How to get pregnant over 35

Beyond the “fertility cliff”

Have you ever gone down the 3 a.m. rabbit hole, searching “how to boost fertility after 35”? You’re not alone. Messaging about the “fertility cliff,” a steep decline in fertility after 35, seems to be everywhere, implying that it is much harder to get pregnant after 35.

From “ovarian decline” to “geriatric pregnancy” and “advanced maternal age,” the language of fertility and pregnancy creates shame and fear about aging. While it’s important to acknowledge that Opens in a new tab: fertility gradually declines in your 30s, everyone’s fertility changes differently. That is why it’s a good idea to talk with your doctor and understand the signals your body is sending.

This natural process is largely out of your control, but there is good science suggesting that lifestyle changes can help extend your reproductive longevity, your ability to conceive over time. Here is how the biological clock works, what’s in your control, and what’s not.

What happens to fertility in your 30s?

Fertility does decrease through our 30s, but many women conceive naturally at this age. Apart from age, overall health, weight, and lifestyle habits all play a role. To understand the biological clock, it helps to look at what happens to egg quantity and egg quality as we get older.

Egg quantity: AMH, ovarian reserve, and your “fertility lifespan markers”

The number of eggs we have decreases gradually with age.

Everyone is different, but fertility doctors use a hormone called AMH as a proxy for ovarian reserve, 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 at ovulation. As the reserve diminishes with age, Opens in a new tab: AMH levels go down. Genetics, smoking, and chemotherapy can also affect AMH.

AMH is only a proxy. Studies show that even with lower AMH levels, Opens in a new tab: you can still conceive naturally. Visit your doctor to understand your fertility status before trying to conceive.

Another fertility hormone is FSH, or follicle-stimulating hormone, which does what its name suggests: it stimulates follicles in the ovaries to grow. With fewer follicles left, the brain’s pituitary gland releases more FSH to grow whatever follicles are present that month, so high FSH can signal low ovarian reserve. But too much of a good thing can become a bad thing: overwhelmed by the signal, follicles can stop responding as well, making it harder for them to grow and mature.

Understanding your ovarian reserve gives you insight into your reproductive health, helps you plan around your timeline, and indicates how successful treatment may be (if there are few eggs to retrieve, IVF chances may be lower).

Egg quality

Egg quality is a broad term for how likely an egg is to be fertilized. Only an embryologist looking under a microscope can assess it directly, but the data show that egg and embryo quality decline with age, which can make it harder to get pregnant. This is thought to be due to a higher rate of chromosomal abnormalities, issues with how the egg cell divides. When people talk about the biological clock, this decline in egg quality is usually what they mean.

For the science-curious: the change is partly attributed to the gradual breakdown of proteins called cohesins, which keep chromosomes together and organized. As they break down, healthy egg maturation can be disrupted, and an egg ovulated with chromosomal issues may be less likely to be fertilized, implant, and lead to an ongoing pregnancy.

Which supplements should you take after 35, and which should you skip?

One of our biggest frustrations is how companies and influencers prey on fears of the biological clock. New products appear every day marketed to women in their 30s and 40s, promising to reverse reproductive aging.

The three most popular supplements marketed to people trying to conceive over 35 are CoQ10, DHEA, and NAD+. They have varying degrees of credible research behind them, but none has unbiased research showing it should be taken after a certain age to support fertility. Before taking any new supplement, talk with your doctor to make sure it’s safe for you: being available over the counter doesn’t mean it carries no risk.

Should I take CoQ10 over 35?

Coenzyme Q10 (CoQ10) is an antioxidant that helps reduce oxidative stress in the body. Early research is promising for its effects on Opens in a new tab: embryo quality and fertilization rates, especially in people with Opens in a new tab: poor ovarian reserve undergoing IVF or IUI. A Opens in a new tab: meta-analysis of five randomized controlled trials suggests CoQ10 may even improve clinical pregnancy rates. None of these studies, however, shows that it particularly helps women over 35.

