Thinking about a baby after 35? What the numbers actually say

I am delighted to present this interesting expert article written for London Mums magazine by Dr Ruby Uddin, GP, Spital Clinic. Enjoy!

If you are considering pregnancy in your late thirties or early forties, you may have come across terms such as “advanced maternal age” or read headlines highlighting the challenges of having a baby later in life. It’s understandable that this can feel unsettling. Age has become one of the most discussed aspects of fertility, yet much of the conversation lacks nuance.

As a GP, one of the most common concerns I hear from women in this age group is that they may have somehow “left it too late”. Often, these worries are fuelled by statistics presented without context or stories that focus on worst-case scenarios. The reality is usually far more balanced. While age does influence fertility and pregnancy outcomes, it is only one part of a much bigger picture.

First, the good news: 35 is not a cliff edge

One of the most persistent myths surrounding fertility is that everything changes at 35. In reality, fertility and pregnancy-related risks tend to change gradually over time rather than at a specific birthday.

Many women conceive naturally and have healthy pregnancies well into their late thirties and forties. In fact, the number of babies born to women aged 40 and over has increased significantly over the last decade, reflecting changing patterns in education, careers, relationships and family planning.

This shift is something healthcare professionals see every day. More women are choosing to start families later, often because they are waiting for the right relationship, greater financial stability or simply because life has taken a different path than expected.

The term “advanced maternal age” remains widely used in healthcare because it identifies a group in whom certain risks become more common. However, it should not be interpreted as meaning that pregnancy after 35 is unusual, unsafe or inevitably complicated. It is a clinical term, not a prediction. For women who would rather understand their own situation than rely on a label, a fertility check can offer a clearer, more personal picture before trying to conceive.

What actually changes after 35?

It is important to be honest about the biology. As Tommy’s explains, from the mid-thirties onwards fertility gradually declines as both the quantity and quality of eggs decrease. This means that conception may take longer, and there is an increased likelihood of miscarriage and chromosomal conditions such as Down’s syndrome.

However, age is only one part of the fertility picture. Conditions such as endometriosis, polycystic ovary syndrome (PCOS), thyroid disorders, irregular menstrual cycles and previous pelvic infections can also affect fertility, regardless of age. This is one reason why fertility journeys can vary so significantly from one person to another.

Risk is often best understood in context. While relative risks increase with age, the absolute likelihood of a healthy pregnancy remains high for many women. This distinction is important, as statistics can sound alarming when presented without perspective.

More than eight in ten couples where the woman is under 40 will conceive within a year of trying. For those who take longer, it does not necessarily indicate a problem, but it may be worth seeking advice earlier so that any potential issues can be identified and addressed.

One of the most reassuring things I tell patients is that fertility is rarely defined by a single number. Age matters, but so do overall health, lifestyle factors, medical history and, of course, a degree of chance that no test or statistic can fully predict.

Understanding the evidence allows women to approach family planning with realistic expectations rather than unnecessary anxiety.

Giving yourself the best start: a check before you try

When discussing pregnancy planning, I often encourage patients to focus on the factors they can influence rather than those they cannot. While no one can change their age, there is a great deal that can be done to optimise health before conception.

Much of the public conversation focuses on fertility itself, but some of the most important preparation happens before pregnancy begins. The evidence is clear that pre-conception health can have a meaningful impact on both maternal and fetal outcomes.

The NHS recommends taking folic acid before pregnancy and continuing until at least 12 weeks, alongside adequate vitamin D, maintaining a healthy weight, stopping smoking and moderating alcohol consumption, all of which can contribute to improved pregnancy outcomes.

A pre-conception consultation with your GP can also be valuable. This provides an opportunity to review any existing medical conditions, discuss medications, ensure vaccinations are up to date and identify any factors that may affect fertility or pregnancy. This can be particularly helpful for women with conditions such as endometriosis, PCOS, thyroid disease or a history of reproductive health concerns.

