Fertility over 40

Improving your chances of falling pregnant naturally

Google ‘fertility over 4o’, and you’re sure to come across a whole heap of not so promising stats on the chances of falling pregnant over the age of 40 and how challenging it is to maintain a pregnancy.

There are a tonne of articles on the internet encouraging women to start a family at a younger age, warning of all the potential health risks to mother and baby if you have a child later in life.

As a naturopath in Sydney the reality is that many of the women I see in my clinic wanting to start a family at this age struggled to find an appropriate life partner or to establish themselves financially to feel secure enough to provide for a child.

The discussion on when a woman should have a child is pointless as many factors impact this decision for a woman, and ultimately it’s possible to start a family in your 40’s. Understanding the state of your reproductive health is vital here.

Taking the relevant steps to protect your fertility is important.

In this article I will tackle just a few of the key areas you need to address to improve your fertility at forty.

At the age of 40-41, it’s predicted that 50 per cent of women would have completely lost their capacity for reproduction. I’ll speak a little more to this further along.

If you are still able to reproduce through the application of preconception care, you can get your body to the healthiest state possible to fall pregnant and maintain that pregnancy.

If you’re over 40 and looking to fall pregnant, I want this post to serve as a starting point for you to think about the actions you can take to increase your chances of starting a family.

This post will focus on women’s fertility as a naturopath for women’s health; this is my primary focus. However, please note that addressing male fertility is just as important.

He’s 50% of the equation, and managing his reproductive health is key! I just needed to keep this post from becoming a novel. Subscribe to the newsletter for updates when I post on male fertility.

An integrative approach to fertility and conception

I occasionally have clients who come to see me who are opposed to IVF or hormonal intervention at this stage. While I'm happy to work within the confines of my patients' choices, it's worth mentioning that IVF is an option for you to start building your team of practitioners and conducting relevant investigations now.

I can't emphasise enough that the best approach is an integrative one. Spend the time developing your health so that you can have the best possible outcomes from your IVF treatments.

There is now ample scientific evidence showing that taking 3-4 months to optimise your egg health and overall health is going to lead to better IVF outcomes.

Applying nutraceuticals and other protocols to support both egg and sperm quality and adequately preparing the terrain for the embryo's implantation becomes a key focus.

I often recommend and refer clients in Sydney to IVF clinics and doctors who are reputable and have good success rates for assisted fertility. It’s been my experience that at this stage a combined approach leads to optimum results.

Can you fall pregnant at 40?

How do you know if it’s even a possibility?

Assuming you’ve been trying for some time and you’re now wondering... is this going to be possible?

Testing is the best way to discover if pregnancy is still a possibility for you. Your reproductive age is mainly dependent on your oocyte age.

Taking a look at your family history can be telling. For example, how old were your mother and grandmother when they fell pregnant? Did anyone in your family have children in their 40’s? There is a strong genetic link there.

We also know that women who can conceive in their 40’s are more likely to live longer. How old were your mother and grandmother when they reached peri-menopause or menopause?

Let’s take a closer look at some of the other testing that can be conducted to assess your current state of reproductive health…

Assessing ovarian reserve and other tests for fertility

I often see clients fixated on the ovarian reserve, the measure used to assess the remaining quantity of eggs in a woman.

AMH- Anti Mullerian Hormone is the protein hormone released by granulose cells of the immature ovarian follicle. By measuring this in the blood, doctors have a rough idea of egg quantity.

You can check your AMH levels at any point of the cycle. However, it’s key to remember that even if your AMH is low, you can have good egg quality, which can get you over the line. 

Also it’s not uncommon to see AMH change with lifestyle and dietary modifications, with some clients seeing improvements in their readings after eliminating toxins, balancing cortisol and blood sugar levels.

So if you have a low AMH, please don’t be disheartened. There may be hope yet.

Look to request an AFC…

AFC- Antral follicle count —this test has high accuracy and sensitivity- it’s performed via ultrasound. Research has found that the number of active antrum follicles on the ovaries corresponds to the potential number of eggs left.

How many follicles are developing in the ovary? As long as you have some detected in your AFC, it’s worth going ahead with preconception care.

Falling Pregnant After 35…

There are things that you can get away with in your 20’s that you simply can’t into your 30’s and 40’s. As we age we know that a poor lifestyle, partying, drinking, eating poorly, stressing often, a lack of sleep will all impact your ability to fall pregnant and stay pregnant.

Beyond addressing these basics of healthy living, having all other general health markers checked at this point is also very useful.

Consider your thyroid function, studies have shown a significant link between hypothyroidism and infertility, and you want to look beyond TSH as this reading alone can be normal while the other thyroid markers show an imbalance.

Nutritional status, low vitamin D has been linked to an increase in miscarriage many of which may happen before you even know your pregnant.

Cholesterol, your sex hormones are made from cholesterol and years of a low fat diet can impact sex hormones and fertility. Fasting insulin and glucose, this list is lengthy and by no means extensive.

It’s important you get across all your health parameters because in many cases these will impact your IVF outcomes. In addition to that old reference ranges used by pathology labs are out of date when we look to some of the new research we see that an absence of a deficiency does not equal optimum reproductive health.

I will say here that your body is a very complex and intelligent system that will not allow you to fall pregnant if it sees the conditions aren’t safe and optimum. So unfortunately the reproductive system is one of the first ones to be compromised in a stressed and under nourished body.

