Yes, it is possible to get pregnant at 45, but the odds are significantly lower than even a few years earlier. Women aged 40 to 45 are about 60% less likely to conceive in any given cycle compared to women in their early twenties. A large North American study found that the cumulative probability of conceiving within 12 months of trying was roughly 55% for women aged 40 to 45, compared to about 79% for women in their mid-twenties.
Why Fertility Drops Sharply in Your Mid-40s
The core issue is egg supply and egg quality. By around age 45, the ovaries typically contain fewer than 1,000 remaining follicles, down from the roughly one to two million a woman is born with. That shrinking pool also means a higher proportion of eggs carry chromosomal errors, which makes successful fertilization, implantation, and a healthy pregnancy less likely with each passing year.
Cycles also become less predictable. Most women in their mid-40s are in perimenopause, meaning they still ovulate and menstruate, but irregularly. As long as you haven’t gone a full 12 consecutive months without a period (the clinical definition of menopause), pregnancy remains possible. Many women mistake early pregnancy symptoms for perimenopause itself, since the two share overlapping signs: missed or irregular periods, mood changes, fatigue, and sleep disruption.
Natural Conception at 45
Natural pregnancy at 45 happens, but the per-cycle odds are low. In the preconception cohort study mentioned above, women aged 40 to 45 had a fecundability ratio of 0.40, meaning their chance of conceiving in any single cycle was less than half that of women aged 21 to 24. Stretched over a year of trying, about 55% eventually conceived, though that estimate comes with a wide confidence interval (roughly 31% to 80%), reflecting how variable outcomes are in this age group.
The practical takeaway: some women at 45 will conceive within a few months of trying, while others will try for a year or more without success. If you’re actively trying, most fertility specialists recommend seeking evaluation after just three to six months of unprotected intercourse rather than waiting the standard year recommended for younger women.
IVF and Assisted Reproduction
IVF with your own eggs at 45 or older has a live birth rate of roughly 2% to 4.5% per cycle. A large single-center study of over 1,000 IVF cycles in women 45 and older reported a live birth rate around 2%, consistent with national data from the Society for Assisted Reproductive Technology (SART). The 2022 SART national summary placed the live birth rate for women over 42 using their own eggs at 4.5% per embryo transfer.
Using donor eggs changes the picture dramatically. Because donor eggs typically come from women in their 20s or early 30s, they carry far fewer chromosomal abnormalities. Live birth rates with donor eggs run around 39% to 46% per cycle, regardless of the recipient’s age. For many women at 45, donor eggs represent the most realistic path to a successful pregnancy through fertility treatment.
Miscarriage Risk
Even when conception occurs, the chance of miscarriage rises steeply. A large prospective registry study published in The BMJ found that women aged 45 and over had a miscarriage rate of about 54%. That’s roughly one in two recognized pregnancies ending in loss, compared to around 10% to 15% for women in their twenties. The primary driver is chromosomal abnormalities in the embryo, which become more common as egg quality declines.
Chromosomal and Genetic Risks
The risk of Down syndrome at 45 is higher than at younger ages but lower than many people assume. A study analyzing over 13,000 live births to women 45 and older found an average rate of 34 per 1,000 births, or about 3.4%. That means roughly 96 to 97 out of 100 babies born to mothers in this age group do not have Down syndrome.
Prenatal screening and diagnostic testing (such as cell-free DNA blood tests and amniocentesis) can identify chromosomal conditions early in pregnancy. For women pursuing IVF, preimplantation genetic testing of embryos before transfer is another option for screening out chromosomal abnormalities.
Health Risks During Pregnancy
Pregnancies after 40 carry higher rates of several complications compared to pregnancies in younger women. In a study comparing mothers over 40 to a younger control group, the differences were striking across multiple categories:
- Gestational diabetes: 14.5% vs. 6.9%
- Preeclampsia: 4.6% vs. 1.5%
- Gestational hypertension: 3.1% vs. 1.1%
- Preterm birth: 10.4% vs. 6.5%
- Stillbirth: 2.1% vs. 0.5%
- Cesarean delivery: roughly 67% (scheduled and emergency combined) vs. about 19%
These are population-level averages, and individual risk depends on your overall health going into pregnancy. Women at 45 who are physically active, at a healthy weight, and free of chronic conditions like high blood pressure or diabetes will generally fare better than these numbers suggest. Still, any pregnancy at this age is considered high-risk and involves more frequent monitoring, additional ultrasounds, and closer blood pressure and glucose tracking throughout.
What This Means in Practical Terms
Getting pregnant at 45 is possible but far from guaranteed, and the path you take matters. Natural conception can happen, particularly if you’re still ovulating regularly, but expect lower odds and a longer timeline. IVF with your own eggs offers only a small boost. Donor eggs provide success rates comparable to what younger women experience with standard IVF.
If you’re 45 and considering pregnancy, the most important variable is time. Fertility at this age declines month by month, so early evaluation of your ovarian reserve (through blood tests and ultrasound) gives you clearer information to work with. For women who aren’t actively trying but want to avoid pregnancy, it’s worth knowing that contraception is still necessary until you’ve gone a full year without a period.