Getting Pregnant After 35: An OBGYN Tells Women What They Need To Know
Dr. Emeka’s Lemon: Turning Fertility Myths into Empowering Truths for Pregnancy Over 35
Fertility for women, especially as we navigate our 30s and 40s, is anything but simple. It’s a tangled mix of fear-mongering, cold hard facts, and societal pressures that can make family planning feel overwhelming. Historically labeled as "geriatric pregnancy," the biological clock is said to tick louder as women enter their late 30s, but the reality is more nuanced.
Over the past decade, the landscape of maternal age has shifted. In 2022, women in their early 30s had a higher birth rate than those in their late 20s for the seventh year in a row, according to Time Magazine. Furthermore, the number of babies born to women in their 40s increased by 6% from 2021 to 2022, signaling a trend toward later-in-life pregnancies.
In my last post:
Tobi Hamilton opened up about her deeply personal journey through late-stage pregnancy loss and the path to finally welcoming a healthy rainbow baby. Like many women over 35, Tobi faced unexpected hurdles with her pregnancy. After enduring several invasive surgeries following her loss, her doctors told her that conceiving naturally would be a challenge. But her story took a transformative turn when she met Dr. Emeka Okaro, a third-generation Nigerian-British OB-GYN whose expertise reshaped her journey.
Tobi credits Dr. Emeka with restoring her hope when other doctors had given up, guiding her through every anxious step of her pregnancy. Inspired by her experience, I knew I had to speak with Dr. Emeka to help other women better understand the challenges and possibilities of pregnancy in their late 30s and beyond.
Dr. Emeka is a consultant obstetrician and lead clinician for benign gynecology at St. Bartholomew's and the Royal London NHS Teaching Hospitals in London. His holistic approach to patient care, combined with his expertise in early pregnancy complications, pelvic pain, and menstrual disorders has made him a trusted figure in the field.
In this Lolly’s Lemons conversation, Dr. Emeka and I explore the essential insights women need to prepare for healthy pregnancies in their 30s and 40s, empowering them to make informed choices about their health and future.
UNDERSTANDING ‘GERIATRIC’ PREGNANCY
What is a “geriatric pregnancy," and why is it termed this way?
A geriatric pregnancy is a medical term used to describe a pregnant woman who’s 35 or older. The term geriatric pregnancy is completely outdated and no longer reflective of modern society. “Our health and life spans have changed so significantly that several decades ago, someone who was 35 was viewed as aged. Now, a 35-year-old is still considered relatively young and healthy. I don’t agree with the terminology as it no longer reflects the current standard of health for women in that age group,” Dr. Emeka clarified. However, it's important to acknowledge that the risks associated with pregnancy and childbirth can increase as women age, including higher chances of complications such as gestational diabetes, preeclampsia, and chromosomal abnormalities.
Why is this term no longer reflective of women over 35? And what is the appropriate terminology?
“Women are healthier and fitter now, and are taking better care of their bodies than previous generations. While women have a biological clock, they can now mitigate many factors that impact pregnancy. The term "geriatric" implies being old, but that doesn't reflect our current reality. Because women today are healthier, they’re less likely to have conditions like diabetes, poor diet, or hypertension that would have affected pregnancy in the past,” according to Dr. Emeka. The more appropriate terminology is ‘advanced maternal age’ which is less pejorative and better reflects the health status of many women in this age group today.
YOUR EGGS, YOUR AGE, AND YOUR FERTILITY
“The quality and quantity of a woman’s eggs decline over time. Most women are born with about 1.5 to 2 million eggs, but this number decreases as they age. With each ovulation cycle, some eggs are released while others naturally degrade. As women mature, the remaining eggs age as well, resulting in fewer healthy eggs available for conception. By age 30, 25% of women will conceive in their first cycle. By age 35, only 10% of women will conceive in their first cycle. By age 40, the percentage decreases further, with only about 5% of women conceiving in their first cycle” Dr. Emeka highlighted.
