Trying to conceive after 40: fertility, self-care and when to seek help

Deciding to have a child after 40 is an increasingly common reality for families.

For some people, this decision comes after building a career, finding a partner, reaching greater stability or simply realizing that the right moment has arrived.

But there is one important point: female fertility changes with age.

This doesn't mean a pregnancy at 40 is impossible, nor that there will necessarily be complications. It means it may be helpful to start this journey with information and professional support from the planning stage.

If you are trying to conceive after 40, understanding these changes can help you swap anxiety for more informed decisions.

Is it possible to get pregnant naturally after 40?

Yes.

Women over 40 can still conceive spontaneously as long as ovulation and favorable reproductive conditions are present.

However, the chance of pregnancy per cycle gradually decreases with age.

The American Society for Reproductive Medicine (ASRM) highlights that female age is one of the most important factors related to fertility and that reproductive potential declines as the years go by.

This decline happens mainly because there is a natural reduction in both the quantity and the quality of available eggs.

It doesn't mean every woman at 40 will have difficulty getting pregnant.

It simply means that time becomes a more important factor in planning.

After 40, do you need to try for a year before seeking help?

Not necessarily.

This is an important difference for anyone planning a pregnancy at this age.

For younger women, it may be recommended to try naturally for a few months before starting a fertility work-up.

For women over 40, however, the ASRM considers that a more immediate fertility evaluation may be appropriate.

In other words: you don't have to wait six months or a year before seeking guidance.

Talking to a gynecologist, obstetrician or reproductive medicine specialist early in the planning stage can help you better understand:

• menstrual history;
• how often you ovulate;
• reproductive health;
• history of previous pregnancies;
• medical conditions;
• medications you take;
• family history;
• factors related to your partner, if applicable.

Seeking an early evaluation doesn't necessarily mean starting assisted reproduction treatment.

The first step may simply be understanding the reproductive health of the couple or of the person who wants to get pregnant.

Does fertility depend only on the woman?

No.

When there is a partner providing the sperm, the fertility evaluation should consider both sides.

The ASRM recommends that, when applicable, the male evaluation take place alongside the female one.

This avoids placing all the responsibility on the woman and can also make the investigation more efficient.

Fertility is a matter for the whole family plan, not the sole responsibility of the person who intends to carry the pregnancy.

What can be assessed before getting pregnant?

The evaluation varies from person to person.

The professional may review your health and reproductive history and, when indicated, order tests related to different aspects of fertility.

Points that may be part of the investigation include:

• ovulation;
• uterine anatomy;
• whether the fallopian tubes are open;
• gynecological conditions;
• menstrual history;
• ovarian reserve in selected cases;
• general health;
• semen analysis of the partner, when applicable.

No single test can predict with certainty whether or not a person will get pregnant.

That's why fertility tests need to be interpreted within the clinical context.

What about so-called ovarian reserve?

Women are born with a set number of eggs, and this reserve naturally decreases throughout life.

In the fourth decade of life, this decline tends to become more significant.

There are tests that help doctors estimate aspects of ovarian reserve, but it's important to understand one distinction:

**ovarian reserve is not the same as fertility.**

These tests can help with treatment planning and clinical assessment, but they cannot determine on their own whether a woman will be able to conceive spontaneously.

That's why a result should not be interpreted without professional guidance.

Does egg quality change too?

Yes.

Besides the number of eggs decreasing with age, changes related to cell division become more frequent.

This increases the likelihood of chromosomal abnormalities in embryos.

ACOG highlights that the risk of chromosomal abnormalities increases with maternal age, including conditions such as Down syndrome, Edwards syndrome and Patau syndrome.

Once again, a higher risk does not mean it will definitely happen.

Most age-related information should be understood as a change in probability, not as a prediction of what will happen to a specific person.

Does the risk of pregnancy loss also increase?

Yes.

Advanced maternal age is one of the factors associated with a higher likelihood of early pregnancy loss.

Brazil's Ministry of Health addresses this increase in its manual on care for women in the menopausal transition and menopause, “Manual de Atenção às Mulheres na Transição Menopausal e Menopausa”, published in 2026, and links part of this risk to the rise in chromosomal abnormalities with age.

