I am currently four weeks along with my second pregnancy at the age of forty-one. I've seen countless articles devoted to women who are trying to conceive at ages often regarded by the medical community as being a bit advanced, and it inspired me to put my two cents in. I'm certainly not a doctor, but I do have a degree in biology, so hopefully some of this will be helpful. It can be challenging for many women to conceive naturally at any age, and perhaps even more so for those over the age of thirty-five. I've outlined some of the things that I think may have contributed to our success in conceiving naturally at the age of thirty-five and forty-one.
Things Out of Our Control
There are quite a few studies examining the relationship between human longevity and age at conception, including the impact of older parents on the health and longevity of the children born to them (this is basically negligible, so please don't add it to your list of worries!) A study in the Journal of Science Research and Reports (2014) examined evidence from eight studies demonstrating that smaller body size is related to greater longevity. My family seems to bear this out! The women are generally petite and tend to live for a very long time. My paternal grandmother was my height (five feet) and lived to the age of 96. My maternal great-aunt was about five four and lived to be 97. My maternal grandmother was about five foot five and lived to be 83. Through my life, I've often joked that I take such good care of my body because I expect to be in it for such a long time! This is relevant for two simple reasons: (1) there appears to be favorable correlation between advanced maternal age and longevity, although it can be hard to figure out which causes the other; and (2) I have always felt that my genetics (not only my lifestyle) allow me to skew a "real age" younger than my actual calendar years.
I think it is important to note that what is most valuable here is the concept of an "inherited" longevity - how long will you be on this beautiful Earth if everything goes well and you make responsible choices? If your relatives barely made it out of their fifties due to lifestyle choices, such as ill-managed diabetes, smoking or illicit drug use, this is not relevant to you at all. What is more valuable is being aware of the genetic legacy your family has bequeathed you and properly managing any negative tendencies (e.g. a propensity toward diabetes or cardiovascular issues) so that you can optimize your health and longevity.
If the women in your family routinely make it to their nineties and people often confuse you for being much younger than you are, these are things that imply that you have been favored with a robust ability to repair age related damage to your cells - not a terrible thing if you are trying to conceive naturally.
When I was in my twenties (e.g. college years) my menstrual cycles were a bit all over the place. I was quite a bit thinner at those ages, and this may have contributed. My frame was likely 15-17% body fat, and my hormones had clearly not found their happy balance yet. Still, by the time I entered my thirties, my body fat percentage increased to 20-24% and you could set Greenwich time according to my cycles, trends which continued to my present age. Having a predictable cycle implies that the underlying biology is working as designed - again, this can't be a bad thing if you want to conceive naturally. For women in their forties, cycles also offer a huge clue as to whether you have entered peri-menopause or menopause; natural events which can certainly impact fertility.
When I delivered my son at the age of thirty-six (I literally went into labor on my birthday after eating five pieces of cheesecake), I had originally expected to have a natural childbirth. I was so committed to this idea, having done meditations every single day for more than six months, that I declined any intervention for six hours of active labor. Well, flash forward twenty four hours later, and I had a baby and a discharge sheet that looked like Keith Richard's 1970s. Still, my body had demonstrated that it could naturally conceive a baby and carry to term. This was especially important for me, as I had a history of multiple cervical surgeries (three to be exact) in my early thirties. I really had no way of knowing whether scar tissue would impede my efforts to get and remain pregnant, and was greatly relieved to find that it did not.
This favorable history was another "plus" when we attempted to conceive at the age of forty-one. While there are plenty of things you can do to foster a healthy pregnancy, the bottom line is that anyone who has been pregnant understands that much of the process is out of your control. Again, favorable prior history speaks to the underlying biology working as designed at least once. With the exception of progesterone supplementation, I had a history of needing little medical intervention to conceive or carry to term.
Longevity, regularity and favorable prior history are blessings that I did little (or nothing) to earn, foster or cultivate. They are simply statistically significant items that help move the needle in a slightly favorable direction. Moreover, they barely scratch the surface of blessings most of us have received that foster fertility, such as access to clean drinking water, affordable medical care, freedom from pollutants, publicly available education and access to healthy foods. Even those who struggle with challenging fertility issues have more things in their favor than they will likely ever really realize.
