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Infertility

Fertility Conception ***

01/22/2009

Question:

What are the odd`s of getting preg. in the 40`s (44). Never been pregnant before or tried. In good health with no conditions or concerns. A little overweight. Husband is older; but has produced two kids in earlier year`s. Would their be more of a chance on Fertility pill`s?? My HSG said one of my tubes was blocked. I`m not understanding that because I`ve never had a infection or had any surgery. Please explain. Could that be a spasm at that moment of testing?? Do I need to find out where the blockage is located??

Answer:

Fertility decreases with age, and unfortunately, there are very few treatment options to improve in this situation. After 40 years of age, less than 1/3 of women will become pregnant on their own, and almost half of these pregnancies will end as a miscarriage. The good news is that those who do not have a miscarriage have only a slightly higher risk of genetic problems (such as Down syndrome). The risk of pregnancy complications such as diabetes or high blood pressure is likewise only slightly increased. Before attempting pregnancy after 40, you should discuss these risks with your obstetrician.

One blocked tube on HSG is common. Most of the time, the tube will not be found to be blocked if the HSG is repeated or the tubes are evaluated with laparoscopic surgery. However, about 1/4th of the time, the blockage on HSG is real and related to pelvic scar tissue from endometriosis or a previous infection.

Most gynecologists recommend that women over 40 be referred to a fertility specialist to discuss diagnosis and treatment options. Fertility pills or injections can sometimes be effective. Other treatment options include intrauterine insemination. The most effective, and most expensive, treatment is in vitro fertilization using eggs donated from someone 30 years of age or younger. Many women have children after 40 years of age, but it is not as easy as it is for women in their 20's and 30's.

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Response by:

William W Hurd, MD William W Hurd, MD
Professor of Reproductive Biology
School of Medicine
Case Western Reserve University