Your Biggest Questions About Pregnancy After 40, Answered

You’re 41, staring at a pregnancy test, and your brain is doing that unhelpful math it’s been trained to do: your age, your AMH, that one article your cousin sent about “geriatric pregnancy.” Part of you is excited; part of you is already bracing for the lecture you expect to get at your first prenatal visit. Are you being wildly irresponsible… or just very normal for this moment in time?

In reality, more and more people are having babies later, and the medical world is finally starting to acknowledge that “advanced maternal age” is a category, not a catastrophe. A large review in Obstetrics & Gynecology shows that pregnancies in people over 35, and especially over 40, have climbed steadily in high‑income countries over the past few decades, even as age remains a clear risk factor for things like gestational diabetes, preeclampsia, and cesarean birth. At the same time, patient resources like the Cleveland Clinic’s overview of advanced maternal age stress that most people in their late 30s and 40s who get pregnant still go on to have healthy pregnancies and babies, with the right monitoring and support.

So no, you’re not “too old,” but you also deserve more than a shrug and a “we’ll see what happens.” Updated guidance from the American College of Obstetricians and Gynecologists (ACOG) now recommends treating pregnancies with delivery at 35 and older as higher‑risk, and specifically suggests extra third‑trimester monitoring and considering delivery around 39 weeks for those 40 and up. Meanwhile, midwife‑led resources like Tommy’s take a more reassuring tone, pointing out that although risks do rise with age, “most women over 40 have healthy pregnancies and babies,” especially with good antenatal care.

This Q&A is here to live in that middle space with you: clear about the science, honest about the numbers, and still deeply hopeful about what’s possible in your 40s.

Yes, many people do conceive after 40—but it’s usually harder and takes longer than it did in their 20s or early 30s. The American Society for Reproductive Medicine’s (ASRM) patient booklet on age and fertility explains that fertility starts to decline in the early 30s and drops more steeply after 37, with natural fertility around age 40 roughly half that of someone in their late 20s. By 40, the chance of conceiving in any given cycle is often under 5%, compared with roughly 20–25% per month in the early 30s.

That said, “less likely” is not the same as “impossible.” ASRM notes that while the probability per cycle is lower at 40+, some people still conceive spontaneously or with help from medications, intrauterine insemination (IUI), or in‑vitro fertilization (IVF). If you’re over 40 and have been trying for six months, or you know you have factors like irregular cycles or a partner with low sperm parameters, ASRM recommends seeking a fertility evaluation sooner rather than later so you can understand your options and timing.

Age affects both how many eggs you have left and how likely those eggs are to be chromosomally “normal.” A major ASRM committee opinion on natural fertility

 explains that ovarian reserve (the remaining pool of eggs) declines over time, and that the proportion of eggs with chromosomal abnormalities increases, especially after the late 30s. This is why it becomes harder to get pregnant and why miscarriage rates rise as you move into your 40s.

Clinically, this shows up as a lower chance of pregnancy per cycle and a higher chance of conditions like Down syndrome or other chromosomal differences. The ASRM Age and Fertility booklet notes that success rates for stimulated IUI cycles in women over 40 are usually under 5% per attempt, whereas IVF success rates with your own eggs might be under 20% per cycle at 40+. These are averages, not destiny: your individual odds depend on your ovarian reserve, your partner’s fertility, and your overall health.

Pregnancy after 40 is considered “higher risk” because certain complications are more common—not because something is guaranteed to go wrong. A large review on advanced maternal age and pregnancy outcomes found that people 35 and older, and particularly those 40 and up, have higher rates of miscarriage, preterm birth, gestational diabetes, preeclampsia, and cesarean delivery compared with younger patients. An observational study of pregnancies at 40 and above reported significantly higher odds of gestational diabetes, preeclampsia, and fetal death in utero versus women under 40. ACOG’s consensus on pregnancy at age 35 and older echoes this, noting increased risks of hypertensive disorders, gestational diabetes, stillbirth, and both small‑for‑gestational‑age and large‑for‑gestational‑age babies, with the highest rates seen in those 40 and above. The Cleveland Clinic’s guide to advanced maternal age similarly highlights higher chances of miscarriage and chromosomal conditions, but also stresses that “most women over 35 and even over 40 have healthy pregnancies,” especially when pre‑existing conditions are managed and prenatal care is consistent.

