IVF Pregnancy Care in Ahmedabad and Pregnancy After 35: My Plan

Pregnancy After 35: Risks and What Changes With Age

The main risks of pregnancy after 35 are chromosomal conditions, miscarriage, diabetes and blood pressure problems. Each rises gradually with every year, rather than jumping at a birthday.

Chromosomal conditions. The approximate chance of Down syndrome at birth rises with the mother's age:

With donor eggs, the chromosomal risk follows the age of the donor, not yours.

Other age-related changes

• Miscarriage rates rise from about 10–15% in the twenties to around 50% at 45.
• Gestational diabetes and chronic hypertension become more common with each decade.
• Stillbirth near term is somewhat more likely over 40, and this shapes when I suggest delivery.

IVF Pregnancy Risks: Why I Plan These Pregnancies More Closely

Many women who need IVF are older, so the risks overlap with those of age. Some, however, are linked to the treatment itself:

• Pre-eclampsia (high BP with protein in the urine) is more common after IVF. This is especially so after frozen embryo transfer or egg donation, and in a first pregnancy over 40.
• Placenta praevia and accreta are slightly more frequent after IVF.
• Twins are more likely after IVF, especially when more than one embryo is transferred.
• Ectopic and heterotopic pregnancies are more common, which is why the early scan checks where the pregnancy is.
• Preterm birth and low birth weight show small increases in large studies.

None of these is a reason for alarm. They are the reason I schedule checks in advance instead of waiting for symptoms.

Your First Weeks After a Positive Pregnancy Test

• Due date. In an IVF pregnancy the due date comes from the transfer date and the age of the embryo, so scans rarely change it.
• Early scan. At about 6–7 weeks I confirm where the pregnancy is, see the heartbeat and count the sacs.
• Ectopic risk. Ectopic and heterotopic pregnancies are more common after IVF. Tell us promptly about pain on one side or any bleeding.
• Hormone support. Progesterone is usually continued to about 10–12 weeks, as your fertility doctor advises. Please do not stop progesterone, oestradiol, aspirin or heparin suddenly. Bring your IVF summary and full list of medicines to your first visit.
• Early blood tests: blood group, haemoglobin, TSH, a sugar screen, and HPLC for thalassaemia trait if it has not already been done.
• Supplements. I review folic acid, vitamin D, calcium and iron. A higher dose of folic acid may be needed if your BMI is high or there was an earlier neural tube defect.

How Your IVF Pregnancy Weeks and Due Date Are Worked Out

In an IVF pregnancy, your weeks are counted from the embryo transfer date, not from your last period, because the day of fertilisation is known exactly. By convention, pregnancy weeks are still counted as if from a period two weeks before fertilisation. So on the day of a day-5 blastocyst transfer, you are counted as 2 weeks and 5 days pregnant. On the day of a day-3 transfer, you are 2 weeks and 3 days.

The same rule applies to frozen embryo transfers, using the embryo's age when it was frozen. Your fertility centre's summary gives both the transfer date and the embryo's day, so please bring it. The pregnancy due date calculator on this site works from a period date or a conception date, and its IVF section explains which date to enter. For an IVF pregnancy, the transfer-based date is the one we keep.

Deciding How to Screen for Chromosomal Conditions

I offer screening to every pregnant woman. Age by itself is not a reason to go straight to an invasive test.

Whichever screening you choose, the 11–14 week scan and the 18–22 week anomaly scan remain important.

Checks for Pre-eclampsia, Sugar and Blood Pressure

• Pre-eclampsia risk. At 11–14 weeks I combine your history, BP, a uterine artery Doppler and blood markers into a pre-eclampsia risk. If it is raised, I advise low-dose aspirin at night from 12 weeks - ideally started before 16 weeks - and continued to about 36 weeks, along with enough calcium.
• Sugar. I screen early, because diabetes may already be present. With the DIPSI method (a 75 g glucose test), a 2-hour value of 140 mg/dL or more means gestational diabetes. If the early test is normal, it is repeated at 24–28 weeks.
• Blood pressure is measured at every visit. A reading of 140/90 or more, protein in the urine, a headache or swelling of the face is assessed the same day.

IVF Twin Pregnancy Care

• I aim to establish chorionicity - whether the twins share a placenta (monochorionic) or have separate ones (dichorionic) - by 14 weeks.
• Monochorionic twins have a scan every fortnight from 16 weeks onwards, looking for twin-to-twin transfusion syndrome.
• Dichorionic twins are usually scanned every four weeks.
• Twins bring a higher chance of preterm birth, anaemia, pre-eclampsia and gestational diabetes, so iron, BP and sugar are checked more closely. Cervical length may be measured in mid-pregnancy.
• Planned delivery is usually around 37 weeks for dichorionic twins and 36 weeks for uncomplicated monochorionic twins.

