Even 20 years ago, women after 28 years were considered to be prominent. Now, when the fair sex is trying to do everything, they often put off motherhood until later. First, education, career, material base are of paramount importance. And more and more often, the time for the first birth is only 30-35 years old.

Closer to forty, when the first-born is growing up (or has already grown up completely), many women are wondering if they should become a mother again. More and more often they look around on the street for women with prams and find themselves thinking that they would love to visit a children's store.

But many are afraid of age, and just a huge assortment of “scary” stories about age-old mothers and their children, which are crammed with the Internet. Let's try to understand this issue in more detail.

Pregnancy after 40 years

To begin with, it is already quite difficult for a woman to become pregnant after 40 years. The level of fertility is rapidly decreasing, and the “healthy”, ready to fertilize the eggs, the ovaries produce less and less. The number of anovulatory cycles is increasing, i.e. cycles in which ovulation does not occur.

However, if pregnancy has occurred, then a woman over 40 should know that the next 9 months will be significantly different from the first pregnancy.

Despite the fact that society has begun to look more favorably at “age” mothers, a certain bias persists in traditional medicine. And a woman will have to face it from the first days of pregnancy. Doctors will more closely monitor the development of the child and the condition of the future mother, they will have to attend the consultation more often than the 20-year-old girls in the situation do, many pregnant women at this age spend almost the entire time in the hospital for preservation.

You can understand obstetrician-gynecologists: by the age of 40, a woman has already accumulated a sufficient burden of chronic diseases, and the process of bearing a child associated with violent hormonal and physiological changes can undermine her health and threaten the baby's condition.

Expectant mother, who is already over 40, will be required to screen tests. There will be three of them. At a period of 11-13 weeks of pregnancy, you will need to donate blood and undergo an ultrasound diagnosis of the fetus.  Based on a combination of factors, the risks of having a baby with genetic pathologies will be calculated. During the screening, the probability of the birth of a baby with Down, Edwards, Cornelia de Lange, Patau syndromes, and neural tube developmental defects is established.

As you know, the older the mother, the greater the likelihood of having babies with Down syndrome. For example, in a 25-year-old woman, this risk is 1: 2000. At 30 years old - 1: 1000, at 40 years old - 1: 150, and by 45 years 1:30, that is, out of 30 births, some will end in the birth of a sick baby. The remaining genetic diseases, the risk of which is revealed by screening studies, are quite rare on their own.

A second screening woman will be prescribed between 20 and 24 weekspregnancy. It will also include a blood test and an ultrasound scan. The third screening of pregnant women is carried out for a period of 30-34 weeks.

Pregnant women after 40, as a rule, without exception, are referred to a geneticist for consultation. And if the results of the screening arouse his concern, a woman may be offered to be examined by invasive methods. They are more informative, for example, amniocentesis (amniotic fluid withdrawal for genetic analysis) gives the result with an accuracy of 99%.

What you should know in this situation? Screening, like invasive diagnostics, is voluntary. No one has the right to force a woman to pass them. Some "age" mothers deliberately refuse such a diagnosis, believing that their own calm and calm of the child is more important than the test results obtained as a result of nervous expectation and doubt.

The so-called late pregnancy will have its pluses and minuses. Let's take a closer look at them.

pros

• Forty-year-old parents tend to be more conscious about child planning.  They already know what parenting is, have a sufficient material and spiritual base, as well as rich life experience in order to raise a new person.
• It is believed that a woman's body over 40 rejuvenates after childbirth.  You can treat this as you like, but doctors do not refute this. The hormonal “shake-up” that the expectant mother receives within 9 months really has a beneficial effect on the condition of the skin, hair, mobilizes internal organs, and the woman “blossoms”. She has a reduced risk of stroke, later climax occurs, and it is less painful.
• Forty-year-old mothers are more patient, calm, balanced and sensitive to their children.  They are more likely to survive the psychological postpartum crisis.

Minuses

• It is much more difficult to bear a baby at 40 than at 25.The load on all organs is so great that against the background of pregnancy, a woman can not only worsen existing diseases, but also indicate new ones.
• Late-born mothers often have problems with lactation.  Milk is insufficient or not at all.
• Quite often, pregnancy at the age of 40 ends with a caesarean section.Doctors do not want to risk the health of the baby and mother during natural childbirth.
• When pregnant at the age of 40, the risk of miscarriage increases significantly.  Compared to baseline values, it increases by about 50%. And the risk of preterm birth is increased by 40%.

