Fertility after 35: what age, AMH tests and egg freezing really tell you

By Shweta Arora, MD, board-certified physician · Medically reviewed by Robin Arora, MD · Updated October 2026

Fertility questions often come with a lot of noise: home tests, social media timelines and well-meaning advice. The most useful facts are simpler, and they apply to both partners.

Age is the biggest factor

According to the American Society for Reproductive Medicine (ASRM), a healthy 30-year-old has about a 20% chance of getting pregnant in any given month, while a 40-year-old has less than a 5% chance. The decline speeds up in the late 30s, mainly because egg quantity and quality fall with age.

Infertility is common. The World Health Organization estimates that about 1 in 6 adults worldwide experience it at some point.

When to ask for an evaluation

ASRM recommends a fertility evaluation if you haven’t become pregnant after:

• 12 months of trying if you’re under 35
• 6 months of trying if you’re 35 or older
• Sooner if you’re over 40, have irregular or absent periods, known endometriosis, prior pelvic surgery, or a partner with known fertility concerns

Both partners should be evaluated at the same time. A semen analysis is part of a standard first workup, because male factors contribute to many couples’ infertility.

What an AMH test can and can’t tell you

Anti-Müllerian hormone (AMH) is a blood test that reflects how many eggs remain in the ovaries. It’s useful for planning fertility treatment. But ASRM advises that AMH should not be used as a test of whether you can get pregnant naturally, or on its own to push anyone toward egg freezing. Women with a low AMH can still conceive, and a normal AMH doesn’t guarantee pregnancy. Age remains a stronger predictor.

Egg freezing: realistic expectations

• Egg freezing works better at younger ages. ASRM notes that a woman around 38 may need roughly 25 to 30 eggs for a reasonable chance of one child.
• It doesn’t guarantee a future pregnancy, and there isn’t yet enough data to give precise live-birth odds for every age.
• Talking it through with a reproductive endocrinologist before deciding helps you weigh cost, timing and odds.

The male partner matters too

A large 2023 analysis found that average sperm concentration fell by about half between 1973 and 2018. Sperm health is also a marker of overall health. Partners should have their own checkup, including a semen analysis when trying hasn’t worked, and a review of medicines, including testosterone, which can lower sperm production.

Getting your body ready

• Review every medicine and hormone treatment with your clinician before trying. Some weight-loss, hormone and other medicines should be stopped ahead of time.
• Folic acid. The U.S. Preventive Services Task Force recommends folic acid for anyone who could become pregnant. Ask us which prenatal option fits you.
• Check the basics: blood pressure, blood sugar (A1c), thyroid and vaccinations.
• Everyday habits: not smoking, limiting alcohol, regular activity, sleep and a nutritious eating pattern help both partners.

Our practice doesn’t provide fertility treatment. We can help with preconception health, review medicines and refer you to a fertility specialist at the right time.

Every plan is individualized, and treatment is recommended only when it’s right for you after your consultation.

Related reading: Endometriosis: more than a bad period · Do I need my hormones tested? · Genetic testing for women: what your DNA can and can’t tell you. Browse the full Women’s Health Library.

See us in person or by video

Visit our physician-led team at our Hudson, Ohio or Barboursville, West Virginia office, or meet Dr. Robin Arora by telehealth from anywhere in Ohio, West Virginia, Kentucky or Florida.

Seek urgent care for one-sided pelvic pain, shoulder-tip pain, dizziness or fainting with a positive or possible pregnancy, or heavy bleeding in early pregnancy. These can be signs of an ectopic pregnancy.

Sources: American Society for Reproductive Medicine: Age and Fertility patient guide, evaluation of infertility (2021), AMH testing (2020) and planned oocyte cryopreservation (2021, 2024); World Health Organization, infertility prevalence (2023); AUA/ASRM male infertility guideline (2020, 2024); Levine et al., Human Reproduction Update 2023; U.S. Preventive Services Task Force, folic acid for prevention of neural tube defects. This page is general education, not medical advice.