You don’t need to wait a full year if you’re over 40. The ASRM guideline on age‑related fertility decline recommends that people over 35 seek evaluation after six months of trying and that those over 40 may benefit from earlier, even immediate, assessment and treatment because of faster fertility decline and higher miscarriage risk.​

A typical fertility workup includes blood tests (such as follicle‑stimulating hormone and anti‑Müllerian hormone), a transvaginal ultrasound to assess ovarian reserve and uterine anatomy, and a semen analysis for a male partner. Getting this information early helps you and your doctor decide whether to continue trying naturally, use ovulation‑inducing medications, move to IUI or IVF, or consider donor egg options based on your specific situation rather than generalized age statistics.

You can expect more frequent check‑ins—and that’s about safety, not punishment. ACOG’s consensus document on pregnancy at age 35 years or older suggests that people who will deliver at age 40 or older be offered a third‑trimester growth ultrasound due to increased risk of both small and large babies. They also recommend offering antenatal fetal surveillance (such as non‑stress tests or biophysical profiles) in the third trimester because of higher stillbirth risk with advancing age.​

For timing of birth, ACOG recommends considering delivery at 39 weeks in well‑dated pregnancies for people 40 and older, since rates of stillbirth and neonatal complications rise beyond that point. The UK charity Tommy’s notes that many hospitals offer induction around the due date for patients over 40, highlighting that a 40‑year‑old at 39–40 weeks has a similar stillbirth risk (around 2–3 in 1,000) to someone in their mid‑20s at 41 weeks. You may also be referred to consultant‑led or high‑risk care, depending on your hospital’s policy.

IVF can improve your odds compared with trying naturally, but age still plays a major role. The ASRM Age and Fertility booklet reports that in women over 40, success rates for stimulated IUI cycles are usually under 5% per cycle, while IVF success rates using your own eggs often fall below 20% per cycle, still meaningful, but significantly lower than success rates in younger age groups.​

Many clinics quote per‑cycle live birth rates in the low double digits for patients in their early 40s with their own eggs, declining further by ages 43–44, which is why donor eggs are often recommended in the mid‑40s and beyond. A 2022 review on pregnancy after 40 and counseling emphasizes the importance of individualized preconception evaluation and careful monitoring during pregnancy, and notes that while fertility treatment can help, success rates and risks must be discussed honestly at these ages. A fertility specialist can show you clinic‑specific numbers and tailor a plan around your age, ovarian reserve, and health rather than generalized estimates.

No. The risk is higher, but most babies born to people in their 40s do not have a chromosomal condition. The review on advanced maternal age notes that the risk of aneuploidy (including Down syndrome) increases with age, particularly after 35, which is why all patients—but especially those in older age groups—are offered prenatal genetic screening or diagnostic testing. The Cleveland Clinic’s advanced maternal age resource similarly explains that age raises the chance of chromosomal conditions, but emphasizes that screening tests can identify higher‑risk pregnancies and that many babies born to people over 40 are chromosomally typical.

Screening options include cell‑free DNA testing (noninvasive prenatal testing, or NIPT), first‑trimester combined screening, and detailed ultrasounds, while diagnostic tests like chorionic villus sampling (CVS) and amniocentesis provide definitive answers but carry small procedure‑related risks. ACOG recommends that all pregnant patients be offered these options and counseled about what different results might mean for them personally. A genetic counselor or maternal‑fetal medicine specialist can help you weigh the benefits and risks of each test and decide how much information you want during pregnancy.

