Trying to get pregnant and 1 or more of the following applies to you?

• You’re over 37 years old, maybe in your 40s
• Diagnosed with low AMH, high FSH, premature ovarian failure (POF), premature ovarian insufficiency (POI), poor egg quality, diminished ovarian reserve (DOR), or advanced maternal age (AMA)
• You’ve been told by your fertility doctors that it’s too late for you to get pregnant with your own eggs so you should consider donor eggs.

Why is getting pregnant into your 40s more difficult than when you were younger?

As you age, your cells become less efficient.  Like a car, the parts wear down over time and with use.  

Part of the reason for the decreased efficiency is that the longer you’re alive on this planet, the more toxins you’re exposed to.  Those toxins accumulate in your cells to impair all functions, including those that will help you get pregnant.

Your metabolism slows so you have to watch what you’re eating.   You can’t run as fast.  Your vision worsens.  Your skin is less youthful.  You’re more forgetful.

Your eggs are just as vulnerable as any other cell to the effects of aging.  

This is why your chances of getting pregnant decrease as you get older.  Any online fertility calculator will show your odds decreasing with each year.  The fertility statistics are dismal as you get further into your 40s.

In fact, pregnancy chances get so low that IVF doctors (specialists known as reproductive endocrinologists or more simply, REs) either recommend doing in vitro fertilization (IVF) right away or going straight to donor eggs.

But don’t worry, there’s probably still hope yet for you to conceive.  Naturally or with IVF.

Before we get to the good news, let’s understand a little more of the medical side of fertility treatments.

How do fertility doctors determine if you can still get pregnant?

With blood tests & ultrasound…

AFC Ultrasound to see your ovarian reserve

The ultrasound visualizes how many potential eggs you may have – the basal antral follicle count (AFC).  

The AFC can give an indication of your ovarian reserve, or how many eggs you have left.  

An antral (resting) follicle is a small, fluid-filled sac that contains an immature egg.  Follicles are not the same thing as eggs.  However, they’re often used interchangeably, even by the medical profession, creating a lot of confusion.  So what you see with the baseline AFC ultrasound are NOT your eggs, but the follicles that your eggs are in.  You need a microscope to see an egg – it’s too small to see with an ultrasound.

Remember that baggie of goldfish you got from the state fair when you were a girl?  Think of the bag as the follicle, the water as the follicular fluid, and the egg as the goldfish.  Remember that image whenever you hear “follicle.”

Blood tests – AMH & FSH

Doctors also look at your cycle day 3 blood hormone levels to gauge your fertility potential.  

One of the most important is the AMH level. Anti-Müllerian hormone (AMH) is a hormone secreted by the follicles in your ovaries.  For many fertility doctors, AMH has replaced day 3 FSH (follicle stimulating hormone) to measure ovarian reserve.

The AFC and Cycle Day 3 hormone levels are used as indicators for estimating ovarian reserve and your chances for pregnancy with in vitro fertilization (IVF).  

Based on those results, fertility doctors will recommend a course of action.  If both AMH and AFC are low, typically donor eggs are recommended.  Unfortunately, this devastating news can come as quite a shock, especially if it’s given at the very first consult you have with your doctor.  

However, these results don’t predict your future to get pregnant naturally.

Those results merely help with gauging how well their fertility treatments like IVF and inseminations will likely work for you.  

The antral follicles are a good predictor of the number of mature follicles in a woman’s ovaries that can be stimulated by IVF medications. The number of eggs retrieved from those follicles correlates directly with IVF success rates.  The more eggs retrieved, then the better the results expected from the IVF.

Are your chances decreased due to low AMH levels or low ovarian reserve?  Yes

Does low AMH or low AFC mean that you can’t get pregnant? Absolutely not!

They don’t take into consideration that your body is a fluid system, constantly changing.  And that you have the ability to influence your outcome depending on the choices you make.

Yes, you’re born with all the eggs you will have.  Unlike men who are constantly making sperm, you can’t make more eggs.

However, you ABSOLUTELY CAN influence how the eggs you already have mature as they get ready for ovulation.

What can you can do to improve your chances of getting pregnant naturally or with IVF?

A LOT!