But here’s the good news: every woman’s fertility journey is unique. Today, we have more tools and knowledge than ever before. With the right care and planning, many women are embracing motherhood later in life. Modern medicine, combined with a healthy lifestyle, offers options our grandmothers could only dream of. So, if you’re feeling uncertain, remember that exploring your choices with a trusted specialist can empower you to make the decisions that truly align with you.
HEALTH RISKS & CONSIDERATIONS
What are some important health considerations for women who are thinking about having a baby later in life?
“First and foremost, I strongly believe in the impact of lifestyle on fertility. I always emphasize to my patients the importance of healthy living: regular exercise, a balanced diet, managing stress, and reducing refined sugar intake to optimize their bodies. If you have pre-existing medical conditions like high blood pressure or diabetes, it's crucial to manage them before trying to conceive. The power of lifestyle changes in fertility cannot be overstated, and this applies to both men and women. Fertility is not exclusive to women—both genders play significant roles. As we age, our bodies become less forgiving, so it's important to be mindful of these factors early on, not just for conception but for extending overall health as well,” advised Dr. Emeka.
While it's true that as women age, the likelihood of certain pregnancy-related risks increases, modern healthcare offers more tools than ever to manage and mitigate these risks. Many women in their mid-30s and beyond have healthy pregnancies due to proactive care and regular monitoring. Knowledge is power, so here are some potential risks to be aware of as you approach your fertility journey to help you plan for the best possible outcome:
Chromosomal abnormalities: “Older" eggs are more likely to cause chromosomal anomalies. At age 30, the risk is around 1 in 940. By age 35, the risk increases to about 1 in 353. At age 40, the risk further rises to about 1 in 85.1
*Chromosomal anomalies are screened for in the first trimester. With advancements in genetic testing, early detection is possible, offering more options and reassurance.
Preeclampsia: Women over 35 have a 1.2 times higher risk of developing preeclampsia, which doubles to 2.4 times for women over 40 and triples to 3.6 times for women over 45.2
*Women today benefit from regular check-ups and tailored care plans that help manage blood pressure effectively.
Gestational diabetes: Pregnant women over 35 have an increased risk of developing gestational diabetes, a type of diabetes that only occurs during pregnancy. The risk for women aged 30–34 years is 2.73 times higher than for women under 20 years old3
*With lifestyle guidance and early screening, gestational diabetes is often managed well, leading to healthy pregnancies.
Hypertension: The risk of developing hypertension during pregnancy increases with age, doubling to about 10%-20% for women aged 35-39, and rising to 30% or more for women in their 40s.4
*Modern treatments and careful monitoring help women keep hypertension under control during pregnancy.
Stillbirth: Women aged 35 to 39 have nearly double the risk of stillbirth compared to women younger than 30. For women aged 40 and above, the risk increases even more, with a 2.4 times higher likelihood of stillbirth compared to women under 30.5
*The risk of stillbirth can be managed by regular prenatal care, monitoring for complications, and considering early delivery if necessary
Miscarriage: At age 30, the risk of miscarriage is 1 in 5, but by age 40, the risk increases to 1 in 2 6
*Maintaining a healthy lifestyle, managing underlying conditions and regular prenatal care can help reduce the risk of miscarriage
What are the potential impacts of fibroids and endometriosis on conception and pregnancy?
“Before attempting to conceive, it is recommended to undergo a comprehensive medical evaluation to identify potential factors contributing to infertility, such as endometriosis, fibroids, heavy periods, and pain. Both fibroids and endometriosis can lead to high-risk pregnancies, with fibroids having a more significant impact. While endometriosis can reduce fertility and make conception more difficult, it generally does not affect the ability to carry a pregnancy to term once conception occurs. On the other hand, fibroids can prevent conception if located in the uterine cavity. Additionally, fibroids can restrict fetal growth, lead to premature delivery, and cause the baby to be in an incorrect position, such as breech,” Dr. Emeka said.
