It is possible to have a baby at age 45, though the journey often involves significant challenges and typically requires medical intervention. The medical term “Advanced Maternal Age” (AMA) applies to any pregnancy occurring at age 35 or older. While some women may conceive naturally, the biological decline in fertility means most successful pregnancies at this age are achieved through assisted reproductive technologies. This later age for childbearing introduces biological hurdles for both conception and carrying the pregnancy to term.
Understanding Fertility Decline at Age 45
The primary barrier to natural conception at age 45 is the dramatic decline in the ovarian reserve, affecting both the quantity and quality of the remaining eggs. A woman is born with all the eggs she will ever have, and their number decreases continuously. By age 45, the number of viable follicles is extremely low.
The quality of the remaining oocytes is substantially diminished due to age-related changes. Eggs have been paused in cell division for decades, making errors in chromosomal separation much more likely upon ovulation. This leads to a high rate of aneuploidy, meaning the egg has an abnormal number of chromosomes.
The natural chance of conceiving per menstrual cycle for a woman aged 45 is estimated to be less than 5%. The majority of conceptions that occur may not be viable due to these chromosomal issues. The risk of miscarriage for women over 45 is over 50%, often because of these genetic abnormalities.
Aneuploidy also raises the risk of having a baby with a genetic condition like Trisomy 21 (Down syndrome), with the chance around 1 in 35 at age 45. The likelihood of an egg resulting in a healthy, sustained pregnancy is severely limited by its poor quality.
Assisted Reproductive Options for Conception
When natural conception is unlikely, assisted reproductive technology (ART) offers alternative pathways. In Vitro Fertilization (IVF) is the most common method, but success depends heavily on the egg source. Using a patient’s own eggs at age 45 yields very low live birth rates, often less than 4% per cycle, due to poor egg quality.
Given this poor prognosis, using donor eggs from a younger woman is often the most effective treatment. Donor egg IVF bypasses age-related quality issues, as the success rate is based on the donor’s age. Success rates for live birth with donor eggs are substantially higher, often ranging from 50% to 70% per fresh cycle.
For couples using their own eggs, Preimplantation Genetic Testing (PGT) can screen embryos before transfer. PGT identifies embryos with the correct number of chromosomes (euploid embryos), which helps reduce miscarriage risk and increases the chance of a successful transfer. However, obtaining enough healthy eggs to create a euploid embryo is rare at age 45.
Increased Health Risks for Mother and Fetus
Pregnancy at age 45 is associated with elevated risks for both the mother and the developing fetus, requiring specialized care throughout gestation. The mother faces an increased likelihood of developing specific medical complications related to the physiological stress of pregnancy on an older body.
Maternal Risks
Gestational hypertension and preeclampsia are common maternal complications, involving the onset of high blood pressure, often with damage to other organ systems. Gestational diabetes, where the body cannot effectively manage blood sugar levels, is also more prevalent. Older mothers also have a higher incidence of placental issues, such as placenta previa. These complications often lead to a higher rate of medical induction of labor and a significantly increased chance of needing a Cesarean section.
Fetal/Neonatal Risks
Fetal risks are compounded by the increased rate of chromosomal abnormalities, leading to a much higher chance of conditions like Down syndrome. Even with genetically normal pregnancies, the risks of adverse outcomes remain elevated. The rate of stillbirth is approximately doubled for mothers aged 45 and older compared to younger groups. Preterm birth (delivery before 37 weeks) is also more common, increasing the risk of the baby having a low birth weight.
Essential Preconception and Prenatal Care
Optimizing health before conception helps mitigate the higher risks associated with advanced maternal age. A comprehensive preconception health screening is recommended to assess and manage pre-existing conditions, such as hypertension, diabetes, or thyroid disorders. Lifestyle modifications, including achieving a healthy pre-pregnancy weight and optimizing nutrition, can improve maternal health outcomes.
Once pregnant, intensive and specialized prenatal care is required. Consultation with a maternal-fetal medicine specialist (perinatologist) is often necessary. Monitoring includes early and frequent blood pressure checks and screening for gestational diabetes.
Advanced fetal surveillance is routine, including non-invasive prenatal testing (NIPT) to screen for chromosomal conditions, and frequent ultrasounds to monitor growth and placental function. Prophylactic measures, such as low-dose aspirin starting in the first trimester, may be advised to reduce the risk of hypertensive complications like preeclampsia. Delivery may be scheduled at 39 weeks gestation to reduce the risk of stillbirth.