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My patient “Kendra” knows what she wants: To get pregnant again.

At 46, she is already a mom to four children, two of them grown. Last year she got pregnant with twins on her own. Tragically, she lost them in the 18th week of pregnancy.

You’d think that might be it for Kendra—and yet she tells me, “I can’t shake this feeling. I really want to have another baby.”

It used to be a big deal for a woman to have her third or fourth child at 35. Now more women are having babies in their late 30s and even 40s. Today, women may want a few more life experiences under their belts before they start a family. Some women may take longer to find their life partner—as was the case for me.

That means I’m seeing more and more Kendras in my practice, where I treat women with high-risk pregnancies. But having a baby later in life still can be a challenge. Here’s what I tell my patients about how to approach having a baby in your late 30s and beyond.

Why Age Matters

As women, we are born with all the eggs we’re going to have. Let that sink in: The eggs that make your babies when you’re 20, 30, or even 45 exist from the moment you are born.

The longer your eggs have been around, the more likely they are to produce a pregnancy with a chromosome problem that can lead to a condition like Down syndrome. This risk goes up significantly after 35. Meanwhile, the number of eggs you have decreases as you get older, causing your ability to get pregnant to decline.

There’s more to consider about pregnancy past your mid-30s. Older women are more likely to miscarry or have a stillbirth. They have a greater chance of developing gestational diabetespreeclampsia, and of delivering a baby who is very small. Then there can be problems with labor, resulting in a higher chance of cesarean birth. And while pregnancy increases a woman’s risk of developing blood clots (deep vein thrombosis), this risk is higher for older moms.

The farther beyond age 35 you get, the higher the risk of all these conditions. This is why the 35-year milestone is so special. Still, it’s not as if you wake up on your 35th birthday as a different person than you were the day before. Risk increases over time, and your own experience will depend on your personal health history and other factors.

Ob-Gyns Are Here to Support You

It’s easy, then, to understand why many women in this age group fear being labeled a “high-risk” pregnancy. I like to emphasize to patients that this doesn’t mean that something bad is going to happen during the pregnancy. Don’t let fear steal your joy. Let’s be proactive and take it one day at a time.

The good news is we have the tools to detect and respond to pregnancy complications early. You can choose to have prenatal screening tests in the first trimester, to help you understand your risks for genetic disorders. More frequent ultrasounds can measure the growth of the fetus and also look for birth defects. We’ll check your blood pressure at every prenatal visit, and we'll test you for gestational diabetes too. Early diagnosis plus treatment creates the formula for the best possible outcomes.

If you’re having trouble getting pregnant, you can talk with your ob-gyn. This step is usually recommended after 6 months of trying on your own if you’re 35 to 39. Your doctor can refer you to a fertility specialist for an evaluation if needed.

If you’re in your 40s, your ob-gyn can refer you to a fertility specialist before you even start trying to get pregnant.

Answering the Call of Motherhood

Even with all the understandable talk of “windows of opportunity” and “biological clocks,” there are ways for women over 35 to make motherhood a reality. Infertility treatments can be difficult and expensive, but fertility specialists can talk with you about options. Age is less of a limitation than it used to be.

Back to Kendra. After giving her body and heart time to heal from losing her twins, she is ready to try again. I referred her to a fertility expert to discuss how she can try to have a successful pregnancy. She’s healthy and feels her family is not yet complete. If I can help Kendra have another baby at 46, I will.

Yes, there can be challenges with having a baby later in your reproductive life. But there are some things you can control. First and foremost, getting early and regular prenatal care can increase the chance of having a healthy baby after 35.

If you are under 35 and would like to have children, start planning now. Talk with your ob-gyn, so they understand your goals and you understand how aging and other factors will affect your fertility. You can revisit your goals and plans every year with your ob-gyn.

Make the decisions that feel right for you. If you choose to get pregnant, remember that your ob-gyn is there to try to help you have the healthiest pregnancy possible—no matter your age.

Last updated: April 2022

Last reviewed: April 2022

Copyright 2023 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

About the Author
Dr. Michelle Owens.
Dr. Michelle Y. Owens

Dr. Owens is a professor of obstetrics and gynecology and a practicing maternal–fetal medicine specialist at the University of Mississippi Medical Center in Jackson. Much of her academic research has explored hypertension disorders in pregnancy. She is a Fellow of the American College of Obstetricians and Gynecologists (ACOG) and a member of ACOG’s Clinical Document Review Panel.