Let’s go over a little science first so you understand why you can still get pregnant despite being of “advanced maternal age” or told it’s too late.

Mitochondria are known as the “powerhouses” of cells.  They convert calories from food, heat from the sun, and oxygen into energy to power the activities of the egg. They’re the “engine” of your eggs.  

Mitochondria are so important that as eggs mature to prepare for ovulation, they increase exponentially from between 5,000-10,000 mitochondria  to 100,000–500,000 or more mitochondria in fully mature eggs.

The reason for this staggering increase is because the egg is actively preparing itself for the increased energy demands of successful fertilization and eventual embryo development.  

So if the mitochondria can’t produce energy, you now by definition have poor egg quality which then contributes to poor embryo quality, if the egg even gets fertilized at all.  

Unfortunately, as you age, the number and efficiency of mitochondria decline.  This happens to both women and men. In all cells. Not just the eggs. This decrease is a result of aging so it’s not unique to your situation.  

Studies show that the mitochondria of older eggs produce significantly less ATP, which is the source of cellular energy. This has a significant impact on fertility, as the rate of division and successful implantation of embryos has more to do with how much energy the egg has than with your actual age.

Your egg has direct access to your blood circulation because it’s physically attached to you before ovulation.  If it’s fertilized and becomes an embryo, it reconnects to your body after implantation.

In contrast, during the window between ovulation and implantation (up to 7 days), the embryo is more or less free floating, dependent on energy produced by the existing mitochondria in the egg at the moment of ovulation.  More mitochondria are made only after implantation.

The older egg might have enough mitochondria (and therefore energy) to allow for fertilization and the initial stages of embryonic development.  However, if there isn’t a surplus of mitochondria, the embryo will run out of “juice” and stop dividing before implantation can be achieved and able to use your body’s resources again.

To increase the egg quality so that fertilization and implantation of a healthy embryo can occur, you therefore need to increase the number and improve the efficiency of the mitochondria.  

And this is where supplements, nutrition, exercise, and lifestyle changes come into play.

Here are some things you can do immediately to improve your egg quality.

It’s important to note that although quality can be enhanced, it’s not as likely that quantity (the number) of eggs can increase significantly enough to use IVF successfully.

This is why trying to get pregnant naturally is often the best solution for women over 40 or with diagnoses of low AMH, high FSH, premature ovarian failure (POF), premature ovarian insufficiency (POI), poor egg quality, diminished ovarian reserve (DOR), or advanced maternal age (AMA).

Sleep

When you sleep, you produce melatonin.  Melatonin is an antioxidant – in that it neutralizes toxins that are naturally produced by the mitochondria as a result of creating energy – like how our urine and stool are byproducts of digesting the foods we eat and drink.  A certain amount of free radicals is normal and healthy. But if there are too much, they become poisonous and can damage the eggs. So melatonin protects the eggs, just like an antidote to a poison protects the person. In order to have adequate production of melatonin, you need enough sleep.   

In addition to protecting the eggs from damage, melatonin directly affects ovarian function, especially in egg maturation and embryo development.

For most women when trying to conceive, 8-9 hours EVERY night is needed.

Supplements

The idea that you can get all your nutrients from food is fine in theory, but virtually impossible in practice, especially if you’re trying to achieve a specific health goal…like getting pregnant with a healthy baby after years of trying.  

As much as we want to eat the right foods 100% of the time, it’s not realistic.  Busy schedules, vacations, and temptations all work against us to shop and cook every day.

Supplements help to bridge the nutritional gap that processed foods create from eating convenient foods with very little nutrients.

Supplements are the ultimate hack.  They’re shortcuts to get your body functioning optimally.  They’re concentrated so they help to shorten the time to your end goal of getting pregnant. 