CoQ10 has the best research behind it for supporting ovarian reserve, though it’s still early, with open questions such as the optimal dose. That is another reason to talk with your doctor first: they can advise on dosage and on interactions with any medications you take.

Should I take DHEA over 35?

DHEA is a hormone that can raise testosterone and estrogen levels; the theory is that this may improve follicle growth and, in turn, ovarian reserve. While Opens in a new tab: some research explores its use in women with diminished ovarian reserve, there is currently no strong evidence that it directly improves fertility in women over 35. A Washington Post Opens in a new tab: investigation detailed how DHEA’s popularity, especially among women over 35, has been driven by physicians who profit from promoting this unproven supplement.

Should I take NAD+ over 35?

NAD+ is heavily promoted by fertility influencers, and sometimes by doctors who partner with its makers, as a way to slow “cellular aging.” In theory, acting on the NAD+ pathway could affect the oxidative state of cells and improve egg maturation (or sperm production and function). But dozens of other agents could do the same, and there is no good evidence that NAD+ works in practice.

Most supplements of this type are also poorly defined. The product our clients ask about most does not list all of its ingredients, though it suggests nicotinamide riboside is the principal one. A PubMed search finds only three studies of nicotinamide riboside and fertility, two in women and one in men, and none shows convincing evidence. The male study was in animals, and looked only at a rare form of infertility caused by a mutation in a gene called BNC1.

It’s a clear example of how supplement makers spin almost no evidence into a plausible-sounding silver bullet. That product can cost over $100 a month: expensive designer supplements should set off alarm bells. No supplement needs to cost this much, and because the industry isn’t regulated by the FDA, companies can make bold claims backed by poor science, or none, with little consequence.

No supplement can increase your existing egg count. If anyone tries to sell you one that claims to, it’s snake oil.

We suggest sticking to the supplements recommended in your personalized lifestyle guidance. These are the ones with good evidence for your unique fertility and lifestyle, and we clearly signal which have established versus early evidence, so you can make the trade-offs that are right for you, without guilt.

A smarter strategy for improving fertility after 35

Rather than spending money on “miracle cures” or getting discouraged, focus on simple, evidence-based strategies.

1. See a doctor after six months of trying

If you’re 35 or older, the Opens in a new tab: American College of Obstetricians and Gynecologists and the Opens in a new tab: American Society for Reproductive Medicine both recommend seeing a specialist after six months of trying. Flagging any issues early saves you time if challenges do need to be addressed.

2. Make lifestyle changes that support your reproductive years

There is very little evidence for “age-specific” hacks. But as we age, lifestyle choices may be particularly important for reproductive longevity. The Opens in a new tab: latest research shows that lifestyle changes can help support egg quality, with important downstream effects:

• fewer chromosomal abnormalities
• a higher likelihood that a fertilized egg becomes a viable embryo
• a better chance that the embryo implants and develops properly

What about egg quantity? No medical or lifestyle intervention has been proven to increase your existing egg count. But simple changes may slow or stabilize the loss of eggs, starting with avoiding what can hasten the depletion of ovarian reserve, such as smoking, environmental exposures, and vitamin D deficiency. Growing Opens in a new tab: evidence also suggests certain lifestyle choices may slow atresia, the process that depletes eggs at various stages of development, which may lead to a longer reproductive lifespan and higher fertility with age.

3. Prepare for a healthy pregnancy with targeted lifestyle changes

As we get older, Opens in a new tab: potential risks during pregnancy increase. Your doctor can help you manage them, and alongside medical care, the choices you make before pregnancy can help you have the healthiest pregnancy possible.

A landmark 2023 Opens in a new tab: study published in Obstetrics & Gynecology followed more than 15,000 women and found that a healthy lifestyle before pregnancy can significantly reduce some of the most serious pregnancy risks, including miscarriage, preeclampsia, gestational diabetes, and preterm birth. These findings are just the tip of the iceberg: decades of research point to many more factors that can improve fertility potential and reduce risks in pregnancy, and even for children’s long-term health.