Myths and Reality

• With pregnancy after 40 years, the probability of giving birth to twins increases significantly. Moreover, the twins are likely to be heterogeneous. It's true. But the opinion that the children of 40-year-old mothers are more capable, talented and almost brilliant is a common myth. The age of the woman in labor in no way affects the intellectual abilities of the baby.
• Women who give birth after 40 years live longer. Sociologists around the world claim that their research confirms this. But most likely, it is not about giving birth. Just ladies who risked becoming pregnant and giving birth to a baby in adulthood, initially have better health, which can not affect their life expectancy.
• Children are shy of age parents. Pure water fiction. It is parents who are shy of themselves. And children love mom and dad for who they are. Moreover, they have nothing to be ashamed of - parents in adulthood, as a rule, are well-off financially, have stable jobs, and the housing issue is not an acute issue for them.

If a woman still decided to get pregnant and give birth to a second child after 40 years, it will be difficult for her without psychological support. The fact is that late pregnancy is associated with a large number of fears. But age is not a sentence, and in fact only the positive attitude of the future mother is of importance.

How to cope with your fears?

• Focus on your feelings.Trust yourself. If you feel good, do not bring too much fuss, and without emergency, do not run around the doctors' offices. Enjoy pregnancy, and then the fears themselves will burst, like soap bubbles.
• Take advantage of time.Maternity leave is a good time for self-improvement. Do not dwell on your fears, listen to your favorite music, finally read all the books that you put off until later, watch movies. Make it a rule to learn something new every day. It is useful for both mom and baby.
• Trust.Trust everyone who is close to you - your husband, your doctor. They understand that pregnancy is a serious test for you, and they are ready to help. Open in response.
• Feel free to tell the household about your feelings and feelings.Share with your spouse, with an older child, if his age allows you to understand. Let all your family members expect the baby to be with you. Feeling that you are one team will help to roll mountains and reduce anxiety.

• Do not neglect the tips to walk more often,take a warm shower in the evenings, learn how to relax, learn breathing exercises.
• Distance yourself from anyone who is trying to sow a bit of doubt in you or criticizes your decision to become a mother. To give birth or not at 40, it's up to you. No one has the right to impose their opinions on you. Do not let anyone disturb your internal state.
• Get like-minded people.  There are communities on the Internet where the same mature mothers, like you, will understand, support and not condemn.

The birth of a child at any age is an extraordinary event. Weighing all the pros and cons, consider the most important factor - love. If you feel that she lives in you, and you are ready to give her in unlimited quantities to loved ones, be sure to give birth to a baby, even if you are under 50.

The joy and tenderness that you will experience while watching how your baby grows and develops more than compensates for all the difficulties that are attributed to the period of late pregnancy.

In the next video, a gynecologist-endocrinologist gives tips on how to ease the course of pregnancy for women who want to give birth at the age of 40.

Look at the video of a clinical psychologist Veronika Stepanova about what a mother will have to face at age 40.

Health

There is no once and for all established rule when it is better to have a baby. Having a baby is a personal decision for everyone, which can be influenced by many factors.

Future mothers and fathers in adulthood think about financial stability, about work and personal goals, before deciding on the appearance of a new family member.

But if we talk about fertility, then age matters.On average, a woman under 30 years old has a 95 percent chance of becoming pregnant during the year without protected sexual intercourse. After 30 years, these chances are reduced by 3 percent every year.

In a 40-year-old woman, only 5-10 percent conceive a child naturally, and this probability is less than 5 percent by 45 years.

Fertility in women

The reason is that every woman is born with a specific set of eggs in her ovaries. With age, the number and quality of eggs decreases significantly.

© Nixxphotography / Getty Images Pro

While still in the womb, the fetus has 7 million eggs. When we are born, we have about 1-2 million left. In adolescence, this number decreases to 400,000.

By the age of 30, we are losing almost 87 percent of our eggs, and by the age of 40, 97 percent of the eggs disappear. There are about 12,000 eggs left, and although it may seem like a lot, most of them are not viable, which increases the risk of miscarriage.

This does not mean that you cannot become pregnant naturally after 35 or 40 years. You probably even have many examples of women who give birth to a child later in life. However, age cannot be ignored if you plan to start a family.

In fact, the birth of children after 40 years has become quite common. The number of primiparous mothers aged 40 to 44 years has almost doubled from the 70s of the 20th century to the beginning of the 21st century.

Although many women are advised to give birth before the age of 35, in reality, many of them prefer to delay the birth of a child to a later age. There are several reasons for this: the desire to build a career, settle down and live for yourself, the lack of a suitable partner.

