Bangladesh represents one of the few countries in south Asia where the pace of fertility decline has been unprecedented over the last three decades. Although there has been significant reduction in fertility levels at the national level, regional variations continue to persist, especially in Sylhet and Chittagong where the total fertility rates are well above the country average. Using data from three consecutive Bangladesh Demographic and Health Surveys (BDHSs) this paper assesses how fertility patterns in Sylhet and Chittagong differ from the rest of Bangladesh through a marriage cohort analysis of the parity progression ratios, and examines the factors determining the transition rates to higher parity in these two regions. Three cohorts of women are identified: those married during 1965–1974, 1975–84 and 1985–94. The results show that the probability that a woman from the recent cohort in Sylhet or Chittagong who had a third birth will have a fourth birth is nearly twice that of her counterpart in other regions. Social characteristics such as education, occupation, religion and residence have no effect on fertility in Sylhet and Chittagong. Additional period-specific analyses using the 2007 BDHS data show that women in Sylhet are considerably more likely to have a third or fourth birth sooner than those in other divisions, especially Khulna. The findings call for specific family planning policy interventions in Sylhet and Chittagong ensuring gender equity, promoting female education and delaying entry into marriage and childbearing.