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A growing number of women are waiting until their 40s to
become new mothers. Experts say several factors, including the
demands of busy careers, improved obstetrical care and longer
life expectancy, have contributed to this trend.

Grace Couchman, M.D., associate clinical professor in the
Department of Obstetrics and Gynecology at Duke University
Medical Center, directs Duke's in vitro fertilization lab. She
said her own experience aligns with national statistics.

"I would say that in the 15 years I've been working in
infertility I'm definitely seeing women who are older when they
first come to the fertility physician. Now that women's life
spans are extending into their 90s, I see lots of healthy women
in their 40s who do not seem old, because they're barely at the
halfway point. I think in today's society, it is more realistic
than ever to give birth and raise a child in your 40s.

"Generations ago, when we were dying at age 50 or 60, it
probably wasn't appropriate to be having a newborn at 45. But
with the trends in health care, I think it's going to be a
definite option that women will continue to pursue."

One of the biggest changes in maternal-age patterns is in
vitro fertilization (IVF). In this technique, which was first
done in humans a quarter-century ago, egg cells are fertilized
outside a woman's body, then transferred to her uterus in the
hope that a successful pregnancy will develop.

"Having the ability to take their eggs and fertilize them
has been a very successful technology and has gotten better
over the years. And with donor eggs we are able to extend that
well into the 40s.

"Having children later still remains a choice based on egg
quality," Couchman explains. "Women are intended biologically,
but maybe not personally, to have children younger. It's far
easier to get pregnant in your 20s than in your 30s or 40s.

"The age of the egg is very important. Older women can't
always get pregnant with their own eggs. Men make sperm every
single day, but women are born with their eggs and that's it.
You use them in your teens and your 20s, and whatever's left at
43, that's what you have."

For this reason, Couchman says, many women who are electing
to become pregnant into their 40s are choosing donor eggs.

"Even though later motherhood is a terrific choice, many
women don't realize that waiting can affect the ability to use
your own eggs. So if that's important, women should seek
consultation early.

"There are some tests that we recommend. One is a level
called FSH, which is a hormone secreted by the brain, which
gives us an idea of how responsive a women's ovaries are. It's
a simple blood test that can be very informative. We are able
to attempt IVF in the early 40s, but often the pregnancy rates
are lower than in a woman in her 30s, for example. Then we do
start talking about donor eggs."

Couchman says there are some health risks for older
moms-to-be during pregnancy, most commonly hypertension and
gestational diabetes. There is also a somewhat increased risk
for genetic abnormalities.

"Other than problems with pregnancy, the other reality is
that there is a higher risk for genetic anomaly in a child if
you use your own eggs. So if you're pregnant at 45, you have a
higher risk for Down syndrome or other genetic factors. But in
general, babies born to older mothers are quite healthy."

For women using in vitro fertilization, there is also an
increased likelihood of multiple births.

"With IVF, there's about a 20 to 30 percent chance of twins.
And depending on how many embryos are put back, even triplets
can result.

"There are terrific options for getting pregnant in your 40s
now. Sometimes it means that, just because you're older, you
may have to use donor eggs. But you're very likely to have a
healthy pregnancy, and most of these pregnancies turn out just
fine."