Some of the reasons why we can’t rely on foods alone to get our nutrients are:

• Soil depletion – Our soils are depleted of nutrients from improper farming practices.  On top of that, most plants are not harvested fresh. They sit on trucks, shelves, and counters for weeks before being eaten. Over time, the nutrient content of these plants decreases.
• Water depletion – Water filtration is essential to remove toxins.  But the process strips the water of important minerals.
• Food and environmental toxins – Your body needs nutrients to deal with toxins.  The more toxins you’re exposed to, the more need for nutrients.
• Poor absorption – As you age, hydrochloric acid and digestive enzyme production naturally declines, making it difficult for you to break down and absorb nutrients from your foods. That’s why heartburn and acid reflux become more of a problem.  As you get older, you also often begin taking medications which can interfere with nutrient absorption. This means you need to compensate with more nutrients in the most absorbable form possible.
• Optimal function – This is the most important reason for supplementing when trying to get pregnant.  If your body has low nutrient levels, this might manifest with low energy, poor willpower, decreased mental clarity and focus, and, of course, not getting pregnant.  Your body has to direct its nutrient reserves to critical, life-giving functions first. Stuff like digestion, breathing, movement, thinking. It doesn’t have the extra reserves for activities that aren’t life-threatening, like getting pregnant.  In times of perceived famine, your body will stop reproducing. It thinks there’s not enough food for both you and a baby. Obviously, we don’t live in times of famine. But we often make poor food choices by eating convenient processed, pre-packaged foods that have little nutrients  which your brain then perceives that you don’t have enough nutrients to support another life.

If the nutrient deficiencies go on long enough, they can cause DNA damage and make you age faster, resulting in poor egg quality.

Helpful supplements to improve egg quality

• Folate improves egg quality, implantation, reduces the risk of miscarriage, and prevents birth defects.  Find out more about it here.  Recommended daily dosage: 800 mcg.
• CoQ10 is used by every cell in your body.  95% of all cellular energy production depends on it.  Aside from its protective qualities as an antioxidant, it also helps produce more energy for your cells.  As we age, we make less CoQ10. So restoring CoQ10 levels can slow and reverse aging.  Recommended daily dosage: up to 600 mg.
• Vitamin D3 helps with improving ovarian reserve, implantation, and protects the embryo.  Read more about Vitamin D’s role in fertility and pregnancy.  
• Magnesium is involved in hundreds of processes in your body.  It’s essential for energy function, ensuring proper blood supply to the uterus,  producing progesterone (one of the most essential hormones for a healthy pregnancy), reducing risk of miscarriage, keeping cortisol (the stress hormone), under control, and detoxification.  Probably magnesium’s most important job in the pre-conception stage is protecting and repairing your DNA. Recommended daily dosage: take to bowel tolerance.

Nutrition

The proper conception diet is critical to providing the essential nutrients needed for any TTC diet.

Choosing the right fertility foods to eat when trying to conceive will increase your chances of getting pregnant dramatically.  Certain foods good for fertility improve female egg quality more than others.  These foods help ovulation as well.

Water

Water is the single most important food that makes you fertile.

Adequate water intake is essential for…

• Healthy egg maturation because without sufficient water, your body can’t process nutrients and hormones.
• …which leads to dehydration interfering with or preventing ovulation
• The cervical mucus, which is important in transporting the sperm to the fallopian tubes for egg fertilization.  Having little to no cervical mucus can be an indication that you’re dehydrated. You should see 2-3 days of egg white, stretchy cervical mucus around ovulation.  Without enough water, the cervical mucus that balances vaginal pH also becomes too acidic, harming the sperm.
• Implantation –  Water is necessary for cell division and metabolism. The cells of the uterine wall must be healthy for the embryo to implant.

For the fetus, staying hydrated is critical for fetal development.  Water helps carry nutrients to the placenta and is an important part of all aspects of development from the time of fertilization. Without water, a developing baby cannot survive, increasing the risk of miscarriage.

Fats

Eating the right fats is important for baby…

The brain is made largely of fat (~60%) and the majority of that fat in the brain is saturated.

The myelin sheath that surrounds the nerves in the brain and ensures their proper function is also largely made of saturated fat and cholesterol.  

For that reason, consuming saturated fats is extremely important, especially when trying to conceive and during pregnancy as these are times of rapid brain development for babies.

Having enough high quality saturated fat as  a reserve for a future pregnancy can reduce the risk of miscarriage.

Eating the right fats is not only important for your future baby but also essential for fertility…

Fats are the basic building blocks of your cell membranes. These fatty membranes surround every cell (including your eggs) and act as the border patrol allowing the right balance of hormones to enter your cells.  Healthy cell walls mean a healthy hormone balance. Unhealthy fats make your cell walls rigid, making it hard for hormones to get into your cells.

