Trying to get pregnant over the age of 40. What you need to know.

Trying to get pregnant when you are over 40 is a challenge, as the odds are firmly stacked against you. However, it is still a possibility, so there is always hope.

For me, it was a self-development project. I was fortunate enough to conceive and give birth to my miracle baby at age 44, but I worked really hard for it for a very long time. For over 10 years, I made a lot of sacrifices on my journey to get pregnant. I avoided certain foods in case I was pregnant, cut out caffeine and alcohol, invested in supplements that may be helpful when the money was needed elsewhere, and avoided high intensity exercise, which was something I loved the most. 

When I was told my anti-mullerian hormone (AMH) was low at age 39 and that my chances of getting pregnant via IVF were quite slim, this motivated me to become the healthiest version of myself that I could be. When my IVF pregnancy ended in another miscarriage at age 41 and I was told my only hope was to use a donor as my eggs were too old, my instinct told me that was not true. I believed I needed to keep going, keep trying, keep striving to become the healthiest version of myself I could be.

I continued to strive for optimal health and by the time I conceived my miracle daughter naturally at age 43, I was the healthiest I had been in my entire life. My gut symptoms and skin rashes were gone, and my asthma was under control. I guess I was fortunate to be a nutritionist and have access to practitioner research, resources and supplements that many don’t have access to. This is why it is now time for me to use this knowledge to benefit others. 

One of the biggest frustrations we are told when we are trying to conceive is that it is a “numbers game” and that our miscarriage or failed IVF cycle was because of a genetically bad egg and that we just need to keep trying month after month until we are successful. This is not true! We can’t expect to do the same thing over and over again and expect a different outcome. We need to look at why this is happening and what we can build on with diet and lifestyle interventions to move forward. Even if you just take one thing to improve on each month, for example reducing sugar or taking that probiotic, to keep yourself moving in the right direction.

I was listening to a webinar last year and Angela Hywood, a renowned fertility naturopath in Australia, quoted, “If you conceive and give birth to a healthy baby in your forties, you have the potential to live to 100”. I have to agree with this. If you are looking to get pregnant in your forties, your health needs to be the best it can be and then some. Try not to waste any time trying different supplements just because you heard about it in a forum. Everyone is different and what works for some may not be what you need. 

Whether you are new to the fertility journey or experiencing challenges, I advise taking a break from trying to conceive and dedicating three to four months to a preconception care program for both partners to enhance your overall health. Three months is the average time it takes for eggs to mature and for new sperm to be produced. I know it is hard when you feel like time is running out, but you really need to take a break from trying to conceive during this time as you want to make sure your eggs are healthy ones, a reflection of your hard work during the three months you spent getting your health on track.

Another thing that is hard to accept but is a reality when trying to conceive over the age of 40 is that in most cases, you will need to take supplements, and likely more than one. There is unfortunately not a quick fix or magic bullet, and if you are over 40, you may well have a few nutritional deficiencies or hormone imbalances that need addressing. Or you might have inflammation or a gut issue that needs some attention. This is just the reality of being an older mum. It takes a huge amount of physical effort and resources to conceive, carry to term, deliver a healthy baby, and then breastfeed in your 40s (if you are able to). I was still breastfeeding at the age of 46 with a very active 21-month-old. I feel that my resources were drained and I was very depleted. At the time my health was not as great as it was before I was pregnant and I looked and felt much older. That’s the reality of being a mum in your 40s. It is exhausting, so your body needs to be really ready for it.

Take advantage of the three-month preconception period to nourish your body with fertility-enhancing nutrients, resolve gut issues, reduce inflammation, balance hormones, and optimize endocrine organ function. Treat this time as a wellbeing holiday and try not to worry about getting pregnant. This may be all you need. Don’t waste time playing the numbers game, or you may run out of time.

What are the chances of getting pregnant over the age of 40?

It is a reality that fertility declines dramatically over the age of 40. This is because of the decrease in the number of eggs that remain in the ovaries, which reduces the chances of conceiving each month. Maintaining a pregnancy can also be a challenge as the incidence of miscarriage increases with age. 

