Discussions about fertility can be very personal and complex. Those coping with infertility may find some of the topics discussed in this article difficult. Please be gentle to yourself.

The world of fertility is a hopeful, exciting place. A literal labor of love, there’s a world of joyful decisions to make after the appearance of those two pink lines, from name selection to nursery decor. And then there’s the world of infertility — a decidedly quieter and challenging space to occupy. The rates of infertility are striking, and not often talked about, compounding an already difficult journey with a deep sense of loneliness. For many people, the road to parenthood is unlike the straightforward path they may have envisioned.

“There’s no shortage of doubt and dejection that can creep into the mind of a woman over forty who’s trying to get pregnant.”

Many women in their forties now find themselves on a fertility journey that can be uncomfortable and isolating. This can be due to any number of reasons. Perhaps you waited because it was never the right time. You didn’t find the right person. You tried over and over again with no luck. Your doctor said it won’t be possible. You have a medical condition that can make your journey more challenging. Or, you just didn’t think much about it until now. There’s no shortage of doubt and dejection that can creep into the mind of a woman over forty who’s trying to get pregnant.

The good news is that I’ve seen many women in my medical practice who were able to get pregnant into their forties using a multifaceted approach to fertility. As medicine and science continue to evolve, we’re learning more and more about the complexity of our reproductive system — and how we can harness conditions conducive to fertility well into our forties. It’s time to talk about it.

The myths, misconceptions, and realities of fertility in your 40s

I take a holistic approach to fertility that is all about meeting couples where they are in their journey. By listening to their story, it becomes possible to identify the best tools to meet their needs and address a spectrum of issues ranging from hormonal imbalances to lifestyle factors. This approach typically requires diagnostic testing, multimodal treatment planning, and above all else, time to implement these strategies. So, let’s dive into some important considerations working from the ground up, shall we?

1. It’s never too early or too late to create fertile ground.

Creating fertile ground within your own body is crucial when embarking on the journey to conceive and bring a baby into this world. Fertility isn’t about any single, biological factor; instead, it’s a reflection of your overall health and well-being. Nourishing your body with a balanced diet filled with nutritious whole foods, regular exercise, and optimal rest lays the foundation for optimal reproductive health.

Stress can be your biggest enemy here, which is why managing it is so crucial to creating an optimal environment for encouraging fertility. When we think about fertility holistically, wellness-promoting habits both enhance your chances of conception, and also support a healthy pregnancy and postpartum period. Prioritizing self-care can empower the path to parenthood and lay the groundwork for a vibrant and resilient family, even in your forties.

2. Age can be important — but is it the most important?

Healthcare providers can make you feel like your eggs are an endangered species so it’s good to remember that age is not a concrete number. There are a lot of factors that affect our true age. Here are some nuts and bolts to help you understand what “aging” really means:

“Healthcare providers can make you feel like your eggs are an endangered species so it’s good to remember that age is not a concrete number.”

In the realm of fertility, understanding the distinction between biological age and chronological age becomes crucial, especially for those trying to conceive after 40. While chronological age refers to the number of years one has lived, biological age encompasses the physiological condition of the body, often influenced by many factors including environment, lifestyle, genetics, and mitochondrial health. 

That means that how you care for your body really matters! Especially for women in their forties, understanding that your reproductive potential may not perfectly align with your chronological age is pivotal. It’s the reason many clinicians emphasize the importance of adopting health-promoting practices and strategies that emphasize wellness all the way down to the cellular level. The more we address foundational aspects of our health, the more we can maximize the potential for a healthy pregnancy.

3. Your cycle isn’t the only important rhythm.

While we often think of our menstrual cycle as one of the most constant, predictable rhythms in our biological life (and a crucial factor in planning to conceive), a strong circadian rhythm is also important when it comes to getting pregnant.

Recognizing and honoring your circadian rhythm is an important factor in optimizing fertility that is often overlooked, especially for individuals over the age of forty. Your body’s natural internal clock regulates many physiological processes, including reproductive function. Aligning lifestyle choices, such as sleep patterns, meal timing, and physical activity with the natural ebb and flow of the circadian rhythm can positively influence hormonal balance and overall well-being. 

“Sleep and rest can be some of your most important allies in this journey.”

For women over forty, this synchronization becomes particularly crucial as it may contribute to improved egg quality and hormonal regulation, factors essential for successful conception. Sleep and rest can be some of your most important allies in this journey. By prioritizing a lifestyle that respects your circadian rhythm, you can create a supportive environment for your reproductive system, enhancing your chances of getting pregnant.

4. Conception is a shared responsibility. Don’t forget about optimizing sperm health.

Understanding the role of sperm health (quality and quantity) is critical to conception, and can directly affect chances of getting pregnant. Diet, exercise, avoidance of harmful substances, and more can play a pivotal role in maintaining optimal sperm health. So while you’re on the road to trying to conceive, even in your forties, it’s equally important to acknowledge and address potential male fertility issues. As a starting point, many companies now offer initial at-home sperm testing that allows for an initial evaluation to look into any potential issues. Some options to explore include Legacy and Fellow.

5. When you’ve tried all the things, there are still resources to help you.

For people who feel overwhelmed by the prospect of facing this journey alone, know that there are specialized fertility clinics, experienced healthcare professionals, and a wealth of information and support networks that can provide guidance. 

There is no shame in approaching your fertility with the help of experienced healthcare professionals who can move the needle to reach your dreams. With advancements in assisted reproductive technologies, individuals over forty can also find hope in tailored solutions including intrauterine insemination (IUI), ART procedures like IVF, conceiving with frozen eggs or donor eggs, using donor sperm, and most recently, utilizing ovarian rejuvenation with PRP. All of these can be valuable options to consider, and a reproductive specialist can help you determine which path might be right for you. 

Motherhood is a deeply personal and diverse journey, and there are so many paths for people to embrace within this transformative role. While traditional conception can be one avenue to reaching your fertility goals, modern reproductive medicine has expanded the choices we have on the road to parenthood.

“It’s also important to remember that your mind needs just as much attention and care as your body.”

Whether you’re pursuing advanced reproductive technologies, or considering options like adoption or surrogacy, it’s also important to remember that your mind needs just as much attention and care as your body. Experiencing infertility can be a whirlwind of appointments, procedures, and processes; but often what we most need is a healthy dose of two pretty fundamental things: hope and belief. Belief in the process, and hope for the future.

Sometimes it’s easy to forget, especially when we’re struggling, that the end goal of this journey is to welcome a child into this world with joy, positivity, and abundance. There is no perfect path to getting there — only the experience that you choose to embrace and the journey you choose to cultivate as your own.

Dr. Jaclyn Tolentino is a Board Certified family physician who currently serves as a Senior Doctor at Parsley Health. As a women’s health & hormone expert, she’s been featured in Vogue, the Wall Street Journal, and Women’s Health.