Birth risks after 40 years

Some complications for mother and baby are more likely at a later age. It includes:

1. It is harder to get pregnant

© Bgmfotografia / pixabay

The biggest disadvantage of delaying pregnancy until the age of 40 is the fact that it will be more difficult for a woman to become pregnant.

The thing is that the supply of eggs decreases significantly with age, and chromosomal abnormalities are more common in older eggs, increasing the risk of miscarriage and birth defects.

After 40, there is a sharp decline in fertility.  So, for example, the chances of getting pregnant at 41 are much better than at 43.

If a 40-year-old woman is undergoing treatment for infertility, her chances of getting pregnant with her own eggs are 25 percent, at 43 years old - this figure drops to 10 percent, and at 44 is only 1.6 percent.

2. The threat of miscarriage

In older women, the risk of miscarriage at an early stage of pregnancy is increased. So, for example, in women under 30 years old, the risk of miscarriage is 12 percent, and in women over 35 years old - already 25 percent.

After 45 years, the risk of miscarriage is 90 percent.

3. Ectopic pregnancy

An ectopic pregnancy is a pregnancy that has occurred outside the uterine cavity. In women older than 35 years, the risk of an ectopic pregnancy is 4-8 times higher than in younger women.

A higher risk of ectopic pregnancy is associated with the accumulation of risk factors over time, such as infections of the genitourinary system or problems with the fallopian tubes.

With this complication, symptoms such as abdominal pain, abnormal bleeding occur, but it can also be asymptomatic. As a rule, a woman needs surgical intervention, since in the absence of treatment, this can lead to internal bleeding.

4. Fertility

The chances of becoming pregnant with twins or multiple pregnancies increase with age. And multiple pregnancy is often accompanied by a high probability of problems for both the mother and the child, which requires constant monitoring throughout pregnancy.

5. Diabetes during pregnancy

In women older than 40 years, it develops 3-6 times more often gestational diabetes  (diabetes mellitus during pregnancy) compared with women 20-29 years old. It passes almost immediately after childbirth, but can become a harbinger of diabetes at a later age and increases the risk of giving birth to an oversized baby.

The risk of diabetes of pregnant women among the general population is 3 percent, while in women after 40 years old it rises to 7-12 percent. This condition poses a threat to potential complications not only for the mother, but also for the baby during pregnancy and childbirth.

6. High blood pressure during pregnancy

The risk of pregnancy-induced hypertension is much higher in later mothers. This leads to a high risk of developing a condition such as preeclampsia - complications accompanied by high blood pressure and damaging other organ systems, most often the kidneys.

Without appropriate treatment, preeclampsia is a threat to both the mother and the baby.

7. Complications of chronic diseases during pregnancy

With age, the onset of problems such as obesity, diabetes, hypertension, and heart disease is much higher.

If you have a chronic illness, you need constant monitoring during pregnancy so that the condition does not worsen. You may need hospitalization, a cesarean section, or premature birth during pregnancy.

8. The partner's sperm also age

Do not forget about men. Although they are physically capable of becoming fathers at both 60 and 70 years old, sperm quality also decreases with age.

The older the man, the higher the chances of the appearance of genetic defects in the child, such as Down syndrome, schizophrenia and autism.

Risk for a child in women over 40

1. Chromosomal abnormalities

© Oleksandr Pidvalnyi / Pexels

The risk of chromosomal abnormalities increases with the age of a woman, especially after 35 years. The most famous abnormality during pregnancy is down syndrome. The risk of Down syndrome in a child, depending on the age of the mother, is:

at 30 years: 1 in 950 pregnancies

at 35: 1 in 350 pregnancies

at 40: 1 in 100 pregnancies

at 45: 1 in 30 pregnancies

2. Other anomalies

The risk of heart defects in a child in women after 40 years is 4 times greater than in women 20-24 years old. The likelihood of congenital clubfoot and diaphragmatic hernia (abdominal hernia, allowing the abdominal organ to move into the chest cavity) also increases.

3. Stillbirth

With a maternal age of 40 to 44 years, the risk of stillbirth is 3 times greater than that of women 25-29 years old. Because of this, the baby will be observed even more closely at the end of pregnancy.

4. Preterm birth or low birth weight

Premature babies experience breathing problems due to insufficient lung development. They are also more susceptible to problems such as infections, brain bleeding, difficulty regulating body temperature and glucose levels.

Premature babies more often have hearing or vision problems, and cerebral palsy, especially if they were born before 32 weeks of fetal development.