Some women find it reassuring to have a clearer understanding of their reproductive health before they begin trying to conceive. Fertility assessments, including ovarian reserve testing, cannot predict fertility with certainty, but they may provide additional information that helps inform future planning.

Ultimately, preparation is not about trying to control every outcome. It is about giving yourself the best possible starting point and ensuring that any potential issues are identified early.

Once you are pregnant: screening and reassurance

For many women, concerns about age become more prominent once pregnancy is confirmed. Questions often shift from fertility to the health and wellbeing of the developing baby.

Perhaps one of the biggest advances in maternity care over recent years has been the quality of information available during pregnancy. Because the likelihood of certain chromosomal conditions increases with maternal age, screening becomes an important part of antenatal care. Fortunately, screening options are now more accurate and accessible than ever before.

Non-invasive prenatal testing (NIPT) can be performed from around ten weeks of pregnancy using a maternal blood sample, and provides highly accurate screening for the most common chromosomal conditions without increasing the risk of miscarriage.

Importantly, screening tests are designed to estimate probability rather than provide certainty. A higher-chance result is not a diagnosis and should always be followed by appropriate counselling and, where desired, diagnostic testing.

For many women, screening provides reassurance rather than anxiety. Having access to reliable information early in pregnancy allows families to make decisions with greater confidence and feel more informed about what lies ahead.

Frequently asked questions

Is 35 really a “high-risk” pregnancy?

Not automatically. The term “advanced maternal age” reflects the fact that certain risks become more common with increasing age. However, the majority of women over 35 experience healthy pregnancies and deliver healthy babies.

How can I improve my chances of conceiving after 35?

The most effective steps remain the simplest: maintaining a healthy lifestyle, taking folic acid and vitamin D, avoiding smoking and limiting alcohol intake. Looking after your general health before conception can positively influence both fertility and pregnancy outcomes.

When should I speak to a doctor?

If you are under 36 and have been trying to conceive for a year without success, it is sensible to seek medical advice. If you are 36 or older, it is generally recommended that you seek advice after six months of trying, as age-related changes in fertility become more relevant over time and earlier assessment may be beneficial.

It is also worth speaking to your GP sooner if you have a known condition that may affect fertility, such as endometriosis, PCOS, irregular periods, thyroid disease, a history of pelvic infection, previous fertility difficulties or recurrent miscarriage. Early assessment can often provide reassurance, identify any underlying issues and ensure that appropriate support is available if needed.

Is NIPT worth considering after 35?

Many women choose NIPT because it provides highly accurate screening for common chromosomal conditions at an early stage of pregnancy. Whether it is right for you depends on your preferences, values and how you would use the information it provides.

Will I need additional monitoring during pregnancy?

Possibly. Depending on your age, medical history and individual circumstances, your maternity team may recommend additional monitoring, such as blood pressure checks or growth scans. For many women, however, antenatal care remains largely routine, with only a small number of additional assessments.

Age undoubtedly plays a role in fertility and pregnancy, but it is only one factor among many. Good health, appropriate support and access to evidence-based care are equally important. While discussions around pregnancy after 35 often focus on risk, they can sometimes overlook the wider reality: many women in this age group conceive naturally and go on to have healthy pregnancies and healthy babies.

The aim is not to view age as a problem to overcome, but to understand it as part of the broader picture. The role of healthcare is not to create anxiety around age, but to provide clear information, evidence-based guidance and personalised support.

With the right preparation, realistic expectations and access to good medical care, pregnancy after 35 can be approached with confidence. The goal is not perfection; it is informed decision-making. And that is something women can feel empowered to make at any age.

The expert

Dr Ruby Uddin is a GP at Spital Clinic and a passionate advocate for women’s and reproductive health. She has worked across women’s and sexual health medicine in Australia and the US, as well as for the NHS in London. Her focus is compassionate, evidence-based care built on collaboration with her patients.