ACOG also points to a progressive rise in the risk of miscarriage as age advances.

This can be emotionally hard for anyone trying to conceive.

It's important to remember that a pregnancy loss usually doesn't happen because the woman worked, exercised, had an argument or did something ordinary “wrong”. ACOG highlights that most early losses are caused by biological events that are beyond the pregnant woman's control.

Is a pregnancy after 40 automatically high-risk?

Age is an important factor in the assessment, but the actual risk depends on a combination of characteristics.

Health before pregnancy, obstetric history and the presence of conditions such as hypertension or diabetes also make a difference.

Pregnant women with conditions that increase the chance of complications may be referred for high-risk prenatal care.

The Ministry of Health advises that the classification of prenatal care take into account each pregnant woman's individual conditions.

That's why two 40-year-old women may have quite different care plans.

Which risks increase during pregnancy?

Older maternal age is associated with a higher likelihood of some complications.

These include:

• high blood pressure during pregnancy;
• pre-eclampsia;
• gestational diabetes;
• chromosomal abnormalities;
• pregnancy loss;
• preterm birth;
• some changes related to the baby's growth;
• a greater chance of needing interventions during pregnancy and birth.

The Ministry of Health states that various obstetric complications become progressively more common with maternal age.

ACOG also notes an increase in complications such as gestational diabetes and pre-eclampsia in women of more advanced maternal age, with risks that tend to rise progressively as age increases.

This doesn't mean these complications will happen.

The purpose of knowing the risks is precisely to allow care to be planned appropriately.

Do I only need to start looking after my health after a positive test?

No.

The period before pregnancy is a great opportunity to review your health.

A preconception visit may include an assessment of:

• blood pressure;
• blood sugar;
• weight and metabolic health;
• chronic conditions;
• medications;
• vaccines;
• family history;
• gynecological health;
• lifestyle habits.

Some medications you take regularly may need to be reviewed before pregnancy.

This doesn't mean stopping them on your own.

Any adjustment should be discussed with the professional in charge of your care.

Diet and physical activity matter too

There is no food or supplement that can “rejuvenate” eggs or guarantee a pregnancy.

On the other hand, looking after your overall health before conception can contribute to a healthier pregnancy.

It's worth talking to professionals about:

• a balanced diet;
• appropriate physical activity;
• sleep;
• smoking;
• alcohol use;
• managing chronic conditions;
• mental health.

The goal isn't to achieve a perfect body for pregnancy.

It's to reach pregnancy with your health as well cared for as possible.

What about folic acid?

Preconception planning usually includes guidance on taking folic acid supplements before pregnancy.

The amount and when to start may vary depending on individual factors.

So instead of choosing doses on your own, talk to the professional supporting your pregnancy planning.

Some people may need recommendations that differ from the routine ones.

I got pregnant at 40. What now?

The first step is to start prenatal care early.

The Ministry of Health recommends that the first appointment take place as soon as the pregnancy is discovered or suspected, ideally by the 12th week of pregnancy.

From there, the care team can decide which assessments are appropriate.

Depending on the case, follow-up may include special attention to:

• blood pressure;
• blood sugar;
• fetal growth;
• ultrasound scans;
• screening for chromosomal abnormalities;
• pre-existing medical conditions.

The frequency and type of tests are not the same for every pregnant woman.

Are there specific genetic tests after 40?

There are screening tests and diagnostic tests that can assess the possibility of chromosomal abnormalities.

ACOG recommends that prenatal screening and diagnostic options be discussed with all pregnant women, regardless of age.

For a pregnancy after 40, this conversation may be especially important because of the progressive increase in the risk of chromosomal abnormalities.

It's important to tell the difference:

Screening: estimates the likelihood of a condition.

Diagnosis: seeks to determine whether that condition is actually present.

An abnormal screening result does not automatically mean the baby has a genetic condition.

Does being 40 mean a C-section will be needed?

No.

Maternal age alone is not an automatic reason for a cesarean.

ACOG considers vaginal birth a safe and appropriate option when there are no other maternal or fetal reasons for a cesarean.

The mode of delivery should be decided taking into account:

• how the pregnancy progresses;
• the pregnant woman's health;
• the baby's condition;
• obstetric history;
• the situation at the time of birth;
• the pregnant woman's preferences within what is clinically possible.

