Getting Pregnant After 35: A Fertility Doctor’s Guide

You've seen the headlines. The magazine covers. The well-meaning relatives. The phrase "geriatric pregnancy" attached to a 36-year-old.  And you're trying to figure out what's actually true.  How much of the urgency is real biology and how much is cultural noise designed to make you feel like you've already missed the window.

The honest answer is somewhere in the middle. Age matters; it's the single most significant variable in female fertility. But the way it's usually presented; as a cliff edge at 35, doesn't match the clinical reality. The decline is real. It's also more gradual, more individual, and more navigable than the narrative suggests.

This guide gives you the actual data, explains what it means for your specific situation, and walks through the options available to you in Ontario; whether you're trying now, thinking about starting, or considering preserving your options for later.

What Actually Happens to Fertility After 35

Egg quantity decline

Women are born with all the eggs they'll ever have; approximately one to two million at birth, declining to roughly 300,000–400,000 by puberty.  By age 35, the reserve has decreased further, and the rate of decline accelerates from this point.  By 40, the number of remaining eggs is meaningfully lower.

This decline is what AMH (anti-Müllerian hormone) and antral follicle count measure. It varies significantly between individuals — some women at 38 have the ovarian reserve of an average 34-year-old, and vice versa. Testing tells you where you personally stand, rather than where the average suggests you should be.

Egg quality declines

This is the more consequential factor. As eggs age, they become more likely to have chromosomal abnormalities; errors in the number of chromosomes that can prevent fertilization, implantation, or healthy development. This is a natural biological process, not a deficiency.

In the broader population, the rate of chromosomally abnormal eggs increases gradually through the 30s and more sharply after 40. This is the primary reason miscarriage rates are higher and per-cycle pregnancy rates are lower in patients over 35; not because the body can't carry a pregnancy, but because the probability of producing a chromosomally normal embryo decreases.

The timeline shifts, but doesn’t end.

*The data, presented honestly, and factually:

*These are population-level estimates and reflect natural conception.  Individual outcomes vary considerably based on ovarian reserve, overall health, partner factors, and other variables.  They are not predictions for any specific person.

What 35 is — and What it Isn't

35 is not a cliff. It's a statistical inflection point; the age at which, across the population, fertility decline begins to accelerate. The reason medical guidelines use 35 as a threshold (see a specialist after 6 months instead of 12) isn't because something catastrophic happens on your 35th birthday. It's because earlier investigation preserves more options in a situation where time is the primary variable.

Patients at 36 are not dramatically different from patients at 34. But patients at 40 are meaningfully different from patients at 36, and the difference accumulates faster than most people expect. The clinical message isn't urgency for the sake of urgency. It's: information earlier gives you more choices.

Your Options — Depending on Where You Are

If you're trying to conceive now (35+)

See a specialist after 6 months, not 12: The standard recommendation for patients over 35 is a fertility evaluation after six months of trying. If you have any risk factors or signs of infertility such as; irregular periods, a known condition like PMOS or endometriosis, a history of miscarriage, or a partner with known or suspected male factor, earlier evaluation is appropriate.

Get baseline testing: AMH, antral follicle count, FSH, and a semen analysis (if a male partner is involved) give your doctor the data to assess your situation. In Ontario, the initial consultation with a fertility specialist is covered by OHIP.

Understand the treatment spectrum: Not every patient over 35 needs IVF. Depending on the cause of infertility, options may include timed intercourse with ovulation induction or IUI.  Your specialist will recommend based on your diagnosis, age, reserve, and goals.

If IVF is recommended:  Age-related egg quality changes are the primary reason IVF is more commonly recommended for patients over 35. IVF allows your doctor to retrieve multiple eggs, culture them to the blastocyst stage, and; if you elect PGT-A testing, screen embryos for chromosomal normality before transfer. This doesn't change the biology, but it gives your team more information to work with.

If you're not trying yet but thinking about the future (35+)

Egg freezing preserves options at the age you freeze: An egg frozen at 36 retains the quality characteristics of a 36-year-old egg, regardless of when it's used. If you're not ready to start a family now but want to preserve the option, egg freezing is the most direct way to decouple your fertility timeline from your biological timeline.

The data on egg freezing and age:  Eggs frozen at younger ages generally have better outcomes when thawed and used later; because they're more likely to be chromosomally normal. This is a population-level pattern, not a guarantee, and individual results depend on the number of eggs frozen, their quality, and the clinic's laboratory.