According to the American Society of Reproductive Medicine, by age 40, a woman’s chance of conceiving is less than 5% per cycle, so fewer than 5 out of every 100 are expected to be successful each month. (1)

The US Centre for Disease Control and Prevention (CDC) quote that 30% of women between the ages of 40 and 44 experience infertility. The reduction in female fertility after age 40 happens because of a natural age-related decline in egg quality and quantity. As women get older, more of their eggs have abnormal numbers of chromosomes, which increases the chance of miscarriage. When eggs have genetic abnormalities, even if they are fertilized, there is a high chance that the pregnancy won’t be able to continue. By age 40, less than 50% of women’s eggs are genetically normal. Also, 34% of pregnancies in women between the age of 40–44 end in miscarriage and this increases to 53% for women over the age of 45. (2)

I came across some interesting statistics from an article published online by the Virginia Physicians for Women. Their article highlights that when girls are born, their ovaries contain the total number of eggs they will ever have, which is around one million. The numbers decline with age and most women lose about 30 immature eggs a day! This means that by the time a woman reaches puberty, her ovaries contain 300,000 eggs and by the age of 30, she is down to 100,000 eggs. Estimates say that by age 40, women only have about 20,000 eggs remaining (3) 

Another factor to consider is that after age 40, you have a higher chance of being diagnosed with other age-related conditions that may affect fertility. Examples of this are blood sugar issues, insulin resistance, weight gain, high blood pressure, thyroid issues and autoimmune conditions.  

This all sounds a bit doom and gloom if you are currently trying to conceive and you are over the age of 40, but it doesn’t mean there isn’t a reason to be hopeful. Despite the odds being stacked against me, I conceived naturally at age 43 after 10 years of secondary infertility and recurrent pregnancy loss, and I gave birth at age 44 to a healthy baby girl. 

Improving egg quality

If you are trying to conceive over the age of 40, your focus needs to be on improving the quality of the remaining eggs you have available in your ovaries.  Optimal ovarian health is required for an egg to develop from its immature state to one that is ready for ovulation and capable of being fertilised, a process that takes around three months.

Egg development requires a great deal of cellular energy and as women age, the ovaries become less efficient at meeting the demands of the growing egg. This affects egg quality and increases the chances of genetic errors occurring. 

Coenzyme Q10 

To improve egg quality, an essential nutrient to take as a supplement is coenzyme Q10 as ubiquinol, its most bioavailable form. 

Coenzyme Q10 is a powerful antioxidant that helps to protect eggs from free radical damage. It is an essential nutrient for fertility over the age of 40 and mitochondrial health. Taking coenzyme Q10 for about three months before trying to conceive may help to improve egg quality and increase your chances of pregnancy and favourable IVF outcomes. 

A 2018 study investigated the effects of coenzyme Q10 on ovarian response and embryo quality in women with poor ovarian response. `Women in the coenzyme Q10 group had an increased number of retrieved oocytes, higher fertilisation rates, and higher quality embryos’ (4)

Coenzyme Q10 is also important for supporting the health of the mitochondria, which is our energy powerhouse at the centre of each cell in our bodies. Therefore, it is essential to prioritize mitochondrial health when trying to conceive after the age of 40.  

What are the mitochondria?

The mitochondria, found at the center of every cell in our body, are essentially our battery power, since they serve as our energy powerhouses. They produce cellular energy from the food that we eat by breaking down glucose into adenosine triphosphate (ATP) which is the cell’s main energy molecule that is used to fuel various other cellular processes. So, you can understand the critical role of mitochondria in our function and survival.  

If mitochondrial energy production is compromised, it can cause weakness, fatigue, can accelerate aging, and is linked to infertility, especially in women over the age of 35.

According to Lee Know ND, `The reason the mitochondria are so important for fertility is that each oocyte contains about 100,000 mitochondria’ (5) and defective or dysfunctional mitochondria are a key contributor to infertility in women over the age of 35. After fertilisation, the zygote goes through rapid cell division, which requires a huge amount of cellular energy. If there is not enough cellular energy to separate chromosomes during cell division, this can lead to chromosomal abnormalities such as down’s syndrome. This is one of the primary reason older women have a higher chance of giving birth to babies with birth defects. `Early embryo and implantation potential has been correlated with mitochondrial function and activity’ (6)   

Coenzyme Q10 is an important compound that plays an essential role in mitochondria function and our ability to produce coenzyme Q10 naturally declines with age. As our aging bodies naturally produce less and less coenzyme Q10, we naturally produce less and less cellular energy, which is essential for reproductive function. This is why low levels of coenzyme Q10 can contribute to infertility. If the body does not produce enough coenzyme Q10, it may compromise the quality of the female egg. Additionally, if fertilization occurs, the fertilized egg may not generate enough cellular energy to divide properly, resulting in chromosomal abnormalities and miscarriage.

Coenzyme Q10 not only plays a key role in protecting DNA at the cellular level and improving egg health in women, but also sperm health in men. As an antioxidant, it helps to protect both the egg and sperm from oxidative stress and harmful free radical damage.

