Getting Pregnant in Your 40s
Whether this is baby #1, 2 or 3, getting pregnant in your 40s can feel a little daunting. And although your ability to get pregnant is highest during your early 20s, the reality is, in our modern world, women are having children at later stages in their reproductive years than ever before. Although women in their 40s can absolutely get pregnant the chances per menstrual cycle starts to decline. In fact, in your 20s and 30s, 1 in 4 women will get pregnant per cycle, however only about 1 in every 10 women will become pregnant from any given menstrual cycle by age 40. Again, this doesn’t mean it is impossible but definitely something to consider when planning out your preconception journey. It may be worth discontinuing birth control and starting to track for ovulation sooner than you may have originally anticipated.
One of the biggest factors associated with getting pregnant in your 40s is optimizing your egg quality. At birth, women are born with approximately 1 million eggs but, by the time they reach puberty, the average woman only has about 300,000 eggs remaining. Of these eggs, it is estimated that a woman will ovulate an average of 300 to 400 eggs during her reproductive years before heading into menopause. Now although I know there is a lot of pressure on 40 year old women when it comes to their fertility, the reality is your fertility has been slowly declining since you were 30 years old. Not only is the number of eggs slowly declining but, most importantly, the quality of those eggs start to decline. So although society likes to make women hitting 40 feel like there is a rapid drop off in their ability to get pregnant, our fertility really starts to decline progressively in our mid-30s.
Now, as our egg quality declines with age, optimizing your egg quality must become an important priority in your preconception journey if you are trying to get pregnant in your 40s. Poor egg quality is closely associated with chromosomal abnormalities in embryos, also known as aneuploidy. It is also associated with an increased risk of miscarriage and fetal abnormalities, which are things we would like to avoid as much as possible.
Now although IVF may be an option for some, it is important to know that even during IVF, high quality eggs are necessary, so if you are thinking about waiting to try to conceive naturally with a backup plan of IVF at age 40, this may not be the best idea. We want to make sure we are taking a more aggressive and proactive approach to your fertility especially in your 40s. This absolutely does not mean that it is impossible to get pregnant in your 40s, it is however important that we take a proactive approach and do not “just wait and see” the way you may have done in your 20s and early 30s. So although we can’t change or predict the number of eggs remaining in your ovarian reserve, are there ways we can improve the quality of your remaining eggs?
The answer is yes! In today’s blog, I wanted to share a few important ways we at, NMD Wellness of Scottsdale, work with our patients to optimize their chances of both natural and assisted fertility in their 40s.
Nutrient Support for Egg Quality
Coenzyme Q10
We can’t talk about improving egg quality, without mentioning one of my favorite coenzymes and antioxidants, CoQ10. Coenzyme Q10, is a naturally occurring antioxidant your body produces that helps your cells grow and maintain their optimal function. CoQ10 is an electron carrier in your mitochondria that helps with energy production. Despite impressive advancements in the field of fertility, many women experience inadequate response to gonadotropin medications and may be considered “poor or low responders”. Low responders not only have trouble responding to gonadotropin medications but, they often experience a higher risk of cycle cancellations, fewer oocytes(eggs) at retrieval, lower oocyte quality and a reduced number of embryos eligible for transfer. Although researchers believe the reason some women are “poor responders” can be multi-factorial, they do believe that a decline in mitochondrial function may play an imperative role. In fact, researchers have found that oral CoQ10 supplementation did not only improve the number of eggs retrieved during IVF, but there was a higher fertilization rate (67.49%) with higher quality embryos. The researchers also noticed a significantly lower rate of cycle cancellation.
So, whether you are trying to get pregnant naturally or gearing up for IVF, it may be worth discussing the possibility of pre-treatment CoQ10 with your doctor. The study mentioned above incorporated CoQ10 supplementation 60 days prior to IVF-ICSI cycle.
N-Acetylcystine
N-Acetylcystine, commonly known as NAC, has also grown in popularity in the field of fertility for improving egg quality, and for good reason. NAC, the supplement form of cysteine, has been shown to be important for a variety of health reasons, including more specifically replenishing glutathione levels in your body. Glutathione has been marked as one of the most powerful antioxidants in our body and has been helpful for a variety of health concerns including chronic respiratory conditions, brain health and fertility. In fact, researchers during a randomized controlled study found that NAC improved both egg and embryo quality in patients with PCOS undergoing intracytoplasmic sperm injection (ICSI) and could be considered as an alternative to metformin for those who may not be responding to or may not tolerate metformin during fertility treatments.
Resveratrol
Another popular supplement often discussed for improving egg quality is Resveratrol. Resveratrol does have a variety of health benefits including acting as an antioxidant, anti-inflammatory benefits and natural insulin-sensitization that all appear to have potential therapeutic benefits on women with diminished ovarian function (DOR), polycystic ovary syndrome (PCOS) and endometriosis. Unlike, CoQ10 and NAC, resveratrol, however, has limited research associated with its effect in women undergoing IVF. In fact, there is only one current clinical trial that has been reported to involve women undergoing IVF using resveratrol. Resveratrol, most commonly known as a key ingredient in wine, is best considered in supplement form for fertility support. So no, increasing your wine consumption isn’t a recommended way to improve your egg quality. Having a glass or two of wine prior to ovulation does not appear to have a significant negative impact on your fertility, however, it is generally advised to abstain from alcohol during and after ovulation as there is a possibility you may be pregnant.
