Aeroelastic design and fatigue analysis of large utility-scale wind turbine blades are performed. The applied fatigue model is based on established methods and is incorporated in an iterative numerical design tool for realistic wind turbine blades. All aerodynamic and structural design properties are available in literature. The software tool FAST is used for advanced aero-servo-elastic load calculations and stress-histories are calculated with elementary beam theory.According to wind energy design standards, a turbulent wind load case is implemented. Fatigue loads are estimated based on 100% availability and a site-specific annual wind distribution. Rainflow cycle counting and Miner’s sum for cumulative damage prediction is used together with constant life diagrams tailored to actual material S-N data. Material properties are based on 95% survival probability, 95% confidence level, and additional material safety factors to maintain conservative results. Fatigue performance is first evaluated for the baseline blade design of the 10MW NOWITECH reference wind turbine. Results show that blade damage is dominated by tensile stresses due to poorer tensile fatigue characteristics of the shell glass fiber material. The interaction between turbulent wind and gravitational fluctuations is demonstrated to greatly influence the damage. The need for relevant S-N data to closely predict such blade stress cycle events is investigated to avoid non-conservative conclusions. State-of-art wind turbine blade trends are discussed and different designs of the NOWITECH baseline blade are analyzed in a parametric study focusing on fatigue performance and material costs.