Mitochondrial function declines from around age 35. `In patients over 38 years of age, most of the luteal granulosa cells from preovulatory follicles exhibit an abnormal mitochondrial morphology and reduced expression of crucial antioxidant enzymes compared to women younger than 32 years of age’ (7) 

What is coenzyme Q10 and where do we get it from?

Coenzyme Q10 is a vitamin-like compound that we can make in our bodies and obtain through food. It naturally declines with age. The best food sources are beef, lamb, pork, organ meat (liver, kidneys, and heart), and oily fish such as salmon, mackerel, and sardines. Plant sources such as whole grains, green leafy vegetables, spinach, kale, broccoli, and nuts are also a source of coenzyme Q10, but they have much lower levels. Vegans and vegetarians are at a greater risk of a deficiency, as they don’t consume the richer animal sources. When we eat meat, we consume all the benefits from the animal, including their mitochondria. 

There is research that supports supplementing with coenzyme Q10 for any female over the age of 35 who is trying to conceive. Coenzyme Q10 can also provide valuable support for anyone undergoing fertility treatments such as IVF, and it is recommended to take it at least three months prior to the procedure. Choose the ubiquinol form as it is more biologically active, so it has better absorption and utilisation. 

According to Rebecca Fett in her book It starts with the Egg, supplementing with 200 - 600mg of coenzyme Q10 daily as ubiquinol is one of the best ways to improve egg quality. `Given everything we know about how coenzyme Q10 increases energy production in the mitochondria, how important this energy production is for egg and embryo development and the positive results from clinical studies to date, the current evidence suggests that adding a ubiquinol supplement is one of the best ways to improve egg quality’ (8)

How else can we support our mitochondria and, therefore, our egg quality?

To maintain healthy mitochondria, it is important to eat a diet high in antioxidants that can neutralize free radicals and protect against oxidative stress. Eating a variety of brightly coloured fruits and vegetables is a great way to supply the diet with a rich source of antioxidants. Fruits such as blueberries, strawberries, raspberries, and Goji berries are excellent sources. Also, leafy green vegetables like kale and spinach, red cabbage, red grapes, and dark chocolate.

Magnesium is another nutrient that is important for ATP cellular energy production in the mitochondria as well as the B-complex vitamins, omega-3 and alpha lipoic acid (see below). A good starting point for optimizing these nutrients is to choose nourishing foods and take a prenatal multivitamin with activated B vitamins.

Alpha lipoid acid (ALA)

Alpha lipoic acid is not something that is necessary for everyone trying to conceive, however can be beneficial for mitochondrial support if you are trying to conceive over the age of 40. 

Alpha lipoic acid is a compound that is made in the mitochondria of all body cells and has a role in converting nutrients into cellular energy. It is also a powerful antioxidant that protects the mitochondria from age related oxidative damage, which helps to improve the function of the mitochondria.  

A study published in the Journal of Fertility and Sterility found that supplementing with 400mg of alpha lipoic acid for 60–90 days increased the number of mature good quality eggs and embryos a woman produced. Pregnancy rates were also higher for women who took alpha lipoic acid supplements compared to the control group, though the difference didn’t reach a statistically significant level (9)

Not forgetting the men, in a 2015 study, men taking 600mg per day of alpha lipoic acid experienced improved sperm count and motility. (10) 

Alpha lipoic acid can therefore be beneficial for both male and female fertility, especially if you are trying to conceive over the age of 40. Supporting your mitochondrial health is critical for improving egg and sperm quality and the prevention of miscarriage. 

Along with supplements, you can also boost your intake of alpha lipoic acid by consuming nutrient-dense foods. Red meat, liver, carrots, beetroot, spinach, Brussel sprouts, broccoli, potatoes, and brewer’s yeast are all good options.

NAC 

NAC stands for N-Acetylcysteine and is a supplement form of the amino acid cysteine, a conditional amino acid found in protein foods such as pork, beef, chicken, fish, lentils, eggs and cheese.

NAC is beneficial for its antioxidant and anti-inflammatory properties and is a precursor to glutathione, which is the body’s primary antioxidant. The body makes glutathione from the three amino acids: glycine, cysteine, and glutamine, and a deficiency in any of these impairs

glutathione production. 

NAC (and glutathione) becomes important as it is a powerful antioxidant that helps to prevent free radical damage to cells and DNA caused by inflammation and oxidative stress, which increases as we age. NAC is helpful for women over 40 to help protect against the age related decline in egg quality.  It can also be helpful with chronic inflammation and conditions such as endometriosis and PCOS.  I discuss this in more detail in my blog post: NAC for male and female fertility issues 

Endometrial receptivity and implantation failure

Another reality of trying to conceive over the age of 40 is that the rates of pregnancy loss tend to be higher. Advanced material age is universally recognised as the single most critical risk factor for pregnancy loss.  The risk of pregnancy loss rises dramatically from approximately 11% in women aged 20-24 to 33-50% in women over 40 and 93% at age 45.  

