More women than ever are trying to conceive over the age of 40, that is a fact. In most developed countries the world over we are finding that women have more freedoms and equalities than past times. There is no denying this is wonderful. This gives us the freedom to focus on career goals, travel, making our creative dreams a possibility, rather than feeling like we have to have children right away in our 20’s. We are no longer as stuck as we once were, but what about that nagging fear of fertility decline as we age?

I hear the doubt daily, “Should I have waited so long to have children?” I find that women over 40 come to us with a huge amount of fear surrounding their fertility journey. Where does this fear stem from? Society? Media? Science? Where? As long as humans have existed, there have been deep emotions, opinions, the “right and wrong” ways to do just about everything in life. So why would we expect it to be any different for those desiring to have children over 40? I am not here to pick sides, but I do think it is very important to be realistic and to listen to your gut. When has any decision that started off in fear been a step in the right direction? Let your journey begin with confidence and belief in your body. If you doubt your body or the health of your future child to begin with, how can you expect to be successful? Even if you don’t succeed, at least you will know you gave it your best shot.

I figure that if you are reading this article, you are all in, ready to have a child over the age of 40. Because of that, I am not here to list statistics on the likelihood of conception for women over 40, or the risks to mother and child. You can find that information elsewhere. We are here to let you know the importance of smart preparation. There are important key areas that need to be focused on. These key areas can help to give you and your baby the best chance at a healthy first 9 months in the womb and beyond!

Understanding Female Fertility for Women 40 and Over

What happens to my fertility as I age?

The Menstrual Cycle: Menarche to the Beginning of Climacteric
Menarche is the beginning of the childbearing years, when the first menstruation begins. Climacteric is the long phase in which hormone production and ovarian function declines, allowing the body to adapt to the natural changes in which menstruation ends. Menopause occurs within the climacteric years of a woman’s life. Climacteric lasts for about 15-20 years, typically beginning at the age of 40.

The Menstrual Cycle in the Childbearing Years of a Healthy Woman
Approximate age of 11-40 years

In very simple terms the hypothalamus produces GnRH (gonadotrophin-releasing hormone) which signals to the pituitary to produce LH luteinising hormone and FSH follicle stimulating hormone. The release of GnRH is pulsatile in women with regular menstrual cycles. This normal pulsatile release of GnRh signals some of the follicles in the ovary to begin maturing and for the ovaries to release estrogen and progesterone. This estrogen/progesterone signal is recognized by the pituitary gland. As the follicles begin maturing they release and increase the hormone estrogen over time. The rising estrogen level signals the pituitary gland to curb release of FSH.

In a normal functioning follicle, the estrogen levels rise and signal the pituitary gland to release Luteinizing Hormone (LH). LH signals the follicle to open and release the mature egg, this is ovulation.

Ovulation is followed by the luteal phase. With LH present the corpus luteum begins to secrete increasing quantities of progesterone and fairly constant levels of estrogen.
The endometrium is now influenced by progesterone causing it to develop to be capable of nourishing a developing embryo.

If fertilization does not occur, the decline of the hormones causes the endometrium to shed, which is dependent on hormones at all times for its health, maintenance and development. When estrogen reaches a low enough point the hypothalamus releases GnRH and the cycle starts over again.

This cycle lasts on average 28 days, though it may vary some from woman to woman.

The Menstrual Cycle in the Climacteric and Menopause Years of a Healthy Woman
Approximate age of 40-60 years for climacteric, age 40-55 for menopause, with menopause occurring within the climacteric years.

Now this may seem very confusing because most of us have very little education on what happens during “the change of life” a woman goes through as fertility declines. Most women begin the natural phase known as climacteric around the age of 40. Remember this is what is supposed to happen, it is part of the natural processes of life. At this time the menstrual cycle length begins to shorten from about 28 days to around 26 days, this is because the ovaries begin to lose their ability to produce mature follicles, estrogen and progesterone. Cycle length may be different for each woman, these numbers are just averages.

Over the next many years the decline in hormone release and mature follicle production causes even more menstrual cycle changes. Cycles may become shorter, longer, or the cycle may be skipped. Ovulation may or may not occur during any given cycle as a woman approaches menopause. Menopause is confirmed once a woman has not had her menstrual cycle for at least one full year, and is between the ages of 40-55. Menopause may take 1-7 years to complete. The changing hormone levels continue until climacteric is complete, which may last until around the age of 60.