How does a woman's fitness level impact her pregnancy experience and recovery?
According to Dr. Emeka, "It depends on your starting point. A fit and healthy woman is generally less likely to experience discomfort during pregnancy, and this can also positively impact her recovery afterward. Fitter women tend to recover better because they are often more motivated to resume physical activity and a normal diet post-pregnancy, leading to an overall smoother recovery."
What extra precautions might be needed for women over 35 during pregnancy?
"For women over 35, especially those with pre-existing medical conditions, additional precautions are necessary. More frequent monitoring, including extra ultrasound scans, is required. Screening for conditions like gestational diabetes is also crucial, as the risk of developing diabetes increases with age. Pregnancy adds extra stress to the body, which further elevates this risk," Dr. Emeka advised.
When should women consider consulting a high-risk OB-GYN?
“If you have comorbidities, such as obesity, high blood pressure, diabetes, or thyroid disease.”
What can women do to mitigate some of the potential risks you mentioned?
Egg Freezing: Freeze your eggs at a younger age (as soon as possible) to lower risks, as fertility naturally declines with age.
Diet: The importance of diet and nutrition needs to be emphasized more in communities of color, where specific dietary patterns can contribute to higher rates of diabetes and hypertension.
Exercise: Staying physically active is crucial—consider pregnancy yoga, swimming, or light weights at the gym. I always tell my patients, "You're pregnant, not ill," so it's important to remain intentionally active. All activities should be adjusted with pregnancy in mind.
Timeline: Start trying to conceive sooner rather than later where possible.
Support: Having a supportive and understanding partner and medical team can be very beneficial.
FAMILY PLANNING
You mentioned earlier that men play a crucial role in healthy conception, can you say more on this?:
"Men play a vital role in the fertility journey as well. While much attention is often given to women's fertility, men also experience age-related declines in their fertility. For a healthy conception and pregnancy, both partners need to prioritize their overall health. Men produce new sperm every three months, so their lifestyle choices significantly impact sperm quality. Supplements like zinc and magnesium, regular exercise, and reducing alcohol and smoking can improve sperm quality and contribute to better fertility outcomes. If there are difficulties with conception, it's important for men to have their sperm assessed as part of the early investigation process," Dr. Emeka explained.
What are the optimal timing considerations for spacing pregnancies in women over 35, given the decline in fertility?
Dr. Emeka advises his patients to start their families as soon as they feel ready. “I recommend moving away from the traditional two-year gap between pregnancies, especially given the natural decline in fertility after age 35. For women in this age group, it's often better to aim for pregnancies closer together. A shorter interval of about a year between pregnancies is generally safe and can be beneficial for fertility.”
How can Assisted Reproductive Technology help with getting pregnant and preserving fertility?
Advances in reproductive technology have greatly expanded options for women over 35 who want to become pregnant, giving them more control over their fertility. These advancements, such as egg freezing, help alleviate concerns about future fertility and reduce anxiety. They allow women to make informed decisions and plan for their future.
“Egg freezing involves storing your eggs, while IVF (in vitro fertilization) is the process of fertilizing an egg with sperm and then implanting it into the womb. To use IVF, you need either a partner or a donor. For single women, egg freezing is often the primary option, although using donor sperm is also possible. The best approach depends on individual circumstances. For a single patient who is 35, the fertility conversation would typically focus on exploring options like egg freezing, especially if the patient is uncertain about when she plans to conceive,” said Dr. Emeka.
What about women who aren’t ready to have children now, but want them in the future?
While there are no guarantees, IVF combined with egg or embryo freezing is a valuable option for women. This approach allows women to preserve higher-quality eggs or embryos, which can later be fertilized in the lab and implanted when they're ready to have children.
