Improving Fertility After Age 35: Five Easy Tips
- Research has established effective ways to promote fertility into the 40s
- Discussing reasonable expectations with your doctor can help you stay well-informed
- Tracking your ovulation allows you to maximize your chances of conceiving
- Relaxation-inducing activities can relieve stress and possibly promote fertility
So, you got caught up in life and forgot to have a baby during the reproductive prime of your 20s? You aren’t alone. Today, more and more women are waiting until their mid-30s and 40s to have children for a number of reasons—higher education, professional attainment, competing on The Bachelor, you name it. And like many of these women, you may be finding out that getting pregnant after 35 can be challenging.
Does this mean getting pregnant after 35 is impossible or improbable? No. Thanks to significant advances in assisted reproductive technologies and research establishing effective ways for women to conceive naturally in the decade following their reproductive peak, women over 35 are now more likely to find themselves losing their morning Muesli than ever before.1 (Don’t worry, it’s happy nausea.)
This article is one of a series aiming to help women over 35 conceive and maintain a healthy pregnancy. In the following sections, we discuss some of the simple ways women can make the “trying to conceive” process a little less trying.
Be optimistic but have reasonable expectations
One of the most difficult parts about trying to conceive later in the reproductive timeline is the sense of urgency that often accompanies it. Whether it’s pressure from aspiring grandparents, a sense that all of your friends are having babies, or a mental meme of Marisa Tomei stomping her foot about her biological clock—women over 35 tend to feel like time is running out.
Unfortunately, this sense of urgency is often compounded by the inconvenient reality that conception tends to take longer after 35. An age-related increase in “time-to-conception” has been evidenced by several national surveys,2,3 including a recent study looking at fertility in American women between the ages of 30-44.4 This study found that, compared to women ages 30-31, the probability of women getting pregnant within a given menstrual cycle was 86% for women ages 34-35 was: 83% for women ages 36-37, 70% for women ages 38-39, 47% for women ages 40-41, and 41% for women ages 42-44.
While these findings may seem discouraging, our intention is to help prevent you from blaming yourself or losing hope if a second pink line doesn’t materialize as quickly as you’d like. The reality is, you will likely see a few negative pregnancy tests before you see a positive one, so be prepared, and try to remain positive. Making a preconception appointment to discuss your reproductive goals with a healthcare professional who can make recommendations based on your age, medical history, and physical condition can enable you to remain as well-informed and proactive as possible.
Having informed expectations can also help you recognize if and when it’s time to consult a fertility specialist. The American Society for Reproductive Medicine recommends that women between the ages of 35-40 consult a specialist after 6 months of unsuccessful attempts to conceive, and that women over 40 undergo reproductive evaluation upon deciding to start trying.5
Don’t assume you know when you ovulate
You’ve probably heard that ovulation occurs in the middle of a woman’s cycle—typically fourteen days before the onset of her next menses, or Day 14 of a 28-day cycle.6
While this may be true for some women, it is not the case for every woman, or even every cycle. That is, the timing of a woman’s fertile window (the five days preceding ovulation +ovulation day) can vary greatly, even among women with regular 28-day cycles. In fact, a prospective study found that less than 30% of women experienced a fertile window between days 10 and 17, as suggested by clinical guidelines.7
This means that if women trying to get pregnant time their intercourse around the assumption that they ovulate 14 days after their period, a lot of these women are not utilizing their fertile window as effectively as possible. And given that a woman’s cycle tends to become more irregular with increasing age, predicting the fertile window can become especially difficult for women over 35.6
Identify your ovulatory cycle
But don’t panic—you can identify your unique ovulatory cycle every month by either charting your basal body temperature, using an ovulation predictor, or noticing changes in your cervical mucus. In addition to optimizing your chances of conception by pinpointing your fertility window, learning about your ovulatory cycle can provide valuable information about whether you are ovulating regularly, the status of your reproductive hormones, and the duration of your luteal phase (the period between ovulation and the first day of your menses). Talk to your doctor if you have reason to believe that you are not ovulating regularly, or if your luteal phaseis shorter than 10 days. These may be symptoms of larger fertility issues that can make conceiving extremely difficult if left untreated.8,9
Relax. Or at least try to.
You know all those anecdotal stories random people love to tell you about women they know who tried to get pregnant for years, but were only successful after they stopped trying? Or about couples they know who decided to adopt, and miraculously got pregnant? Well, according to the research, there may besome physiological truth to those stories. That is, research indicates that the physiological consequences of stress can lead to menstrual irregularities and difficulty conceiving but finding ways to alleviate stress can actually promote fertility. 10,11
Still not buying it? Evidence for the link between elevated stress levels and trouble conceiving comes from prospective studies finding an association between salivary alpha-amylase concentrations (a biomarker of chronic psychosocial stress)12 and decreased fertility in women of reproductive age. In one such study, researchers found that women with high levels of salivary alpha-amylase (high stress) were 12% less likely to conceive within six menstrual cycles than women with low levels of alpha-amylase. 13
A second prospective study collected saliva samples for analysis of stress hormones in women trying to get pregnant and followed them for 12 months. Consistent with previous findings, this study found that the women with the highest levels of alpha-amylase at the beginning of the study took, on average, 29% longer to conceive then women with the lowest levels of alpha-amylase. Importantly, this translated to a two-fold increased risk of infertility for women with the lowest levels of alpha-amylase. That is, women with the highest levels of the stress biomarker at the onset of the study were twice as likely to qualify for a diagnosis of infertility than women with lower levels of alpha-amylase. 14
Several limitations—including this study’s observational design and the fact that saliva samples were only taken towards the beginning of the study—make it impossible to definitively conclude that stress negatively affects fertility from this research. Nevertheless, looking for ways to reduce stress is never a bad idea. In fact, several studies report that alleviating stress through relaxation-inducing activities such as yoga, meditation, and mindfulness can actually promote various health outcomes—including fertility. 11,15,16,17,18
Manage your stress
Of particular interest, a randomized controlled study found that women participating in a mind/body program for stress management and relaxation were significantly more likely to get pregnant during an IVF cycle than women who didn’t participate in the stress management program.11 Whereas 52% of the women participating in the mind/body program got pregnant, only 20% of control group had successful IVF cycles.
So, as frustrating as it may be to hear “Just relax and you’ll be pregnant in no time,” science suggests that the lady who cuts your hair, the woman from your Mom’s book club, and your neighbor’s brother’s wife may be on to something. Stay informed, remain positive, and try to relax while you wait for that second pink line to materialize. Chances are, it’s coming.
Cervical mucus: Fluid or gel-like discharge from the cervix; fluctuating hormone levels lead to changes in thickness and amount throughout a woman’s menstrual cycle.
Infertility: failure to conceive after twelve months of timed and unprotected sexual intercourse.
Prospective study: a study that watches for outcomes (such as the development of a disease) during the study period and relates this to other factors (such as suspected risk of protection factors).
Time-to-conception: The time period between trying to conceive and getting pregnant.