• Spain has some of the oldest moms, with 11% of women having kids post-40, compared to 4% in the US.
• Financial insecurity and settling down later in life play a notable role.
• But Spain's accessible fertility treatments and excellent public healthcare are also factors.

Monica Cruz-Lemini, a 46-year-old obstetrician living in Spain, had her first child at 44.

While pregnancies after 35 are considered "advanced maternal age," Cruz-Lemini's experience is far from unusual in Spain, where more than 10% of all births involve mothers 40 or older.

"I think there's a growing pool of women in recent years — and I've seen it both professionally and personally — who are a bit like me," Cruz-Lemini told Business Insider.

Spanish moms are among the oldest

According to Eurostat's latest data, Spain had the second-highest average age of women at childbirth in Europe in 2022, at 32.6 years, as well as the second-oldest average age for first-time mothers, at 31.6 years.

Spain also ranked second for the share of births to women aged 40 or older; 11% of live births in the country were to mothers in their fifth decade or beyond.

In comparison, only about 4% of live births in the US were to women over 40, according to data from the US National Center for Health Statistics, compiled by nonprofit group March of Dimes.

(Comprehensive global data isn't readily available, but Ireland came top in the most recent European stats.)

Financial insecurity

Delaying motherhood is a growing trend across Europe and beyond, not just in Spain.

However, Juan García-Velasco, chief scientific officer for IVIRMA Global, which operates a network of fertility clinics, highlights "a combination of factors" that help explain Spain's particularly high ranking.

One key factor, he said, is financial insecurity.

Spain has the highest unemployment and youth unemployment rates in the EU, and García-Velasco said that this, combined with low wages and financial instability, leads many women to wait until they are more financially secure.

Sarah Richards, a Barcelona-born mother of two who had her second child at 40, said that people want to be financially secure and own their own house before starting a family, "so that's going to happen a lot later here than it would in the UK, where salaries certainly are higher."

Property prices in cities and coastal areas also make it harder for many to afford a home, with Spain having one of the highest average ages in Europe for young people leaving the family home — at just over 30.

"You can't buy there, and the rents are just out of control," Richards said. "You either have a very good job, or you have a rich family that can help you and help with childcare."

Fertility treatments

Waiting longer often leads to a growing reliance on treatments like IVF, and Spain is a leader in Europe in IVF success rates, according to the global fertility agency International Fertility Group.

While a like-for-like comparison between Spain and the US isn't available — as different countries and clinics measure success rates differently — Spain remains a popular destination for Americans exploring international fertility treatment options.

García-Velasco said this may be why it may feel less risky for some women in Spain to leave trying for kids until later in life. "As the outcome is good, this reduces the pressure and the fears," he said

IVF is also widely accessible in Spain and is free for women 40 and under, including those who are single or in same-sex relationships.

In comparison, the estimated average cost per IVF cycle in the US is about $12,000, according to the American Society for Reproductive Medicine.

Spain also has more IVF clinics than any other country in the EU, per the European IVF Monitoring Consortium.

"The more facilities that are offered to become a mother later in life, the easier it's going to be," said Pauline Bronkurst, who had her second child this year at the age of 43.

"In our case," Bronkurst added, "both of our babies were conceived through IVF, so that definitely played a role."

Genetic risks

Having kids later in life does increase the risk of genetic conditions.

But Bronkhurst emphasized the importance of Spain's public healthcare system, which was particularly beneficial after her second child was born with a genetic condition.

While getting pregnant at an older age can increase the likelihood of complications, Bronkhurst said that in countries with universal healthcare and a high standard of medical care, the perceived risk of advanced-age pregnancy is significantly lower.

"I think that plays into the whole thing of waiting longer," she told BI.

Slow to settle down

Another major factor contributing to delayed motherhood in Spain is that people are simply settling down later in life.

The average age of first marriage among men in Spain is 36.8, the highest in Europe, while for women it's 34.7, also the highest, according to the latest Eurostat data.

Stephanie Galavodas, who had her son three years ago aged 41, told BI she waited until her 40s to have a child because she was "saying yes to things in life when I didn't have the partner to build a family."

