There is no universally accepted age after which pregnancy is not recommended. Advanced maternal age is traditionally defined as pregnancy at or over the age of 35 years. Not only does it become harder for women to conceive after age 35, pregnancies carry higher risk of complications including preterm delivery and multiple gestation. Some chronic diseases such as high blood pressure and diabetes are also more common at older age and can be exacerbated by pregnancy.
Pregnancy after age 43 usually involves use of donor egg or embryos (Donor Eggs). Whereas the fertility potential of the eggs rapidly declines in the late 30s to early 40s, the uterus does not “age” and success rates do not decline with increasing maternal age in women receiving embryos derived from donor oocytes. The figure below illustrates the effect of the intended mother’s age when using her own eggs and donor eggs.
With the use of donor eggs, the primary constraint is the health of the prospective mother. Multiple studies indicate that pregnancy over age of 44 carries elevated risks of maternal and delivery complications. The overall outcomes, however, remain favorable and pregnancy in late 40s to early 50s in a healthy woman is generally considered to be a higher risk, but usually safe.
The decision to pursue pregnancy should be an individualized decision based on consideration of multiple factors. It is recommended that patients have a pre-conception medical evaluation, including stress echocardiogram, to assess their health status as well as a consultation with a high risk obstetrician to discuss obstetrical risks of pregnancy. Prospective parents should also weigh considerations of parenting at an older age.
