how to get pregnant over 35

How to Get Pregnant Over 35

Can lifestyle changes and supplements boost fertility in your 30s?

Have you ever gone down the 3 AM rabbit hole, googling, “how to boost fertility after 35?” You’re not alone. It seems like the messaging about the “fertility cliff”, or the hard decline in fertility after the age of 35, is everywhere. It implies that it is harder to get pregnant after 35. 

From the “fertility cliff” and “ovarian decline” to “geriatric pregnancy” and “advanced maternal age”, the language used in the fertility and pregnancy space creates shame and fear about aging. 

While it’s important to acknowledge that fertility gradually declines in your 30s, everyone’s fertility changes are different. This is why it's a good idea to talk to your doctor and understand what signals your body is telling you. 

Though this natural process of your reproductive system is largely out of your control, there is good science suggesting that lifestyle modifications can help expand your reproductive longevity, or your ability to conceive over time. Let’s break down how the biological clock works and what’s in your control — as well as what’s not.

The Secrets of Our Fertility Biological Clock: What Happens In Our 30s?

While it's true that our fertility decreases as we hit our 30s, you should know that many women conceive naturally at this age. Apart from age, other factors like overall health, weight, and lifestyle habits play a role. 

To understand the biological clock, let's look at what happens to the quality of our egg and ovarian reserve as we get older. 

Understanding What Happens to Egg Quantity As We Age: AMH, Ovarian Reserve, and Our “Fertility Lifespan Markers”

As we grow older, the number of eggs we have naturally decreases gradually. As a rough guide, egg count on average looks something like this as we age:

  • At  5 months gestation (aka, before you’re born!): about 5 million eggs

  • At birth: about 1 million eggs

  • At puberty: 300,000 to 400,000 eggs

  • During your reproductive years: About 120,000 at age 30 and 25,000 at 38 (this sharp decline is why people talk about the "fertility cliff" during your 30s)

  • At menopause: About 1,000 eggs left (though they don’t have capacity to mature for ovulation)

So, you might be asking, “what is my egg count, and how fast is it changing?”

Everyone's different, but fertility doctors use a hormone called AMH as a proxy for your ovarian reserve, which is the number of healthy eggs left in your ovaries. Think of it as your egg bank. Each month, your body releases one of these eggs during your ovulation. As you age, this reserve diminishes, causing your AMH levels to go down. Other factors like genetics, smoking, and chemotherapy can also affect AMH.

It's important to remember that AMH is just a proxy. Studies show that even with lower AMH levels, you can still conceive naturally. Visit your doctor to know your fertility status before trying to conceive.

Another fertility hormone is FSH. High FSH levels show a low ovarian reserve. Follicle stimulating hormone (aka FSH) acts as you might suspect it does, given its name: it stimulates follicles in the ovaries to grow. As we naturally age, our overall egg count declines. When we have fewer follicles left, the brain’s pituitary gland wants to put growth on overdrive and continues to release the FSH hormone to grow whatever follicles are present that month. However, too much of a “good thing” can become a “bad thing”: in response to the loud signal from our body to grow, the follicles can become overwhelmed and stop responding as well to the FSH, making it harder for them to grow and mature. 

Understanding your ovarian reserve gives you more insights into your reproductive health, how to plan around your reproductive timeline, and how successful treatment can be (if there are no or few eggs to retrieve, your IVF chances may be lower). 

Understanding What Happens To Egg Quality In Our 30s

Egg quality is a broad term that ultimately impacts how likely an egg is to get fertilized by a sperm. An embryologist needs to look at the egg under a microscope to directly assess its quality. However, even without undergoing IVF, we know that the data shows that as people age, egg (and embryo) quality declines, which can make it harder to get pregnant. This is thought to be due to an increased rate of chromosomal abnormality, aka issues with how the egg cell divides. When people talk about the “biological clock” and fertility, this decline in egg quality is usually what they mean.

If you want to get really nerdy about the science specifics: this change in egg quality with age is partly thought to be due to the breakdown of proteins called cohesins, over time. These proteins are responsible for keeping chromosomes together and organized. So, when this protein breaks down, it may lead to issues with the processes of healthy egg maturation. If the resulting egg ovulates with chromosomal issues, it may impact the chance of fertilization, implantation, and ongoing pregnancy.

What Supplements to Take and What To Skip After 30

So, are there specific supplements that are important for TTC when 35+?

One of our biggest pet peeves is that companies and influencers prey on our fears of the “biological clock” and other ideas related to getting pregnant after 35. We see new products every day that are marketed specifically for women in their 30s and 40s that promise to reverse the reproductive aging process. 

The 3 most popular supplements marketed to people “TTC over 35” are: CoQ10, DHEA, and NAD+. While they have varying degrees of credible research behind them, none of these supplements have unbiased research that shows these supplements should be taken after a certain age to support fertility. 

Additionally, before taking any new supplements, it's important to talk to your doctor to make sure they’re safe for you to take. Just because they are available over-the-counter doesn’t mean they have no risks.

Should I take CoQ10 over 35?

Coenzyme Q10 (or CoQ10) is an antioxidant that plays a role in helping reduce oxidative stress in the body. 

Early research is promising for the potential effects of coenzyme Q10 on embryo quality and fertilization rates, especially in individuals with poor ovarian reserve undergoing IVF or IUI. According to a meta-analysis of five randomized controlled trials, CoQ10 supplementation may even positively impact clinical pregnancy. However, it’s important to note that none of these studies show this supplement can particularly help women over 35.

