More and more women are waiting to have babies until later in life. There are so many reasons why—finances, career, relationship status—whatever the reason, it's becoming increasingly common to have a baby in your 30s or well into your 40s.
But despite these trends, it's also super common to sense a looming, ticking biological clock as you get older. It doesn't help that once you hit 35, if you become pregnant, you’re suddenly categorized as advanced maternal age. Just what every woman wants to hear.
The reality is that you can get pregnant and have a perfectly normal pregnancy later in life, but reproductive health does gradually change as you get older (for men too!). But no, the moment you turn 35, your eggs don't immediately 'go bad.'
So what really happens when you hit 35 and why does this age matter? With the help of Lucky Sekhon, MD, an OB/GYN and reproductive endocrinologist and fertility expert, we explore the details below.
What exactly does advanced maternal age mean?
Advanced maternal age simply means that you are 35 when you give birth. Even if you turn 35 a week before your baby comes, it still counts. But why is this age the cutoff?
There are a few reasons, but primarily 35 was picked back in the 1970s to measure the risk of invasive genetic testing (amniocentesis) versus genetic conditions that were more likely after 35. Even though genetic testing and screening have improved since then, 35 remains the cutoff for what is considered a high-risk pregnancy. Now it's also become the age to justify more testing and visits during pregnancy.
The risk for health conditions for mama like gestational diabetes, high blood pressure, or risk of miscarriage do rise as a woman reaches her late 30s, but the changes don't happen overnight on the day you turn 35.
"Women are told that it gets harder to get pregnant, easier to miscarry, and more likely to have complicated or difficult pregnancies in their late 30s and early 40s and beyond," says Dr. Sekhon. But this designation can also make women feel nervous about having a baby in their 30s.
What reproductive changes could affect pregnancy after 35?
As we age, so do our eggs. According to Dr. Sekhon, the chance of having a baby born with certain genetic conditions like down syndrome increases a little more each year as you get closer to 40, and this is related to the health of your eggs. But the change is gradual.
"Women are born with all of the eggs they will ever have, and we lack repair mechanisms to reverse age-related changes in egg quality," says Dr. Sekhon.
Egg quality refers to the genetic content found in each egg. Dr. Sekhon shares that the likelihood of eggs with genetic errors increases as we age. "Embryos with genetic errors will either not implant, result in miscarriage, or the birth of a child with major medical issues."
Even though this sounds a little scary, it helps to remember that most women in their late 30s will have healthy pregnancies. It just may mean extra testing or prenatal visits to monitor the baby.
What about fertility after 35?
Many women also think of 35 as a deadline for getting pregnant. "So many women view turning 35 like the flip of a switch, where all the eggs suddenly ‘go bad'," says Dr. Sekhon.
But it's not that simple. "Women who come to see me assume they are 'old' and will often overestimate the problems anticipated with their egg and resulting embryo quality," she shares. "There is definitely a lot of fear surrounding fertility at age 35 and over."
Egg quality does reduce with age, but it’s not all doom and gloom—Dr. Sekhon says that her patients are often pleasantly surprised to hear they are perfectly capable of becoming pregnant and having a healthy pregnancy at 35.
There could be an upside to pregnancy after 35
A recent cross-sectional study that looked at more than 50,000 pregnant women around the age of 35 found that the extra care given based on advanced maternal age improved health outcomes for the baby, lowering the risk of stillbirths and deaths.
In other words, the extra care for mamas in this age range reduced the risk of complications for the baby.
Being labeled an older mom may not feel that great, but Dr. Sekhon believes it's a good thing. "While it may make patients feel anxious that they are being treated as having a higher risk pregnancy due to their age, ultimately, I think it is beneficial."
She says earlier screenings could catch problems before they become more serious.
Age is only a number, but it's still worth paying attention to
So should you panic when you turn 35? No, but don't be surprised if you have a few more doctor's visits during your pregnancy. Try to embrace that extra TLC.
If you aren't quite ready to have a baby (even if it's not your first), it's worth being a little more proactive about your fertility. Dr. Sekhon encourages all women to speak with their OB/GYN for a reproductive checkup and counseling. A visit with your doc could help alleviate concerns about pregnancy or fertility and help you develop a plan for starting or growing your family.
She also adds you could even consider egg or embryo freezing if you aren't ready. "Fertility preservation can act as a backup plan in case you run into fertility issues and need help to conceive."
Lucky Sekhon, MD, is an OB/GYN, reproductive endocrinologist and fertility expert from Reproductive Medicine Associates of New York.
Berkowitz, R. L., Roberts, J., & Minkoff, H. (2006). Challenging the strategy of maternal age-based prenatal genetic counseling. JAMA, 295(12), 1446–1448. https://doi.org/10.1001/jama.295.12.1446
Geiger CK, Clapp MA, Cohen JL. Association of Prenatal Care Services, Maternal Morbidity, and Perinatal Mortality With the Advanced Maternal Age Cutoff of 35 Years. JAMA Health Forum. 2021;2(12):e214044. doi:10.1001/jamahealthforum.2021.4044