The Associated Costs:
For information on the cost of egg freezing, IVF, and fertility packages, please contact Dr. Emeka. See the details below:
Mr. Emeka Okaro FRCOG
Consultant Obstetrician and Gynaecologist
London, United Kingdom
Practice Manager
Justina Airall
Phone Number: +447730368009
Email: justina.airall@hje.org.uk
SPECIFIC CONSIDERATIONS FOR BLACK WOMEN:
The age-related risks previously mentioned have additional implications for Black women that health professionals must consider. Could you provide more details on this?
Preeclampsia: 60% higher in black women
Gestational diabetes: Twice as common in black women
Hypertension: 40% higher in black women
Stillbirth: Twice as common in black women
Miscarriage: 40% higher in black women
Are there specific health disparities or additional risks that black women should be aware of regarding fertility and pregnancy after age 35?
“Black women face increased risks in fertility and pregnancy after age 35 due to higher rates of fibroids, obesity, and hypertension. Fibroids can complicate both fertility and pregnancy, while obesity and hypertension elevate risks such as gestational diabetes and preeclampsia,” Dr. Emeka explained. “Systemic healthcare disparities worsen these challenges, highlighting the need for regular check-ups and advocacy for quality care to manage these risks effectively.”
Black women are diagnosed with fibroids roughly three times as frequently as white women. How does this impact our ability to conceive after 35?
“Depending on their location, fibroids can hinder conception and increase miscarriage risk. During pregnancy, they may lead to premature delivery or necessitate a cesarean section if they affect the baby's position, potentially resulting in a breech presentation,” said Dr. Emeka.
How can black women advocate for their health and ensure they receive appropriate care?
“Don’t hesitate to advocate for yourself—this is crucial. Black women, statistically, tend to self-advocate less, but it's your right to seek a second opinion. Don’t wait until it’s too late; speaking up can make a significant difference in your care. Self-help support groups or talking to friends can also provide valuable guidance on how to assert your needs effectively. When in doubt, always ask for a second opinion to ensure you receive the best possible care,” Dr. Emeka emphasized.
LEMONADE STAND:
Dr. Emeka’s Recommendations for Women Who Want to Get Pregnant in Their 30’s & 40’s
Mentally: Prepare yourself both physically and mentally for pregnancy. Understand that it comes with challenges—stress, bodily changes, and discomforts like heartburn and sleepless nights. Educate yourself with helpful information so you can effectively advocate for your needs. Stay open-minded and relaxed, as childbirth can often unfold in unexpected ways. Remember, the baby ultimately determines the birth process—whether it’s a vaginal delivery or a cesarean.
Physically: Invest in a healthy lifestyle. It's one of the most crucial factors for a healthy pregnancy at any age. A woman in her mid-30s who maintains her health will likely have an easier experience than someone in their 20s who is unhealthy.
The Vitamin & Self-Care Checklist: Start taking specific supplements and making lifestyle changes before you plan to conceive. By doing so, your levels will be saturated, and your body will be in optimal condition prior to conception. Many women start supplements when they're already pregnant, but ideally, you want to begin beforehand.
Folic Acid
Vitamin D
Iron
Omega 3
Drink 2-3 liters of water per day
Sleep for at least 7 hours at night
Frequent and consistent exercise
A healthy and balanced diet
BEFORE YOU GO!
I'm putting together a fertility FAQ sheet that will be sent directly to subscribers inbox only, so make sure you’re subscribe! You can ask your questions anonymously through my Instagram stories for the next 24 hours, DM me @lolahenrietta_, or email me at thelollyslemons@gmail.com!
Until next time.
xx,
Lolly
The Cleveland Clinic
The National Institute of Health
The Cleveland Clinic
John’s Hopkins Medicine
Contemporary OB/GYN
The Royal College of Obstetricians and Gynaecologists
Thank you for this! So informative
Thank you Lolly and Dr Emeka for this! I’ve been seeing testimonials about Dr Emeka so this was perfect that he was able to share his knowledge in this area.