Fertility & IVF
Getting Pregnant After 35: Fertility Facts, Testing and Tips
Getting pregnant after 35 is very possible, but it usually takes longer than it would have in your 20s because the number and quality of eggs decline with age. ACOG notes that fertility drops gradually from the early 30s and more quickly after about 37. Because time matters, ASRM and ACOG recommend seeing a fertility specialist after six months of trying if you're 35 or older, not a full year.
That six-month rule is the most useful thing in this article. Plenty of people hear "try for a year" from a friend or an old pamphlet and lose six months they didn't need to.
What actually changes with age
Two things:
- Egg quantity. You're born with all your eggs, and the supply shrinks every year.
- Egg quality. Older eggs are more likely to have chromosome errors. Those errors can stop a pregnancy from starting, cause a miscarriage or, less often, lead to conditions like Down syndrome.
Age also raises the odds of things that get in the way of fertility, like fibroids, endometriosis and tubal problems. And partner age counts: sperm quality declines too, just more gradually.
| Topic | What tends to happen with age |
|---|---|
| Monthly chance of pregnancy | Goes down gradually |
| Time to conceive | Often longer |
| Miscarriage risk | Goes up |
| Chromosomal conditions | Become more common |
| Twins | Slightly more common, even without treatment |
| Pregnancy complications | Higher risk of gestational diabetes, preeclampsia and cesarean birth |
These are trends across big groups of people. Your own odds depend on your health, history and test results.
A practical six-month plan
Before month one: get ready.
- Start a prenatal vitamin with folic acid at least a month before trying.
- Book a preconception visit with your OB/GYN. Bring your medication list so they can check what's safe in pregnancy.
- Ask about genetic carrier screening, which ACOG recommends offering to everyone considering pregnancy.
- Get chronic conditions like diabetes, high blood pressure or thyroid disease under good control.
Months one to six: make each cycle count.
- Time sex well. Every one to two days in the six-day fertile window. Ovulation test strips from any drugstore can help you find it. Our guide to ovulation tracking walks through the options.
- Stop smoking and avoid secondhand smoke. Smoking speeds up egg loss.
- Limit alcohol, and keep caffeine moderate.
- Aim for a healthy weight. Being underweight or having obesity can both affect ovulation.
- Skip the "egg quality" supplements unless your doctor recommends one. The evidence is thin.
A common worry in this stretch is that sex on a schedule starts feeling like homework. Many couples say it helps to stop tracking so intensely outside the fertile window.
Month six (or sooner): get evaluated. Not pregnant yet? That's not a sign something is wrong. It's a sign it's worth checking, because finding a problem sooner gives you more options.
Skip the waiting entirely and go right away if:
- You're 40 or older
- You have irregular periods, known endometriosis or tubal problems
- Your partner has known sperm issues
- You've had two or more miscarriages
More detail in when to see a fertility specialist.
What the fertility workup is like
Most of it is done within one or two cycles:
- AMH blood test and antral follicle count (a transvaginal ultrasound) to estimate egg supply. These don't predict natural fertility, but they help plan treatment. See AMH and ovarian reserve.
- Hysterosalpingogram (HSG), an X-ray where dye goes through the cervix to check that your tubes are open. Expect strong cramps for a few minutes. Many clinics suggest taking an over-the-counter pain reliever beforehand; ask yours.
- Pelvic ultrasound of the uterus and ovaries
- Thyroid and other hormone tests
- Semen analysis for a male partner. It's a quick, non-invasive test, and it gets skipped more often than it should.
Treatment options after 35
Depending on your results, a specialist may suggest:
- Ovulation medicine plus IUI, usually for a limited number of cycles
- IVF, which may be suggested sooner after 37 or 38, or if ovarian reserve is low
- IVF with embryo genetic testing (PGT-A), which some patients consider, though the benefit is debated
- Egg or embryo freezing if you want children later
Many specialists move faster after 35, because spending months on less effective options uses up time you can't get back.
Myth vs. fact
"I have regular periods, so my fertility is fine." Regular cycles usually mean you ovulate. They don't tell you anything about egg quality.
"A normal AMH means I can wait." AMH estimates quantity, not quality, and doesn't predict when fertility will drop.
"IVF can make up for age." IVF helps many people, but success with your own eggs still depends on how old the eggs are.
"Most people over 35 can't get pregnant without help." Not true. Many healthy people in their mid-30s conceive within six months to a year.
Not ready yet? Egg freezing
If you're 35 or older and not ready to try, egg freezing is worth a conversation. ASRM and ACOG note that age at freezing is the strongest factor in later success, so freezing at 35 generally offers better odds than freezing at 40. It isn't a guarantee, and more eggs are usually needed as age rises. Our egg freezing guide walks through the process.
Pregnancy after 35: what prenatal care looks like
Most people over 35 have healthy pregnancies. You may notice a few extras:
- Prenatal genetic screening or diagnostic testing. ACOG recommends offering this to all pregnant people regardless of age, so you'd be offered it at 25 too.
- Earlier glucose screening for gestational diabetes if you have risk factors
- Low-dose aspirin if you have risk factors for preeclampsia; your clinician decides whether it's right for you
- Possibly more ultrasounds later in pregnancy
You may see "advanced maternal age" on your chart. It's a clinical label, not a judgment, and it mainly flags that a few extra checks are worth doing.
New York insurance after 35
New York's Department of Financial Services says insurers may not impose age restrictions on coverage for infertility treatment, IVF or fertility preservation. Since 2020, insured large-group plans (more than 100 employees) must cover three IVF cycles. Self-funded employer plans and Medicaid follow different rules. Call the number on your card and ask whether your plan is fully insured or self-funded; that one answer tells you a lot.
When to see a doctor
See a fertility specialist or OB/GYN if:
- You're 35 to 39 and have tried for six months without getting pregnant
- You're 40 or older and want to conceive
- You have irregular periods, very painful periods or a known pelvic condition
- You've had two or more miscarriages
- You want to talk about egg freezing
Find fertility specialists in New York, including Manhattan, Long Island and Westchester.
Frequently asked questions
Is it harder to get pregnant after 35?
Usually somewhat harder, yes. ACOG notes that fertility declines gradually from the early 30s and more quickly after about 37, because both the number and quality of eggs decrease. Many people still conceive naturally in their late 30s.
How long should I try to get pregnant at 35 before seeing a doctor?
ASRM and ACOG recommend a fertility evaluation after six months of trying if you're 35 or older, instead of the 12 months recommended for younger people. At 40 or older, get evaluated right away.
Does New York insurance cover fertility treatment after 35?
New York's Department of Financial Services says insurers may not impose age limits on infertility, IVF or fertility preservation coverage. Whether IVF itself is covered depends on your plan type.
What are the pregnancy risks after 35?
Pregnancy after 35 carries higher risks of miscarriage, chromosomal conditions, gestational diabetes, high blood pressure disorders and cesarean birth. Most people over 35 still have healthy pregnancies with good prenatal care.
Sources
- ACOG — Female Age-Related Fertility Decline (Committee Opinion 589)
- ASRM — Optimizing natural fertility: a committee opinion
- ASRM — Definitions of infertility and recurrent pregnancy loss: a committee opinion
- ACOG — Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy FAQ
- NY DFS — Infertility Coverage Consumer FAQ
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.