This supplement has the best research behind it when it comes to supporting ovarian reserve,  though it’s still early with lots of open questions. For example, the science is a bit fuzzy on the optimal dosage to support fertility outcomes. This is another reason why you should talk to your doctor before taking CoQ10 supplements. They can advise you on the appropriate dosage and potential interactions with other medications you may be taking.

Should I take DHEA over 35?

DHEA is a hormone that can increase testosterone and estrogen levels. The thought is that by increasing these hormones, follicle growth might be improved and therefore enhance ovarian reserve.

While some research explores its use in women with diminished ovarian reserve, there's currently no strong evidence that it can directly improve fertility in women over 35. In fact, The Washington Post did an expose detailing how the popularity of DHEA, especially for women over 35, has come from physicians profit from pushing this unproven supplement on women who are TTC. 

Want to go deeper on DHEA? We break down the science of whether DHEA can improve ovarian reserve here — check it out!

Should I take NAD+ over 35?

NAD+ is pushed a lot by fertility gurus and sometimes even doctors who partner with NAD+ makers. It’s marketed as a supplement that can decrease "cellular aging."

So how does this impact fertility? Well, in theory, acting on the NAD+ pathway could affect what's called the "oxidative state" in cells and improve egg maturation (or sperm production and function). But the truth is dozens of other agents could do the same thing and there is no good evidence that NAD+ actually works in practice.

Unfortunately, most supplements of this type, like this one, are not well defined — the website, for example, does not provide all ingredients, but suggests that nicotinamide riboside is the principal ingredient. A PubMed search shows only three studies on nicotinamide riboside, 2 on female effects and one on male. None of these studies show convincing evidence. In fact, the one study on male infertility was on animals, not humans, and looked at only a rare kind of infertility induced by the mutation in a specific gene called BNC1 which impaired sperm production; this is not a likely cause for many cases of male infertility.

This is a great example of how supplement companies take almost no scientific evidence, spin it into a plausible reason-to-believe it will be your fertility silver bullet, and take advantage of people trying to conceive.

Plus, the supplement maker our members ask about most (Tru Niagen) can cost over $100 a month! When you see really expensive designer supplements, it's a good idea to have some alarm bells go off. No supplement needs to cost this much, and this whole industry is not regulated by the FDA. This means companies can make big bold claims about "it works!" and point to poor science (or no science) with little repercussion. We feel these brands can be predatory, especially during such a vulnerable time when people are trying to get pregnant.

We suggest sticking to the supplements Doveras recommends for you in your fertility lifestyle program. These will be the ones with good evidence for your unique fertility and lifestyle — and we will clearly signal which have established vs. early evidence so you can make tradeoffs right for you, with no guilt.

The Smarter Strategy For Improving Fertility After 35

Rather than spend money on “miracle cures” or get discouraged, focus on simple evidence-based strategies that can boost fertility in your 30s.

1. See A Doctor After 6 Months of Trying

If you’re 35, the American College of Obstetricians and Gynecologists and the American Society For Reproductive Medicine both recommend seeking out specialist help after 6 months of trying. 

Talking to your doctor can help make sure any issues are flagged earlier, so you save time addressing any challenges if needed! 

2. Make Lifestyle Changes To Help Extend Your Reproductive Years

Right now, there is extremely limited evidence that there are any “age-specific” hacks ("do this after 35!") that make a difference. But what we do know is that as we age, lifestyle choices may be particularly important to help extend your reproductive longevity. 

The latest scientific research has shown that making lifestyle changes can help boost egg quality — resulting in a number of important downstream impacts, including:

  • reducing chromosomal abnormalities

  • increasing likelihood of a fertilized egg to be a viable embryo

  • improving ability of the embryo to implant and develop properly once implanted

So, what about egg quantity? Unfortunately, there are currently no medical or lifestyle interventions that have been proven to increase your existing egg count. If anyone tries to sell you something that claims this, it’s snake oil! 

However, what we do know is that making simple lifestyle changes may be able to slow or stabilize the loss of eggs. For example, it’s important to avoid things that can hasten the depletion of ovarian reserve (like smoking, environmental exposures, and Vitamin D deficiency).

Additionally, more and more evidence suggests that certain lifestyle choices can slow down the rate of ovarian decline. How? Certain lifestyle factors may slow down the rate of something called "atresia," which causes the depletion of eggs at various stages of their development in the pre-follicular phase. This may lead to a longer reproductive lifespan and higher fertility with age.

If ovarian decline is something you’re concerned about, our lifestyle programs can help you develop a strategy to support your reproductive longevity.

3. Prepare For a Healthy Pregnancy With Targeted Lifestyle Changes

As we get older, it's true that our potential risks during pregnancy increase. Your doctor can help you manage these risks effectively. But alongside medical care, you can make lifestyle choices before getting pregnant that help ensure you have the healthiest pregnancy possible.

At the end of last year, a groundbreaking new study connected the dots between pre-pregnancy lifestyle and better pregnancy outcomes — underscoring why we do what we do at Doveras.⁠

Published in Obstetrics & Gynecology, the study followed 15,000+ women and showed that adopting a healthy lifestyle BEFORE pregnancy can significantly reduce some of the most devastating maternal health risks during pregnancy — including miscarriage, preeclampsia, gestational diabetes, and preterm birth.⁠

This is HUGE, and we are already addressing these exact lifestyle risk factors for some of our country’s most vulnerable and overlooked populations.⁠

These findings are just the tip of the iceberg. Alongside these factors, our fertility programs address many more that decades of studies show can improve fertility potential and decrease pregnancy (and even downstream child health!) risks.⁠ 

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