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Age & Fertility

Age & Fertility Overview

Age is the most important factor in determining a woman’s chance of a healthy pregnancy. Both egg count and egg quality naturally decline over time, with a faster drop starting around age 35. This affects fertility, the likelihood of miscarriage, and the risk of certain pregnancy complications.

Female Fertility & Age

Women are born with all the eggs they will ever have—about 1 to 2 million at birth. Over time, this number decreases:

  • By age 32: ~120,000 eggs remain

  • By age 37: ~25,000 eggs remain

  • By age 43: very few eggs remain, and only about 10% are chromosomally normal

It’s not just quantity that matters. Egg quality also declines with age. For women under 35, around 70% of eggs are chromosomally normal. By age 40, only about 25% of eggs are normal, which increases the chance of infertility, miscarriage, or chromosomal abnormalities (This is why Preimplantation genetic testing is recommended if the mother is 35 or older).

At Carolina Conceptions, we can check ovarian reserve with tests like:

  • Anti-Müllerian Hormone (AMH) blood test

  • FSH and Estradiol tests

  • Monitoring ultrasound to check the antral follicular count, which represents the number of immature eggs available each month

These tests are not 100% accurate in measuring ovarian reserve, and ovarian reserve does not define fertility or chance of pregnancy. Instead, these tests help us make the most informed decision about your treatment.

Live Birth Rate: Comparing Carolina Conceptions to National Data

When to Seek a Fertility Evaluation:

If You’re Under 35

We encourage you to seek assistance after 12 months of trying to conceive unsuccessfully.

If You’re Over 35

We encourage you to seek assistance after 6 months of trying to conceive unsuccessfully (this time frame is shorter due to a higher sense of urgency when the mother is quickly losing their ovarian reserve)

Even with regular ovulation, age-related egg changes make it harder to achieve a healthy pregnancy. Women over 35 are also at higher risk for complications such as miscarriage, gestational diabetes, and preeclampsia.

For women over 40, natural conception is uncommon, but treatments such as IVF with donor eggs can provide pregnancy rates of up to 70%.

Male Fertility & Age:

Unlike eggs, sperm is produced everyday, resulting in age being a more subtle factor in male fertility.  A man’s fertility begins declining in his early 40s, with a steady decrease after age 45. One study has shown that men over 40 are 30% less likely than men under 30 to conceive within 12 months.

This decline can be caused by an age and health-related decrease in sperm quality, quantity, or a combination of both.

Considerations for Paternal Age

As risk of certain conditions such as Down Syndrome are connected with maternal age, paternal age has it’s own heightened risks. As a man ages, he is slightly more likely to conceive a child with mental health disorders. These children more commonly develop conditions including autism spectrum disorder, attention deficit hyperactivity disorder, schizophrenia, or bipolar disorder. Please note that research on this topic is limited, and studies merely show a correlation between paternal age and mental health disorders.

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