If you are in the process of trying to conceive, age might play a role in your plans for family building. My blog and online community are called “Babies After 35” because I specifically focus on those who are trying to conceive or pregnant after age 35.
First, a person age 35 and older is at an increased risk for certain complications during pregnancy. This includes increased risk for developing diabetes and/or high blood pressure, having a multiple gestation, delivering prematurely, having a large or a low birth weight baby, requiring a cesarean section, having placenta previa and experiencing pregnancy loss. This does not mean that your pregnancy will result in complications or that you cannot have a successful pregnancy and delivery. These conditions will be monitored for no matter the age of the patient; they are simply more common in a pregnancy after age 35. It is simply important that you are educated on any potential risks due to age.
In addition, as we age there is the potential for developing medical diseases; an aging patient who becomes pregnant is no exception. If you have these or any other pre-existing medical conditions, in addition to being of advanced maternal age, you will be monitored more closely during your pregnancy. It is also very important that you get any pre-existing medical conditions under control before trying to conceive.
A person is born with all the eggs they will ever have in their lifetime: approximately 1-2 million eggs. At puberty there are 300,000-500,000. At age 37 there are 25,000. And at age 51, only 1,000 eggs remain. Both egg quantity {the number of eggs a person has available for fertilization or “ovarian reserve”} and egg quality {the eggs that are genetically normal} decrease as a person ages. The decrease starts to accelerate by age 35-37 and drastically decreases after age 40. A decrease in egg quality means that although there are available eggs after age 35 and 40, a higher percentage of them may be damaged, which makes the chromosomes defective and unable to produce a normal pregnancy. As a result, there is an increased risk of pregnancy loss.
The chances of early pregnancy loss and having a pregnancy with a genetic abnormality, like Down Syndrome, start to increase after age 35. Unfortunately, these factors have nothing to do with how healthy you are after age 35; these factors are purely due to age alone and increase with increasing age. Although this aspect of an after 35 pregnancy is often the most feared, it is a reality that all pregnant persons after age 35 face. As a result, antenatal screening through a blood test (there are many available) and a detailed ultrasound are recommended. It is also common for an appointment with a genetic counselor to be offered. It is up to each individual, of course, as to what testing and counseling is accepted.
Yes! An otherwise healthy person age 35 and older with no significant pre-existing medical conditions should be expected to have a completely normal, healthy pregnancy. After consideration and assessment for the risk of a genetic abnormality in the fetus, followed by a detailed ultrasound for fetal anatomy, the pregnancy should progress as normal. In this case the only reason for being “different” may be the risks mentioned above due to your age alone. Maintaining a healthy lifestyle both during the preconception period and during the pregnancy is ideal in order to minimize potential complications.
There is something called infertility trauma, and though it is not widely discussed, it is very real. Infertility trauma refers to the psychological and mental health impacts of experiencing loss(es) or inability to conceive. On my podcast with Dr. Loree Johnson, a licensed marriage and family therapist, we discuss infertility grief and trauma and therapeutic options, EMDR, psychotherapy, therapeutic coaching, infertility coach vs infertility therapist, navigating infertility support groups, and how to vet your provider and support group.
I experienced infertility grief and trauma during my own journey, and even though I am a medical doctor, I sought out therapy. Getting therapy to help you move through feelings and experiences is not shameful. It allows you to heal psychological and emotional scars that can impact your daily life.
While the age of 35 is a marker of sorts when it comes to conception rates and pregnancy outcomes, it does not mean that you cannot have a successful pregnancy. I have seen many families expand and blossom at age 35 and beyond, my own included! For additional support from a community, head over to our Babies After 35 Facebook Group where we celebrate, discuss, and learn together!
Shannon M. Clark, MD, MMS is a double board certified ObGyn and Maternal-Fetal Medicine Specialist, and founder of Babies After 35. In her roles as a clinician, educator and researcher at UTMB-Galveston, she focuses on the care of people with maternal and/or fetal complications of pregnancy. Dr. Clark has taken a special interest in pregnancy after the age of 35, which according to age alone, is considered a high-risk pregnancy.
Follow Shannon on TikTok @tiktokbabydoc, Facebook @babiesafter35, and Instagram @babiesafter35.
Check out the products for TTC through parenthood in the Babies After 35 Amazon shop, online courses and other services that come "Dr. Clark-approved"!
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