getting pregnant at my age? I eat healthy foods, don’t smoke, exercise regularly and have regular periods. I had no problems getting pregnant with my daughter. Should we be concerned about the time it’s taking to get pregnant?
A: I’m glad to see that you are taking an active role in staying healthy. Some factors that contribute to fertility, like diet and exercise, are in your control. Other factors, like the functioning of your ovaries, are dependent on your age rather than your behavior.

You were born with your life’s supply of eggs, a quantity that steadily decreases over time. Menopause occurs when menstruation ceases, indicating a woman has no more viable eggs. A woman’s fertility will decline with increasing age, even when menstrual cycles remain steady. Though most women continue to menstruate until age 50, ovaries go through a “reproductive menopause” many years earlier. When conceptions occur in older women, miscarriage rates and unhealthy pregnancies increase. Women who conceive past the age of 35 are advised to have genetic testing because the chance of carrying a baby with a chromosomal problem is higher.

Fertility rates tend to decrease dramatically after age 40, so I recommend that you consult with a gynecologist sooner rather than later. Your doctor can evaluate whether there are any correctable factors that are interfering with your fertility, and will offer fertility testing to you and your husband. One blood test, called FSH, can be done on the third day of your menstrual cycle to provide information about your ovarian reserve of healthy eggs.

If this test suggests that you have a healthy supply of eggs, your doctor will be able to advise you whether there are interventions to improve your chance of a successful conception. If the FSH test suggests your ovaries are not capable of producing a healthy egg to achieve a pregnancy, you and your husband can decide whether to pursue other means of expanding your family. Some women choose in vitro fertilization using a younger woman as an egg donor, some couples consider adoption, and others may decide not to have another child.

Laura E. Stachel M.D. Obstetrician & Gynecologist