Lifestyle - Risks & Rewards of becoming a mother after 40

Jennie Villa wanted to have it all. A great education and career. Financial security. A loving husband. And kids. For Villa, the dream came true, albeit a little later than she would have liked. At age 37, she met that man of her dreams. Three years later they got married. This past August, at age 41, Villa, of Cleveland, gave birth to fraternal twins: a son, Quinn, and daughter Kendall. Her life, she says, is "pretty perfect." And when it comes to her kids, she is over the moon. "I think they're a miracle," says Villa, who got pregnant the old-fashioned way, without the use of assisted reproductive technologies.

Any woman who has had a child after age 40 can understand Villa's hyperbole. That's because, statistically speaking, the chances of having a successful pregnancy at what doctors call an "advanced maternal age" are fairly dismal. By about age 40, a woman's chance of getting pregnant naturally is only about 5 percent in any given month (down from about 20 percent at age 30). The use of assisted reproductive technologies ups the odds—but not as much as it could if a woman were younger. By age 45, a woman's chance of getting pregnant with her own eggs is virtually zero.

Still, some women are defying those odds. According to the National Center for Health Statistics, the number of mothers giving birth at age 40 or older has doubled in the last several decades, partly due to medical assists like in vitro fertilization or the use of donor eggs.

The reasons women become first-time moms or add to the brood later in life are as varied as the women themselves. There are career goals to meet. And bank accounts to grow. Some women waited for marriage. Some never married at all. There are second marriages. And even surprise births.

For those who wait, getting pregnant is a roll of the dice even with the help of science. "Not every egg over age 40 is created the same," says Dr. Karen Ashby, assistant professor of reproductive biology at University Hospitals Case Medical Center. "Some healthy women will get pregnant without a problem, other women simply won't."

It's clear that even as medical interventions are helping more older women get pregnant, science can't keep up with the increase in the number of women who delay childbearing and then find themselves battling the clock. For every high-profile midlife mom like actress Marcia Cross or Nicole Kidman, there are lots of women who can't get pregnant. The total number of women age 40 to 44 who don't have kids at all is about 20 percent—double what it was 30 years ago, according to a census report released in August.

There's no breakdown of how many of the childless women in that age group chose not to have kids and how many didn't have them because of fertility issues or other circumstances. But choice seems to be the operative word when it comes to how women feel about the lack of children. Women without children who believed it was better to have a child were more likely to report being lonely and depressed in their later years than women who said it didn't make a difference, says Tanya Koropeckyj-Cox, associate professor of sociology at the University of Florida, author of a 2003 study that analyzed data from a survey of more than 3,800 men and women about relationships and family life.

Those women who do get pregnant after 40 may face a laundry list of age-related medical issues. "When you're older you tend to acquire diseases" such as high blood pressure and diabetes, both of which can affect pregnancies, says Dr. Alan Peaceman, chief of the division of maternal fetal medicine at Northwestern Memorial Hospital and professor of obstetrics-gynecology at Northwestern's Feinberg School of Medicine.

And simply being older and pregnant carries a much greater risk of miscarriage. Babies of older moms aren't immune to problems, either. They may be born too small or have underdeveloped lungs. And there is the risk for Down syndrome, which increases with maternal age, a problem that was in the spotlight recently when 44-year-old Alaska Gov. Sarah Palin, whose 5-month-old son Trig has the disorder, became the Republican nominee for vice president.

But "assuming they can get out of the first trimester without a miscarriage, most women can do fine," says Peaceman, who stresses that if women want to get pregnant later in life, it's important to protect fertility. That means quitting smoking, staying at a normal weight and avoiding sexually transmitted diseases.

The problems with later-in-life pregnancies are all too familiar to Terry Runyon, a 41-year-old banking executive from Chicago. Diagnosed with unexplained infertility in her mid-30s, Runyon underwent a series of assisted reproductive treatments. She got pregnant, but miscarried. Then she got pregnant again, and 17 weeks into the pregnancy, she lost one of the twins she was carrying. The surviving twin, Brandon, now 3, is healthy, happy and "completely the love of our lives," says Runyon.

And earlier this year, Runyon got a surprise. She's pregnant and due this October. "Everyone said I was infertile—and then I get pregnant just by having sex with my husband," she says. "I'm astounded."

She admits that the fears of the pregnancy problems like those she experienced in the past made her first trimester difficult. "I know what can go wrong, and I was petrified," she says. "But at the end of the day, I can only change certain things. I can't change the fact that I'm older, but I can take the best care of myself as possible."

That's what Sandy Robertson did. When she was in her late 30s, Robertson, a part-time teacher, went through numerous medical treatments, including fertility drugs, insemination and in vitro fertilization. She did get pregnant with IVF, but miscarried due to an ectopic pregnancy that resulted in the loss of one of her fallopian tubes. Robertson quit using medical assists. Her doctors told her she would probably never get pregnant again.

She refused to accept what they said. She started taking better care of herself by improving her diet and reducing stress with meditation and visualization. Despite the odds, she did get pregnant several times in her early 40s. But the pregnancies ended in miscarriage. At age 44, Robertson got pregnant again. This time she carried to term, and she is now the proud mom of 5-year-old Patricia.

But the pregnancy wasn't easy. "Every doctor I saw put me through every test possible," she says. "But all the doctors could find was that I was a 44-year-old woman with one fallopian tube who just happened to be healthy and pregnant."

With celebrity magazines chock full of photos of famous over-40 moms, it's easy to forget that women like Robertson are the exception, not the rule. Reproduction has its own timetable, doctors caution. "It's not our place to tell women forget your education and career and go have babies," says Dr. Tommaso Falcone, professor and chairman of the Department of Obstetrics-Gynecology at the Cleveland Clinic. "But it's irresponsible to not share information. And it's clear that it's harder to have a child at 40. No one should get pregnant until they are ready to be pregnant, but women need to make reproductive decisions based on facts."

Those facts can't take the glow off successful late-in-life moms. "I said numerous times that I should have had kids earlier," says Villa, who was monitored closely during her pregnancy and was on bedrest for several weeks due to complications. "It can be a rough ride when you're older. I am probably in the worst shape of my life. But I'm also the happiest. I was ready to be a mom." Which is the best reason to get pregnant—regardless of age.