Updated August 26, 2026

It’s becoming more and more common for people to delay getting pregnant until later in life, but what is the impact of waiting to have children? Many individuals over age 35 who are trying to conceive will experience issues with fertility and, once they become pregnant, are at a higher risk for certain complications. Fortunately, there are steps you can take to help plan your pregnancy and reduce the risk of complications. Vasiliki Moragianni, a reproductive endocrinologist and infertility specialist with the Johns Hopkins Fertility Center, discusses advanced maternal age and your options.

What is advanced maternal age?

Advanced maternal age historically refers to a pregnancy in which the individual will be age 35 or older at the estimated date of delivery. The majority of healthy people who get pregnant in their late 30s, and even into their early 40s, have healthy babies, but “age is one of the most important factors in fertility,” says Moragianni. “Your overall health, habits and medical history can impact your likelihood of becoming pregnant at any age. Fertility factors are really specific to each individual, which is why it can be helpful to consult a fertility expert when trying to conceive.”

How does age affect fertility?

Fertility begins to decline in the early 30s, with a more rapid decline after age 37. The ovaries contain approximately 1 to 2 million eggs at birth. As you age, both the quantity and the quality of your eggs decreases, making it less likely to have a successful pregnancy. By age 45, pregnancy is highly unlikely, but still possible, until your menstrual cycle officially ends and menopause begins.

Risk Factors for Advanced Maternal Age

Any pregnancy can experience complications. Some of the more common pregnancy complications include bleeding, miscarriage or amniotic fluid complications.

There are additional risk factors associated with becoming pregnant later in life. These can include an increased risk of:

• Miscarriage: Early pregnancy loss occurs in about 10% of clinically recognized pregnancies overall, and the risk rises substantially with maternal age. About half of early pregnancy losses are due to fetal chromosomal abnormalities.
• Gestational diabetes: The risk of gestational diabetes, a type of diabetes specific to pregnancy, increases with maternal age and is higher in pregnant individuals age 35 and older.
• Fetal chromosomal abnormalities: Genetic conditions like Down syndrome may be more common as the quality of eggs decreases with age.
• Cesarean delivery: Older mothers are at a higher risk of complications that may necessitate a C-section birth, but vaginal delivery is still the most common route of delivery after age 35. It can also depend on the health and personal preferences of the mother.
• Preterm birth: Preterm birth occurs more often with advancing maternal age; some preterm births are spontaneous and others are medically indicated. Giving birth before term can increase the risk of low birth weight and other health problems for the baby.
• Stillbirth: The risk of stillbirth remains low, but becomes higher with age.
• Multiple pregnancy, or carrying more than one baby at a time, is also more likely with advancing maternal age. Fertility treatments can further increase this chance, especially ovulation induction or transfer of more than one embryo during in vitro fertilization (IVF).
• The risk of preeclampsia increases with maternal age; age 35 or older is considered a moderate risk factor, and risk rises further after age 40.

Increased risk factors can also depend on the mother’s overall health. For example, you are more likely to develop high blood pressure as you age, and if you already have high blood pressure, your risk of developing additional symptoms from preeclampsia is much higher.

Benefits of Advanced Maternal Age

There are also some potential benefits associated with having children later in life, besides waiting until you feel you are ready. Some observational studies have found an association between older maternal age at last childbirth and longevity, but this does not show that delaying pregnancy causes longer life. Older parents also tend, on average, to have higher income and more education than younger parents, which may provide additional resources for their children.

What are the chances of getting pregnant at 35 and older?

Healthy individuals in their 20s and early 30s typically have a 25% chance of becoming pregnant during a single menstrual cycle. These odds gradually decrease to a less than 10% chance by age 40.

“The vast majority of people will become pregnant within the first 12 months of trying to conceive with regular unprotected intercourse,” Moragianni says.

When to See a Fertility Specialist

Fertility specialists can help with a variety of patient needs, from pregnancy planning and genetic testing to egg freezing. If you are struggling to conceive or know that you have an existing medical problem that may make it harder to get pregnant, you should seek consultation with a fertility specialist.

Moragianni recommends that those trying to conceive come in for an infertility evaluation after six months of trying if they are age 35 or older. For those over age 40, more immediate evaluation may be appropriate.

Fertility Consultations Prior to Pregnancy

If you are thinking about trying to become pregnant, start by making an appointment with your Gyn/Ob doctor for a health exam. There are vitamins, vaccines and other prenatal care tips that your gynecologist can offer to help provide the best chance for conception and staying healthy while pregnant. Early and regular prenatal care is very important for a successful pregnancy, especially if you are higher risk because of age. Your doctor can also assist with calculating your monthly fertility window so you know the optimal time to have sex to conceive.

A fertility specialist can go even further by working with you to craft a reproductive life plan. “We’re thinking about more than just your current pregnancy,” says Moragianni, “but also your overall health, infertility factors that may prevent conception, your options for genetic counseling, your wants and needs with this pregnancy and also your desires with future pregnancies you may wish to have. Our goal is to provide all available options so that you can make the right choices for you and your family, both for now and for later.”

Preserving Fertility

What if you aren’t ready to have children, but you want children in the future? There is no technique that can guarantee future fertility, but egg or embryo freezing may be an option to help preserve fertility for the future. Eggs can be frozen unfertilized for later use, or they can be fertilized through IVF and the resulting embryos frozen for later transfer.

Fertility preservation can also be a good option for patients with gynecologic cancer who are about to undergo surgical treatment, or for transgender people undergoing gender affirmation surgery who wish to have children after completing their treatment.

How does age affect recovery after birth?

For well-dated pregnancies with anticipated delivery at age 40 or older, delivery at 39 0/7–39 6/7 weeks is recommended because the risks of stillbirth and neonatal morbidity increase beyond this gestational age. For ages 35–39, age alone does not support a routine recommendation for delivery at 39 weeks; timing should be individualized. Maternal mortality is rare, but U.S. maternal mortality rates are substantially higher among individuals age 40 and older. Postpartum care should include contact with an obstetric care provider within the first three weeks after delivery, followed by ongoing care and a comprehensive postpartum visit no later than 12 weeks after birth.

Patients with specific risk factors or complications may need earlier follow-up; timing depends on the clinical situation. If you experience any of the following, seek medical care immediately:

• Dizziness
• Shortness of breath
• Fever and/or chills
• Heavy or gushing vaginal bleeding

Medically reviewed by Vasiliki Moragianni, M.D., M.S.C.