There are 3 distinct phases of change for women in the climacteric phase of life.

Phase 1 Perimenopause: 2 to 8 years leading up to cessation of menstruation

• Menstrual cycles become irregular
• Hormone levels change
• It is still possible to conceive naturally and carry a baby to term
• Doctor’s may suggest medical assistance options like Clomid, IUI or IVF

Phase 2 Menopause: Defined by absence of menstruation for one year. Doctor’s may also use certain hormone testing to indicate menopause, they are as follows:

• Elevated FSH level between 60 to 100mL/L on two tests done at least 1 month apart may indicate menopause
• LH level greater than 50mIU/L and estradiol less than 50pg/mL
• Some reproductive endocrinologists are willing to do IVF with an egg donor for women in menopause

Phase 3 Post-menopause: the first stage typically lasts about 4 years of continued physical symptoms of hormonal changes, with the second stage lasting for years until all symptoms of hormonal changes end. This last stage is different for each woman, but usually ends by age 58-60.

The human female body is designed to go through these changes very slowly over time. Sudden change in a short period of time may cause more severe symptoms in the body. This great shift in fertility, though it is long and drawn out, may produce many unwanted physical symptoms including:

• Muscles of the vagina, cervix, uterus and ovaries atrophy
• Muscles in the pelvic floor and surrounding supportive tissues lose tone
• Lack of cervical mucous
• Bone mass declines
• Metabolic rate slows down
• Breast shape, firmness and size changes
• Hot flashes
• Mood changes, depression, insomnia and anxiety
• Mild incontinence due to weakening and shrinking of pelvic tissues
• Heart palpitations

Though these symptoms can be uncomfortable, this process is completely natural and is what is supposed to happen to the body. It is a “rite of passage”. I know, this may not be comforting to hear, but it is the truth. Research has shown that other cultures that are not Westernized do not report severe symptoms of menopause and are not medically managed. Menopause is not a disease that needs to be treated, but in the United States we have come to believe it does.

Knowing what is happening to your body gives you an advantage. It helps you to know key areas you need to focus on to give yourself the best possible chance at a healthy pregnancy.

Preparing for Conception Over 40

Healthy fertility over 40 is probably going to take a bit more effort on your part. It is vital you eat well, exercise regularly, reduce poor lifestyle choices and consider seeing a fertility specialist. If you have been trying to get pregnant for over 6 months it is important to see a doctor. Having a full hormone test panel run will help you to know where your hormone levels are at and what hormones may need to be supported. Seeing a doctor can help you to know if there are other fertility issues that may be hindering conception and pregnancy as well.

Because of normal life changes women over 40 need to focus on the following key areas:

Tools for your fertility tool box!

• Improving egg health
• Improving uterine health
• Supporting hormonal balance
• Strengthening pelvic floor muscles
• Supporting cervical mucous production
• Managing stress
• Timing ovulation and sexual intercourse

In addition, typically the older we are, the more time we have been exposed to the negative effects of stress, environmental toxins, poor dietary and lifestyle habits. These can contribute to fertility issues which may decrease healthy fertility at all ages, but especially for women over 40.

Medical Options

If you have been trying for a child naturally for 6 months or longer with no success, it is time to get in to see a doctor. Many women over the age of 40 will find they have diminished ovarian reserve (DOR). This is completely natural and normal. Regardless of what your test results are, a natural therapy plan may greatly increase your chances of a successful pregnancy. It does not matter if you are going for IUI or IVF or using a donor egg, simple natural preparation can still be done. A natural therapy plan may increase your chances of a successful medical procedure as well.

What will your medical options be if you find out you do have low ovarian reserve? Depending what your ovarian reserve is determined as, they may suggest Clomid to stimulate ovulation, intrauterine insemination (IUI), in vitro fertilization (IVF), or an egg donor (if your reserve is extremely low), or suggest hormonal medications. If you are planning to do any of the medical options I just mentioned, you can still follow a natural therapy plan prior to beginning any hormonal medications for those procedures. For example you could prepare naturally for an upcoming IVF. We always encourage couples to continue eating well and exercising through any type of fertility plan regardless if it is natural or medical.

