As a woman, your fertility peaks before 30 and declines steadily after that time. By age 44, your body is preparing for menopause by turning off its production of the female sex hormones, estrogen and progesterone. Becoming pregnant without medical assistance can be difficult after 40, and by 44, achieving a successful pregnancy usually requires the use of donor eggs.
Menopause is technically the day that falls twelve months after your last menstrual period, but the menopausal transition is a gradual process of change. Preparing your body for both menopause and pregnancy actually requires embracing the same good health habits.
Bring your body to its highest possible level of wellness before attempting conception regardless of your age. This is especially critical if you are near menopause. If you want to conceive, follow the recommendations of the Centers for Disease Control and Prevention: start prenatal vitamins and a 400 microgram supplement of folic acid at least three months before attempting pregnancy. Also, make sure you are getting the 1500 mg of calcium and 900 mg of vitamin D recommended for all women near menopause
Correct your weight to a healthy body mass index of 18.5 to 24.9 before conception. The National Institutes of Health recommends losing weight by eating a diet based on foods high in nutrients but low in calories, and free of white sugar, white flour, processed foods and saturated fats. Obesity is a high risk factor in pregnancy and that matters even more when you're older. For example, if you are over 44, your risk of a miscarriage is 59 percent simply because your progesterone level, the hormone which maintains the pregnancy, is low, according to the Centers for Disease Control and Prevention. Obesity brings its own 20 percent risk of miscarriage, according to the findings of the July 2004 issue of "Human Reproduction." Obesity also raises the risk of diabetes, high blood pressure and heart disease both in your pregnancy and after menopause, making correcting your weight a wise investment in your health.
Schedule a preconception visit with your primary health care provider and have the tests recommended by the American College of Obstetricians and Gynecologists for all women seeking to become pregnant. These include a hemoglobin A1C, the blood test for diabetes and a lipid profile. Testing for all sexually transmitted diseases and HIV, as well as a pap smear and a mammogram, should also be done, and a bone density test is recommended for women over 40 to determine their risk of osteoporosis. If any problems are detected, additional lab work and treatment should be completed before you stop using contraception.
Determine if you are still ovulating by having your physician or nurse-practitioner run a follicle stimulating hormone or FSH test. When the result of this blood test is above 11.4, it indicates what physicians refer to as a loss of ovarian reserve. At that point, even if you take medication to stimulate your ovaries and use in-vitro fertilization, you are unlikely to conceive using your own eggs, according researchers at the University of Pennsylvania, writing in the January 2002 issue of "Human Reproduction."
Make an appointment with a fertility center. At age 44, if you have not previously been pregnant and you use your own eggs for in-vitro fertilization, the chance of a successful birth is only 1.9 percent, according to the Society for Assisted Reproductive Technology. Because of this, fertility specialists will ask you to consider the option of using an egg donor combined with in-vitro fertilization. This process involves fertilizing multiple ova in a test tube, and then implanting the embryo/embryos into your uterus. To further increase the chance of having a successful outcome, there is a process to test for the presence of many genetic defects in embryos before implantation. Preimplantation genetic diagnosis, or PGD, is accomplished by removing a single cell shed by a five to eight-day old embryo while it is being incubated outside the body. After that testing, according for the Centers for Disease Control and Prevention, an embryo, or embryos, that are found to have no detectable genetic damage are implanted in the uterus. Assisted reproductive technology is allowing some women to experience menopause and motherhood at nearly the same time.
- National Institutes of Health: Time for a Change, Page 4: 2009
- Centers for Disease Control and Prevention: Preceonception Care: 2009
- Centers for Disease Control and Prevention: Assisted Reproductive Technology, Risk of Miscarriage by a Woman's Age: 2007
- "Human Reproduction"; Obesity is Associated with Increased Risk of fFrst Trimester and Recurrent Miscarriage; H. Lashen, M.D. et al ;July 2004
- National Institutes of Health: Tips for Healthy Eating