Abstract Sub-Saharan Africa has entered the early stage of the demographic transition with differences in and between countries. The relation between fertility preference and actual fertility is at the core of the demographic changes during the demographic transition in sub-Saharan Africa. At the current pace of the demographic transition, overachieved fertility (actual fertility being higher than fertility preference) is more prevalent in sub-Saharan Africa although some women do achieve their fertility preference. Our aim is to assess the trends and identify factors that consistently influence women with completed fertility to achieve their fertility desires in Ghana over a 10-year period. We used secondary data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys for the analysis. The sample size was restricted to currently married/living in union women aged 45–49 years. The results indicate that underachieved fertility has increased from 25.1% in 2003 to 35.8% in 2014. Similarly, achieved fertility has also increased from 23.8% in 2003 to 26.0% in 2014. On the contrary, overachieved fertility has decreased from 51.1% in 2003 to 38.2% in 2014. The most persistent determinants of achieved fertility relative to overachieved fertility in Ghana during the last three rounds of the Ghana Demographic and Health Surveys are child survival status, ethnicity and couple’s fertility preference. The study provides support for programmatic interventions targeting improving child survival and regulating men’s fertility preference.