If you’re seeing me for a consultation expect to walk away with a referral to request this pathology from your Dr or to have it done via a private lab.

Test don’t guess! At this stage you simply don’t have the time to waste. Cover all bases cover them well. That’s my approach as a naturopath.

The future health of your baby is dependant on the health of your egg and sperm. That’s where it all starts!

Pathology testing for fertility

Continuing with the topic of testing…

Time is of the essence here, so attending to any existing conditions may impact your ability to fall pregnant and maintain a healthy pregnancy. Unfortunately, the statistics show that miscarriage over the age of forty is as high as 33%, so it’s not simply about falling pregnant at this stage.

You also want to ensure you have a great baseline of healthy nutrients and hormonal health to maintain a pregnancy. Testing can help here as well.

Deep dive into your hormones, have this investigated at the right time in your cycle, and it’s different depending on which hormones you’re looking at. Your health practitioner will guide you here. Looking at your entire hormone picture is key for knowing where you might need to focus your attention and which aspects of your cycle need some attention.

Improving fertility

Factors you can start addressing right now:

Obesity

Underweight- yes believe it or not this is a factor that can increase your time to conception by 4 fold.

Smoking

Alcohol consumption- limit it to one drink.

Caffeine

Stress reduction/ management (learn more about stress & fertility here)

Illicit drug use has been found to increase infertility by 70%

Toxic exposure— solvents and environmental (more on this in a future post…It’s vital!!!)

Naturopath for fertility

How do they help?

Naturopathic interventions for fertility are centred around several factors lets take a closer look:

It is improving the overall health and health of the reproductive system in both women and men. This includes supporting any prolonged standing or existing health conditions like PCOS, endometriosis, auto-immune conditions etc.

As a naturopath, I look to decrease oxidative stress, toxic load on the body, and low-grade inflammation. We measure these through functional pathology and then implement the right tools to address them and reduce their impact on fertility.

Ensuring you have all the nutrients essential for a healthy egg and sperm is key!

To learn more about PCOS head across to this post.

To learn more about endometriosis head across to this post.

it all starts with an egg and a sperm cell

It’s worth mentioning here that it can take four months for your oocytes to develop, meaning that the quality of the eggs you’re carrying right now is primarily influenced by what you did four months ago.

This is important because whether you’re planning to conceive naturally this month or going through IVF to harvest your eggs.

You want to make sure those eggs are of the best quality possible. The health of your baby and your pregnancy starts with this single egg and sperm, so optimising the quality is essential.

If you’re in the 35 and above age bracket it’s ideal to invest the 4 months needed prior to egg collection and fertilisation!

I will further explain during our session together but this four months is vital for ensuring better outcomes with egg counts and quality.

But taking the time to improve your egg quality with behavioural, dietary and nutraceuticals can make a significant difference to the success of other treatments that follow, including fertilisation, embryo development and subsequent pregnancies.

Herbs and vitamins for fertility

Before jumping into some of the nutrients that may be indicated, it's important to note that clinically your naturopath will consider these on a case by case basis, and no two clients will walk away with the same recommendations. Your naturopath will ideally recommend a protocol based on your particular needs and only after you've undergone relevant testing.

This is a short list only and is by no means exhaustive.

Coenzyme Q10—Plays a vital role in the powerhouse of your cells, the mitochondria. Beyond ensuring adequate energy production, it is also a powerful antioxidant protecting cells against damage.

Iodine—This is a mineral that we know to be low for many women due to its lack in the diet. Maturing oocytes are highly dependant on thyroid function, and thyroid function is highly dependant on Iodine. 

Having adequate levels is essential. However, have the proper testing to avoid excess is also key.

Ladies Mantle—This herb has been traditionally used for many years to support women with reproductive bleeding disorders. It may also help with progesterone levels which are key for the formation of a healthy uterine lining. 

True unicorn root—Another master herb traditionally used to help with miscarriage prevention, poor menstrual flow or compromised endometrial lining. 

Shatavari—Also known as the herb for the woman with 100 husbands, it's thought to have an oestrogen like effect with a positive influence on cervical mucous production and ovulatory phase of the period.

Black cohosh —Traditionally has been used as a uterine and ovarian tonic. It may help support the poor uterine tone, and studies have found it helpful before IVF.

If you're undergoing IVF, you need to inform your health care providers of the nutraceuticals you're taking and follow your doctors' instructions. You are also reporting to your naturopath of where you are in terms of your IVF treatment. Certain compounds should not be taken at the same time as certain IVF drugs.

Please avoid self prescribing! It can lead to adverse effects and having a collaborative team is key.

I'll continue the discussion on fertility and health here in future posts, including presenting some of the information on some research on different nutraceuticals that have been found beneficial for fertility. So please stay tuned for those; subscribe to the newsletter for updates.

The key takeaway is that you can start doing many things now to plan for your family, even at the age of 40. There is always hope, and make sure you test and don't guess. 

One resource I often refer clients to is the book "It starts with the egg" by Rebecca Fett. There is a good discussion here on nutrients and how they affect fertility.

Start building out your health care team and ensure you've got either a functional medicine practitioner or naturopath in your corner to cover as many bases as possible.

If you have any questions, please don't hesitate to reach out; I'm here to help. To read more about the one to one sessions head across to this page.