Conception Tips

Foods to consume while trying to get pregnant:

Getting Pregnant At 40: FAQs And Tips For Optimizing Your Fertility Health

In the 1970s, the average age of first-time mothers in the United States was 21. By 2020, that average age had jumped to 26. Studies show this trend is mostly due to career goals and financial concerns – children aren’t cheap!

Unfortunately, evolution has not caught up with the newer preference of becoming pregnant later in life, and our bodies face some unique pregnancy challenges as we age.

Having a baby at 40 or older is not always easy even if you feel perfectly healthy and capable of carrying a baby.

As obstetricians and gynecologists, we’ve seen an increase in patients asking us questions about getting pregnant at 40.

We thought we would address a few of the most common questions and offer some tips for getting pregnant at 40 or later.

Is it possible to get pregnant naturally at 40?

YES! While fertility does decline naturally as we age, starting around age 30, it is possible to become pregnant without fertility treatments after age 40. (This is why we often recommend staying on birth control until menopause if pregnancy is undesired…if you are having periods, there is a chance you can get pregnant!)

However, women have a much lower chance of conceiving naturally after 40 than at a younger maternal age .

Fertility specialists quote approximately a 5% chance per menstrual cycle of getting pregnant naturally after age 40 vs. a 25% chance per cycle for women in their 20’s, which is when fertility typically peaks and you have the best chance of experiencing healthy pregnancies.

The reason for the decline in successful pregnancies after 40 is multifactorial, with risk of miscarriage being the biggest concern. The rate of miscarriage is about 40% after the age of 40.

This is due to many reasons, but the biggest is a higher chance of genetic abnormalities in each egg. Women’s ovarian reserve also decreases over time, meaning they have fewer eggs by age 40.

How many eggs does a woman have at 40?

When girls are born, their ovaries contain the total number of eggs they will ever have – about a million! This number declines as they age. Women lose about 30 immature eggs a DAY!

This means that by the time a woman reaches puberty her ovaries contain 300,000 eggs; by age 30 she’s down to 100,000. Estimates say that by age 40 women only have about 20,000 eggs remaining.

Ovarian reserve can be tested by a physician with a blood test called the Anti-Mullerian Hormone. AMH is a hormone produced by the follicles in a woman’s ovaries where egg cells develop, and it declines through a woman’s reproductive lifespan. The lower a woman’s AMH number, the fewer eggs remain in her ovarian reserve.

However, it’s important to remember that a woman’s AMH test results are just one piece of data that her doctor will look at when discussing her fertility health. They don’t tell anything about the quality of her remaining eggs and their chances of resulting in a successful pregnancy.

Are my eggs bad after 40?

All women have a percentage of eggs that are genetically abnormal. This means that even if those eggs are fertilized, the pregnancy will not end in a live or genetically normal baby. The percentage of normal eggs a woman has decreases as she ages.

At age 25, a woman has approximately 75% normal eggs. By age 35, that number drops to around 45%, and by 40, it’s around 20-30%. This is one reason why most physicians recommend genetic testing for conditions such as Trisomy 21 in a pregnancy over age 35.

Is Having a Baby at 40 Too Old?

Even beyond simply wondering if you’re too old to conceive, a lot of patients will ask us if we think that 40 is too old to have a baby and raise a child. We simply say, do what feels right. If you want to get pregnant at 40, we will do our best to help you reach that goal and have the healthiest pregnancy possible.

We also want you to be aware that there are more challenges involved with pregnancy at 40 and older. Dr. Allison Giles discusses some of the risks for both mother and baby in her blog post, Odds and Risks of Pregnancy After 40. We encourage you to schedule a preconception visit with your doctor to discuss your personal risk and what you can do to minimize it even before you become pregnant.

How long does it take to get pregnant at 40?

At peak fertility (in their 20’s), the chance of a fertile couple conceiving in any one month is about 20-25%. After a year of unprotected intercourse, approximately 85-90% of those couples will conceive. This is why OB/GYNs generally recommend fertility testing for couples under 35 who have not become pregnant in one year of trying.

By age 35, the chance of a successful natural pregnancy drops to 10-15% per cycle, and by 40, the chances hover around 5%. This does not mean that getting pregnant after 40 is impossible, just that it will likely take longer. That’s why the recommendation for considering fertility testing after 40 is only 6 months.