After years of pursuing degrees, traveling, and establishing her career, she eventually met her partner, with whom she had her child.

"I always knew that I would have kids someday," she said, "and so it felt fine to me to kind of go out in the world and experience things instead of rushing to have a child first."

Going it alone

A growing number of Spanish women are also going it alone.

García-Velasco said the fastest-growing group seeking fertility treatment at his clinics in Spain are single mothers who have decided to raise a child on their own.

This trend is not unique to Spain. A 2020 study published in Fertility and Sterility found a significant rise in the number of single women undergoing IVF in the US over the preceding 12 years.

In Spain, García-Velasco said that many single mothers pursuing fertility treatment cite a "lack of adequate partner" as their primary motivation for going solo.

For Cruz-Lemini, the doctor who had her child at 44, this was the reality. "I'm a single mom by choice," she told BI.

Cruz-Lemini was occupied with studies, training, and then work as a doctor, but, she said, "You get to be around 40 years old and then suddenly you realize that it might be your last chance or chances to have a child."

She found a sperm donor and pursued IVF. A little over two years ago, she gave birth to her daughter.

Sometimes, she said, "you have to do it by yourself because you don't have time to get into a relationship."

For the past decade, Rock Health cofounder and prolific startup investor Halle Tecco has made her name as a voice for the voiceless in fertility care.

She founded fertility e-commerce startup Natalist in 2019 and egg freezing and donation startup Cofertility in 2022. She bet early on several fertility startups like unicorn Kindbody and healthcare provider Tia. She espoused radical transparency about her previous struggles to have a child.

While she raised funding to help other people get pregnant, though, Tecco's battles with infertility continued. She suffered eleven miscarriages, including losing twins at 17 weeks pregnant.

Now, she's taking a huge step back from the industry she helped cement.

"People expect me to continue that narrative. But I've moved on, and I don't want to continue talking about it," she told Business Insider. "I'm not trying to be an infertility influencer."

As she built businesses that aimed to give women control in their fertility journeys, Tecco struggled with a lack of control over her own. Behind closed doors, her dogged optimism clashed with grief and frustration. Her therapist told her, "This is you getting PTSD treatment while still at war."

Today, Tecco is done making new fertility bets. She wants to return to what got her excited about digital health in the first place — encouraging new and exciting ideas in a sluggish industry.

She's writing a book about what to expect when innovating in healthcare. She started teaching a course at Harvard Medical School this year about the complex network of stakeholders involved in healthcare entrepreneurship. She co-hosts the digital health podcast The Heart of Healthcare, and she sits on the boards of healthcare benefits company Collective Health and Cofertility.

She'll continue to support the women's health companies she's invested in. But as far as she's concerned, the fertility-centered chapter of her life is closed.

"I'm a healthcare investor, not a fertility investor. And I want to get back to that," she said.

When Tecco went to Harvard Business School to get her MBA in 2009, she was already interested in healthcare innovation. But it was her time at Apple, where she spent the following summer working on healthcare offerings in the tech giant's app store, that brought her frustrations with the industry to a head.

"There's so much money in healthcare, and such a big opportunity to improve healthcare. Why is nobody building fun, useful things over here?" she recalls thinking.

Returning to business school for her second year, Tecco reconnected with classmate Nate Gross as he was getting his clinician networking startup Doximity, now a publicly traded company, off the ground. Together, they began an independent study about how to get entrepreneurs to bring fresh ideas and technologies to healthcare.

From that study, Rock Health was born — named for the many hours Tecco and Gross spent in front of a whiteboard in Harvard's Rock Center for Entrepreneurship.

Tecco and Gross started Rock Health in 2010 as an accelerator program at a time when few vertical-focused startup accelerators existed. Y Combinator and Techstars both launched about five years earlier to supercharge seed-stage tech startups with venture funding and expert guidance. Rock Health offered founders the chance to do the same in healthcare, with backing from VC firms like Accel Partners and NEA plus companies like Microsoft and Nike.