Interesting fact!  At present, the 74-year-old woman Mangayamma Yaramati from India, who gave birth to twins conceived with the help of IVF, is considered the oldest mother in the world.

IVF risks for women after 40 years

Although IVF technology allows women to become pregnant at almost any age, experts are concerned about the increased risk of various health problems in mothers, ranging from heart disease to the onset of tumors.

1. Cancer risk

© Bryan Schneider / Pexels

Although there are many women who can easily become pregnant after 40, the older the woman, the more difficult it is to conceive a child and the more often you have to resort to treatment for infertility.

About a third of women after 35 years old and half of all women after 40 years old seek help from a reproductive health specialist. In addition, the age of the partner also affects the chances of becoming pregnant.

Often in these cases, you need to resort to medications for infertility and IVF (in vitro fertilization). But you need to remember that any medications, including infertility drugs, have side effects and are associated with a certain risk.

Experts believe that   The artificial insemination procedure cannot lead to the development of cancer during pregnancy.  However, IVF can activate the development of an already existing tumor in the body. Do not forget that during pregnancy there is a serious hormonal restructuring, and a woman already receives high doses of hormones, in particular estrogen.

For 20 years, Danish scientists monitored the health status of 600 thousand women, and 58 534 of them who underwent artificial insemination. They found that childbirth after artificial insemination after 40 years, increases the risk of developing breast cancer by 65 percent.

To produce an egg for fertilization, women often take strong drugs to stimulate the ovaries. This increases the level of estrogen - a hormone that provokes the growth of breast tissue and which can contribute to the growth of cancer cells.

With age, the risk of developing breast cancer becomes higher, and additional hormones can interfere with the natural aging of breast cells.

If a woman has breast cancer in the initial stage, then during pregnancy an increased level of estrogen can accelerate tumor growth.

2. Risk for the heart

Pregnancy, experts say, can be compared with stress during a marathon, and the older a woman, the more often she has complications.

Pregnant women over 40 years old are most worried about preeclampsia - a complication, one of the symptoms of which is high blood pressure, which most often pops up in the third trimester of pregnancy.

This condition occurs in only 3-4 percent of expectant mothers, but the risk rises to 5-10 percent in women over 40 and up to 35 percent if you are over 50.

In addition, pregnancy can trigger an early occurrence of health problems that could appear much later. So a 50-year-old woman with borderline high blood pressure, in which hypertension may not manifest until she is 60, may encounter her during pregnancy. And this threatens complications for both the expectant mother and the child.

Many women, wanting to take place in the profession and achieve a certain material well-being, postpone the birth of a child “for later”.

Pregnancy after 40 years is something that gynecologists around the world are increasingly confronted with.

This phenomenon has its pros and cons. Is it so dangerous for mom and baby - pregnancy and childbirth after 40?

Should a middle-aged woman become a mother, and what are the risks of pregnancy after 40? Let's talk about this in more detail.

Is it easy to conceive a child after 40?

With age, the woman’s body changes. This affects the possibility of conception is not the best way.

The number of eggs in each woman is individual. There is only one thing in common: they are all laid at the stage of intrauterine development.

With age, stocks are depleted, and the chance of becoming pregnant is almost halved. But it is important not only the number of eggs, but also their quality. After 40, not everyone is capable of fertilization.

In addition, hormonal disruptions appear, chronic diseases accumulate, including in the reproductive sphere. If we add to this a decrease in the number of healthy sperm and a decrease in their activity with age in the future dad, it becomes clear that late pregnancy after 40 years may simply not occur.

If time is running out, but fertilization does not occur naturally, resort to the IVF procedure. Sometimes nature "jokes" with some women and sends them a pregnancy on the verge of menopause.

Many do not even realize that they are pregnant, and the delay in menstruation is attributed to menopause. Typically, these women go to the doctor in the late stages and most often give birth to healthy children.

Risks during pregnancy after 40 years

Psychologists believe that you need to give birth at the age of 27 to 33 years, gynecologists reduce the favorable age to 29 years.

But this does not mean that you can not become a mother later. Just in this case, the probability of not only conception, but also a successful outcome of pregnancy, is less likely for both mother and baby.