The purpose of starting with items "out of our control" is to establish a bit of a baseline: If your periods are not regular, you will likely need to work with a medical professional to fix that up before you can make any meaningful attempt to line up your - ahem - extracurriculars with your ovulation date. If you do not see youth and vibrancy when you look in the mirror, then you may need to work with a medical professional to understand what is dragging you down (e.g. a subtle hormonal imbalance or stressful lifestyle). After all, four decades is plenty of time to accumulate the effects of bad habits or otherwise trigger an underlying disease propensity: those who will be diagnosed with Type II diabetes in their 70s likely show signs of metabolic syndromes or imbalance as early as their 40s. If you have a history of challenging conception(s) or inability to carry to term, you need to seek understanding of your personal biology and environment to best confront those challenges.
Biological processes are intricate - any improvement you make will likely have a ripple effect. That is how the body works: change one variable either internally or externally and watch for its impact. Pregnancy - at any age, for any woman, with any history - is partially an exercise of fate, which we humans can influence one way or another only by trying to take statistically meaningful actions based on the research in existence that particular day.
I actually take great issue with the common phrase "getting pregnant." The word "getting" seems to imply an action of grabbing, grasping, obtaining, and these concepts completely trouble me when used with pregnancy, especially because the word "get" is so fraught with connotations about deserving-ness - we "get" what we deserve, some people just "get" lucky. Creation of human life is no different than creation of any other life. Flowers don't "get" blooms, trees don't "get" seeds - the continuation of life for any organism is simply cultivated or not cultivated by its environment. All we mothers can hope for is that we have been partially blessed with and partially created the proper environment for such cultivation, just like a garden.
Things Within Our Control
I don't believe that the things we do "on and off" do much to impact our chances of conception (unless that "on and off" activity is rolling around in pesticides or the like). So here, I am only going to focus on things that I do religiously, every single day, as these are most likely to be pertinent to an actual attempt to conceive.
Consuming a LOT of nuts and seeds.
I will go out on a limb and say that my consumption of cashews, almonds, flaxseeds, sunflower seeds, pepitas, and peanut butter is probably higher than fifty percent (or, um, ninety percent) of the population. I don't do this because of any attempt to improve my fertility. I do it because sugar/insulin sensitivity runs in my family and nuts and seeds are a quick, easy snack with enough protein to keep me away from things like fudge or Fruit Loops. Nuts and seeds are quite nutrient dense, containing zinc, omega-3 essential fatty acids, protein, and vitamin E (all of which are utilized in biological pathways relevant to fertility.)
Increasing my heart rate - a little bit
I've mentioned before that I believe having a low body fat percentage may have unfavorably impacted my hormonal balance when I was younger. What can I say? I wanted abs. So, I think it is important here to note that overdoing anything - including exercise - will likely have a negative impact on your fertility. For me, I make an effort to simply boost circulation and build strength without taxing myself to the point of exhaustion: no Bikram/hot yoga or strenuous HIIT programs, even outside of pregnancy.
I aim to keep my heart rate at an appropriate range (generally below 179 bpm - actually who am I kidding? generally below 160 bpm). If I went harder, I'm sure that I would be pleased with the aesthetics, but I suspect it would have other deleterious effects over time (as it did when I was younger). Exercise is very personal, and advanced athletes may have a lot more latitude to challenge themselves than the typical desk-bound lawyer.
I would only say that regular exercise is essential to flood ALL of your organs with nutrients and oxygen, and cleanse away toxins. Exercise sends key biological messages to your brain: "I am healthy. I am capable. I am safe. Look, I am not under physical stress or strain, nor at risk of exhaustion or overheating." This is the kind of biological atmosphere that fosters fertility, and frankly, better health in general.
Drinking green tea
I drink one or two weak cups of green tea every morning. This is not a meaningful intake of caffeine, which can be detrimental to pregnancy. In low amounts, green tea offers a nice boost of antioxidants and (surprise!) folic acid. It also contains trace amounts of potassium and polyphenols that have been linked to reduction of inflammation. People often talk about green tea as a panacea - a cure for everything! I think that likely overstates its health benefits. Still, as a substitute to sugary, caffeinated drinks like the ones I covet from Starbucks, it's a solid choice. As a daily beverage, it likely provided me with a consistent level of compounds that helped to keep the inflammation load within my body fairly low. The rest of the day, I attempt to consume at least 60 oz of plain old water. When I bore of regular water, I mix in a little bit of apple juice or a few drops of Mio.
