“Pregnancy in your 40’s” – with Karen Bleier

In this episode of Healthful Woman, Karen Bleier discusses her experience with pregnancy in her 40s. Karen is a patient and friend of Dr. Fox, and now the mother of an 8-month-old. Bleier wrote in to Dr. Fox to suggest this episode topic, because she once held the misconception that it’s always difficult to get pregnant on your own after turning 40 and wanted to share her story.  

Bleier explains that she got married relatively late in life, and got pregnant for the first time at 40. Unfortunately, she had an early miscarriage at 9 weeks due to a genetic abnormality. After that experience, she consulted with a fertility specialist who recommended that she could try IVF, but decided instead to wait and conceived natural with relative ease at 41.  

Dr. Fox explains that at 40, it’s possible to have difficulty conceiving as well as a higher risk of miscarriage, typically from genetic abnormalities. He says that “it’s just odds,” and that it’s by no means impossible for women to get pregnant and have healthy babies if they’re over 40. While the rate of early miscarriage is about 40-50% after a woman turns 40, many patients are surprised to learn that in fact the average rate of early miscarriage is around 20% for women through their 20s-30s as well. He explains “advanced maternal age,” which refers to women who are pregnant over 35. This term was originally coined because the risk of Down syndrome and the risks associated with amniocentesis tests were the same, and while this isn’t necessarily true anymore, the term has stuck. Dr. Fox also says that there are some other risks in pregnancy that increase as a patient gets older, such as gestational diabetes, but this increase is marginal.  

Dr. Fox explains that many people choose IVF after 40 because it is increasingly widely available and many have insurance that covers the procedure. Bleier also says that her fertility specialist joked that she sometimes suggests IVF because “women in New York are impatient,” but she was comfortable waiting to get pregnant instead of pursuing the procedure.  

When she did get pregnant, Bleier chose to have a CVS test to screen for the genetic abnormality that caused her previous miscarriage. She explains that she felt no pain or discomfort during this procedure, but was a bit nervous waiting for the results.  

Bleier also explains that while she did find pregnancy difficult, she didn’t experience many common symptoms like indigestion. However, she did have back pain and while normally a runner, couldn’t exercise in the same ways, although she did swim while pregnant. Bleier notes that she did feel tired, but it wasn’t extreme, and says that she feels she had a slightly more difficult pregnancy than her 32-year-old cousin who was also pregnant and “didn’t complain.” Dr. Fox explains that the symptoms and experience during pregnancy has more to do with how healthy a patient is before their pregnancy than their age.  

Despite some difficulty, Bleier describes pregnancy as “a happy time” and didn’t feel anxious, but notes that this reflects her mood throughout her life. She says that “everyone was rooting for me” and recalls people, including strangers, giving her attention and encouragement through her pregnancy.  

Ultimately, Bleier planned to be induced at 39 weeks to have a vaginal delivery, but ended up having a C-section. Dr. Fox says that there is a much higher risk of a C-section delivery as women get older, and the reason is unknown. Some suspect that older women and their doctors are more conservative, or that the uterus doesn’t contract as strongly. Regardless, the chance of a C-section doubles to 40% in a patient’s 40s.  

Finally, Bleier and Dr. Fox discuss the importance of finding an OB/GYN who is the right fit for you. Bleier explains that “I believe you need to find the right doctors and the right practice. I’m not the expert, but I knew I was in good hands.”