Text: Émilie Mathys

Becoming a mum at 40: the fertility challenge

The desire for motherhood still comes up against biology. While scientific progress has made it possible for women in their 40s to have children, fertility itself remains a challenge for the medical world.

Eva Longoria, Adriana Karembeu and Céline Dion are celebrities who all became mothers late in life, attracting media attention. Closer to home, in August the magazine L’Illustré featured a story about women in French-speaking Switzerland who gave birth after age 44. These stories raise hopes in a country where the average age that women have their first child is 31.2 according to the Swiss Federal Statistical Office (FSO). But they often hide the role of science in these “late pregnancies”. “I see patients over 40 several times a day and, several times a month, expectant mothers aged 45 and older. It’s not a rare phenomenon,” says Professor David Baud, chief of the Service of Obstetrics at Lausanne University Hospital (CHUV), who specialises in high-risk pregnancies. The FSO estimates that the number of women who give birth over age 40 has doubled since the 2000s. Two-thirds of the patients he sees in his practice got pregnant through medically assisted procreation (MAP).

Social changes come up against biology, which does not always follow. Longer studies, travel, longer working hours, unstable jobs and relationships are some of the factors that explain why plans to have a baby sometimes take a long time to materialise. Not to mention the overall decline in fertility, primarily due to the older age of first-time parents.
With no lack of patients, fertility medicine at the CHUV actually saw an increase in activity of almost 70% between 2016 and 2021. “Most of our patients are over age 38,” says Anna Surbone, senior physician at the Fertility Medicine and Gynaecological Endocrinology unit, which offers a range of MAP services. “Even though women are getting pregnant later in life, fertility rates are not necessarily keeping up,” the specialist says. She frequently sees 40-year-old women, who expect science to perform miracles and are shocked when they hear about the success rates. “Over the age of 43, the chances of success (i.e. carrying a baby to term) of in vitro fertilisation are around 5%, because ovarian reserve and oocyte quality decline rapidly with age. There are biological limits that cannot be exceeded. We really need to educate people, especially so that young women, if they wish to, freeze their oocytes as early as possible.” Otherwise, for the time being, egg donation is prohibited in Switzerland. Single women and couples aged 45 and older often go to Spain or Denmark to obtain “younger” oocytes.

A baby at any cost

Those who decide to take the route of in vitro fertilisation (IVF), the most successful MAP technique, are better off doing so with a full bank account. A cycle of IVF costs between 8,000 and 10,000 Swiss francs and often takes several tries before eventually giving birth. The cost is high and is not reimbursed. “Despite the financial sacrifice of MAP, we receive a wide range of profiles. They want a child, whether rich or poor. Some couples take out loans or dip into their savings. But we sometimes see couples forgo an additional cycle because they can’t afford it. It's very frustrating.”

For couples who are fortunate enough to reach a positive pregnancy test, the road to parenthood can be a tortuous one. “It’s not crazy to have a child over 40, if you’re in good health. Most pregnancies go well. But it’s true that with age the likelihood of getting diseases such as hypertension and diabetes increases.
It’s also more common to give birth to premature babies or by Caesarean section,” Professor David Baud says, underlining that the most important thing is the woman’s pre-existing state of health before pregnancy.

Medical progress and MAP legislation will continue to change with time (see box), likely giving many women the opportunity to experience motherhood in the second half of their life. But the fact remains that fertility will be a major issue for the next few years. “Sperm quality is declining by 1% per year worldwide, mainly because of pollution and high temperatures, which disrupt sperm production. At this rate, there won’t be any sperm left in 100 years,” Professor Baud laments. By that time, MAP treatments will be obsolete. /

The Swiss Federal Act on Medically Assisted Reproduction (LPMA)

Swiss law puts the child’s well-being first. While there are no official limits on access to MAP, parents must be able to provide for the child’s needs until the age of 18. In addition, any treatment is subject to consent from both partners.

Switzerland is currently the only European country, along with Germany, to prohibit egg donation, but that is likely to change soon. The Council of States followed the National Council in accepting a motion in September 2022 to authorise egg donation, aligning it with sperm donation, which is authorised for married couples when the man is infertile.
Married female couples have also had access to sperm donation since July 2022. However, egg donation will only be possible for couples in which the woman is infertile.

For now, couples and single women who want to benefit from egg donation must travel abroad, as treatment is not reimbursed here.
Surrogacy and sperm donation for unmarried couples and single women are excluded from the LPMA, as is gender selection (except for cases involving a serious sex-related disease).



Anna Surbone

“Even though women are getting pregnant later in life, fertility rates are not necessarily keeping up,” says Anna Surbone, senior physician at the Fertility Medicine and Gynaecological Endocrinology unit.