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Recently, there’s been a lot of criticism of terms like “advanced maternal age” (and its far more offensive, outdated cousin “geriatric pregnancy”). The term feels almost shame-y — and in today’s world, where more and more people are delaying family-building well into their thirties, it also feels incongruous.
But at the same time, the relationship between age and fertility — and age and pregnancy outcomes — is real. So how do we reconcile our need for language that better serves prospective parents alongside our need to inform people of reproductive realities? It’s a complicated issue, to say the least.
Is it Time to Say Goodbye to These Qualifiers?
“I think it is really difficult. I don’t like [terms like advanced maternal age], point blank. I think they come with a lot of baggage, especially how they’re worded. Geriatric pregnancy in particular is very problematic, so that’s why we’ve moved away from geriatric pregnancy and toward advanced maternal age, which is a little bit better, but still comes with stigma and a lot of internalized pressures on the patient,” says Andi Schmerin, PA-C , COO and Director of Telehealth at Binto.
According to Schmerin, terms like advanced maternal age don’t necessarily need to seep into our public conversations about reproductive health — rather, they’re simply medical qualifiers.
“I think the [real question] is: In medicine how [necessary] is a term? Obviously, one of the first things anyone is looking at when reviewing a medical chart is a person’s age — and all it is is an age qualifier,” says Shmerin. “[There’s] room to evaluate [whether] we really need that label. Because we already have people’s ages on their medical charts, which is all we really need to know as a provider [to alert you to] other concerns once you hit a certain age — and that’s just an age-related fact.”
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The Reality of How Fertility Changes With Age
One issue with terms like geriatric pregnancy and advanced maternal age is that they create a very binary approach to considering fertility and the safety of carrying a pregnancy. The fact of the matter is, age does affect both of these things. With that being said, having these age qualifiers firmly in place creates the idea that someone’s ability to conceive or have a complication-free pregnancy automatically leaves the building the day they turn 35 — and that’s not necessarily true.
For many people, fertility changes gradually, rather than overnight as the terms seem to suggest. “There is no sharp decline after 35, it's a gradual process, but they chose 35 because they had to have a cutoff value that had significance,” says Kim Langdon, MD, an OB/GYN with Medzino.
“Age is just one puzzle piece for people’s fertility, but it’s an important one, and one that you can at least predict,” adds Schmerin. It’s an important point to note: After all, though it’s not necessarily a common experience, even people in their twenties can face infertility, while we’ve all heard stories of people who conceived quickly at 40.
With that being said, it’s important that people understand their fertility and how it progresses over time.
“You start at your most fertile when you’re first getting your period — maybe not at the very beginning when you’re having irregular cycles, but generally speaking, within your first year of getting your period, you’re going to be the most fertile,” says Schermin. “And you’re going to plateau at your most fertile for a while. It’s really around your mid-30s that you start to see the decline. It’s around 33-35 that we start to see, on average, female fertility starts to be affected.”
“As you approach your mid-thirties, with 35 being the cutoff for AMA, your fertility with regard to egg quality goes down and you ovulate less regularly,” adds Dr. Langdon. “AMA also confers some high-risk conditions during pregnancy such as high blood pressure, gestational diabetes, and chromosomal abnormalities.”
While advanced maternal age is simply a medical qualifier, it does alert the general public to the patterns of fertility — and that matters. By understanding when our chances of getting pregnant decline, as well as having some understanding of when risk levels begin to increase during pregnancy. This knowledge empowers people to take control over their reproductive health and get intentional about family planning.
“[People are] aware that there’s a window of time, and it dwindles or changes with time more than anything. As of right now, that’s the biggest impact [on fertility] Across the board, age is the number one most predictive thing for people’s ability to conceive. So I do think it’s so important to have these conversations often,” says Shmerin.
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The good news? We have options now where fertility preservation is concerned, and that knowledge of our reproductive systems work can inform those choices.
And for those who are pregnant, there’s no reason to panic if you’re pregnant after 35. Both Schmerin and Dr. Langdon say that pregnant people who are 35 and over don’t necessarily need to approach their pregnancies with extra precautions. You don’t need to seek out care from a high-risk specialist unless there are other risk factors that warrant it, according to both experts.
The Bottom Line
“Even though [advanced maternal age is] a named status on your medical chart, I think it’s totally okay to disconnect from that because it really is just meant to ensure you’re getting the proper screening and the proper access to care,” says Schmerin. “Even though the term itself is terrible, it really is designed and meant to be there to protect you and to protect the pregnancy.”
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.