As well as optimising egg quality, addressing any health conditions that could be playing a part, and optimising nutrition, it is also important to investigate the receptivity of the endometrial lining and whether implantation failure could also be a factor. 

With fertility education over the age of 40, the main focus is usually on the health of the egg and the sperm; however, without a receptive endometrial lining, even a perfect embryo cannot implant into the uterus and the pregnancy is unlikely to progress.

Recurrent chemical pregnancies, which are early pregnancy losses, usually as early as 4–5 weeks, are very common and account for 50-75% of pregnancy loss. Chromosomal abnormalities account for 70–75 % of these, but many are unexplained, especially recurrent ones. A huge number of these unexplained early pregnancy losses are because of implantation failure, which is the inability of the embryo to implant successfully into the uterine lining, resulting in early pregnancy loss. My blog post Endometrial Receptivity: 5 reasons why you may be experiencing implantation Failure raises awareness of some of the common factors that may make an endometrial lining unreceptive to the developing embryo. The process of implantation is such a delicate orchestra involving hormones, the immune system, our endometrial microbiome, and nutrient cofactors that it is amazing that pregnancies can happen successfully in the first place; they truly are a miracle. 

Boron

Boron is an underrated mineral that is important for hormone balance and fertility over the age of 40. It was a supplement that I started taking about three months before I got pregnant naturally at age 43 after 10 years of secondary infertility and recurring pregnancy loss. Since I made other changes at the same time, I didn’t fully appreciate the importance of boron until a similar situation occurred with one of my clients. After three months of working with me to support her nutrition, my client discovered she was pregnant at age 43 after experiencing multiple pregnancy losses. She made other changes to her diet, lifestyle, and supplement regime over those three months, so it is unclear if boron played a part in her getting pregnant, but we would like to think so. The knowledge that it has happened twice, though, has made me pay some more attention to this underrated mineral. 

I started taking boron about three months before I conceived at age 43. The reason I started taking it was because I felt I was entering the beginning stages of perimenopause and my hormones were out of balance. After doing some research on perimenopause, I felt it would be useful to try. As a practitioner who worked in a health shop, I would often research supplements and experiment on myself to see what happens and pass on any lessons to my clients. I had a lot going on at the time, so I didn’t really notice a big difference when I took it, but that’s usually the case with hormone supporting supplements. The changes are often subtle and it can take a few months to notice the benefit.

What is Boron and how does it help with hormone balance?

Boron is an important trace mineral that is not talked about that often, especially in terms of fertility. This may be because there is a lack of knowledge about the importance of boron, but also there is limited clinical research about the mineral and its uses. There still seems to be lots to learn about this mineral.

If you eat plenty of fruit, vegetables, nuts, and legumes in theory, you should be getting enough boron from food. However, there are certainly times in our lives when we could do with supplementing with some extra boron. One of those times would be during perimenopause, menopause, or if you are trying to conceive and you are over the age of 40. This is because boron can increase estrogen and testosterone levels in women, and if you are perimenopausal or trying to conceive over 40, these are the hormones that can start to get erratic and for many women are on a natural decline. Estrogen and testosterone are important not only for egg quality but also for healthy ovulation, healthy libido, and a sense of wellbeing.

Not only does boron play a crucial role in the synthesis of estradiol (E2) and testosterone, but it also plays a role in maintaining a healthy balance of other reproductive hormones. `Numerous studies indicate that boron intake affects the presence or function of hormones, including vitamin D, estrogen, thyroid hormone, insulin, and progesterone’ (11)

Enhancing dietary boron intake can have many benefits, including increased fertility, vitality, and the reduction of perimenopausal symptoms and PMS, which are the consequence of hormones that are out of balance.

`In animal studies, boron depletion is linked to fertility problems and birth defects, which suggests that boron can play a role in healthy reproduction and fetus development’ (12).

Food Sources of Boron

As mentioned earlier in this chapter, if you eat well and eat a variety of fruits, vegetables, nuts, and legumes, you should be getting enough boron in your diet. Foods that are rich in boron are avocados, apples, pears, oranges, grapes, grapes, leafy greens, peanuts, pecans, red kidney beans and lentils.