Sleeping eight hours
Sleep is your body's repair cycle. Lack of sleep can disrupt your monthly cycles, impact hormone levels of hormones linked to both dietary and fertility cycles and thwart your body's ability to repair cells properly. I am in bed no later than 9:00 PM every night, and aim to be asleep no later than 9:30 PM. The sleep-wake pattern of human beings is intimately tied to fertility. There is a reason that our cycles line up so beautifully to that of the lunar transitions.
The CLUE App
I've been using the CLUE App on my Note 8 for about a year and it's fantastic. I currently use it to track the following: Period start date, PMS symptoms (e.g. cramping or headaches), emotions and temperament, the amount of sleep I had that night, extracurriculars (sorry, I was raised by a literal 1950s housewife!), digestive issues (e.g. nausea or bloating), and even cravings. The app provides predictions based on past entries, including the start date of your cycle and your most fertile days. Perhaps most importantly, it's so nice to have this information at my fingertips when I go to the doctor. Doctors can still sometimes be dismissive of women, so it is nice to come "armed," especially if you feel that something with your health is not quite right. CLUE is a fantastic free app, even if having a baby is the farthest thing from your mind.
Easy@Home Ovulation Test Strips & Pregnancy Test Strips
We had tried for a couple of months using only the CLUE App to guide us to our optimal days, without success. Around this time, I had a candid conversation with a close friend who had recently had her second child. She is a couple of years younger than me, so I was a little taken aback when she revealed that they had not been cavalier at all about conceiving their second child. My partner and I had always had a really chill, "whatever happens, happens" approach. Still, I was starting to feel like maybe being that laid back was irresponsible at our age, when it seems like every article I read admonished me with a huge ticking biological clock. She mentioned that she had used these strips and found that the ovulation date she identified by using tracking methods was actually off by a couple of days. Sure enough, I used them for one month and found that the strips actually informed an ovulation date about 24 hours prior to the "peak fertility day" represented by CLUE. Although this seems like a subtle difference, apparently it was a notable one, as we conceived that month. I definitely recommend combining both the tracking and test strips into one approach.
Consuming heme iron sources
Having been vegetarian for twenty years, I found that as I entered my late thirties I was finally struggling with nutritional deficiencies. For a couple of years, I scoffed at my symptoms, such as extreme fatigue ("What working mom doesn't feel tired all of the time?"), disrupted sleep cycles ("I must have had too much to drink before bed?"), heart palpitations ("It must be caffeine") and tingling and numbness in my extremities ("I must have slept wrong.")
While all of those rationalizations may have held a kernel of truth, the simple fact was that I was significantly deficient in iron, zinc and most B vitamins, despite my efforts to incorporate sources of these into my diet. So now, I eat heme protein (a delicate way of saying "Meat") every single day. I try to obtain this from sources that are most respectful to the environment and cause the least offense to my personal ethics.
I make no mistake about the fact that reincorporating heme protein sources into my diet has been absolutely critical to the restoration of my general health and fertility. Other women may be able to overcome such nutritional deficiencies via supplementation, an approach that proved unsuccessful for me. I think that the most important point I can make here is that I "thought" I had been eating extremely healthy, and still had significant deficiencies in vitamins and minerals that can directly impact fertility and general health, so I have to assume that many women out there may also have a similar dietary profile. Particularly if you subscribe to any kind of specific diet, such as keto, vegan, vegetarian, paleo - I recommend paying for an extensive blood testing panel by a qualified functional medicine clinic to identify deficiencies - plus a healthy dose of humility and openness to change when reviewing the results.
At the age of forty-one, I can still count the times that I have consumed any sort of alcoholic beverage on my fingers. I've always been a teetotaler, even in high school and college. A lot of this simply stems from a general intolerance of alcoholic beverages - I would usually get sick to my stomach long before any sign of that fun "buzz" everyone assured me was waiting around the next corner. In addition: I'm tiny. I've felt the effects of a shot glass of beer or wine. I have no moral or religious prejudice against imbibing, I just simply don't like it, it doesn't make me feel particularly good, and I have yet to identify a single meaningful benefit to its consumption. The presence of alcohol is so ubiquitous, I can't help but feel that I may be painting an inaccurate picture by not mentioning my abstention. I'm not sure if it impacts my fertility or not, but it is a noteworthy feature of how I live my life, so I suspect the answer is likely "yes."