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Getting Pregnant After 40: What to Know About Your Fertility and Your Options

Authored and medically reviewed by Dr. Eli Reshef

Dr. Eli Reshef is a reproductive endocrinologist and fertility specialist who sees patients in Chicago and the greater Chicagoland area.

More people than ever are building their families after 40 — and many succeed, often with the help of fertility treatment. Conceiving at this age can come with challenges and understanding how age affects fertility, what the success rates actually look like, and which options are available puts you in the best position to make rational decisions. Here's a clear, honest overview.

How Fertility Changes After 40

The biggest factor is your eggs. As you age, both the number of eggs and their quality decline — and by your 40s, a growing percentage of eggs carry chromosomal abnormalities that prevent a healthy pregnancy. This is what drives most of the changes you may have read about:

• Lower monthly odds of natural conception — roughly 5% per cycle by the early 40s, compared with around 15–20% in the early 30s.

• More chromosomally abnormal eggs, which is the main reason both miscarriage risk and the chance of conditions like Down syndrome rise with age.

• A longer average time to conceive, and a higher likelihood of needing treatment.

Men's fertility declines too, though more gradually — sperm quality and testosterone can decrease over time, and paternal age is linked to a modestly higher risk of certain genetic conditions, including birth defects. Still, many couples may conceive healthy pregnancies in their 40s.

What the Success Rates Show

Realistic expectations help you plan. The figures below are national averages from the most recent SART data (2024 preliminary), measured as live births per egg retrieval using a patient's own eggs (all embryo transfers). Your individual odds depend on your own health and testing.

Nationally, live birth rates per IVF egg retrieval with your own eggs run approximately:

• Under 35: ~42%

• 35–37: ~30%

• 38–40: ~18%

• 41–42: ~9%

• Over 42: ~3%

The drop after 40 is steep, and egg quality and number are the main reasons. It shows up in two other numbers worth knowing: the share of retrievals that don't produce a transferable embryo climbs from about 7% under 35 to roughly 37% at 41–42, and the miscarriage rate rises from about 12% to around 21% over the same span. None of this means pregnancy is off the table after 40 — it means the path often runs through treatment, and sometimes through donor eggs.

Why Donor Eggs Change the Picture

Here's the most important thing to understand about fertility after 40: success with your own eggs is limited mainly by egg age — but that limit largely disappears with donor eggs.

Because donor eggs come from younger women, national live birth rates with donor eggs hold around 40% or higher per transfer regardless of the recipient's age. For many people over 40 — especially over 42, where own-egg success is low — this offers a genuinely high-success path to a healthy pregnancy. It's not the right choice for everyone, but it's why age is far less of a barrier than many people assume.

Health Considerations During Pregnancy

Pregnancy after 40 is often healthy, but does carry higher risks that your care team will monitor closely:

• Miscarriage and chromosomal conditions

• Gestational diabetes

• High blood pressure, preeclampsia, other cardiovascular problems

• Preterm birth

Consistent prenatal care and appropriate screenings make a real difference, and most people with good monitoring and good health go on to have healthy babies.

Steps That Improve Your Odds

If you're planning for pregnancy after 40, a few proactive steps matter more than at any other age:

• See a fertility specialist early. Over 40, don't wait a year — seek evaluation right away.

• Get your ovarian reserve tested with AMH and an antral follicle count by ultrasound to understand your egg supply.

• Optimize your health — balanced nutrition (see our fertility diet guide), a folic acid supplement, and limiting smoking and alcohol.

• Consider genetic testing of embryos (PGT-A), which is often recommended after 40 to identify chromosomally normal embryos and reduce miscarriage risk.

• Freeze eggs or embryos if you're not ready to conceive yet — the earlier, the better.

Your Options for Building a Family After 40

Depending on your evaluation, your specialist may discuss:

• IVF with your own eggs — often with PGT-A to select healthy embryos.

• IVF with donor eggs — the highest-success option when own-egg IVF isn't working.

• Embryo donation — using donated embryos created by others.

• Ovulation induction or IUI — less invasive options that may fit certain situations, usually after evaluation.

The Emotional Side

The path to parenthood after 40 can be an emotional one, with the possibility of setbacks like a failed cycle or a loss along the way. Leaning on a support system — friends, family, a support group, or a therapist who specializes in fertility — helps, and so do stress-reducing practices like exercise, yoga, or acupuncture. You don't have to navigate it alone.

When to See a Fertility Specialist

If you're over 40 and trying to conceive, the single most useful step is to be evaluated sooner rather than later. A fertility evaluation gives you a clear picture of your egg supply and options — and time is the one variable you can't get back.

Frequently Asked Questions

Can you get pregnant naturally at 40? Yes, though monthly odds are lower — around 5% by the early 40s. Many people do conceive naturally, but if you've been trying for six months without success (or you're over 40 and just starting), an evaluation is worthwhile.

What are IVF success rates after 40? Nationally, live births per egg retrieval with your own eggs are roughly 9% at 41–42 and about 3% over 42. Donor-egg success is much higher and largely independent of your age.

Is 40 too old for IVF with my own eggs? Not necessarily — many people succeed with their own eggs in their early 40s, especially with PGT-A. Success declines with each year, which is why early evaluation matters.

When should I consider donor eggs? Often when own-egg IVF hasn't succeeded or when testing shows very low ovarian reserve or egg quality. Your specialist can help you decide based on your results and goals.

The Bottom Line

Getting pregnant after 40 takes planning and patience, but it's very possible — and you have more options than you might think. Understanding your egg supply, knowing the real success rates, and acting sooner rather than later are the keys. The team at Advanced Fertility Center of Chicago can evaluate your fertility and build a plan around your goals. Schedule a consultation today.

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