‍A consultation is not a commitment:  You can see a fertility specialist, get your AMH tested, understand your reserve, and make a decision from a position of knowledge rather than speculation. Many patients in their mid-to-late 30s come in "just to know where they stand" — and that information alone is valuable, regardless of what they decide to do with it.

If you're 40 or older

Consult a specialist early. Ideally before or when you start trying:  At 40, per-cycle pregnancy rates are lower and the probability of chromosomal abnormalities in eggs is higher. A specialist consultation gives you realistic expectations and a plan based on your specific numbers, not averages.

IVF with PGT-A is commonly considered:  For patients over 40, selecting chromosomally normal embryos for transfer (when available), may help reduce the risk of miscarriage and improve the probability of a successful pregnancy per transfer. This is a population-level association, and your doctor will discuss whether PGT-A is appropriate for your situation.

Egg quantity becomes a bigger variable:  Patients over 40 may need more than one IVF cycle to produce embryos, particularly if they're doing genetic testing. Your specialist will discuss realistic expectations based on your reserve.

What About Men?

Male fertility also declines with age, though the timeline is more gradual and the research is less definitive. Studies in the broader population have associated advanced paternal age (generally over 40–45) with longer time to conception, increased risk of certain chromosomal conditions, and modestly higher rates of miscarriage. A semen analysis is a straightforward first step that provides useful data regardless of age.

Getting Started in Ontario

The referral process

In Ontario, you need a physician referral to see a fertility specialist. Your family doctor, walk-in clinic doctor, or OB/GYN can provide one. Some fertility clinics also arrange a referral for you through a partner clinic if you don't already have one — a process that takes minutes.

If you have a GP:
You can send your doctor the referral link on our website:
Pollin Toronto referral link

Pollin Ottawa referral link
At Pollin, If you do not have a family doctor and require a referral to be facilitated for you, we will set you up with a virtual, OHIP-covered referral appointment with our partner GP after you have booked your consultation.

OHIP coverage

Your initial fertility consultation is covered by OHIP. Diagnostic bloodwork and ultrasound are also typically covered. If IVF is recommended, Ontario residents may be eligible for a government-funded IVF cycle through the Ontario Fertility Program (OFP).

What to expect at your first appointment

A comprehensive consultation with a reproductive endocrinologist, a review of your history and goals, and a diagnostic plan. You'll leave with a clear understanding of where you stand and what your options look like. The entire evaluation typically takes two to four weeks.

Frequently Asked Questions

Is 35 too old to get pregnant?

No. The majority of women at 35 who try to conceive do so within 12 months. Fertility does decline after 35; the rate of chromosomal abnormalities in eggs increases, and ovarian reserve decreases, but 35 is an inflection point in a gradual decline, not a cutoff. A fertility evaluation is recommended after six months of trying at this age.

What are the chances of getting pregnant naturally at 38?

Population-level data suggests approximately 50% of women at 38–40 conceive within 12 months of trying naturally. Individual outcomes vary significantly based on ovarian reserve, overall health, and partner factors. Baseline fertility testing gives you a clearer picture of your specific situation.

Should I freeze my eggs at 35?

It depends on your timeline. If you're not planning to try for pregnancy in the near term and want to preserve the option, egg freezing at 35 captures your eggs at their current quality. A consultation with a fertility specialist can help you evaluate whether egg freezing is the right step based on your AMH, AFC, and personal circumstances.

Does IVF work after 40?

IVF can be effective after 40, though per-cycle success rates are lower than for younger patients; primarily due to age-related changes in egg quality. PGT-A testing can help your doctor select chromosomally normal embryos when available. Some patients over 40 require multiple cycles. Your specialist will give you realistic expectations based on your individual evaluation.

When should I see a fertility doctor if I'm over 35?

After six months of trying to conceive, or sooner if you have risk factors (irregular periods, known reproductive conditions, history of miscarriage, suspected male factor). If you're over 38 and planning to start trying, a consultation before or when you begin is clinically appropriate.

Is the initial fertility consultation covered by OHIP?

Yes. In Ontario, the initial consultation with a fertility specialist is covered by OHIP. Diagnostic tests (bloodwork, ultrasound) are also typically covered. You'll need a physician referral, but some clinics coordinate this on your behalf.

Ready to find out where you stand? 

Book a consultation at Pollin Fertility.  Your initial visit is OHIP-covered, there’s no waitlist, and we handle your referral.