I am over 35 and thinking about a baby, now or later

Every woman is born with all the eggs she will ever have, and the number falls across her life. From the mid-thirties the fall is faster, and the eggs that remain are more likely to carry a chance error in their chromosomes, which is why conceiving takes longer on average and why early miscarriage is more common. That is what “age matters” means, and it is all it means. It is a slope, not a cliff, and where you are on it is measured, not assumed.

What age does not do is change the rest of the picture. Tubes, ovulation, the lining of the uterus, his count: each of these is either fine or not, at any age, and any one of them is a far more common reason for not conceiving than age alone. A woman of 38 with regular cycles and a good reserve is in a different position from a woman of 38 with PCOS or a partner with a low count, and neither should be handed the same advice.

The story: your cycles now and how they have run, previous pregnancies, your health, and what you are hoping for and when. Whether there is a partner, and whether he is part of the plan yet; the visit works either way. Then an examination and a scan of the ovaries, which counts the small resting follicles on each side. That number, the antral follicle count, is a picture of your reserve on the day. A blood test for AMH reads the same thing a different way. Together they tell you how many eggs you are likely to have to work with, which shapes the advice about timing and, if it ever comes to it, about treatment.

What they do not do is predict whether you will conceive. A low reserve does not mean you will not; a high one does not mean you will. Anyone who reads a pregnancy off an AMH result is reading more than the test can say, and you will be told exactly what yours means and what it does not.

You leave with a clear sense of time: whether to try now and for how long before asking for help, or, if you are not ready, what the sensible thing to do this year is.

• Trying, with the clock set honestly. After 35, six months of trying before getting help, not twelve. After 40, come as soon as you have decided to try. The steps are the same as for anyone else; they are moved through a little faster.
• The simple things, checked now rather than later. Thyroid, prolactin, sugar, weight, smoking, folic acid. Each of these is fixed in weeks and each of them matters more when there is less time to lose.
• His test, early. A semen analysis at the start rather than after a year, because part of the answer is often on his side whatever your age.
• Tablets to help an egg release, then IUI, then IVF, each given a fair but shorter run. The order on the fertility page holds; the number of cycles at each step is smaller.
• A conversation about preserving eggs, if you are not ready to try for some years. Freezing eggs is a real option in the early and mid-thirties and a weaker one later; it is a hedge, not a promise, and it is done at a registered ART bank. What it involves, and whether it is worth it for you, is discussed honestly. Where it is chosen, you are told which centre and why, before anything is decided.

You are 36 and want to try next year. Come this year. A scan and an AMH now tell you whether next year is fine, which for most women it is, or whether it would be wiser to bring the plan forward. Either way you decide with information instead of worry.

You are 38 and have been trying for four months. Come now. Six months is the usual line at your age and there is nothing to be gained from waiting for it; the first visit either reassures you or finds something worth acting on early.

You are single and want to know your options. Come alone. The visit is the same: a scan, a blood test, and an honest conversation about time, about egg freezing, and about what the law in India allows. You will not be judged and you will not be sold anything.

• You are 40 or older and have decided to try
• You are 35 or older and have been trying for six months
• Your cycles have shortened to under twenty-five days, or become irregular
• You have had a miscarriage
• You have had surgery on an ovary, or chemotherapy at any time
• Your mother or a sister reached menopause before 45

IVF is discussed sooner after 35 than before it, and sooner again after 40, because each month matters more. It is planned and followed up here; the laboratory part of the cycle, the egg collection and the transfer, happens at a registered ART centre, and you are told which one, and why, before anything is decided. Egg freezing, where it is chosen, follows the same path: stimulation and scans planned here, collection and storage at a registered ART bank.