Recommended dietary intake

At the time of writing this, there is not a set adequate intake level for boron, despite the many studies showing the beneficial effects of boron. Instead, the United States Institute of Medicine Food and Nutrition Board has set a tolerable upper intake level of 20mg/d for adults, which includes pregnancy and breastfeeding. Research suggests that 3–5 mg a day is considered an optimal range, and many supplements on the market are in 3g doses.

According to Levy J, `the risks of consuming this mineral are thought to be minimal, especially from natural food sources. It is widely recognised as being very safe for consumption in both humans and animals. The only caution would be with people with hormone sensitive conditions like breast or prostate cancer, endometriosis or uterine fibroids since supplementing with boron can increase estrogen levels’ (13)

I think we will hear more about the benefits of boron as more research comes into light. Boron’s anti-inflammatory, antioxidant, hormone balancing, and mineral metabolism properties make it a vital part of improving fertility in all females, but especially females over the age of 40. Nielsen H and Macham L suggest that boron intakes above 1 mg/day could help people live “longer and better” (14) We can do this simply by eating more fruits, vegetables, nuts, and pulses. I am up for that.

Summary

If you are trying to get pregnant over the age of 40, your health needs to be the best it can be and then some. Even with a healthy diet, you are likely to need to take a few supplements.

Three months is the average time it takes for eggs to mature and new sperm to be produced. This highlights the importance of a three-month preconception health care plan for optimising fertility and egg quality.

Coenzyme Q10 is important for egg quality and supporting mitochondrial health, which is important for fertility over the age of 40. The preferred choice of coenzyme Q10 supplement is as ubiquinol. The antioxidant alpha lipoic acid and NAC can provide further support by protecting the mitochondria from age related oxidative damage. 

Boron is an important trace mineral for hormone balance and shows potential as a support for improved fertility outcomes over the age of 40.

References 

1. American Society of Reproductive Medicine, Age and Fertility Booklet- sourced from www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/age-and-fertility-booklet (sourced June 2023)

2. Extend Fertility – Fertility Statistics by Age. Sourced from: www.extendfertility.com/your-fertility/fertility-stats-by-age (sourced June 2023)

3. Brim E. S MD. Getting Pregnant at 40, FAQS and Tip for Optimising your Fertility Health. Virginia Physicians for Women. Sourced from: www.wpfw.com (sourced 9/11/23)

4. Yangying Xu et al. Pretreatment with Coenzyme Q10 Improves Ovarian Response and Embryo Quality in Low Prognosis Young Women with Decreased Ovarian Reserve: A Randomised Controlled Trial. Reprod Biol Endocrinol, 27th March 2018. Vol 16: 29

5. Know Lee ND. Mitochondria and the Future of Medicine. Charles Green Publishing, 2018

6. Benkhalifa M et al. Mitochondrial Participation to Infertility as a Source of Energy and cause of Senescence, Int. J. Biochem. Cell. Biol 2014. 55: 60-64.

7. Tatone C et al. Age-Dependent Changes in the Expression of Superoxide Dismutase and Catalase are associated with Ultrastructural Modification in Human Granulosa Cells. Mol. Hum. Reprod 2006: 12 655-666.

8. Fett R, It Starts with the Egg. Second Edition, 2019, Franklin Fox Publishing.

9. Kim C et al. Lipoic Acid Supplementation Increases the Expression of Pgc-1 Alpha Gene in Granuosa Cells and Improves IVF results in Aging Women Undergoing IVF. September 2017. Fertility and Sterility, Vol 108, issue 3, supplement E228. Sourced from: www.fertstart.org/article/S0015-0282 (17) 31211-6/fulltext 

10. Haghighlan H K et al. Randomised Triple-blind, Placebo Controlled Clinical Trial Examines the Effects of Alpha Lipoic Acid Supplementation on the Spermatogonium and Seminal Oxidative Stress in the Infertile Male. August 2015. Fertility and Sterility. Vol 104 (2): 318-24.

11. Forrest F H (PHD) and Meacham S L (PHD). May 9th, 2011. Growing Evidence for Human Health Benefits of Boron, Journal of Evidence-Based Complementary and Alternative Medicine. Vol 16 (3) 169 -180.

12. Levy J. Boron Uses – Boost Bone Density and Much More. 12th September 2020. sourced from: www.draxe.com/nutrition/boronuses

13. Levy J. Boron Uses – Boost Bone Density and Much More. 12th September 2020. Sourced from: www.draxe.com/nutrition/boronuses

14. Forrest F H (PHD) and Meacham S L (PHD). May 9th, 2011. Growing Evidence for Human Health Benefits of Boron, Journal of Evidence-Based Complementary and Alternative Medicine. Vol 16 (3) 169 -180.