The Indian Express ·
Health
Pregnancy after 40: What celebrity moms don’t tell you about fertility, IVF and pregnancy risks
Mahira Khan at 41, Lady Gaga at 40 and Anne Hathaway at 43 are among the latest celebrity mothers or expectant mothers putting pregnancy in the 40s firmly in the spotlight. But while later motherhood is increasingly visible, the biology deserves a closer look
American singer-actor Lady Gaga is 40 and has just entered motherhood. Pakistani actor Mahira Khan, 41, has announced that she is expecting her second child. Hollywood actor Anne Hathaway, 43, is expecting her third. For women watching these stories, the message can feel both reassuring and aspirational: perhaps 40 is no longer a deadline for motherhood.
Pregnancy after 40 is possible, and many women have healthy pregnancies and babies in their 40s. But celebrity pregnancy announcements can obscure an important part of the story: the ability to become pregnant, the risks during pregnancy and the route to conception are not the same for every woman. “Pregnancy after 40 is possible, but it can be different from pregnancy at a younger age. And while women are entitled to delay their choices, they must also factor the challenges that are unique to them,” says Dr Neelam Suri, senior consultant, Obstetrics & Gynaecology, Indraprastha Apollo Hospital, Delhi. “What matters is understanding an individual woman’s fertility and overall health and planning appropriately rather than comparing one woman’s experience with another’s,” she told The Indian Express. Excerpts:
The first challenge is fertility itself. Women are born with a finite number of eggs, what we call ovarian reserve, and both the number and quality of those eggs decline with age. The decline becomes more pronounced as women move through their late 30s and into their 40s. As egg quality declines, the likelihood of chromosomal abnormalities rises, which can increase the chances of miscarriage and certain health conditions.
Some women conceive naturally in their 40s. Others may need fertility treatment. And some may find that ovarian reserve or egg quality makes conception with their own eggs considerably more difficult. Ovarian reserve and egg quality are not the same thing. Tests can give us useful information, but they have to be interpreted in the context of the woman’s age, menstrual history, medical history and fertility goals.
For women over 40 who are trying to conceive, fertility evaluation may be warranted much sooner rather than waiting a year to see what happens. A preconception consultation can therefore be useful even before a couple begins trying. A doctor may review menstrual and ovulatory patterns, previous pregnancies, medical conditions and medications. Depending on the individual history and ovarian reserve, the uterus and fallopian tubes may also be assessed.
Male factors can contribute to difficulty conceiving, which is why a fertility assessment should not automatically become an investigation of the woman alone. Semen evaluation is part of the standard assessment when infertility is being investigated.
Getting pregnant is only the beginning. As maternal age rises, so does the risk of several pregnancy complications. These include gestational diabetes, hypertension and pre-eclampsia or BP-induced organ damage. This does not mean that a 40-year-old automatically has a high-risk or complicated pregnancy. It means that clinicians may watch certain parameters more closely.
Blood pressure and blood sugar deserve attention. Prenatal screening and ultrasound assessments become important tools for monitoring both mother and baby. Options for prenatal genetic screening and diagnostic testing must be discussed and offered to all pregnant patients, irrespective of age, while pregnancies in women aged 40 and above may warrant additional foetal growth assessment and antenatal surveillance. depending on the clinical situation.
Screening is about understanding the pregnancy better and giving the woman the information she needs to make informed decisions.
For women trying to conceive in their 40s, IVF (in-vitro fertilisation, where the egg is fertilised with sperm in a laboratory and the resulting embryo is transferred to the uterus) can become part of the conversation.
But IVF is sometimes misunderstood as a technological workaround for reproductive ageing. IVF can help overcome particular fertility problems, but when a woman uses her own eggs, the age and quality of those eggs still matter. Ovarian stimulation cannot manufacture younger eggs.
The number of eggs retrieved, fertilisation, embryo development and the eventual chance of pregnancy can vary considerably between women. Some may require more than one cycle.
Embryo testing for certain chromosomal abnormalities may also be discussed in selected cases. But a tested embryo does not guarantee implantation or a live birth.
This is where celebrity fertility stories can inadvertently create unrealistic expectations. A public figure may talk about IVF, pregnancy or motherhood without revealing the number of treatment cycles, previous fertility preservation, donor eggs or other aspects of her medical history.
For some women, particularly when ovarian reserve is very low or egg quality has declined substantially, donor eggs may be discussed. With donor-egg IVF, an egg from a donor is fertilised to create an embryo, which is then transferred to the intended mother. This is fundamentally different from IVF using a woman’s own eggs.
The option can be emotionally significant and requires careful counselling, but medically it is an established pathway for some women whose own egg supply or quality makes conception difficult. The important thing is to discuss all the options honestly and early. There should not be an assumption that IVF with a woman’s own eggs will necessarily work simply because she has seen someone else conceive in their 40s.
There is another advantage to planning rather than rushing into pregnancy. Conditions such as high blood pressure, diabetes and thyroid disorders should ideally be identified and managed before conception. Medication, vaccinations, nutrition, weight, sleep and lifestyle can all be reviewed.
Smoking and tobacco use should be stopped, and excessive alcohol consumption avoided. A healthy weight, balanced diet, regular physical activity and adequate sleep support overall reproductive and pregnancy health.
So, is 40 the new 30?
Not biologically. But neither is 40 a point at which motherhood suddenly becomes impossible. For a woman contemplating motherhood after 40, the smarter question is not “If she did it, can I?” It is: “What is my fertility profile, what is my health profile, and what should I do now?”