There’s never been a safer time to be an "older" pregnant mom. Women in their late 30s and early-to-mid 40s are having babies at higher rates than ever these days, and the vast majority have healthy pregnancies and babies.

But because being pregnant at age 45 comes with some potential additional risks, it’s wise to take some extra precautions and care to ensure that you have the best outcome possible for your pregnancy and baby.

Can you get pregnant at 45?

Yes, you can get pregnant at 45, though conceiving naturally may come with more roadblocks than it would if you were in your 20s or 30s (or even early 40s). A woman's prime fertility time is between her late teens and her 20s. Once you reach your mid-30s and beyond, your ability to get pregnant may start to decline.

From the mid- and late-30s on, especially from age 40 and up, this dip in fertility tends to happen a bit more rapidly. That’s because a woman is born with a fixed number of eggs in her ovaries, and as she ages, the number of eggs starts to decrease.

What’s more, those remaining eggs are more likely to have chromosomal abnormalities, making a healthy conception trickier and raising the chance of miscarriage. Women who are 40 and older also tend to be more prone to gynecological issues that may affect fertility (uterine fibroids, for instance, or endometriosis).

There are exceptions, however, and plenty of women in their 40s have no problem getting and staying pregnant (and likewise, plenty of women in their 20s and 30s have health issues that affect their ability to conceive).

Still, because of the tendency for these added risks as you age, it can be challenging for women to get pregnant naturally at 45. But it's not impossible. And assisted reproductive technology can help.

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What are the chances of getting pregnant at 45?

For healthy couples in their 20s and early 30s, there's a 25 to 30 percent chance of getting pregnant in any single menstrual cycle (meaning that around 1 in 4 women in that age group get pregnant per cycle).

By age 35, there’s about a 15 percent chance of getting pregnant naturally per menstrual cycle, and by 40, it drops to around 5 percent or less per cycle (around 1 in 10 women per cycle). At 45, there’s an even slimmer chance of conceiving naturally without fertility treatments or help, though, again, every woman is different.

What are the chances of getting pregnant at 45 naturally?

By the time you turn 45, fertility has typically declined to the point that getting pregnant naturally is not likely for most women — though it can happen and there are exceptions.

So if you find yourself in that position, you're not alone. But if you're 45 and hoping to get pregnant, you should first talk to your doctor about your outlook and your own personal situation.

Depending on what your practitioner tells you after running some routine fertility tests, your best bet may be to continue trying to conceive on your own. Or it could be to try options like in vitro fertilization (IVF), getting pregnant with a donor egg, or using your own eggs you've frozen in the past, if that applies to you.

When a women in her 40s undergoes IVF with her own eggs, chromosomal screening of embryos (also known as PGT-A) is recommended. The likelihood of a choromosomally normal embryo at age 45 or greater tends to be lower than for women who are younger. However, if you (and your uterus) are in good health, the likelihood of conceiving with a donor egg can be extremely high. 

Symptoms if you’re pregnant at 45

Your pregnancy symptoms at 45 will be the same as those you’d have if you’re pregnant at any age and may include the following (to name only a handful):

Because you sometimes have more aches, pains and health issues in your 40s than you did when you were younger, you may feel some of your pregnancy symptoms more acutely than you would have in the past. That’s not an absolute, of course — you may be as fit and healthy as a woman in her 20s and not experience any worse or more noticeable pregnancy symptoms now than you would have back then.

What prenatal tests will you need if you’re pregnant at 45? Will there be more than usual?

You may have more screenings and ultrasounds than your younger-mom counterparts. But the additional testing and extra attention can be reassuring.

You’ll be scheduled for routine prenatal testing, including NIPT for chromosomal conditions and the glucose test for gestational diabetes (which is more common in older moms-to-be).

You’ll also be closely monitored for high blood pressure and preeclampsia, which can crop up more often when you're in your early-to-mid-40s. And you may have additional ultrasounds to monitor the baby’s growth, since there's more of a chance of having a low birth weight baby.

Because the rates of Down syndrome and other chromosomal conditions are somewhat higher in babies of older moms-to-be, you may be encouraged to undergo chorionic villus sampling (CVS) between 10 and 13 weeks of pregnancy or amniocentesis, which is done between weeks 15 and 20 of pregnancy (most often between 16 and 18 weeks).

If you conceive with a donor egg or your own eggs that were previously frozen, the risk of chromosomal abnormalities in your baby would be based on the age of the donor or your age when your eggs were frozen. It's a good idea to inform your doctor of those details so they can provide an accurate assessment of that risk.

Can you have a normal, healthy pregnancy at 45?

Yes. Assuming you have good prenatal care during your pregnancy and have a generally healthy lifestyle, your pregnancy can be problem-free.

It's true that your risks of various pregnancy complications increase with age. But with the right doctors and care, there's a good chance you can have a healthy pregnancy at 45.

Tips for a healthy pregnancy if you’re pregnant at 45

The best ways to tip the odds so that your pregnancy is a healthy one are to:

  1. See your doctor before you try to conceive to make sure that any appropriate testing is performed and medications are adjusted to maximize the safety of your pregnancy.
  2. See your doctor regularly during your pregnancy and follow all recommendations, including the ones about screenings and diagnostic tests.
  3. Stay on top of any chronic conditions by taking your doctor-recommended, pregnancy-safe medications.
  4. Eat well by following a healthy pregnancy diet.
  5. Take your prenatal vitamin daily.
  6. Drink enough water to stay hydrated.
  7. Avoid pregnancy-unsafe habits such as smoking, using drugs and drinking alcohol.
  8. Gain the recommended amount of weight while you're pregnant.
  9. Get some moderate exercise at least 30 minutes a day most days, as long as you have a green light from your doctor.
  10. Get the flu shot, the COVID-19 vaccine, the Tdap vaccine, the RSV vaccine, and any other vaccines as recommended by your doctor.
  11. Be alert to signs of preeclampsia, gestational diabetes and other pregnancy complications.
  12. Count those baby kicks starting in week 28.

What are the risks to mother and baby of being pregnant at 45?

Being an expectant mother of "advanced maternal age," as doctors call it, does come with some risks. If you’re pregnant at 45, you have a higher chance of:

When to call the doctor

Call your doctor if you notice any of these pregnancy warning signs:

There’s plenty of good news for women who are pregnant at 45 (or in their 40s in general). There’s an excellent chance you’ll have a healthy and complication-free pregnancy. You can increase those chances even more by starting off your pregnancy in tip-top shape and staying as healthy as possible during your pregnancy.