Pregnancy of a woman after 40 years may be accompanied by the following risks:

1. chronic, including vascular diseases adversely affect gestation;
2. preeclampsia occurs more often, its course is more difficult;
3. greater risk of phytoplacental insufficiency;
4. pregnancy can be a provoking factor for the occurrence of diabetes mellitus, gestational pyelonephritis, oncology;
5. at this age, many women have osteoporosis, which provokes diseases of the hip joints and symphysitis;
6. exacerbated by diseases of the vegetative-vascular system, up to hypertensive crises;
7. metabolic disorders do not allow the absorption of vitamins and minerals, which complicates pregnancy;
8. the uterus is aging, the functional ability of its tissues decreases;
9. soft tissues lose their elasticity, hence tears and injuries during childbirth, which often happens if this is the first pregnancy after 40.

Pregnancy planning after 40 should be carried out after risk assessment for the fetus. It can be born with developmental delay and various genetic abnormalities. Statistics say that if at the age of 40 mothers give birth to 1 sick child for 112 healthy children, then after 3 years - 1 in 49.

At this age, pregnancy often freezes, spontaneous miscarriages occur. But women are not protected from such pathologies at any age, therefore a normal pregnancy after 40 years is quite possible, the doctors say that with the proper preparation of the woman, she will be successful.

Preparing for late pregnancy

If a decision is made to give birth, and preparation for pregnancy after 40 years has begun, a woman will have to reconsider much in her lifestyle.

But you need to start with a visit to the gynecologist. He examines the reproductive organs, prescribes tests for hidden infections and sends them to specialists, including a cardiologist, orthopedist, gastroenterologist, neurologist, dentist, geneticist and endocrinologist.

If you are planning a pregnancy after 40, tests for the amount of hormones must be taken. Any failure in their content can not only negatively affect the bearing, but will also hinder conception.

An endocrinologist and overweight ladies will be required. It will have to be normalized before the onset of conception.

It is necessary to treat the existing chronic diseases. In the "interesting position" many drugs are contraindicated.

Bad habits (smoking and drinking alcohol) are discarded not after conception, but at least six months before it: the body must completely overcome their consequences.

Before pregnancy, you need to saturate the body with vitamins and minerals:

• dairy products (primarily cottage cheese, and 2 tablets of preparations with its content daily) will help normalize the calcium content;
• the necessary amount of omega-3 and omega-6 can be obtained by eating oily fish or capsules with fish oil;
• drugs with iodine and iron content will be required;
• you will have to take special vitamin complexes for pregnant women in advance.

In order for a future pregnancy to proceed without complications, they take care of walks and moderate physical activity in advance. Stress must be avoided.

Pluses of having a baby after 40

Pregnancy of a woman after 40 years is a serious test for the body. Strength will be required after the appearance of the baby.

But, despite all the difficulties, many women decide to take such a step and rarely regret it. The disadvantages and possible risks of late motherhood have already been said. Are there any advantages?

There are a lot of them:

1. a hormonal surge after a normal pregnancy rejuvenates the body;
2. if the late child is the only one, parents have a chance to experience all the joys of motherhood and fatherhood;
3. studies show that late-child abilities exceed average levels;
4. at the age of 40, the financial situation is stable;
5. mature parents can give much more to the baby in terms of education and have time for this;
6. there is an incentive to monitor your health.

Women who give birth after 40 live longer. If earlier it was just an everyday observation, then recently it has received scientific confirmation in the studies of American and Canadian scientists. Late births not only extend the life of the mother, this ability to longevity becomes genetic and inherited.

Conclusion

To give birth or not after 40 - each woman decides on her own, taking into account not only her desire, but also deviations in health, family circumstances.

The state of medicine in our time allows at this age to give birth without damage to the body.

Various studies will reveal any abnormalities in the development of the fetus at an early stage.

Doctors learned how to correct developmental abnormalities in the womb, conducting operations using specially developed technology.

Video: Late pregnancy give birth after 40

Recently in Russia, cases of the birth of children by women who have crossed the milestone of 40 years have become more common. In Europe, a similar trend has been observed for a long time due to the fact that women acquire offspring there, having achieved certain successes in personal growth and preparing the financial ground for the birth of a child.

What do doctors say about childbirth after 40 years? Should I take risks? You will receive answers to these and other questions regarding late birth in this article.

Features of childbirth after 40 years

Pregnancy and childbirth after 40 have their own characteristics, and it is best to understand this issue by finding out what are the positive and negative sides in late births.

Women who are over 40, having become pregnant, begin to grow younger just before our eyes, and all because:

• the functioning of the ovaries is activated;
• the thyroid gland begins to work;
• muscles come in tone;
• become stronger bones;
• the appearance and condition of the hair, skin and nails improves due to the fact that a large dose of homons is thrown into the blood during this period.