You can’t change your age, but you can change a lot of the context around it. The Cleveland Clinic’s guide to pregnancy after 35 recommends optimizing chronic conditions (such as high blood pressure, diabetes, or thyroid disorders), reaching a stable, healthy weight, and taking a prenatal vitamin with folic acid before conception to reduce the risk of complications. They also advise stopping smoking, limiting alcohol while trying to conceive, and working with your care team to manage conditions like PCOS or endometriosis.

During pregnancy, ACOG encourages consistent prenatal care, early screening for gestational diabetes and hypertensive disorders, and following through on recommended ultrasounds and fetal surveillance, particularly in pregnancies with delivery at 40 and above. A 2022 review on pregnancy after age 40 suggests that third‑trimester fetal surveillance and considering induction around 39–40 weeks can help balance risks and outcomes. For your mental health, research summarized in mind‑body and self‑compassion work (such as that referenced in the Path to Parenthood editorial brief) shows that approaches like cognitive‑behavioral strategies, mindfulness, and self‑compassion can reduce distress and improve coping during fertility treatment and pregnancy, even though they don’t “fix” fertility.​

It’s understandable if this is the statistic that lands hardest. A large management review of advanced maternal age pregnancies notes that miscarriage risk rises with age, with rates higher in the late 30s and 40s due largely to chromosomal abnormalities in the embryo. Patient‑facing summaries (such as those compiled by clinics and educational sites) often cite that miscarriage risk is roughly 1 in 5 at age 30 and can approach 1 in 2 by the mid‑40s, reflecting this age‑related shift in egg quality.

For stillbirth, ACOG’s consensus on pregnancy at 35 and older reports that the cumulative risk through 41 weeks is about 12.8 per 1,000 pregnancies for people 40 and older, compared with roughly 6.2 per 1,000 in those under 35. Tommy’s translates this into more concrete terms, explaining that people over 40 have a stillbirth risk of about 2–3 in 1,000 at 39–40 weeks—similar to the risk a person in their mid‑20s would see at 41 weeks. These numbers are higher than in younger age groups, but the majority of pregnancies after 40 do not end in miscarriage or stillbirth, especially when conditions are managed and extra monitoring is in place.

Advocating for yourself in pregnancy after 40 often means managing both medical facts and emotional weight. The Path to Parenthood editorial brief encourages using a self‑compassion lens, drawing on work by researchers like Alice Domar and Kristin Neff—to normalize feelings of anxiety, grief, or ambivalence, and to gently challenge thoughts like “I waited too long; this is all my fault.” Mind‑body and cognitive‑behavioral approaches have been shown to reduce distress and improve coping for people going through infertility and high‑risk pregnancies, even though they don’t change your age or guarantee outcomes.​

On the practical side, both ACOG and ASRM emphasize shared decision‑making: asking your provider to explain absolute risks (“What does that mean in numbers?”), requesting referrals to maternal‑fetal medicine or fertility specialists when needed, and making sure your preferences around screening, delivery, and mental health support are clearly documented. Bringing a partner or friend to key appointments, keeping a running list of questions on your phone, and seeking out trauma‑informed therapists or support groups (online or local) can help you feel less alone and more in control as you navigate this chapter.​

Pregnancy after 40 can feel like living in two tabs at once: one filled with scary statistics, the other with real‑life stories of people who did this and are now posting first‑day‑of‑school pics. Both are true. The numbers matter, and it is worth getting good preconception advice, extra monitoring, and honest conversations about your risks and options. But none of that cancels out the fact that many people in their 40s go on to have healthy pregnancies and babies, especially with a care team that actually sees you, not just your birth date.

If there’s one takeaway from the research and the guidelines, it’s this: you’re allowed to ask questions, push for clarity, and choose doctors who make you feel like a partner, not a problem. You don’t have to pretend your age isn’t on your mind, but you also don’t have to let it be the only thing that defines this chapter. You get to hold the data in one hand and your very real hope in the other, and walk into your next appointment knowing you deserve thoughtful, respectful, 40‑something‑specific care.