Forty is not too old to have a baby, but it does come with real trade-offs in fertility, pregnancy risk, and the path you may need to take to get there. About half of women who try to conceive naturally at 40 will succeed, and over 141,000 babies were born to women aged 40 to 44 in the United States in 2024 alone. That number has been climbing almost continuously since 1985. Having a baby at 40 is more common than ever, but it helps to understand exactly what changes at this age so you can plan accordingly.
Your Chances of Getting Pregnant at 40
Fertility declines gradually through your 30s and then drops more sharply around 40. The main reason isn’t your overall health or fitness. It’s the number and genetic quality of eggs remaining in your ovaries. By 40, a larger proportion of your eggs carry chromosomal errors, which makes each individual cycle less likely to produce a viable pregnancy.
Still, the odds are far from zero. Roughly 50% of women who want to conceive at 40 will get pregnant naturally, without any fertility treatment. The per-cycle chance is lower than it was at 30, so it may take more months of trying. If natural conception doesn’t happen within six months, most fertility specialists recommend moving to evaluation rather than waiting the full year that’s typically advised for younger women.
Miscarriage Risk Increases Significantly
One of the biggest shifts at 40 is the miscarriage rate. For women in their 20s, the chance of a pregnancy ending in miscarriage is roughly 9% to 17%. At 35, it’s about 20%. At 40, it jumps to around 40%, and by 45 it reaches 80%. This steep climb is driven almost entirely by chromosomal abnormalities in the embryo, not by anything a woman is doing wrong. Many of these losses happen very early, sometimes before a missed period is even noticed.
This is why genetic screening becomes especially relevant at 40. A simple blood test (cell-free DNA screening) can check for chromosomal conditions like Down syndrome as early as 10 weeks into pregnancy. Diagnostic tests like amniocentesis can confirm results with high accuracy. These are offered to all pregnant women regardless of age, but the conversation carries more weight at 40 because the baseline risk is higher. The chance of Down syndrome specifically is about 1 in 100 at age 40, compared to 1 in 400 at 35 and 1 in 1,250 at 25.
Pregnancy Complications to Expect Monitoring For
Women over 40 face roughly 2.5 times the risk of gestational diabetes, preeclampsia, and high blood pressure during pregnancy compared to younger women. In one large study, gestational diabetes affected about 14.5% of women 40 and older versus 6.9% of younger women. Preeclampsia occurred in 4.6% versus 1.5%. These aren’t rare outliers, but they’re also not the majority experience.
Because of these elevated risks, your prenatal care will likely look a bit different than it would for a 30-year-old. You can expect a detailed anatomy ultrasound, and your provider will probably offer additional fetal monitoring in the third trimester to watch for growth issues and reduce the risk of stillbirth. If you have other moderate risk factors for preeclampsia (such as a first pregnancy, obesity, or a family history), your doctor may recommend daily low-dose aspirin starting in the first trimester. None of this is alarming on its own. It’s closer monitoring, not crisis management.
Delivery Looks Different at 40
The cesarean delivery rate for women 40 and older is 53%, more than double the rate for women in their mid-20s (26%). Some of this reflects the higher rate of complications like preeclampsia that make C-sections medically necessary. Some of it reflects provider caution with older pregnancies. And some reflects the higher likelihood of interventions like induction that can cascade toward surgical delivery.
A C-section is major abdominal surgery with a longer recovery period, typically four to six weeks before you can resume normal activity. It also carries a slightly higher risk of infection, blood clots, and complications in future pregnancies. If you’re planning more than one child, this is worth factoring into your timeline.
What IVF Can and Can’t Do at 40
If natural conception isn’t happening, IVF is the most effective assisted option. For women aged 38 to 40 using their own eggs, the live birth rate per egg retrieval cycle is about 26%, according to the most recent national data from the Society for Assisted Reproductive Technology. On a first embryo transfer specifically, the rate is closer to 21%. These numbers are meaningful but notably lower than the 40% to 50% success rates seen in women under 35.
The success rate drops further after 40. By 42 or 43, the per-cycle odds with your own eggs become quite low, and many clinics will have a frank conversation about when to consider alternatives.
Donor eggs change the math dramatically. Because the eggs come from a younger woman, the live birth rate per transfer jumps to around 40%, and cumulative rates across multiple cycles exceed 50%, even for women in their late 40s. The age of the uterus matters far less than the age of the egg. This is one of the most important facts for women over 40 to understand: if you’re open to donor eggs, age becomes much less of a barrier to a successful pregnancy.
The Bigger Picture on Timing
The birth rate for women aged 40 to 44 rose again in 2024, reaching 12.8 per 1,000 women, a 2% increase from the year before. This trend has been building for nearly four decades, driven by later marriage, career development, better fertility treatment, and shifting cultural norms. Having a baby at 40 is no longer unusual, and the medical system is well equipped to support it.
What the statistics tell you is this: 40 is not too old, but it’s an age where the window is actively narrowing. The difference between 40 and 43 is larger than the difference between 33 and 36. If you’re considering pregnancy at 40, moving sooner rather than later gives you better odds with each passing month. If you’re already 40 and trying, the majority of your risks are manageable with good prenatal care, and most women in this age group deliver healthy babies.