The firm has made some impressive investments through its venture fund, including in Waystar and Tempus AI, which both went public in 2024; Omada Health, which appears to be eyeing an IPO in 2025; and Lyra Health, which last raised capital at a nearly $5.6 billion valuation in 2022.

Gross and Tecco both attested that they were told "no" many, many times during Rock Health's creation. They faced plenty of pushback from longtime healthcare builders and investors who rejected their vision to bring more tech into the industry.

Those dismissals only strengthened Tecco's resolve.

"I made the promise that I will never be the cranky old guard. There's no use in it," Tecco said. "We need as many smart people helping us solve these problems as possible."

After Tecco moved with her husband Cloudera cofounder Jeff Hammerbacher from San Francisco to New York City in 2016, she stepped away from Rock Health. She'd set her eyes on her next goal: building a family.

Getting pregnant turned out to be "a huge struggle," Tecco said, as she confronted the high costs of fertility treatments, a stunning lack of support and education, and no guarantees of pregnancy. She told Business Insider in 2019 that her own fertility journey was fraught with "a lot of misinformation, a lot of secrecy and shame."

Tecco's son was born through IVF in 2017 after four years of trying. Adamant about improving the fertility care experience for others, Tecco officially launched Natalist two years later to provide products and educational materials to people trying to get pregnant, from at-home ovulation tests to prenatal vitamins.

"It gave me a lot of satisfaction to support others in a way that I hadn't been supported," she said.

Tecco was early in the femtech investment wave, too, founding and backing fertility startups when few others did. She first invested in Kindbody's seed round in 2018; by some estimates, VC funding for women's health increased more than 300% between 2018 and 2023, even as healthcare funding slumped overall last year.

While running Natalist, overseeing women's health strategy at Everly Health after Natalist was acquired, and then cofounding egg donation startup Cofertility, Tecco wanted to have a second child.

Getting pregnant a second time proved even more difficult. Tecco endured multiple unsuccessful rounds of IVF and eleven miscarriages, over nearly five years.

Throwing herself into her work did little to help her escape the heartbreak. Infertility and pregnancy, as she spent her spare time helping thousands of patients trying to conceive, were always on her mind. She wrestled with jealousy over other people's "miracle babies" as she waited desperately for her own.

Secondary infertility, the difficulty of having another child after a previous successful pregnancy, robbed Tecco of countless hours of her life and plenty of happiness. Miscarrying twins at 17 weeks pregnant was "the first time in my years where I didn't have a plan B," she wrote in a 2023 blog post.

She paused fertility treatments in the summer of 2022 to spend time with her family. After much reflection and therapy, she realized that "overcoming" her secondary infertility wouldn't mean having another child. It meant making peace with the idea that she never would.

"It was harder than I can explain to make that decision, especially if you're someone like me, where you're like, I want this thing, I'm going to get this thing," Tecco said.

But, she said, "I wanted to go into my 40s being really clear about my intentions of moving on."

Tecco entered healthcare not solely to invest in startups, or to build her own, but to help other aspiring healthcare entrepreneurs with fresh perspectives and technologies in clearing the industry's many hurdles. Now 41 years old, she wants to get back to that.

This year, she's been focused on writing a book with that very thesis, aiming to pass along her knowledge to the next generation of healthcare builders. She sees it as the natural next step up from her blog, where she's covered topics from the value of an MBA versus a master's degree in public health (both degrees that Tecco holds) to why a startup may not be venture-backable.

But, true to form, Tecco is juggling multiple other ventures as she writes. She's still recording The Heart of Healthcare podcast alongside industry experts including Bessemer Ventures Partners investor Steve Kraus and Fenwick & West startup lawyer Michael Esquivel. In her classes at Columbia University and Harvard Medical School, she's teaching and learning from hopeful healthcare innovators. She's stopped angel investing, choosing instead to focus on the startups she's already backed, but she's also invested her personal wealth in top venture funds, including Oak HC/FT, Seven Seven Six, and Union Square Ventures.

While Tecco's Cofertility cofounder Lauren Makler oversees day-to-day operations at the startup as CEO, Tecco remains deeply involved with the company's strategy and fundraising efforts as a board member. And Rock Health is "still running Halle's game plan," Gross said.

