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For many women, the phrase “advanced maternal age” can land with a thud—bringing fear, shame and a sense that time has run out.
But one obstetrics and gynecology nurse practitioner says that narrative doesn’t reflect the reality she sees every day in clinical practice. Monica Elston Carter, MS, FNP-BC, shared a reel on Instagram (@monicathenp) with a message aimed at women trying to conceive after 35.
On a regular day in Carter’s Washington, D.C., clinic, over half of her patients were in their late 30s and early 40s. While acknowledging that pregnancy risks do increase with age, she stressed something she believes gets lost in the conversation: “If you’re out there trying, there’s still hope.”
Carter, who is a mom to 7-year-old triplet daughters with her husband Ben, told Newsweek that one of the biggest issues she sees is how women internalize the term ‘advanced maternal age,’ or AMA.
Medically, the label is meant to guide care and monitoring—not to serve as a verdict on whether someone should try to get pregnant at all.
“Many women in their mid to late 30s and early 40s go on to conceive naturally and experience healthy pregnancies,” Carter said. “The most-powerful thing we can offer women is accurate information and proactive care, not fear.”
Fear, she added, often stems from misconceptions. One of the most common is the belief that, if pregnancy hasn’t happened by 35, the opportunity has been missed altogether.
“That simply isn’t true,” Carter said. While fertility does gradually decline, pregnancy after 35 is common—and often healthy. What matters most is awareness, timely evaluation when needed and individualized care, rather than self-eliminating based on age alone.
For women over 35 who are actively trying to conceive, Carter emphasized the power of preparation. Preconception health can make a meaningful difference before complications ever arise.
She encouraged women to schedule a preconception visit to review medical history, ensure labs and screenings are up to date and address any chronic conditions early.
Seeking fertility evaluation sooner—particularly if cycles are irregular or pregnancy hasn’t occurred within six months—can also be beneficial.
Carter also urges couples to take a team approach. Male factor infertility is common and often overlooked, making semen analysis an important part of the process.
Beyond medical evaluations, lifestyle factors play a key role. Carter said: “Engaging in at least 150 minutes of cardiovascular exercise per week, plus two strength-training sessions, prioritizing whole, nutrient-dense foods while limiting excessive sugar, ultra-processed and fried foods, eliminating tobacco [and] drug use and minimizing alcohol intake and actively managing stress” can help couples take a proactive approach.”
Equally important is choosing the right care team. “Choose a care team that listens, respects your goals, and is equipped to provide appropriate surveillance if needed,” Carter said. “Informed, supported patients tend to have the best experiences.”
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