Natural Therapy Plan for Women Trying to Conceive Over 40

Note: If you have been diagnosed with a fertility issue please also see one of our guides related to that particular issue.

There are many key areas that need to be focused on. I am briefly going to cover each of them below. At the bottom of each section is a link to more information specific to that subject.

Fertility Diet

The single most important thing you can do, if you do not already eat a whole food diet, is switch to one! I have seen the most dramatic improvement in egg health through diet changes alone, specifically by switching to a nutrient dense fertility diet that includes fertility superfoods like spirulina, maca, and royal jelly. Also, supplementing with key nutrients such as antioxidants, CoQ10 Ubiquinol, and folic acid have been shown to increase egg health.

Exercise

If you are not sweating regularly, your body is not going to be able to detoxify itself! Sweating helps the body to remove excess toxins, especially xenohormones, which are human-made chemical toxins shown to cause hormonal imbalance through endocrine system disruption. Exercise also helps to reduce fat in the body, quell depression, increase a sense of wellbeing, increase stamina and strength for the hard work of labor and early motherhood!

Most toxins are stored in our liver, kidneys and fat cells. If you plan on breastfeeding your baby, it is important to try to cleanse toxins from your body as much as possible prior to conception and breastfeeding. Your body will use fat stores during pregnancy and breastfeeding, which go directly to your baby, exercise is an essential way to cleanse the body of toxins in preparation for pregnancy!

Great Ideas for Exercise:

• Walking
• Fertility Yoga
• Biking
• Dancing
• Swimming Laps
• Pilates

Be sure you are exercising for 30 minutes a day, 5 times a week.

Kegel Exercise
Learn to make Kegels a part of your daily routine! What are Kegels? Daily Kegels strengthen the pelvic floor muscles. Contracting and relaxing the pelvic floor muscles repeatedly will help to keep the reproductive organs in place, support vaginal, cervical and uterine strength, as well as help to prevent uterine prolapse and incontinence after childbirth and post-menopause.

Fertility Cleansing

Women over 40 have had more time to be exposed to environmental toxins and are more likely to have an accumulation of toxins in the body. If there are poor diet and lifestyle choices involved such as drinking alcohol or smoking, being sedentary, etc., there is an even greater need for fertility cleansing prior trying to conceive.

The number one complaint we get from women over 40, is that fertility cleansing requires the couple to take one month off of trying to conceive. We understand that it can feel as though time is running out and that one cycle may be your missed opportunity for conception. Stop and think about this for a minute: Do you want to give your baby the best chance at a healthy beginning? Your body will use fat stores during pregnancy and breastfeeding, which go directly to your baby, regular exercise and cleansing is an essential way to rid the body of toxins in preparation for pregnancy!

Improve Egg Health

Egg health and count begins to dramatically decline on average around the age of 37-40. It is imperative you work to preserve and increase your egg health now. We suggest working on this for at least 3 months prior to beginning to try to conceive, whether naturally, through IUI or IVF. The cycle of an egg in preparation for ovulation is around 90 days. This is why we suggest taking 3 months to focus on increasing the health of your eggs.

To help improve egg health we like to focus on increasing circulation, boosting nutritional levels and supporting hormonal balance with fertility superfoods and vital nutrients.

Key tips for improving egg health:

• Eat a fertility diet
• Exercise
• Fertility Superfoods like maca, royal jelly and green foods
• Fertility cleansing
• Stress reduction
• Key nutrient supplementation with a whole food multivitamin, antioxidant blend, CoQ10 Ubiquinol, & L-Arginine

Improve Uterine Health

Due to the gradual changes in hormone levels after the age of 40, the uterus slowly begins to lose muscle tone. All women need to have a strong uterus for pregnancy and the hard work of labor. If you have a sedentary lifestyle it is even more important to work to improve uterine health. We already discussed how Kegel exercise can help to improve and preserve muscle tone of the pelvic floor muscles and uterus. Fertility massage and castor oil packs done externally over the lower abdomen helps to strengthen the uterus, improve hormonal balance, detoxify the tissues of the reproductive organs and surrounding tissues, and increase circulation to the reproductive organs. There are also specific herbs that have a direct action on uterine tone.