How do I improve fertility after age 40?

There are many ways to improve fertility in general, and they become especially important after age 40.

Besides naturally declining fertility, another challenge women over 40 face is that many will have been diagnosed with other conditions which can cause pregnancy complications and/or more difficulties getting pregnant. Examples are obesity, high blood pressure, diabetes, thyroid disorders, fibroids, and endometriosis.

Women with other medical conditions should make sure that their physicians know that they are trying to conceive so that they can optimize their health to prepare for the pregnancy.

This may mean changing medications, working on eating healthy, exercising, and weight loss (see Dr. Pound’s 4 Tips for Becoming Pregnant in 2022), or being more aggressive in controlling some conditions like diabetes.

A preconception counseling appointment with your regular gynecologist can help pinpoint areas for improvement and give you personalized recommendations.

It is important to take a prenatal vitamin daily when trying to conceive. They help you get the nutrients needed for healthy development of a fetus if you do become pregnant – even before you know it. Some reproductive endocrinologists also recommend supplementing with CoQ10 to help with egg quality. Learn more in Dr. Dogal’s blog post, Everything You Want to Know About Prenatal Vitamins (Whether You’re Pregnant or Not)

Here are some tips for getting pregnant at 40 or older:

Try More Frequently During Your Fertile Window

One of the simplest ways to increase your chances of getting pregnant as an older mother is to try more often during the times in your menstrual cycle when you are most fertile. Track your cycle and look for ovulation indicators to understand when your fertile window will occur if you want to increase your chances.

Eat Right

Obesity and a poor diet high intrans fats and processed foods can decrease your chances of getting pregnant. If you’re struggling to control your weight, talk to your doctor about some of the things you can do. Dr. Stephen Pound has some great tips .

Ditch Drinking and Smoking

If you’re drinking or smoking while trying to get pregnant, it’s recommended that you stop. Drinking alcohol and smokingwill hurt not only your chances of conceiving but also of having a healthy, successful pregnancy.

Is there help if I haven’t gotten pregnant after 40?

YES! Reproductive endocrinologists specialize in assisting women with fertility issues. After age 40, we recommend having a consultation with a specialist if you haven’t become pregnant within 6 months of trying.

There are many options for how to proceed depending on a woman’s age and health history, her partner’s age and health history, etc. You can go over these options together and figure out the best plan for you and your partner. We wish you the best of luck!

To schedule a preconception consultation with a VPFW provider, call us at 804-897-2100 or set an appointment online.

Conception Tips

It’s important you prepare your body and adjust your lifestyle to maximise your chances of conception. Here are some tips that can really make a difference to your level of fertility.

• Water
  When trying to conceive it is very important to drink lots of water (about 8-10 cups a day). This helps the kidneys to flush out waste products from the body and increases fertile quality cervical fluid.
• Avoid alcohol
  It is a good idea to avoid or strictly limit alcohol intake as this reduces fertility. Department of Health advice is to avoid alcohol completely if trying to conceive or during pregnancy.
• Caffeine
  Caffeine is thought to restrict the growth of a developing baby by constricting blood vessels and reducing blood flow to the uterus. Current advice is to limit caffeine intake to below 300mg per day, equivalent to 4 cups of instant coffee, 3 cups of fresh coffee or 6 cups of tea.
• Smoking
  Women have a 40% lower chance of getting pregnant if they smoke, according to a report published by the British Medical Association (BMA). Smoking decreases sperm count and increases sperm abnormalities in men. Ask your GP or Practice Nurse for help in quitting.
• Exercise
  Women who exercise regularly are less likely to experience the uncomfortable side effects of pregnancy (back pain, piles, swollen ankles, etc), to have excessive weight gain and more likely to feel good about their changing body. A fit, healthy body is also more likely to cope better with child birth. Find a balance though because excessive amounts of exercise can lead to fertility problems such as irregular periods and anovulatory cycles (cycles where ovulation does not occur).
• Stress less
  There are so many people who worry excessively about becoming pregnant and once they release that stress, their body reacts to the new peace by creating a new life. So try not to worry and enjoy the fun of trying to conceive.
• Supplement
  Taking a supplement specially formulated for before conception will provide you with 400mcg folic acid and other nutrients such as l-arginine vitamin D and vitamin B12 which help support the nutritional requirements of women trying to conceive.
• Sex
  Have sex often, at least 3 times a week, the more often you try, the more chances you get at becoming pregnant.
• Lay low
  Lying down for at least a few minutes after sex increases the odds that the sperm will be able to keep their date with the awaiting egg.
• STDs
  Make sure that you have been properly screened for STDs. Pelvic inflammatory disease is common amongst women with the number-one cause being an untreated sexually transmitted disease.