In general, women after 40 are self-confident people who are already wise with experience and are ready to pass it on to their child. Pregnancy will only betray them vigor and smartness, which simply cannot but please their spouses.

Cons of late birth

The main disadvantages of late birth can be called the fact that sometimes a successful conception does not occur as fast as we would like, but all because:

1. infections or abortions may occur;
2. over time, women experience a decline in hormonal activity;
3. hormonal drugs can have a negative effect and contribute to the appearance of blood clots.

Statistics

What can be said about childbirth after 40 years? Statistics say that if we turn to the facts and look at the bare numbers, we can conclude: many women, in spite of everything, still got offspring at this age and are quite happy mothers.

Important! If you are pregnant, do not pay attention to the birth statistics after 40 years in Russia. Everyone has their own individual characteristics, so unnecessary worries certainly will not do you any good.

If you firmly decided that you want a baby after 40 years, it is worth paying special attention to the state of your health. So, it is very important:

• in the presence of bad habits, get rid of those;
• review your diet and, if necessary, start eating right;
• how to relax, be in the fresh air;
• perform at least elementary exercises within the framework of physical development.

In addition, the psychological attitude is also very important. In order for the pregnancy to be successful, there must be a positive attitude. The fact that you will know about probable reasons does not mean at all that you should think only about this, let alone worry. Let this be an additional incentive for you to carefully monitor your health. So, for example, you should be vigilant about the timely delivery of tests and passing the examination.

Attention! Remember, if there is no problem, then worrying about its likely occurrence is not only pointless, but also harmful to health.

The ideal option would be if you are in advance, namely 3 months before the planned conception, visit a gynecologist who can prescribe all the necessary tests and examinations. You should definitely visit such narrow specialists as a mammologist, endocrinologist, and general practitioner. Only after appropriate consultation will you have a clear understanding of how safe it is to conceive a child after 40 years.

Preparing for Conception

If a woman still decides to become a mother at 40, she, in any case, must approach the matter with great responsibility. So, before conception, it is necessary to be carefully examined.

1. Examination of the thyroid gland. As you know, thanks to this gland hormones are produced that contribute to the conception and bearing of a child. As part of the examination, you will be assigned tests for the level of thyroid-stimulating hormone.
2. Electrocardiogram. With age, everyone's heart load increases, therefore, before conception, consultation with a cardiologist is necessary.
3. Blood coagulation test.

Only after all the necessary studies are done and the tests are completed, and you receive the doctor’s recommendations regarding the upcoming pregnancy, you can think about conception after 40 years. In particular, if the doctor says that everything is fine with you, you don’t have to worry, but in case of some deviations it’s best to give up all efforts to eliminate them.

All studies prescribed by doctors are necessary for the reason that after 35 years in the female body, eggs with an altered set of chromosomes can mature. And this can cause the loss of a child in the early stages.

When, finally, you see the expected two strips on the test, and the doctor in the medical institution confirms the fact of the successful conception of the baby, in addition to joy, many women experience fear. In particular, future mothers worry about the health of their child.

If you have any concerns, it is worthwhile to conduct the following studies:

• Amniocentesis.
• Cordocentesis.
• Chorionic villus biopsy.

Amniocentesis is a study of amniotic fluid, thanks to which it is possible to determine any pathology in the development of the fetus. This study can also show if the fetus has certain gene mutations.

If there is a Rhesus conflict between the fetus and the mother, doctors recommend conducting a study called cordocentesis. This method involves taking blood from the umbilical cord of the fetus for genetic research.

A chorionic villus biopsy involves sampling a small number of placenta cells, after which the resulting material is examined for the presence of genetic mutations. In particular, thanks to this method, it is possible to determine even in the womb whether the baby has Down syndrome.

Many women are still worried about how the birth itself will go. It is worth noting that childbirth after 40 years does not have significant differences from others.

Before deciding whether to have a child in adulthood, it is necessary to listen to the opinions of doctors. In practice, not all doctors give a unified answer to this matter, and if you get a consultation of two specialists, most likely, the opinions will differ dramatically. This situation is due to the fact that late birth after 40 years, according to doctors, is associated with certain dangers that can threaten both the health of the mother and her unborn child.

If the first birth after 40 takes place, then the risks increase. The fact is that at this age, pregnancy can provoke the development of hereditary diseases, which before that did not manifest themselves. So, for example, there are studies that show that women after forty have a decrease in ovarian reserve.