Emotions are part of this journey too

Trying to conceive after 40 can bring up very different feelings.

There may be:

• anxiety about time;
• fear of not being able to get pregnant;
• worry about tests;
• comparison with other families;
• outside pressure;
• fear of losing a pregnancy.

These emotions deserve attention.

Information can help, but no one needs to turn trying to conceive into an endless series of tests and pressure.

Talk to your partner, trusted family members and the professionals who look after your health.

If the journey is causing significant distress, seeking psychological support can also be part of your care.

How can family help?

A support network plays an important role even before pregnancy.

A partner or family members can help by:

• coming to appointments when wanted;
• not pressuring about when the pregnancy will happen;
• not constantly asking about results;
• sharing responsibilities;
• supporting healthy habits;
• respecting decisions about fertility treatments;
• offering support in moments of frustration;
• understanding that fertility is not solely the woman's responsibility.

**“How can I help you during this phase?”**

That is much better than offering solutions nobody asked for.

Key takeaways

• It is possible to get pregnant naturally after 40, but female fertility gradually declines with age.
• For women over 40, it may be appropriate to seek a fertility evaluation without waiting through many months of trying.
• When there is a male partner, the fertility evaluation should consider both people.
• Older maternal age is associated with a higher risk of chromosomal abnormalities and pregnancy loss.
• Some pregnancy complications, such as gestational diabetes and pre-eclampsia, become more common as age advances.
• A higher risk does not mean a complication will necessarily happen.
• A visit before pregnancy can help review health conditions, medications, vaccines and other health factors.
• After a positive test, prenatal care should start early.
• Being over 40 does not automatically mean needing a cesarean.
• Planning needs to consider physical and emotional health and each family's reality.

I'm 40. How long should I try before seeing a specialist?

There's no need to wait a full year. The ASRM considers that, for women over 40, it may be appropriate to start a fertility evaluation more promptly.

Is it impossible to get pregnant naturally after 40?

No. Spontaneous pregnancies still happen after age 40. However, the chance of pregnancy gradually decreases with age.

Will every pregnancy after 40 have complications?

No. Age increases the likelihood of some complications, but it doesn't determine what will happen in a specific pregnancy.

Is there a higher risk of Down syndrome after 40?

The risk of chromosomal abnormalities, including Down syndrome, increases progressively with maternal age. There are screening and diagnostic tests that can be discussed during prenatal care.

Do I need in vitro fertilization because I'm over 40?

Not necessarily. Whether treatment is needed depends on an individual assessment. Some women conceive spontaneously, while others may need specialist help.

Does a woman over 40 have to have a cesarean?

No. Age alone does not determine the mode of delivery. In the absence of other indications, vaginal birth remains an option.

Main source

Text provided for producing the article — “Tentantes acima de 40 anos” (Trying to conceive over 40).

This material was used as a starting point for the topic and for the language approach aimed at people trying to conceive and their families.

Passages unrelated to the subject — such as baby motor development, wardrobe organization and mastitis — were not included.

Additional sources

Brazil's Ministry of Health. “Manual de Atenção às Mulheres na Transição Menopausal e Menopausa”. 2026.

Used for updated information on fertility after 40 and obstetric risks associated with maternal age.

**Brazil's Ministry of Health. Prenatal care.**

Used for guidance on starting prenatal care early in pregnancy.

**Brazil's Ministry of Health. Maternal health.**

Used for information on prenatal follow-up and its classification.

American Society for Reproductive Medicine — ASRM. Fertility evaluation of infertile women.

Used for guidance on the age-related decline in fertility and earlier evaluation for women over 40.

American College of Obstetricians and Gynecologists — ACOG. Pregnancy at Age 35 Years or Older.

Used for information on chromosomal abnormalities, obstetric complications, pregnancy follow-up and mode of delivery.

Important notice

This content is for educational purposes and does not replace fertility evaluations, appointments, tests, diagnosis or individual guidance from health professionals.

Fertility and pregnancy risks vary significantly between people of the same age. If you are over 40 and want to get pregnant, talk to a gynecologist, obstetrician or reproductive medicine specialist to assess your individual situation.