Key tips for improving uterine health:

• Daily fertility yoga, walking, and Kegels
• Fertility massage
• Castor Oil packs
• Herbs

Cervical Mucous

Cervical mucous production naturally declines with hormonal changes as well. It is important to support healthy cervical mucous production over the age of 40. For women that have low or no cervical fluid, it is harder for the sperm to reach the awaiting egg for conception.

Key tips for supporting cervical mucous production:

• Drink plenty of clean, filtered water daily, about 8 full glasses
• Take a complete omega essential fatty acid supplement daily
• Consider herbs that support cervical mucous production

When having sexual intercourse use a sperm friendly lubricant if CM is scant. This will help get the sperm where they need to go!

Chart Your Cycle

If you do not already chart your cycle, begin now. I know I said I wouldn’t throw any statistics out there, but let’s be realistic, women over 40 only have about a 5% chance per cycle of conceiving. If you do not have your timing down, it is going to be extremely difficult to get pregnant.

You have a 6 day window to get pregnant, with only 2 peak days. So begin trying to conceive 3 days prior to ovulation, the day of ovulation and 2 days after that. If your male partner has low sperm count or poor sperm health, try to have sex only on the day of ovulation. Abstaining from sexual intercourse for the days prior to ovulation will help to build up his sperm count.

Most women ovulate 2 weeks before menstruation begins. Charting helps you to know if and when you may be ovulating, which will help you to know when to try to conceive.

Support Hormonal Balance

The entire menstrual cycle relies on hormonal balance. Ovulation, conception and a healthy pregnancy cannot occur without hormonal balance! We know that hormone changes occur as we age, if hormone levels specific to fertility are too high or too low it may prevent conception or cause miscarriage.

Key hormones to learn about and support for a healthy pregnancy:

• Estradiol (E2)
• Progesterone
• Follicle stimulating hormone (FSH)

You may find that as you age, your changing hormone levels may interfere with conception or maintaining pregnancy. It is imperative to support the endocrine system at this time, as it is responsible for hormonal balance. We find that most women over 40 will need to support hormonal balance in some way. We like to utilize herbs and specific herbal formulas to help women encourage fertile hormone levels. Here are some herbs to consider:

• FertiliCare Phase 1 & 2 (a liquid herbal blend)
• Vitex (Vitex agnus-castus)
• Maca (Lepidium meyenii)
• Shatavari (Asparagus racemosus)

Other Important Considerations

Your Male Partner
We have focused so much on you, but what about your male partner? If he is also over 40, it is a good idea to get him in for some testing to determine sperm count and quality. There are many great natural ways to support healthy male fertility, you can learn about them here…

Support
Make sure you have a support network to help you out. Having a baby over 40 may bring more challenges and opinions from others, having a solid support network is going to give you more confidence and provide a cushion for days that may be tough!

Summary

Conception, pregnancy and having a healthy child over 40 is possible. Having a natural therapy plan in place may increase your chances of success by improving egg health, uterine health and maintaining hormonal balance. Natural therapies take time to be effective, we suggest you give yourself 3 months to implement a natural fertility therapy plan prior to beginning to try to conceive. This will give you the best possible chance at success.

Continue your natural fertility therapy plan throughout the time you are trying for natural conception. If you are planning on trying medicated cycles to achieve pregnancy such as Clomid, HRT, IUI or IVF, please discontinue any herbs or supplements you have been taking to improve your fertility.

Here is a quick summary of important key tips for preparing for conception over 40:

1. Eat a nutrient dense fertility diet, which will contribute to improving fertility overall.

2. Improve your egg health, uterine health and pelvic floor muscles with diet, exercise, herbs and supplements.

3. Support hormonal balance with stress management, herbs and supplements.

4. Support cervical mucous production by staying hydrated, supplementing with omega EFAs, herbs and possibly using a sperm friendly natural lubricant during intercourse.

5. Learn to chart your cycle so you can correctly time ovulation and sexual intercourse.

References:
1. Hoffmann, David , FNIMH, AHG, (2003) Medical Herbalism: The Science and Practice of Herbal Medicine, Healing Arts Press: Rochester, Vermont.
2. Romm, Aviva (2010) Botanical Medicine for Women’s Health, Churchill Livingstone: St. Louis, Missouri.
3. Fertility After Age 40 – IVF in the 40s. (n.d). Advanced Fertility Center of Chicago. Retrieved online at: http://www.advancedfertility.com/fertility-after-age-40-ivf.htm