Elizabeth Yepez, MD is a board certified ObGyn and Clinical Instructor of Obstetrics and Gynecology at the University of Illinois at Chicago School of Medicine. Dr. Yepez has focused much of her career in eliminating racial and socioeconomic health disparities. Much of this is through women’s health education, teaching women about their bodies and encouraging them to be engaged in decisions about their health and well-being. Dr. Yepez promotes empowerment of women and active participation in our communities. She is compensated for her participation in FIRST RESPONSE™ communications.


We’ve all heard about a woman’s ever-elusive “biological clock,” but never has the term been brought to life more vividly than by actress Marisa Tomei in the comedy, My Cousin Vinny, when – while complaining to her fiancé – her character, Mona Lisa Vito, says,”…meanwhile my biological clock is ticking, like this [pounding her 4-inch stiletto heel into the ground while wearing a full-body jumper].

It’s a funny scene, but in reality, she’s right – there is such a thing as a woman’s “biological clock,” and unfortunately, it is ticking away. However, when that alarm goes off may be different for everyone.

When it comes to fertility, the facts are this:

  • A woman is born with all of the eggs she will have for her lifetime
  • A woman reaches the peak of her fertility during her mid-20s
  • By the time she reaches her mid-30s, approximately 80% of a woman’s eggs are depleted

When a woman becomes pregnant at the age of 35 or older, she is considered to be of Advanced Maternal Age (AMA). This indicates that, due to her age, there is more difficulty in getting and staying pregnant and that there are more risk factors involved during the pregnancy than if she were younger.

I should point out that a 35-year old woman can still get pregnant and have a healthy and wonderful pregnancy (both of mine were amazing experiences), but it is important to understand those potential risk factors so you know how to take care of yourself properly.


First things first: Your health

It should come as no surprise, but your taking care of your overall health is very important to your fertility – at any age – but especially for women over the age of 35.

Generally speaking, the older we get, the more health problems we have. Therefore, if you suffer from any chronic health conditions or are taking any current medications on a daily basis, it is important to speak with your doctor before attempting to get pregnant so you can plan out the best route for your medical treatment.

Furthermore, there are a variety of factors can affect your fertility and potentially alter the course of your pregnancy – these include chronic health conditions like diabetes or hypertension, smoking, or even obesity. Research has even shown that obese women are three times more likely to suffer from anovulation and infertility, and many women suffer from irregular menses that can often times be linked to being overweight. If you are obese and hoping to become pregnant, appropriate diet and exercise, and (in some cases) bariatric surgery has been found to improve fertility rates.

Given that obesity plays such a big role in preventing normal fertility and increasing risk factors during pregnancy for older women, it’s also very important for any woman to make exercise a part of her everyday routine. Being “fit” cannot be achieved without daily exercise, plus the boost in libido from cardiovascular exercise doesn’t hurt!

In addition to exercise, substituting a diet that is high in sodium, animal fats, processed carbohydrates, and simple sugars with one that is clean and full of pure proteins, fruits, legumes, and vegetables is a great way to ensure your body is getting the nutrients you need to prepare for pregnancy. Women of childbearing age should also consider taking folic acid to help prevent neural tube defects like spina bifida – if you’re thinking about trying to get pregnant, you should start taking a prenatal vitamin with folic acid at least 6 months prior to conception to have its fullest effect. Luckily, First Response Prenatal Gummies have just the right amount you need to get you started!


Ovulation: Know before you go

If you are 35 or older and looking to become pregnant, it is important to note that there are only certain days in the month when you are most fertile. So as that “biological clock” keeps ticking, make your efforts count.

You can accurately track your fertility to know when your most fertile days occur by investing in an at-home ovulation or LH predictor kit. First Response Daily Digital kits are a good place to start and you can begin checking your urine on day five of your cycle until the test indicated LH surge. When it does, ovulation is likely to occur within the next 24-48 hours.


Be in the Know: Risks associated with pregnancy after the age of 35

There are a number of risk factors that women of AMA should be aware of during their pregnancy. These risks can vary and will always be evaluated by your doctor, but can include gestational diabetes, preeclampsia, placenta previa, preterm delivery, fetal death and increased risk for Cesarean section.

However, if you are 35 or over and in good health, then rest assured – despite being considered of AMA, the chances of having any of these complications are quite low. But women who are of AMA and also smoke, are obese, diabetic, or have hypertension, may need enhanced monitoring throughout their pregnancies to assure prevention, early diagnosis, and management of complicating risk factors.


You should also know: Egg quality decreases

As you learn in biology class, each egg in a woman’s ovary contains a copy of her genetic information and has 23 chromosomes. As we age, our eggs age too, and when this happens is when errors can occur that result in either too few or too many copies of these chromosomes (called aneuploidy) which may lead to genetic conditions like Down Syndrome. The risk of aneuploidy increases with age, roughly from 1 in 400 at age of 30 to 1 in 40 at the age of 40.


Fertility in your 30’s diminishes…or does it?

I’ve explained to my patients that a healthy 30-year-old woman has about a 20% chance of getting pregnant each month (so, out of 100 thirty-year-old women trying to get pregnant each month, about 20 will succeed and 80 will have to try again). By age 40, that drops to 5 in 100 successful pregnancies. However, it turns out that these statistics date back to the 1700’s! There are more recent studies that have shown better odds for women in their 30’s and pregnancy rates, so the reality may be that there is not as much of a “cliff” when it comes to our fertility when we hit 35 as previously thought.


When should you start to worry?

Many women are afraid to talk to their OB about having trouble getting pregnant because they fear that diagnosis of infertility or dread the thought of having to go through IVF. But don’t let this stop you from seeking help and saving valuable time.

If you are over the age of 35 and a positive/YES+ result has not appeared on a pregnancy test after 6 months of unprotected intercourse, or there is no indication of ovulation with the predictor kits, then you should consult your OB.


But don’t forget to focus on the “Advanced”

Yes, there are some potential hurdles involved in postponing getting pregnant until later in your life, and yes, there will be the possibility of some risk factors with your pregnancy. But waiting for the right time to start a family increases the likelihood you will be ready to take on the challenges of being a parent – and that is equally important.

At whatever age you decide to start your family, you should be aware of your overall health, the possible risks based on your age and lifestyle choices, and if necessary, seek help sooner rather than later. Staying healthy is your best defense against the risk factors that can alter the course of your pregnancy. But, don’t forget to enjoy this time, regardless of your age, and celebrate this time in your pregnancy journey.