Studies show that low fat diets can decrease ovulation.  That’s because fats are a structural component for hormones and hormone-like substances.  In fact, cholesterol is converted to all hormones, including progesterone, estrogen, testosterone, cortisol, DHEA, and vitamin D.

Fat soluble vitamins such as vitamins A, D, E, K are found in the fat so when you eat low fat, you lose vital fertility nutrients.

Fat provide fuel for mitochondria and produce less damaging free radicals than sugar or carbohydrates.

Proteins

You need protein to build bones, muscles, skin, and cells.  

Because your body can’t store protein the way you can store carbohydrates and fat, you need to get enough protein every day.

Proteins are broken down into their component amino acids, the building blocks of new proteins. They are like Legos, coming in different shapes, sizes, and types that help construct the different structures your eggs (and the embryo) need.  

It’s a perfect economy, with the amino acids being recycled into new proteins on a supply-and-demand basis.

Studies have shown adequate, high quality protein can…

• improve egg quality so that embryo quality doubles
• doubles pregnancy rate
• decrease miscarriage rate by half

IVF patients who switched to a low-carbohydrate, high-protein diet and then underwent another IVF cycle increased their blastocyst formation rate from 19% to 45% and their clinical pregnancy rate from 17% to 83% (1)

Inadequate high quality proteins can decrease frequency of menstrual periods.
      
While choosing the right foods to eat when trying to get pregnant is important, pay attention to food that can cause harm.

Here are some foods to avoid when trying to get pregnant:

Sugar

One of the key mechanisms by which sugar causes premature aging, thus reducing egg quality and fertility is through mitochondrial dysfunction.

When your body burns sugar (as opposed to fat) for its primary fuel, more toxins called free radicals are produced that damage DNA, cell membranes, and proteins.  

Researchers found that perceived age using facial photographs increased nearly half a year per 1 mmol/L increase in glucose level in non-diabetic people.  In other words, the higher your glucose levels, the older you’ll tend to look. If the glucose is damaging your skin cells to age you more quickly outwardly, how do you think it would affect your cells INSIDE your body – specifically your eggs?

When blood sugar levels are consistently high as is the case when eating a lot of sugar in a high carb and high sugar diet, sugar binds to protein unpredictably forming advanced glycation endproducts (AGEs).  

AGEs are linked to DNA damage in the eggs, lower fertilization rates, poor follicular and embryonic development and lower pregnancy rates regardless of age.  

Eggs need to be plump with a soft outer shell of proteins so that sperm can easily penetrate it. Hardening of the outer shell from the cross linking of the AGEs to the shell’s proteins makes it very difficult for the sperm to penetrate it.   The good news is old glycated collagen (which causes wrinkles and shriveled hard eggs) will eventually be eliminated. It will be recycled and reused for new collagen formation. But this time you need to make sure you are not bombarding your cells with S-U-G-A-R!

Dairy

Dairy is one of the most confusing food groups because so many people rely on drinking milk daily to get their calcium.

Unfortunately industrial milk and dairy products are loaded with hormones, antibiotics, and toxins.

Dairy products are the single largest source of dietary estrogen for humans.  Researchers estimate that 60-70% of our food-sourced estrogen comes from milk, yogurt, ice cream, cheese, and other dairy products.  

Too much foreign estrogen-mimicking chemicals called phthalates disrupts normal hormonal balance and fertility. In women, phthalates are linked to poor egg health and early pregnancy loss.

 

There is simply no reason to drink cow’s milk.  

Get your calcium from other food sources e.g. dark, leafy greens, sardines, broccoli, almonds, sprouted seeds

Bottom line:  Your fertility can be improved with mindful practices, regardless of your age or diagnosis.  There is no one-size-fits-all approach to getting pregnant into your 40s…what works for one woman may not work for another.  However, adhering to general guidelines as described above will significantly improve your overall health and therefore your fertility.

For even more information on how to improve your fertility and have a healthy baby even in your 40s, download the first 5 chapters of my book “Cracking the Egg Myth: Proven Ways to Improve Your Fertility” here.