The record – denounced by all specialists – is Indian: 71 years old. In France, in no case above 50 years. The life expectancy of women, more than a century ago, did not exceed this age. So she could have children around the end of her life. Today, this hope is doubled; however, the duration of fertility has not changed. A 40-year-old woman who has no children yet, for professional reasons most of the time, has not yet reached half of her life expectancy; she finds this perfectly unfair. But her fertility became low.
There is a huge difference between man and woman. Man makes his sperm all his life, until his death. The woman is born with a stock which is built up when the fetus is 3 months old; at 40, his oocytes are therefore 40 years old. They are less numerous, and above all, aging. The age of the father is also taken into account for the success of a pregnancy, but it has nothing in common with the influence of that of the woman, which is the determining factor of fertility. The share of failure is 80% for women and 20% for men.
Above 45 years of age, a woman returns to an area where pregnancy is dangerous, at risk, in 20 or 30% of cases. These are essentially vascular complications, high blood pressure, diabetes, premature birth, increase in the number of cesareans … A woman who wants to have a child beyond 40 years must therefore have a serious cardiological assessment.
For the baby, the risks are partly linked to the complications of the mother. Trisomy is also a problem: 2 to 3% occurred at the age of 40, ten times less. There is, however, a particularly effective screening test.
Regarding the chances of being pregnant, a 30-year-old woman has an 80% chance of having a baby; at 40, 40-45% with huge variations from woman to woman. Those who wish to become pregnant after 40 years must consult a specialist if they do not obtain a result after six months of a regular sex life; if you make love once a week, you have a 15% chance of having a child after one year, 80% if you do it every day, because the woman is only fertile one day per month.
To help nature, the doctor will perform ovarian stimulation, with hormones being injected. He will detect the ideal period, and if the future father’s sperm is normal, reports will be scheduled; not very romantic, but effective. If there is a sperm problem, the next phase will be insemination in addition to stimulation. We take the best sperm and put it directly in the womb. If the ovaries work well but all these simple treatments have failed, remains in vitro fertilization: we put together the oocytes of the woman and the sperm of the man to give birth, in a test tube, to embryos, which will then be implanted in the womb of the future mother.
A special case: for single women, who have not yet found the future dad, it is possible to freeze the oocytes for later use. A very sophisticated technique… However, with a caveat: this practical solution is prohibited in France. Fortunately, it is possible in Spain and many young French women use it. Problem, the cost of conservation and implementation.
Above 45 years of age, these techniques no longer work (except for freezing beforehand) and an egg donation must be used. We are going to take an egg from a young donor, which will be fertilized by the sperm of the husband of the 45-year-old woman, then placed in the womb of the future mother. Finally, if all else fails, it remains the adoption … knowing that it is long, expensive and not easy.
Doctor Jean-François Lemoine
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