So, for example, Dr. Sherman Silber in his writings notes that at birth every girl has about 300 thousand eggs in her body and their level decreases every year. By the age of 37, a woman loses about 13 thousand eggs a year, and after this age their number begins to decrease rapidly.

Such a situation, naturally, leads to the fact that at the age of 40 it becomes problematic to quickly conceive a child yourself. If we turn to the numbers, then about 5% of women can become pregnant without problems the first time, and it doesn’t matter whether the woman’s first pregnancy or not, the body is still aging.

If we talk about the danger of giving birth after 40 years, it is worth mentioning that they can lead to an exacerbation of the following diseases:

• diabetes;
• kidney disease
• diseases of the biliary tract;
• pathology of the cardiovascular system.

In addition, many doctors cannot call the interesting situation at such a late age very encouraging, since during this period there is a slow preparation for menopause, which, in principle, adversely affects the woman’s health. So, for example, hormonal bursts, mastopathy can occur (most often there is a cystic form of this disease, which is a consequence of a violation of hormone production).

While modern young people are building a career and postponing the creation of a family indefinitely, reproductologists and geneticists are figured out how to deceive nature and give women the opportunity to give birth when they are ready for it. Specialists of the Center for Maternity and Reproductive TechnologiesClinical Hospital on Yauza   They tell how to give birth to a first child at 40, why IVF may not work, and how to insure yourself against having a child with a genetic pathology.

Photo: Getty Images

Every year, women in Russia prefer to give birth to their first child all later. Compared to the 1990s, women first become mothers five years later - at 26. In Europe, the USA and Canada, this age is even higher: from 27 years in Italy, Spain, Germany, the UK and Sweden to 31 years - in Greece . And the number of women who decide to give birth after 40 has more than doubled since 1990.

“Today there are more opportunities, many women put on the first place a career, first they want to get on their feet. And about the first child they can think at the age of 40. At this age, women often believe that they feel the same way as they did at 20, and therefore overestimate their reserves, ”says Gulnara Makhmudova, chief physician of the Clinical Hospital in Yauza. “The feeling of self can be like 20, but the reserves are not the same.”

In most cases, a woman's reproductive potential begins to decline sharply after 35-36 years. This is due to a decrease in the so-called ovarian reserve, the supply of eggs. By the age of 40, in most women, it is practically exhausted. This is clearly seen in the example of stimulating ovulation, the first stage of the in vitro fertilization (IVF) procedure, when, thanks to hormone replacement therapy, several eggs mature in one body in the female body, and not one, as is usually the case. With this procedure, a 35-year-old woman can mature ten or more eggs, and a 40-year-old woman - half as much, and their quality is worse - only one or two embryos remain alive several days after fertilization. At the same time, as clinic specialists remind, one should not forget that these processes are individual: in some women, depletion of the ovarian reserve can occur even in 30 years.

So can science give an answer to the question of when to give birth to the first child? A group of researchers from the University. Erasmus of Rotterdam analyzed the data on pregnancies and childbirth of more than 58 thousand women over three centuries, up to the 1970s. Scientists came to the following conclusion: if a woman wants to give birth to three children, then it is better to start at 23; for a future mother of two, the optimal age of the first birth is 27 years; if the family plans to limit itself to one child, then you can wait until 32 years. The researchers also calculated the appropriate age for conception of one, two or three children with IVF - 35, 31 and 28, respectively.

The specialists of the Clinical Hospital in Yauza have a different point of view. “There may be patients who, at the age of 28, think that all their lives are ahead, but if you look at the analysis, it turns out that there are not many reserves left,” Gulnara Makhmudova says. If a woman finds out that her reserves can be completely depleted in a few years, she can go through the ovulation stimulation procedure, freeze her eggs and use them when she sees fit. If a woman thinks about a child when the reserves are already depleted, she can use donor material.

But many people find it difficult to accept the second option. “After 40 years, donor material is very often used. It’s always better to use donor cells than to quit hormones and squeeze the last when the body is no longer able to produce high-quality material. In the West, the use of donor cells and donor embryos is calm. We have to psychologically prepare women for this, ”says Gulnara Makhmudova.

The problem of reducing reserves is exclusively female - the reproductive potential of a man does not depend on age, since the process of spermatogenesis persists throughout life. But there is another, common problem for all. After 35-40 years, in both men and women, the number of germ cells with chromosomal disorders is growing. This, first of all, means an increased risk of pregnancy by a fetus with a genetic pathology. “If at the age of 30 years the number of eggs with an abnormal chromosome set (meaning a violation of the number of one or several chromosomes - aneuploidy) is about 40 percent, then by the age of 40 their proportion gradually increases to 80 percent,” says a geneticist, specialist in preimplantation genetic diagnosis (PGD) of the Clinical Hospital at Yauza Mikhail Kibanov. “Accordingly, the likelihood of getting a healthy embryo is greatly reduced.” In this case, doctors resort to the technology of preimplantation genetic screening (ASG) - the study of embryos for chromosomal abnormalities before being transferred to the uterine cavity.

