Advancing maternal age impacts the risk of poor perinatal outcomes in women who conceived naturally to a greater extent than those who conceived by ART. Less is known about very advanced maternal age (>45) with use of ART compared with spontaneous conceptions due to the small numbers available for such analysis. Generally, there is no significant increase in adverse perinatal outcomes in pregnancies over 40, regardless of the mode of conception. Using donor oocytes to conceive at any age has increased adverse perinatal and neonatal outcomes compared to using IVF/ICSI with autologous oocytes or spontaneous conception. Single embryo transfer can minimize these associated risks with donor oocyte cycles. With advancing maternal age, there is an associated increased risk of childhood cancers. There is sparse data on this topic; however, there is evidence that an increased risk of childhood morbidity not requiring hospitalization is associated with advanced maternal age. Being an older mother shows to positively affect their children’s behavior and cognitive abilities, though age alone cannot explain all these observations. There is a well-documented increased risk of ASD associated with both increasing maternal and paternal age.