Pregnancy After 35: Your Real Chances, Risks and Next Steps

Last updated October 2, 2026. Educational information, not medical advice: see our Medical Disclaimer.

If you’re thinking about pregnancy after 35, you’ve probably heard two opposite messages: that 35 is a fertility “cliff,” and that plenty of women have babies in their 40s. Neither is the full picture. Fertility does decline with age, and some pregnancy risks rise. But those changes build gradually, and some risks don’t rise until 40 or later.

This guide covers what changes after 35, using guidance from the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM). It includes the real numbers for women in their late 30s and early 40s, when to get help sooner, and the steps that improve your odds of a healthy pregnancy. If your cycles have become unpredictable, our guide to irregular periods in perimenopause covers that related question.

In this article:

• You’re Not Alone in Having a Baby After 35
• How Fertility Changes After 35
• When to See a Doctor About Fertility
• Pregnancy Risks After 35, in Context
• What Changes at 35 vs 40
• How to Prepare for Pregnancy After 35
• What About Egg Freezing?
• Pregnancy After 35 FAQ
• Your Next Step

You’re Not Alone in Having a Baby After 35

You’re far from alone in starting or growing a family later. In the CDC’s final birth data for 2024, the average age of mothers at first birth reached a record high of 27.6 years. The number of births to women ages 35 to 39 rose 3% from 2023, though the birth rate for that age group held steady. The birth rate for women ages 40 to 44 rose (CDC National Center for Health Statistics).

Knowing how fertility and pregnancy change with age isn’t meant to scare anyone off. It helps you plan with accurate expectations.

How Fertility Changes After 35

According to ACOG, a woman’s peak reproductive years are from the late teens to the late 20s. By 30, fertility starts to decline. The decline speeds up in the mid-30s, and by 45 getting pregnant naturally is unlikely (ACOG).

Three things drive that change:

• Fewer eggs. You’re born with all the eggs you’ll ever have. ASRM estimates about 1 million egg-containing follicles at birth, falling to about 300,000 by puberty (ASRM).
• Egg quality. The eggs that remain are more likely to have abnormal chromosomes.
• Other conditions. With age, you’re more likely to have developed conditions that affect fertility, such as uterine fibroids or endometriosis.

In practical terms, ACOG says about 1 in 4 women in their 20s and early 30s will get pregnant in any single menstrual cycle. By 40, it’s about 1 in 10. A man’s fertility also declines with age, though less predictably.

Age isn’t the only factor. ACOG calls PCOS one of the most common causes of female infertility (ACOG). If your cycles have always been irregular, our guide to PCOS symptoms is worth a read.

When to See a Doctor About Fertility

The timeline for asking for help shortens with age. ASRM sets the first two timelines below (ASRM), and ACOG adds advice for women over 40:

• Under 35: seek an evaluation after 12 months of trying without success.
• 35 or older: seek an evaluation after 6 months.
• Over 40: ACOG recommends an evaluation before you start trying.

Here’s how that plays out. Say you’re 37 and start trying in January. If you’re not pregnant by July, that’s the point to book a fertility evaluation. If you’re 41, ACOG’s advice is to book it before you start in January.

ACOG adds that seeing someone early matters even more if you have a known condition that can affect fertility, such as endometriosis. An evaluation involves a physical exam and tests to look for a cause. Treatment can often help even when no cause is found, but ACOG notes that success rates for fertility treatment also decline with age, one reason earlier evaluation is advised.

Pregnancy Risks After 35, in Context

You may see the term “advanced maternal age” in your records. ACOG and the Society for Maternal-Fetal Medicine note it has historically meant being 35 or older at your due date. They suggest doctors treat it as a risk factor when counseling patients and planning care (ACOG/SMFM Obstetric Care Consensus No. 11).

That label doesn’t mean every risk jumps at 35. ACOG stresses that these risks don’t all increase at once, and some don’t rise until 40 or later. Part of the increase comes from health conditions that become more common with age, such as high blood pressure. ACOG also notes that older women without any health conditions can still have complicated pregnancies (ACOG).

Miscarriage

Miscarriage risk rises with age, and most of that rise comes after 35. A study of 421,201 pregnancies in Norway between 2009 and 2013, published in the BMJ in 2019, estimated miscarriage risk at each age (Magnus et al., BMJ, 2019):

• About 10% at ages 25 to 29, the lowest of any group
• About 11% at 30 to 34
• About 17% at 35 to 39
• About 32% at 40 to 44
• About 54% at 45 and older

Across all ages, 12.8% of pregnancies ended in miscarriage (Norwegian Institute of Public Health).