Medications
If you are taking any prescription or over-the-counter drugs be sure to ask your doctor if it’s safe to continue taking them once you start trying to conceive. Contrary to popular belief, taking the contraceptive pill, antibiotics or analgesics should not affect the accuracy of your pregnancy test.

Pill
If you have been on the pill for a long time you may be low on certain vitamins and minerals especially the B-group vitamins.

Calendar
Keep a menstrual calendar and note the date when your period starts, the number of days it lasts and anything else your doctor or midwife might want to know.

Numbers game
Keep in mind that baby making is a numbers game. Even if you do everything ‘right’ you still only have a 25-30 percent chance of conceiving in any given cycle.

Diets
Don’t go on a crash diet. They affect your ovulation and consequently your fertility.

Dietary Advice

Eating a healthy balanced diet when trying to conceive helps the body to be in optimum condition for conception and pregnancy , and also helps to build adequate stores of vitamins and minerals for the baby to call upon when needed.

Foods to consume while trying to get pregnant:

• Leafy greens such as broccoli, fortified breakfast cereals, citrus fruits and pulses provide folic acid which is important for the baby’s neural tube development.
• Fortified breakfast cereals, lentils, soy beans, dried fruit and leafy greens such as spinach are great sources of iron.
• New research (Dr Jorge Chavarros, Harvard School of Public Health) indicates women who want to get pregnant should eat a Mediterranean-style diet rich in avocados and olive oil but light in diary and meat.
• Eating mono-unsaturated fat – found in peanuts, almonds and cashews may support conception too.
• Fish, wholegrain breads, asparagus, spinach and watercress will provide zinc to help keep the immune system strong, which is essential when trying to get pregnant. Zinc can also help the production of healthy eggs, as well as healthy sperm.
• Fibre rich beans and whole grains keep the bowels healthy, helping to flush away the bodies waste, thereby increasing the chances of getting pregnant.
• It is also a good idea to consider taking a supplement designed to support conception which contains 400mcg folic acid and other nutrients to help support the nutritional requirements of women trying to conceive.

Myths Unravelled

Planning for a baby is one of the most important times in a couple’s lives, but for many it can be confusing and complicated. Here we dispel some of the common fertility myths below.

• Myth: Having sex every day will increase our chances of conceiving
  Couples trying to conceive are encouraged to have intercourse regularly to increase their chances of conception, but having intercourse every day is likely to leave you exhausted, particularly as it takes many couples 6-12 months to conceive. However, as sperm can survive up to 5 days after release, and predicting ovulation is an in-exact science, most GPs advise having intercourse every 2-3 days to maximize the chances that sperm are around to fertilize an egg once ovulation occurs.
• Myth: You can’t get pregnant when you are menstruating
  While women cannot conceive during menstruation as the hormones resulting in menstruation are the opposite of those required for a pregnancy to occur, she can conceive from sex during menstruation as she may ovulate early and sperm can survive for up to 5 days after release. Research in the USA1 has found that women may be fertile as early as day 4 of their cycle (day one is taken as the first day of bleeding) therefore pregnancy could occur at any point in a cycle.
• Myth: You can only conceive from sex on the day that you ovulate
  Not true. The human egg is viable for fertilization for around one day after it is released from the ovaries. However given that sperm can survive for up to 5 days after intercourse and women may produce more than 1 egg in a 24 hour period, technically a woman can conceive from intercourse occurring from anything up to 5 days prior to or even up to 2 days after ovulation, i.e. for one week of each menstrual cycle.
• Myth: A normal menstrual cycle is 28 days
  Not true, this is a myth perpetuated by the pill which makes all menstrual cycles regular and 28 days in length. In fact menstrual cycles can vary from anything between 24-36 days, and not only vary between women but can vary considerably in any individual woman from month to month.
• Myth: Lying down with legs raised after sex will increase chances of getting pregnant
  While there is no scientific evidence to support this approach, some people claim it helps and as it is totally harmless it has to be worth a shot.
• Myth: Eating oysters will boost my fertility
  There is a grain of truth in this because oysters are a rich source of zinc, low levels of which can be a factor in hampering fertility. Take stock of your diet and ensure that you are eating plenty of fruit and vegetables, wholegrain cereals, which are rich in antioxidants, include oily types of fish twice each week (e.g. salmon, herring, sardine, etc) to boost essential fatty acid and cut down on caffeine and alcohol both of which can hinder conception if taken in excess. Don’t forget to keep active and if you are a smoker, quit.
• Myth: You can get everything you need from diet and don’t need to take supplements
  This is definitely not true, and in fact all women are advised to take a supplement containing 400mcg of folic acid daily while trying to conceive and for the first 3 months of pregnancy. Taking a folic acid supplement is important for neural tube development in the baby. As most of us don’t manage to eat a perfect diet all the time, taking a supplement specifically designed for conception or pregnancy can help to ensure that there are plenty of all the vitamins and minerals important for conception.

