Ages 45 to 49
The percentage of women who have babies in this age group is .03, and the chance of successful infertility treatment drops tremendously. Just being able to conceive and sustain a pregnancy is an achievement and to some degree a reflection of your own good health. "We all hear success stories of women who had children in their late forties through in vitro fertilization," says Dr. Younger. "But more than half of all pregnancies conceived through IVF in women over age forty are produced through donor eggs."
Once you've conceived, you're more likely to undergo rigorous testing than you would if you were younger. Most pregnant women in their 40s have some stress testing to check their cardiovascular health, and they'll be more closely monitored for signs of diabetes or kidney problems than those in their 20s, says Dr. Younger.
Even if you're in top physical shape, carrying and delivering a baby will be more difficult than it would be if you were in the same physical shape in your 20s. "Pregnancy, in a sense, is like an athletic event," says Dr. Niebyl. "Blood volume nearly doubles, increasing the strain on your heart, and the extra weight puts some strain on your muscles and joints."
YOUR EMOTIONAL SELF
Most women in their mid-40s are concerned about the health of their baby as well as their own health -- with good reason, since there are increased risks for both at this age. But most pregnancies, even among women in their 40s, have good outcomes. The better you care for yourself, the more successful your pregnancy is likely to be.
RISKS TO YOUR BABY
More than half of all pregnancies in women over age 45 end in miscarriage (before 20 weeks gestation). Risk of stillbirth is doubled for women in their 40s, compared with those in their 20s; for this reason, many doctors perform more stress tests and ultrasounds in the last weeks of pregnancy in older women. The chance of chromosomal abnormalities increases sharply. At age 45, there's a 1 in 30 chance of delivering an infant with Down syndrome and a 1 in 21 chance of having a baby with any chromosomal abnormality. In a 49-year-old those risks rise to 1 in 11 and 1 in 8, respectively.
The average age for menopause is 51, but typically the range runs from 45 to 55. Almost all pregnancies beyond age 50 require some assistance, whether from fertility drugs, hormone supplements, or, more often, donor eggs. Women still ovulating usually have to take progesterone for at least the first two months to maintain the pregnancy. Women who have stopped ovulating need donor eggs to conceive and must take estrogen and progesterone for much of the pregnancy, until the placenta begins to produce those hormones on its own.
At this age, there's a high rate of complications -- including hypertension, kidney problems, and placental problems -- that requires strict monitoring and care.
Then there's the issue of the woman's age once the baby is born. We all know 50-year-olds who are more energetic and alert than their 20-year-old counterparts, and they have the added benefit of maturity and experience. But women over 50 may need extra energy -- not to mention stamina -- to awaken every two hours with a newborn or to chase after a toddler.
Statistics show that once a woman has gotten pregnant, if she takes good care of herself and if prenatal screening tests are negative, she's much more likely to deliver a healthy baby than not -- regardless of her age. The rate of fetal deaths has dropped by about 70 percent since the 1960s. That's great news for all pregnant women.
Laura Flynn McCarthy writes often about women's health. She lives in New Hampshire with her husband and their two sons.