Chromosomal conditions

The overall risk of a chromosomal condition is small, but it rises with age. Down syndrome is the most common one linked to later pregnancy. ACOG lists these risks:

Even at 40, that means roughly 85 of every 86 pregnancies are not affected by Down syndrome. ACOG is also clear that prenatal screening and diagnostic tests are offered in every pregnancy, at any age. Whether to have them is your choice, and your ob-gyn can walk you through the options.

Other risks and delivery

• Preeclampsia: the risk rises for women who get pregnant after 40. If you’re 35 or older and have certain other risk factors, your ob-gyn may recommend low-dose aspirin during pregnancy.
• Stillbirth: the risk is higher after 35. To reduce it, ACOG says your ob-gyn may recommend giving birth at 39 weeks if you’re 40 or older. You may also have extra visits and tests late in pregnancy.
• Twins: multiple pregnancy is more common with age, partly because aging ovaries are more likely to release more than one egg. Multiple pregnancies can be healthy but can raise the risk of preterm birth.
• Delivery: older age by itself doesn’t mean you need a cesarean birth. If your pregnancy has few or no complications, a vaginal birth is an option.

What Changes at 35 vs 40

Because many changes happen gradually, it helps to see them side by side:

How to Prepare for Pregnancy After 35

These steps from ACOG apply at any age. ACOG says talking with your ob-gyn before trying is especially important if you’re older than 35:

1. Stop alcohol, tobacco and marijuana. Ask a health care professional for help if you need it.
2. Start a prenatal vitamin with folic acid. The CDC recommends 400 micrograms of folic acid daily for anyone who could become pregnant, starting at least one month before conception (CDC).
3. Book a prepregnancy visit with your ob-gyn. ACOG says this visit covers your medical and family history, past pregnancies, medications and vaccines. It can also cover your diet and weight, screening for sexually transmitted infections, and carrier screening for genetic conditions.

Questions to bring to your prepregnancy visit

Based on ACOG’s guidance, these questions can help you use the time well:

• Do any of my current medications need to change before I try?
• Am I up to date on the vaccines recommended before pregnancy?
• Should I have carrier screening, and should my partner?
• Do I need screening for sexually transmitted infections?
• Do I have any risk factors for preeclampsia that we should plan for?
• Given my age and history, when should I come back if I’m not pregnant yet?

Track your cycle

It also helps to know your cycle. Tracking cycle length and any symptoms for a few months gives your doctor useful information. Our free printable perimenopause symptom and cycle tracker works for this. If your cycles are changing in your 40s, our perimenopause symptoms checklist can help you spot whether perimenopause is starting.

What About Egg Freezing?

Egg freezing gets a lot of attention, but ACOG’s position on it is cautious. ACOG says no medical technique can guarantee fertility will be preserved. It recommends egg freezing mainly for women having cancer treatment that will affect their fertility, and says there isn’t enough research to recommend routine egg freezing only to delay childbearing. It’s also expensive and may not be covered by insurance (ACOG).

Age at freezing matters too. ASRM notes that outcomes using frozen eggs become less favorable the older a woman is when her eggs are frozen (ASRM). If you’re weighing it, a consultation with a fertility specialist can give you numbers specific to your age and health.

Pregnancy After 35 FAQ

Your Next Step

If you’re 35 or older and planning a pregnancy, book a prepregnancy visit now, start folic acid, and track your cycles for a few months. If your periods are becoming irregular or you’re noticing hot flashes or mood changes, take our 2-minute perimenopause self-check quiz and bring the results to your appointment. Changes in your cycle can also have hormonal causes beyond age. Our guide to hormonal imbalance symptoms covers the common ones.

About the author: Jessica Bordo writes Daily Health Cycle out of personal interest in women’s health, not as a clinician. She summarizes what sources such as ACOG, ASRM and the CDC say and links to them so you can check the claims yourself. No medical reviewer is listed for this article, so use it to prepare questions for your own clinician, not to replace their advice. Our editorial standards explain how we source and check articles.

This article is for general education and isn’t medical advice. See our full disclaimer and talk with a qualified clinician about your own care.

More guides for you

• Cortisol Belly Fat: What Stress Really Does to Your Waist
• PCOS Symptoms: What to Look For and How It’s Diagnosed
• Period Every 2 Weeks in Perimenopause: Causes and When to See a Doctor