Makler and Gross both called Tecco's ambition "relentless."

"If Halle has conviction in something, she does not look back," Makler said. "And even having gone through what Halle has gone through, her conviction, effort, and enthusiasm for what we're doing has never wavered."

Tecco doesn't regret the many years she spent speaking out about infertility. She still feels strongly about the twisted financial incentives in fertility care and the stigmas associated with assisted reproduction, even though she's not a patient anymore.

"I don't want to add anything, but I wouldn't want to take anything away. It is still such an important part of my story," she said.

Tecco's book, which she hopes to publish in late 2025, will be infused with her personal experiences, which Tecco said she understands people are interested in. But at its core, she hopes it'll be the "welcome guide" she never got for people interested in healthcare innovation, as motivating as it is practical.

"My goal is that readers close the book, and they're like, let's do this," she said.

• Florence Pugh, 28, was diagnosed with PCOS and endometriosis at 27.
• She froze her eggs at 27 because both conditions can impact fertility.
• Pugh said a different doctor dismissed the diagnoses because of her age.

Florence Pugh has opened up about two recent diagnoses that prompted her to freeze her eggs at 27 years old.

Speaking on Dear Media's SHE MD podcast with her Beverly Hills gynecologist, Pugh, now 28, discussed the moment she was diagnosed with polycystic ovarian syndrome (PCOS) and endometriosis — conditions that can impact fertility.

The Oscar-nominated actress said it was a "mind-boggling" experience to find out that having kids may not be a straight-forward process for her, and embarking into the world of fertility preservation.

Pugh also said that another doctor back home in London, whom she did not identify, dismissed her diagnoses.

"She shook her head and she said, 'well, that's just not possible,'" Pugh recalled. She said she told the doctor about her egg count and hormone test results done in LA. Pugh said the doctor responded: "No, you're fine. And even if you do have it, you'll be fine to have kids well into your 30s."

Dr. Thais Aliabadi, the gynecologist who diagnosed Pugh, reacted to her story on the podcast: "That is what women go through every single day."

PCOS and endometriosis — the leading causes of infertility — often go undiagnosed

PCOS and endometriosis are some of the most common causes of infertility. PCOS is a condition where ovaries produce excess male sex hormones, or androgens, creating hormonal imbalances. Endometriosis occurs when the lining of the uterus grows outside of the uterus.

Common symptoms of both include irregular and painful periods, as well as bloating or weight gain. PCOS symptoms also include thinning hair, excess hair growth, acne, and darkened skin.

Pugh said she had some of the symptoms, like weight fluctuations, acne, and "hair that shouldn't be in certain places." She attributed them all to work stress and just "part of being a woman."

Pugh said she went to get a checkup after being hit by a "sudden feeling" that something was off with her body. "I'd had a few weird dreams; I think my body was telling me," Pugh said.

At the appointment, Aliabadi asked Pugh if she'd ever had her eggs counted — something Pugh said she never thought of doing because she was young.

After counting her eggs and giving Pugh a hormone test, Aliabadi diagnosed her with both PCOS and endometriosis, encouraging her to freeze her eggs in her 20s.

Pugh said she had heard of the conditions before, but didn't think they were common. 1 in 10 women have PCOS, and roughly 200 million people worldwide have endometriosis.

She also didn't expect to have fertility problems because of her family history. "My family are baby-making machines," she said. Her mother had babies into her 40s, for example. She said she was grateful to get diagnosed and freeze her eggs because she'd been wanting kids since she was a child.

These conditions are often misdiagnosed or ignored

PCOS and endometriosis are commonly underdiagnosed or misdiagnosed entirely.

Pugh said she understands that she has "privilege in areas where others won't," so if her symptoms were dismissed, other patients might take even longer to get proper treatment.

PCOS disproportionately impacts women of color, who are also more likely to be misdiagnosed due to racial bias around symptoms like weight gain.

Pugh said she believes everyone should be educated on PCOS and endometriosis because "it's something that will be the defining factor of whether you can have children or not."