After fertilization, embryos develop in artificial conditions for five to six days. During this time, natural selection occurs - part of the embryos stops in development, survivors become objects of genetic research. At this stage, the embryo consists of two types of cells - the so-called trophectoderm, or the outer membrane, from which the placenta will later develop, and the internal cell mass, from which the fetus itself will form. In order not to harm the unborn child, doctors analyze the cells of the outer shell. “This is one of the reasons why PGD cannot be considered a guarantee for the birth of a healthy child,” Kibanov explains. - We are still investigating the wrong tissue from which the fetus develops later. Correlation between tissues certainly exists, but there are exceptions. ” During the study, specialists identify chromosomal pathologies. They “see” the sex of the unborn child, but they do not have the right to inform their parents, since the choice of the sex of the child during artificial conception is prohibited by law.

Before the introduction of PGD, IVF procedures often ended in multiple pregnancies. This was due to the fact that two or three embryos were transferred at once, so that at least one would take root. If the parents agreed, then they made a reduction - they stopped one of the embryos in development. Genetic screening has made IVF programs more controlled.

There are other studies with which modern doctors increase the effectiveness of IVF programs. For example, when the embryo does not take root several times in a row. Doctors know that the cause may be either the state of the embryo or the condition of the uterine cavity. If everything was in order with the embryo, specialists begin to investigate the features of the woman's reproductive system. One of the reasons for failed IVF attempts may be a shifted “implantation window” - the period of the menstrual cycle, when the uterus is as ready for implantation as possible. In most cases, this occurs on the 21st day of the cycle, but there are exceptions. Today, this feature can be traced using the ERA test (Endometrial Receptivity Array), which shows how the uterine cavity is ready for implantation on a given day of the cycle. This test is carried out by the only laboratory in the world - the Spanish research center IGENOMIX. In Russia, only the Yauza Hospital cooperates with him.

Chromosomal abnormalities in one or both partners may become another factor that impedes pregnancy during conception, both naturally and with IVF. In some people, chromosomes can be rearranged - outwardly, this does not appear at all, because the balance of genetic material is not upset. But part of the germ cells will carry variants of deviations. “Most often, such people don’t even know that they are carriers, they are just trying to conceive a child, and they have a miscarriage after a miscarriage. Or an undeveloped pregnancy. When they come to the clinic, we first recommend a karyotype analysis (a set of signs of a complete set of chromosomes), and then we see the reason in the germ cells of one of the parents. Accordingly, PGD is mandatory for such pairs, since we can isolate embryos with a balanced chromosome set, ”Kibanov explains.

Genetic screening can also help when there is a high risk of having a child with a genetic disease in the family. Today, scientists know about 10 thousand diseases that are associated with a change in one of the genes. These changes lead to the birth of children with a genetic disease. And if with diseases such as phenylketonuria or hemophilia, it is possible to maintain a person’s condition with medication or diet, then other pathologies turn out to be incompatible with life and the baby dies almost immediately after birth. “Usually, parents find out that they have a risk of having a baby with a similar disease, only after the first birth. Further they already ask a question why so, and pass inspection. And then it turns out that each of the spouses is a carrier of a mutation in the same gene, ”the geneticist explains. Thanks to genetic screening of the embryo, such couples can avoid giving birth to a second child with a disorder.

Sometimes, when a child is born with a genetic disease of the circulatory or hematopoietic system, parents, in order to save him, decide to give birth to a second child, who will become a donor for the first. In this case, during the genetic diagnosis, embryos are selected not only healthy, but also genetically compatible with the first. Then, after the birth of the second child, hematopoietic stem cells are taken from the umbilical cord and transplanted into the bone marrow of the first. “This, of course, is a rare case,” notes Mikhail Kibanov.

However, today, spouses do not have to learn about their genetic mutations experimentally. Modern laboratories offer special tests for genetic compatibility. Experts examine the genes of potential parents for several dozen different mutations. If as a result they do not have a coincidence, the risk of having a sick child is minimal. If these coincidences exist, it is better to resort to assisted reproductive technologies and initiate pregnancy under the supervision of specialists.