IVF Antenatal Care: Your Scan Timetable

IVF antenatal care follows the same core scans as any pregnancy, with a few additions where IVF or age calls for them:

• 6–7 weeks: location, heartbeat and number of babies
• 11–13+6 weeks: NT scan, early anatomy, combined screening and pre-eclampsia risk.
• 18–22 weeks: level II anomaly scan, position of the placenta, and cervical length where relevant.
• Fetal echocardiography (a detailed heart scan) when indicated. Examples are after ICSI with added risk factors, with diabetes, or if a heart finding is seen.
• 28–36 weeks: growth scans with Doppler, more often if BP, sugar or growth is a concern.
• Third trimester: a placental position check if the placenta was low at 20 weeks.

Looking After Your Emotional Health

Anxiety after fertility treatment is very common, even when every scan has been good. Ask me anything at any visit; a phone call to clear up a report is far better than days of worry. If low mood, panic or poor sleep lasts more than two weeks - during pregnancy or after the birth - please tell us. I ask about your mental health at routine visits and arrange support or referral when it is needed.

IVF Pregnancy Care Tips for Day-to-Day Life

After the long road to a positive test, many couples become very cautious. Most everyday life can carry on as before. These are the points I usually stress:

• Medicines: keep progesterone, oestradiol, aspirin or heparin going exactly as prescribed until we agree how to taper them.
• Activity: walking, light housework and office work are generally fine; there is no need to stay in bed.
• Food and supplements: regular, balanced meals with protein at each one, plus the folic acid, iron, calcium and vitamin D I prescribe. Calorie needs rise only modestly, and only after the first trimester.
• Habits: no tobacco in any form and no alcohol; keep tea and coffee moderate.
• Your IVF summary: keep a copy on your phone, so any doctor who sees you in an emergency knows your transfer date and medicines.
• Intimacy and travel: usually fine in an uncomplicated pregnancy; I will tell you if bleeding, a low placenta or complicated twins mean you should hold back.

Pregnancy After 40: Risks and Planning the Birth

After 40, the risks described above rise further, and they shape how I plan the birth. The chance of Down syndrome is about 1 in 100 at 40. Miscarriage and pre-eclampsia in a first pregnancy are more common, and stillbirth near term is slightly more likely.

IVF on its own is not a reason for a caesarean, and many women in their late thirties and forties give birth vaginally. The way your baby is born depends on the baby's position and size, the placenta, your health and how labour progresses.

For women aged 40 or over, I commonly offer induction at about 39 weeks, because the risk of stillbirth late in pregnancy is slightly higher. Trials have not shown it to raise the chance of a caesarean. Twins, placental problems, high BP or diabetes may bring the timing earlier. Your own preferences are part of the plan.

After the Birth, and Looking Further Ahead

• Your BP is watched closely through the first week after delivery, especially after pre-eclampsia.
• After gestational diabetes, plan a glucose test 6–12 weeks after delivery and then a yearly sugar test; the lifetime risk of type 2 diabetes is several times higher.
• Pre-eclampsia is a lifelong reminder to keep an eye on BP, weight and cholesterol.
• If you have frozen embryos and plan a sibling, I suggest at least 12–18 months between transfers, and longer after a caesarean.
• A pre-conception visit before the next pregnancy helps us get your thyroid, BP, weight and medicines right.

How My Care Runs, in Five Stages

1. Handover from the IVF centreI go through your IVF summary, transfer date and medicines, and agree a plan for tapering them.
2. Early screeningviability scan, NT scan, combined or cell-free DNA screening, and pre-eclampsia risk at 11–14 weeks.
3. Structured follow-upanomaly scan, sugar and BP checks, and growth scans by week, with the plan explained in Gujarati, Hindi or English.
4. A delivery plantiming and mode agreed in advance, with the hospital's 24×7 labour, theatre and neonatal service at Divine Women's Hospital.
5. A postnatal review at six weeksBP, sugar follow-up, feeding, mood, and contraception or planning for the next pregnancy.

Reasons to See Me After IVF or Over 35

• A positive pregnancy test after IVF, ICSI or IUI.
• You are 35 or older and pregnant, or planning a pregnancy.
• You conceived with donor eggs or after a frozen embryo transfer.
• You are carrying twins or more after fertility treatment.
• You have had miscarriages before and are pregnant again.
• You have high BP, diabetes or thyroid disease alongside a new pregnancy.

IVF and Age-35 Myths, Answered

Questions Patients Often Ask Me About IVF and Later-Age Pregnancy