Many women in modern India are having their first child later than previous generations — in their mid-to-late 30s rather than their early 20s. The fertility implications of this shift are real, but they are not always well-explained. Understanding what actually changes with age — and what does not — helps women make informed decisions without unnecessary panic or unjustified complacency.

Dr. Shachi Singh, consultant gynaecologist and fertility specialist at Prakash Hospital, Sector 33, Noida, explains.

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What Changes With Age

Egg quality: The most significant age-related fertility change. Eggs become increasingly prone to chromosomal errors (aneuploidy) as women age — particularly from the mid-30s. An aneuploid egg, even if fertilised, typically fails to implant or results in miscarriage. This is the primary reason both natural fertility and IVF success rates decline with age.

Ovarian reserve (egg quantity): Women are born with their entire lifetime supply of eggs. This supply is fixed at birth and declines continuously — from approximately 1 million at birth to 300,000 at puberty to 25,000 at 37, to 1,000 at 51 (approximate menopause). The rate of decline accelerates from the mid-30s.

Conception probability per cycle:

• Age 20 to 25: approximately 20 to 25% per cycle
• Age 30 to 35: approximately 15 to 20% per cycle
• Age 35 to 37: approximately 10 to 15% per cycle
• Age 38 to 40: approximately 8 to 10% per cycle
• Age 40 to 42: approximately 5% per cycle
• Over 43: approximately 1 to 2% per cycle

Miscarriage rate: Increases with age — from approximately 10 to 12% at age 25 to approximately 25% at 35 to 40% at 40. Most age-related miscarriages are from chromosomal errors in the egg.

Time to conception: Statistical — not every woman over 35 will struggle, but on average conception takes longer.

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What Does Not Change With Age

Ability to carry a pregnancy: The uterus ages much more slowly than the ovaries. Women in their 40s carry pregnancies successfully — the uterus is capable of supporting a healthy pregnancy at ages when ovarian egg quality is significantly diminished. This is why donor egg IVF (using a younger donor's eggs with the recipient's uterus) is so effective — it bypasses the age-related egg quality decline while the uterus continues to function well.

Success with donor eggs: Women over 40, even over 45, using donor eggs have IVF success rates close to those of the donor's age — typically 50 to 60% per transfer. The age barrier in fertility is primarily egg quality, not uterine function.

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How Long to Try Before Seeking Help

Standard guidelines say 12 months of trying before investigation. After 35 — this shortens to 6 months. After 37 to 38 — prompt investigation without waiting is appropriate. Over 40 — see a fertility specialist at the time of deciding to try, not after months of unsuccessful attempts.

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Optimising Fertility After 35

• AMH testing to assess current ovarian reserve
• Early investigation of both partners (semen analysis in parallel, not sequentially)
• Optimise health: BMI, thyroid function, blood glucose, folate
• Consider IUI earlier than in younger couples — 3 cycles rather than 6
• Lower threshold for IVF — time is the limiting factor

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Fertility Care in Noida and Greater Noida

Dr. Shachi Singh at Prakash Hospital, Sector 33, Noida, provides comprehensive fertility assessment and treatment for women over 35 across Noida and Greater Noida.

To book a consultation with Dr. Shachi Singh, call: +91 97023 46853

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This blog is for informational purposes only.