PREPARING FOR CONCEPTION OVER 40

More women than ever are trying to conceive over the age of 40, that is a fact. In most developed countries the world over we are finding that women have more freedoms and equalities than past times. There is no denying this is wonderful. This gives us the freedom to focus on career goals, travel, making our creative dreams a possibility, rather than feeling like we have to have children right away in our 20’s. We are no longer as stuck as we once were, but what about that nagging fear of fertility decline as we age? 

I hear the doubt daily, “Should I have waited so long to have children?” I find that women over 40 come to us with a huge amount of fear surrounding their fertility journey. Where does this fear stem from? Society? Media? Science? Where? As long as humans have existed, there have been deep emotions, opinions, the “right and wrong” ways to do just about everything in life. So why would we expect it to be any different for those desiring to have children over 40? I am not here to pick sides, but I do think it is very important to be realistic and to listen to your gut. When has any decision that started off in fear been a step in the right direction?  Let your journey begin with confidence and belief in your body. If you doubt your body or the health of your future child to begin with, how can you expect to be successful? Even if you don’t succeed, at least you will know you gave it your best shot.

I figure that if you are reading this article, you are all in, ready to have a child over the age of 40. Because of that, I am not here to list statistics on the likelihood of conception for women over 40, or the risks to mother and child. You can find that information elsewhere. We are here to let you know the importance of smart preparation. There are important key areas that need to be focused on. These key areas can help to give you and your baby the best chance at a healthy first 9 months in the womb and beyond!

Understanding Female Fertility for Women 40 and Over

What happens to my fertility as I age?

The Menstrual Cycle: Menarche to the Beginning of Climacteric
Menarche is the beginning of the childbearing years, when the first menstruation begins. Climacteric is the long phase in which hormone production and ovarian function declines, allowing the body to adapt to the natural changes in which menstruation ends. Menopause occurs within the climacteric years of a woman’s life. Climacteric lasts for about 15-20 years, typically beginning at the age of 40.

The Menstrual Cycle in the Childbearing Years of a Healthy Woman
Approximate age of 11-40 years

In very simple terms the hypothalamus produces GnRH (gonadotrophin-releasing hormone) which signals to the pituitary to produce LH luteinising hormone and FSH follicle stimulating hormone. The release of GnRH is pulsatile in women with regular menstrual cycles. This normal pulsatile release of GnRh signals some of the follicles in the ovary to begin maturing and for the ovaries to release estrogen and progesterone. This estrogen/progesterone signal is recognized by the pituitary gland. As the follicles begin maturing they release and increase the hormone estrogen over time. The rising estrogen level signals the pituitary gland to curb release of FSH.

In a normal functioning follicle, the estrogen levels rise and signal the pituitary gland to release Luteinizing Hormone (LH). LH signals the follicle to open and release the mature egg, this is ovulation.

Ovulation is followed by the luteal phase. With LH present the corpus luteum begins to secrete increasing quantities of progesterone and fairly constant levels of estrogen.
The endometrium is now influenced by progesterone causing it to develop to be capable of nourishing a developing embryo.

If fertilization does not occur, the decline of the hormones causes the endometrium to shed, which is dependent on hormones at all times for its health, maintenance and development. When estrogen reaches a low enough point the hypothalamus releases GnRH and the cycle starts over again.

This cycle lasts on average 28 days, though it may vary some from woman to woman. 

The Menstrual Cycle in the Climacteric and Menopause Years of a Healthy Woman
Approximate age of 40-60 years for climacteric, age 40-55 for menopause, with menopause occurring within the climacteric years.

Now this may seem very confusing because most of us have very little education on what happens during “the change of life” a woman goes through as fertility declines. Most women begin the natural phase known as climacteric around the age of 40. Remember this is what is supposed to happen, it is part of the natural processes of life. At this time the menstrual cycle length begins to shorten from about 28 days to around 26 days, this is because the ovaries begin to lose their ability to produce mature follicles, estrogen and progesterone. Cycle length may be different for each woman, these numbers are just averages. 

Over the next many years the decline in hormone release and mature follicle production causes even more menstrual cycle changes. Cycles may become shorter, longer, or the cycle may be skipped. Ovulation may or may not occur during any given cycle as a woman approaches menopause. Menopause is confirmed once a woman has not had her menstrual cycle for at least one full year, and is between the ages of 40-55. Menopause may take 1-7 years to complete. The changing hormone levels continue until climacteric is complete, which may last until around the age of 60. 

There are 3 distinct phases of change for women in the climacteric phase of life. 

Phase 1 Perimenopause: 2 to 8 years leading up to cessation of menstruation

• Menstrual cycles become irregular
• Hormone levels change
• It is still possible to conceive naturally and carry a baby to term
• Doctor’s may suggest medical assistance options like Clomid, IUI or IVF

Phase 2 Menopause: Defined by absence of menstruation for one year. Doctor’s may also use certain hormone testing to indicate menopause, they are as follows:

• Elevated FSH level between 60 to 100mL/L on two tests done at least 1 month apart may indicate menopause
• LH level greater than 50mIU/L and estradiol less than 50pg/mL
• Some reproductive endocrinologists are willing to do IVF with an egg donor for women in menopause

Phase 3 Post-menopause: the first stage typically lasts about 4 years of continued physical symptoms of hormonal changes, with the second stage lasting for years until all symptoms of hormonal changes end. This last stage is different for each woman, but usually ends by age 58-60.

The human female body is designed to go through these changes very slowly over time. Sudden change in a short period of time may cause more severe symptoms in the body. This great shift in fertility, though it is long and drawn out, may produce many unwanted physical symptoms including:

• Muscles of the vagina, cervix, uterus and ovaries atrophy
• Muscles in the pelvic floor and surrounding supportive tissues lose tone
• Lack of cervical mucous
• Bone mass declines
• Metabolic rate slows down
• Breast shape, firmness and size changes
• Hot flashes
• Mood changes, depression, insomnia and anxiety
• Mild incontinence due to weakening and shrinking of pelvic tissues
• Heart palpitations

Though these symptoms can be uncomfortable, this process is completely natural and is what is supposed to happen to the body. It is a “rite of passage”. I know, this may not be comforting to hear, but it is the truth. Research has shown that other cultures that are not Westernized do not report severe symptoms of menopause and are not medically managed. Menopause is not a disease that needs to be treated, but in the United States we have come to believe it does. 

Knowing what is happening to your body gives you an advantage. It helps you to know key areas you need to focus on to give yourself the best possible chance at a healthy pregnancy.