Vitamin C
Vitamin C, a wonderful antioxidant that has also grown in popularity in the world of fertility. And although Vitamin C is a wonderful antioxidant that is said to protect your cells against the effects of free radicals commonly found in our environment, the research on it’s benefit specifically in terms of egg quality are limited, especially for those suffering from endometriosis. So although incorporating Vitamin C rich foods daily is an important way to support your body’s ability to fight free radicals, doubling up on Vitamin C supplements, specifically for egg quality purposes may not be as valuable. The other important factor to mention here is that reducing your exposure to free radicals in your environment is really more important. Again, although we love the use of supplementation, it does not and shouldn’t replace a high quality diet and lifestyle. So, if you are looking for the best way to improve your egg quality, focusing on a high quality whole foods diet and exercise are some of the most powerful ways to improve mitochondrial function and support antioxidant status to help improve your chances of getting pregnant. So before you start adding “fertility supplements” to your online cart, start with changing your diet, environment, and daily movement. These are the things that seem to have the biggest impact.
Why Ditching Plastic Really Matters
I know we often immediately look for supplements to support our egg quality, but after years in practice and working with hundreds of patients, our environment, what we eat, how we live and how we move our body ultimately makes the biggest impact for our patients. So again, although supplements can be beneficial, if you are consuming a toxic lifestyle whether that be a high stress job, sedentary lifestyle, poor sleep, processed foods; a simple supplement isn’t going to reverse the effects your lifestyle has on your egg quality.
Now, I understand why most people would rather pop another supplement than address their lifestyle, but as an expert and someone who really sees this first hand in a variety of patients, your lifestyle has the biggest impact on your fertility. One non-negotiable we advocate for in our patients is cleaning up your environment, this includes ditching as much plastic in your life as possible. Plastic is just about everywhere so although we would like to eliminate it completely (and some people do), at least reducing your daily exposure is really important. Not only does the major ingredient in plastic, Bisphenol A (BPA) act as a strong endocrine (hormone) disrupting chemically but, it can have a direct impact on the health of ovarian follicles, thereby impacting fertilization rates and pregnancy rates. But before you switch to “BPA-free plastics”, please note that BPA-free plastics still contain harmful chemicals that may act as endocrine disruptors. Instead opt for glass or stainless steel products as a safer alternative. Another common mistake we see is when patients decide to opt for glass food storage containers. Although glass food storage containers are a great and much safer alternative to your typical Tupperware, the biggest mistake people make is they forget that most glass food storage containers still contain a plastic lid. Most people will often place their leftovers directly into the glass container before the food has time to cool and will place the plastic lid on top before throwing it into the refrigerator. This is a huge NO-NO. Always make sure that your left overs have time to cool prior to placing the plastic lid on the container. This will help prevent BPA or BPA-like chemicals from leeching directly onto your food. You can also opt for a lid made from beeswax as a safer alternative.
EXERCISE AND YOUR FERTILITY
In today’s modern world, most of us live a relatively sedentary lifestyle. This reduction in physical activity has not only been associated with obesity but a variety of health conditions. Most of us likely can admit that we are likely not moving as much as we should. But, how much exercise should we actually get and are there particular forms of exercise that are better than other? Although most of social media will have you convinced that “their” form of exercise is the “best” form for fertility, PCOS and etc, the reality is the research is still unclear on whether one particular type or form of exercise is more suitable for health and fertility than others. What the current research does seem to agree on is that for the average adult, at least 150-300 minutes of moderate intensity exercise and 75-150minutes of vigorous (zone 2 cardio) intensity exercise seems to be the most beneficial for overall health. That's about 20-30 minutes of exercise per day. So although the idea of 1 hour sessions, three times a week used to be the favored form of movement, the reality is short daily movement seems to out compete longer, more intense exercise. So unless you are currently undergoing an active cycle of IVF and have been told otherwise by your doctor, most women can aim for about 20-30minutes of exercise daily without any limitations. At NMD Wellness of Scottsdale, we believe that the most important aspect of exercise is consistent. Make sure to choose something you actually love and start there! Don’t feel pressured to exercise in a way that you dislike. If you dislike the exercise routine you are participating in, chances are, you won’t be consistent. Stick to something you love and make it a priority. We often advise our patients to take just 10-15 minutes to plan out what days and times work best for them to get in their daily movement. Most people are most successful with being consistent with exercise when they are able to implement it into their morning routine or lunch break. Remember, although 20 minutes may seem nearly impossible in your busy life, think about all the time we spend on social media or between calls or meetings. Some of our favorite forms of exercise include low-impact movement, including yoga and Pilates as well as strength training.
About the Author: Meet Dr. Zen
Alissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...