1.Fehring RJ, Schneider M, Raviele K (2006) Variability in phases of the menstrual cycle. J Obstet Gynecol Neonatal Nurs 35: 376-384

Fertility Facts

Age and fertility
According to research, women are leaving it later to start a family. The Office of National Statistics has reported that, since the 1980s the rates for women giving birth at age 30 or over have gone up, while the rates for women giving birth aged under 30 have fallen.

Fertility falls more sharply for women as they age than for men. As you can see from the chart below, women are most fertile between the ages of 20 and 24 years – as women grow older the likelihood of getting pregnant falls while the likelihood of infertility rises sharply. Men can remain fertile for much longer but male fertility still declines with age, although less dramatically.

Chart: Pregnancy rates over the course of one year both of the line graphs are for women with normal reproductive function

Source: Management of the Infertile Woman by Helen A. Carcio and The Fertility Sourcebook by M. Sara Rosenthal

Fertility factors

Tips for her

As women get older, there are a number of factors that can make it more difficult to conceive. Fertility factors that change include:

• Ovarian reserve – this is the number of functioning follicles left in the ovaries. As women get older they have fewer viable eggs left; in cases of early menopause, the eggs run out much sooner than usual.
• Menstrual cycle – as women approach the menopause their menstrual cycles can become irregular and shorter.
• Lining of the womb – the endometrium may become thinner and less hospitable to a fertilised egg.
• Mucus secretions – vaginal secretions can become less fluid and more hostile to sperm.
• Diseases affecting the reproductive system – some conditions can damage the reproductive organs as time passes, or worsen if not treated properly, including endometriosis, PCOS and Chlamydia.
• Chronic illnesses – some illnesses can have a negative impact on fertility.

Tips for him

Men can do a great deal to improve their chances of conception by paying attention to health and lifestyle. Below is a check list for men who are trying for a baby.

• Avoid alcohol
  It lowers men’s sperm count even when men are only drinking small amounts.
• Sex
  Have it in the morning as research shows that a man’s sperm count is higher at this time so take advantage of it!
• Keep cool
  Men have a higher sperm count when their genitals are kept at a cooler temperature. So stay away from hot tubs, hot showers and tight fitting underwear.
• Smoking
  Cut it out. Smoking has been shown to reduce both the sperm count and the sperm motility.
• Diet and supplements
  If men are malnourished or not getting enough of the right foods and nutrients their sperm count can suffer. Take a supplement which contains specific nutrients such as zinc for male reproductive health.
• Workaholic
  Fatigue can have an effect on a man’s interest in sex so it is important to try and find a balance.
• Toxins
  Stay clear of environmental poisons and hazards. These include pesticides/insecticides, organic solvents, lead, ionizing radiation, heavy metals, and toxic chemicals.
• Drugs
  Even in moderate amounts, for example cannabis, can cause a low sperm count, poor sperm speed and increased sperm abnormalities.
• Exercise
  Swap the exercise bike for the treadmill. The repeated banging of the groin against the bicycle seat can damage critical arteries and nerves.
• Mobile phones
  According to research by scientists in Hungary, men who keep mobile phones switched-on in their trouser pocket or on belts have significantly lowered sperm counts and risk their fertility being cut by up to a third. Also, the sperm’s motility may be affected by long calls.