More women in Ahmedabad are having babies in their mid-thirties and forties, and many pregnancies now begin with IVF, ICSI or other fertility treatment. Most of these pregnancies go well. They do carry a higher chance of certain conditions - pre-eclampsia, gestational diabetes, placenta problems, twins and, with rising maternal age, chromosomal conditions - so they benefit from a schedule planned in advance rather than one that reacts to problems.
After a long journey to conceive, it is natural to feel anxious before every scan. A clear plan helps: you know what is being checked, at which week, and why. Knowing that most checks are routine precautions, not signs that something is wrong, makes the months ahead easier.
Dr. Devang Patel looks after IVF and 35+ pregnancies at Divine Women’s Hospital, Gota, Ahmedabad, taking over from your fertility centre once the pregnancy is established and continuing through delivery. Scans, including the FMF (UK) accredited NT scan, are performed by the same consultant who manages your pregnancy.
Why these pregnancies are planned more closely
Age and fertility treatment each add a small amount of risk, and they often occur together. The extra care is not because something is expected to go wrong; it is so that the commoner problems are found early, when they are easiest to manage.
- Chromosomal conditions: the chance of Down syndrome at birth is roughly 1 in 1,250 at 25, 1 in 350 at 35, 1 in 100 at 40 and 1 in 30 at 45; with donor eggs, it follows the donor’s age
- Pre-eclampsia is more common after IVF, particularly after frozen embryo transfer, egg donation and in a first pregnancy over 40
- Gestational diabetes and chronic high BP become more common with each decade
- Placenta praevia and placenta accreta are slightly more frequent after IVF
- Twins are more likely after IVF, especially when more than one embryo is transferred
- Miscarriage rates rise with age, from about 10–15% in the twenties to around 50% at 45
- Stillbirth risk near term is somewhat higher over 40, which affects the timing of delivery
The first weeks after a positive test
In an IVF pregnancy the dates are exact, calculated from the transfer date and embryo age, so the due date is rarely changed by scan. An early scan at about 6–7 weeks confirms that the pregnancy is in the uterus, shows the heartbeat and counts the sacs. Ectopic pregnancy and the rare heterotopic pregnancy (one in the uterus and one outside) are more common after IVF, so one-sided pain or bleeding should be reported quickly.
Progesterone support after embryo transfer is usually continued until about 10–12 weeks, as advised by your fertility specialist. Do not stop any fertility medicine suddenly. Bring your IVF summary and full medicine list to the first visit so that each one - progesterone, oestradiol, aspirin or heparin - can be continued, tapered or stopped at the right time.
Early blood tests include a blood group, haemoglobin, TSH, sugar screening, and HPLC for thalassaemia trait if not done before. Folic acid, vitamin D, calcium and iron are reviewed, and women with a high BMI or previous neural tube defect may need a higher folic acid dose.
Choosing how to screen for chromosomal conditions
Screening is offered to every pregnant woman, and age by itself is not a reason to go straight to an invasive test. The options differ in what they look for, how accurate they are and whether they carry any risk to the pregnancy.
| Test | When | What it tells you |
|---|---|---|
| Combined first-trimester screening | 11–13+6 weeks | NT scan with blood markers gives a personalised chance for Down syndrome and trisomies 18 and 13; also an early look at the baby’s anatomy |
| Cell-free DNA test (NIPT) | From 10 weeks | A blood test detecting over 99% of Down syndrome pregnancies; a high-chance result still needs confirmation |
| CVS | 11–14 weeks | Diagnostic: tests placental cells for a definite answer; small procedure-related risk |
| Amniocentesis | From 15 weeks | Diagnostic: tests amniotic fluid cells; small procedure-related risk |
Whatever screening you choose, the 11–14 week scan and the 18–22 week anomaly scan remain important for checking the baby’s structure.
Pre-eclampsia, sugar and blood pressure checks
At the 11–14 week visit, your history, BP, a uterine artery Doppler and, where available, blood markers are combined into a pre-eclampsia risk. Women at raised risk are advised low-dose aspirin taken at night from 12 weeks, ideally started before 16 weeks, and continued to about 36 weeks. Adequate calcium intake also helps.
Sugar is checked early in IVF and 35+ pregnancies, because diabetes may already be present. Following the DIPSI approach used in India, a 75 g glucose test with a two-hour value of 140 mg/dL or more indicates gestational diabetes. If the first test is normal, it is repeated at 24–28 weeks.
BP is measured at every visit. A reading of 140/90 or more, protein in the urine, headache or swelling of the face is assessed the same day.
Twins after fertility treatment
If the early scan shows twins, the most important step is to determine by 14 weeks whether the babies share a placenta (monochorionic) or each have their own (dichorionic). Twins who share a placenta need scans every two weeks from 16 weeks to watch for twin-to-twin transfusion syndrome; those with separate placentas are usually scanned every four weeks.
Twin pregnancies carry a higher chance of preterm birth, anaemia, pre-eclampsia and gestational diabetes, so iron, BP and sugar checks are closer. Cervical length may be measured in mid-pregnancy. Delivery is usually planned around 37 weeks for dichorionic and 36 weeks for uncomplicated monochorionic twins.
Scans through pregnancy
- 6–7 weeks: location, heartbeat, number of babies
- 11–13+6 weeks: NT scan, early anatomy, combined screening and pre-eclampsia risk
- 18–22 weeks: level II anomaly scan, placental position and, where relevant, cervical length
- Fetal echocardiography when indicated, for example after ICSI with additional risk factors, diabetes or a heart finding
- 28–36 weeks: growth scans with Doppler, more frequent if BP, sugar or growth is a concern
- A third-trimester check of placental position if it was low at 20 weeks
Looking after your emotional wellbeing
Many couples who have been through fertility treatment find it hard to relax even after a good scan. That anxiety is common and understandable. You are welcome to ask questions at every visit, and a short phone call to clarify a report is always better than worrying for days.
