More women are starting or expanding their families later - after completing studies, building careers, or after a second marriage or fertility treatment. A pregnancy after 35 is sometimes still described as “geriatric” or “elderly”, terms that cause needless worry. Most women in their late 30s and 40s have healthy pregnancies and healthy babies. Age does bring some changes in fertility and in the chance of certain complications, and knowing about them allows you to plan, screen and monitor in a sensible way.
How fertility changes with age
A woman is born with all the eggs she will ever have. Both the number and the quality of eggs fall with age, and the decline becomes faster after about 35 and more marked after 40. Lower egg quality means a lower chance of conceiving each month and a higher chance that an embryo has a chromosomal problem, which is the main reason miscarriage becomes more common with age.
- Under 35: seek advice if you have not conceived after 12 months of regular intercourse
- 35 to 39: seek advice after 6 months of trying
- 40 and above: an assessment soon after deciding to try is reasonable
- At any age, see a doctor sooner if periods are irregular, you have known endometriosis, PCOS, previous pelvic surgery or infection, or your partner has a known sperm problem
Tests of ovarian reserve, such as AMH and an antral follicle count on ultrasound, help estimate how many eggs remain and guide treatment choices. They do not predict exactly when you will conceive. For women who wish to delay pregnancy, egg freezing is an option that works more reliably when done before 35.
The male partner’s age matters too, though less sharply. Sperm quality declines gradually with age, and men over about 45 to 50 have a slightly higher chance of a longer time to conception and of some rare genetic conditions in the baby. A semen analysis is a simple, early part of any fertility assessment for the couple.
Before you conceive
- Start folic acid at least three months before trying
- Have a pre-pregnancy check of blood pressure, blood sugar, thyroid, haemoglobin, vitamin D and rubella immunity
- Review any long-term medicines - some need to be changed before pregnancy
- Bring blood pressure, diabetes and thyroid disease under good control first
- Aim for a healthy weight and regular activity; stop smoking and alcohol
- Update your cervical screening (Pap smear) if due
Screening and tests for the baby
The chance of a chromosomal condition such as Down syndrome rises with the mother’s age - at term it is roughly 1 in 350 at 35 and about 1 in 100 at 40. That means the large majority of babies born to older mothers do not have a chromosomal condition. Screening is offered to every pregnant woman, and is especially worth discussing after 35.
- The NT scan with combined blood test at 11 to 13 weeks 6 days
- Cell-free DNA screening (NIPT) from 10 weeks, which has a higher detection rate for the common trisomies
- Diagnostic tests - CVS or amniocentesis - if screening shows a higher chance, or by choice after counselling
- A detailed anomaly scan at 18 to 22 weeks, and a fetal echocardiogram when indicated
Pre-natal sex determination is prohibited under the PCPNDT Act. The sex of the baby is not detected or disclosed at any scan.
Pregnancy risks that rise with age
The overall risk for any individual woman remains low, but the following are more common after 35 and especially after 40, which is why antenatal care is planned more closely:
- Miscarriage and ectopic pregnancy
- Gestational diabetes - an early sugar test is usually advised
- High blood pressure and pre-eclampsia - low-dose aspirin may be recommended from the first trimester
- Twins, particularly after fertility treatment
- Placenta problems, including placenta praevia
- A baby who is smaller than expected, and a slightly higher risk of stillbirth near term
- A higher chance of caesarean delivery
How your antenatal care may differ
- An early dating scan, and first-trimester risk assessment for pre-eclampsia
- Earlier and repeated sugar testing
- Closer blood pressure monitoring
- Growth scans in the third trimester, with Doppler when needed
- Discussion of the timing of delivery - for women 40 and above, RCOG suggests offering induction of labour at 39 to 40 weeks, because the risk of stillbirth rises after this point
Looking after your own health during pregnancy makes a real difference: take the iron, calcium and folic acid you are prescribed, keep active with walking or prenatal yoga, follow a balanced diet, and keep every scheduled visit. Older mothers are also more likely to have demanding jobs and older children at home, so plan rest and support in advance, especially for the last weeks and the months after delivery.
Age alone is not a reason for a caesarean. Many women over 35, including first-time mothers, have a normal delivery. The plan is based on how the pregnancy progresses.
Pregnancy after IVF
Many pregnancies after 35 follow IVF, sometimes with donor eggs. IVF pregnancies carry a somewhat higher chance of high blood pressure, placenta problems and preterm birth, especially with donor eggs or twins. Transferring a single embryo lowers the chance of twins. Once pregnant, care continues like any other high-risk pregnancy, with extra attention to blood pressure and growth.
When to see a doctor
If you are 35 or older and planning a pregnancy, a pre-pregnancy visit is a useful first step. Seek advice after six months of trying, or sooner at 40 and above. Once pregnant, book your first visit early, by 8 to 10 weeks, so the NT scan and early tests are not missed. At Divine Women’s Hospital, Gota, Dr. Devang Patel, who holds an FNB in High Risk Pregnancy & Perinatology, provides pre-pregnancy counselling, screening and antenatal care for women conceiving after 35, including after IVF.
Related care: IVF pregnancy and pregnancy after 35
More patient guides
- The NT scan at 11–14 weeks: what it checks and how to prepare
- High blood pressure in pregnancy: the warning signs you should not wait on
- Expecting twins? Why “do they share a placenta?” is the first question
- NIPT or NT scan: which test do you need, and can one replace the other?
- Uterine fibroids: symptoms, when to treat, and the options available
This guide is general information for patients and does not replace a consultation with your own doctor.