Advanced Maternal Age

What is advanced maternal age?

Advanced maternal age usually refers to women who are 35 or older when trying to conceive or at the time of delivery. It is not a disease, but age is the single most important factor in female fertility. A woman is born with all her eggs, and both the number and the quality of eggs fall over time. Fertility begins to decline gradually from the early 30s and falls more quickly after about 37. More women are planning pregnancy later in life, and with the right information and timely care, many have healthy babies.

Signs to look out for

Age-related fertility decline usually has no symptoms. Some possible signs include:

• Taking longer to conceive than expected
• Shorter or more irregular menstrual cycles
• A low AMH or antral follicle count on testing
• Miscarriage, which becomes more common with age

How age affects fertility and pregnancy

• Fewer eggs remain, so there are fewer chances each cycle
• A higher proportion of eggs have chromosomal abnormalities, which raises the risk of miscarriage and of conditions such as Down syndrome
• Conditions such as fibroids, endometriosis and polyps become more common
• Pregnancy risks such as gestational diabetes, high blood pressure, pre-eclampsia and caesarean delivery increase
• Male partner age also matters, though the effect is smaller

How fertility is assessed

• AMH blood test and antral follicle count to estimate ovarian reserve
• Day 2 to 3 FSH and estradiol
• Pelvic ultrasound to check the uterus and ovaries
• Tubal patency test (HSG or sonosalpingography)
• Semen analysis for the male partner
• Thyroid, prolactin, blood sugar and other pre-pregnancy health checks

Treatment options

Timely evaluation

Professional guidelines advise women aged 35 to 39 to seek evaluation after 6 months of trying, and women 40 or older to be assessed straight away.

Ovulation induction and IUI

Some women in their mid to late 30s with good reserve and open tubes may try a limited number of stimulated IUI cycles.

IVF

IVF gives more eggs and embryos to work with in a single cycle and is often recommended sooner as age increases. Preimplantation genetic testing (PGT-A) may be discussed to help select chromosomally normal embryos; it may reduce miscarriage and time to pregnancy for some women, but it does not create more healthy embryos.

Egg or embryo freezing

Women who are not ready for pregnancy can freeze eggs to preserve fertility. Results are better when eggs are frozen at a younger age, ideally before 35.

Donor eggs

When chances with a woman's own eggs are very low, IVF with donor eggs offers higher success rates because the eggs come from a younger donor.

Chances of pregnancy

Chances of pregnancy fall steadily with age, with each year after 35 making a difference. Iswarya Fertility reports IVF success of about 75 percent for women under 35; rates are lower for women in their late 30s and 40s, and they vary according to ovarian reserve and other factors. No treatment can guarantee pregnancy.

When to see a fertility specialist

See a specialist after 6 months of trying if you are 35 to 39, immediately if you are 40 or older, or earlier if you have irregular periods or known fertility problems. Iswarya Fertility has 91+ centres, with EMI options from ₹9,999 per month for eligible treatments.