Low mood, panic or sleeplessness that persists for more than two weeks, during or after pregnancy, deserves attention in its own right. Mental health is asked about as part of routine visits, and support or referral is arranged when needed.
Planning the birth
An IVF pregnancy is not, by itself, a reason for a caesarean, and many women in their late thirties and forties deliver vaginally. The mode of birth is decided on the same grounds as for any pregnancy: the baby’s position and size, the placenta, your health and how labour progresses.
For women aged 40 and over, induction of labour at about 39 weeks is commonly offered because of the slightly higher stillbirth risk near term; it does not increase the caesarean rate. Twins, placental problems, high BP or diabetes may bring the timing earlier. Your preferences are part of this plan.
After the birth and the years ahead
BP is watched closely for the first week after delivery, especially after pre-eclampsia. Women who had gestational diabetes have a glucose test 6–12 weeks after birth and yearly sugar checks thereafter, because their lifetime risk of type 2 diabetes is several times higher. Pre-eclampsia is also a lifelong signal to keep an eye on BP, weight and cholesterol.
If you have frozen embryos and are thinking of a sibling, a gap of at least 12–18 months before the next transfer is generally advised, longer after a caesarean. A pre-conception visit before the next cycle allows thyroid, BP, weight and medicines to be optimised.
Your care, step by step
- Handover from the IVF centreYour IVF summary, transfer date and medicines are reviewed to confirm dates and plan when each medicine is tapered.
- Early screeningViability scan, then NT scan, combined or cell-free DNA screening and pre-eclampsia risk at 11–14 weeks.
- Structured follow-upAnomaly scan, sugar and BP checks, and growth scans planned by week, with the plan explained in Gujarati, Hindi or English.
- Delivery planTiming and mode of birth agreed in advance, with 24 × 7 labour, theatre and neonatal cover at Divine Women’s Hospital.
- Postnatal reviewBP, sugar follow-up, feeding, mood and contraception or future-pregnancy planning at the six-week visit.
When to book a visit
- You have 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 frozen embryo transfer
- You are carrying twins or more after fertility treatment
- You have had previous miscarriages and are pregnant again
- You have high BP, diabetes or thyroid disease alongside a new pregnancy
Warning signs - get same-day care
- One-sided lower abdominal pain or fainting in early pregnancy
- Heavy vaginal bleeding or passing clots
- Severe headache, blurred vision or sudden swelling of the face and hands
- Rapid abdominal swelling, breathlessness or very little urine soon after IVF, which may signal ovarian hyperstimulation
- Reduced baby movements in the second half of pregnancy
- Leaking fluid or regular tightenings before 37 weeks
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: IVF babies always need a caesarean.
IVF is not a reason for caesarean on its own. Mode of birth depends on the same factors as in any pregnancy.
Myth: Complete bed rest protects an IVF pregnancy.
Bed rest does not reduce miscarriage and raises the risk of blood clots. Normal daily activity is encouraged unless there is a specific reason.
Myth: Women over 35 must have amniocentesis.
Age alone is not a reason for an invasive test. Screening first gives a personalised chance, and many women avoid an invasive test altogether.
Myth: Once the IVF pregnancy is confirmed, the risks are over.
The first trimester is only the beginning. Pre-eclampsia, diabetes and growth problems tend to show later, which is why follow-up continues.
Frequently asked questions
Is pregnancy after 35 high risk?
Pregnancy after 35 carries a somewhat higher chance of chromosomal conditions, diabetes, high BP and placenta problems, so it is managed with extra screening. Most women over 35 have healthy pregnancies and healthy babies.
Is an IVF baby different from a naturally conceived baby?
Most IVF babies are entirely healthy. Large studies show only a small increase in some risks, such as preterm birth and low birth weight, partly related to the reasons for infertility rather than IVF itself.
Should I have NIPT or amniocentesis because of my age?
Age alone is not a reason for an invasive test. The NT scan with blood screening, with or without NIPT, gives a personalised result. CVS or amniocentesis is offered if screening shows a higher chance or if you prefer a definite answer.
Does an IVF pregnancy always need a caesarean?
No. The mode of delivery is decided on the same grounds as any pregnancy: the baby’s position, the placenta, your health and how labour progresses.
When can I stop progesterone after IVF?
Progesterone support is usually continued until about 10–12 weeks, when the placenta takes over hormone production. The exact timing depends on your IVF protocol and is agreed with you and your fertility specialist.
Why is aspirin given in IVF pregnancies?
Low-dose aspirin reduces the chance of early, severe pre-eclampsia in women at raised risk. It is started from 12 weeks, ideally before 16 weeks, taken at night and usually stopped at about 36 weeks.
How is the due date calculated in an IVF pregnancy?
From the date of embryo transfer and the age of the embryo. For a day-5 blastocyst transfer, the due date is 261 days after the transfer. Because the dates are exact, scans are not used to change them.
Can I get pregnant naturally after 40, or do I need IVF?
Natural conception after 40 is possible, but fertility falls and miscarriage becomes more common. Women over 35 who have tried for six months without success are advised to have a fertility review. Once pregnant, the care plan is the same whichever way the pregnancy began.
Is travel allowed in an IVF pregnancy?
Short car journeys and flights are generally fine in an uncomplicated pregnancy, ideally in the second trimester. Keep moving, drink water and carry your reports. Avoid long trips if you have bleeding, twins with complications or high BP.