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Pregnancy after 40: What to watch out for

Changes in our lifestyle in recent years are leading more and more women to the decision to have children at an older age.
But after 40, there are many factors that can negatively affect pregnancy.

By Anastasios Sykoutris MD, Phd, MSc, obstetrician-gynecologist, specialized in in vitro fertilization, scientific associate IVF Unit of MITERA Obstetrics

So how possible is it to have a child at such an age and what should every woman know?
Nowadays it is very common to start having children after the age of forty. The causes are mainly social due to the great changes in the lives of women in recent decades. Women today study for several years and the career unfortunately also takes several years to stabilize. Similar situations apply to men, which leads to a delay in the decision to seek a partner to start a family.
But, unfortunately, the physiology of reproduction in man does not follow the social changes of the structures of modern life. The burden of eggs over time by aging factors is high and hormonal changes are conducive to reduced fertility. Also, over time, the anovulatory cycles increase, ie the cycles where ovulation does not occur.
Many women resort to assisted reproduction methods, such as insemination or in vitro fertilization. The existence of other problems in the couple, such as sperm problems, often lead to treatment with assisted reproduction methods, with or without the use of ovarian stimulation drugs.

The new methods
Recently, IVF protocols have been developed friendly to older women. The use of stimulation from the second day of the cycle and the use of an antagonist from the sixth day of stimulation, enables faster treatment with fewer ovarian stimulation drugs and reduced rates of complications, such as ovarian hyperstimulation syndrome.
These new protocols result in the use of fewer hormones and endogenous hormones, ie those produced by the woman’s own body.
Also, with the improvement of freezing techniques such as vitrification, a new technique from Japan, it makes sense to create fetuses from natural cycles without taking stimulant drugs, especially in women over forty. This method results in the creation of three or four embryos in one embryo transfer.

The special exams
In pregnancy in this age range it is very likely that a trophoblast or amniocentesis will be needed, tests that should be done after consultation between a doctor and a couple due to the increased chance of genetic abnormalities in women over forty years.
These examinations are performed by gynecologists in fetal gynecology, they have a small percentage of miscarriages (about 0.5%) and the result comes out in a few twenty-four hours.
In pregnant women over the age of forty, laboratory tests and blood pressure measurements should be performed more often. This is because preeclampsia, a pregnancy complication associated with increased blood pressure and protein in the urine, is more common in women over forty. Also, miscarriages are increased in this age range due to obviously genetically abnormal eggs.
Another problem is the increase in premature births, which forces the woman and her gynecologist to be ready to deal with any signs of premature birth. Premature contractions should be reported to the gynecologist immediately.

Gestational diabetes
Blood sugar should also be measured regularly and the blood sugar curve is essential for the early diagnosis of gestational diabetes. Women over forty are more likely to develop gestational diabetes, but also to bleed during or after childbirth due to placental abnormalities. Proper nutritional advice should also be given and ultrasounds should not be omitted. The clinical examination each time in the doctor’s office should be detailed and complete. Blood pressure and weight measurements are necessary, and laboratory testing must be complete.
The good cooperation of a patient and a gynecologist is an essential element for a good outcome of the pregnancy. Patients should immediately report to their doctor what concerns them and not neglect their laboratory tests and visits to the doctor’s office.

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