Fertility Over 40
Trying for a baby over 40 can feel like fertility suddenly comes with a clock attached to it
If you're trying to conceive in your 40s, you probably don't need another person simply telling you that your age matters. You already know. Every month can feel important, and it's very easy to find yourself researching another supplement, another test or another treatment because it feels as though you should constantly be doing something.
Age does matter when we're talking about fertility, and we won't pretend otherwise. But your age alone doesn't tell us everything about your individual fertility. The most useful next step is to understand your own fertility picture, so you can make informed decisions about what deserves your attention now, what doesn't, and when it may be sensible to consider fertility treatment.
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Can you get pregnant naturally after 40?
Yes, it is possible to conceive naturally after 40. But fertility does decline with age, and that decline becomes more significant from the mid 30s onwards. The NHS therefore advises women aged 36 and over who are concerned about their fertility to see their GP sooner rather than waiting for a year, partly because fertility investigations themselves can take time.
That doesn't mean turning 40 suddenly makes natural pregnancy impossible.
Nor does it mean that because somebody you know conceived naturally at 43, your fertility will be the same as theirs. Age gives us important information about probability. It doesn't give us an individual fertility diagnosis.
Your cycles, ovulation, ovarian reserve, reproductive health, medical history, how long you've been trying and your partner's fertility where relevant all help build a much more useful picture. There is still so much you can do that could improve your fertility. What we appreciate is you're not in a position to be waiting around, or trying some basic lifestyle changes to see it if works. You're looking for the best way forward, and time matters.
Why does fertility decline with age?
Women are born with the eggs they will have during their lifetime. As we get older, both the number of eggs remaining and the proportion capable of developing into a healthy pregnancy decline.
One important factor is an increase in chromosomal abnormalities within eggs as we age. This can make it harder for an egg to fertilise and develop successfully and increases the chance of miscarriage. This is why age remains an important predictor of fertility even if you're fit, healthy, have regular periods and feel no different at 40 than you did at 35.
But there are two different things that often get confused here:
egg quantity and egg quality. And understanding the difference can make fertility test results, particularly AMH, much less frightening.
AMH, egg quantity and egg quality aren't the same thing
If you're trying for a baby over 40, you may suddenly hear a lot about AMH, ovarian reserve and egg quality. They are connected, but they don't mean the same thing, and understanding the difference can make fertility test results feel much less frightening.
We're born with the eggs we'll have throughout our lifetime, and the number gradually reduces as we get older. But an egg doesn't simply sit in the ovary fully mature waiting to be released. Follicles go through a lengthy development process before one reaches the stage where an egg may be ovulated. This is why we encourage lifestyle changes to support the eggs in that process, with an aim to improve the quality where possible. The body needs energy to complete that process, so in supporting it well we could be helping it to put more energy into our egg maturation and fertility.
What is AMH?
AMH, or Anti Müllerian Hormone, is a blood test that gives us information about your ovarian reserve.
AMH is produced by small developing follicles in your ovaries. Follicles are tiny fluid filled sacs in which eggs develop. Generally, having more of these follicles means a higher AMH level, while having fewer tends to mean a lower AMH level.
This is why AMH can be useful when you're considering fertility treatment. It can help a fertility clinic estimate how your ovaries might respond to stimulation and approximately how many eggs they might be able to collect. But this is the important bit: AMH doesn't tell us the quality of those eggs, and a low AMH result does not mean that you cannot become pregnant.
What is egg quantity and how is it measured?
Egg quantity is essentially about how many eggs you have remaining. There isn't a test that can simply count every egg left in your ovaries, so clinicians use markers to help build a picture. Two of the most useful are your AMH level and your antral follicle count, where the small follicles visible in your ovaries are counted during an ultrasound scan.
As we get older, ovarian reserve naturally declines. Two women of the same age can still have very different results, which is one reason looking at your individual fertility picture is more useful than making assumptions based on age alone.
What is egg quality and how is it different to egg quantity?
Egg quality is different from egg quantity. When fertility specialists talk about egg quality, they're broadly talking about whether an egg has the biological potential to fertilise and develop into a healthy embryo.
One particularly important part of this is chromosomes. As we get older, a greater proportion of our eggs are likely to have chromosomal abnormalities. This is one of the main reasons fertility declines with age and the risk of miscarriage increases.
Unfortunately, there isn't a simple blood test that can tell you, "your egg quality is X". AMH certainly can't.
That means someone can have a good AMH level but still experience age related changes in egg quality. Equally, someone with a low AMH may have fewer eggs available, but that result doesn't tell us the quality of an individual egg. We can only make assumptions on egg quality in situations where perhaps IVF has not been successful in creating embryos, even if the sperm quality seems ok.
However you can still support the quality of your eggs by living a healthy lifestyle and managing your stress levels. Think of it as the more you support your body, the more energy it has to put into your fertility and mature the eggs to the best of its ability.
AMH isn't an egg quality test.
This is probably the most important message to take away. If you've been told that you have a low AMH, it's very easy to hear that as "I have very little chance of having a baby". But that's not what the result means.
AMH and antral follicle count are particularly useful for helping predict how your ovaries may respond to fertility medication and for planning assisted conception. They should not be used on their own to predict your chances of becoming pregnant naturally.
So rather than looking at one AMH number in isolation, we want to look at the bigger picture: your age, cycles, whether you're ovulating, your follicle count, hormone results, reproductive health, your partner's fertility where relevant, and how long you've been trying. Your AMH result is useful information. It isn't a verdict on whether you can have a baby.
I've been told my AMH is low. What does that actually mean?
Being told that you have a low AMH can be frightening, particularly if you're already worried about your age. It can feel as though you've suddenly been given a fertility score. You haven't. A low AMH can suggest a lower ovarian reserve and may indicate that your ovaries are likely to produce fewer eggs in response to stimulation during fertility treatment.
But it doesn't tell us the quality of the eggs you have, and it cannot tell an individual woman whether or not she can conceive naturally.
One of our clients in IVF treatment had more than 30 follicles in her scan which she was thrilled with, however it didn't lead to any viable embryos. In a later treatment cycle years later she had only 4 mature eggs collected. However 1 of those developed into an embryo who is now their beautiful son. Although she had fewer eggs, she had worked hard on lifestyle changes through our fertility coaching, and had regular fertility reflexology. They also focussed on improving sperm quality and addressed many issues on that side with the help of a urologist we recommended.
This is just an example of how AMH and having fewer eggs does not mean you can't have a baby, and it's worth doing what you can to try and support the quality of the remaining eggs.
Can I improve my AMH?
This is another question we're asked a lot and it can be widely misunderstood. You'll find plenty of supplements, diets and treatments online promising to ‘boost’ AMH. However you can't increase your ovarian reserve. AMH is a suggestion of how many eggs you have in your reserves.
If your AMH fluctuates, this is because it is a hormone being released by your egg follicles. There are other factors that might affect how much or how well this process happens. So although the figure itself may change, you can't improve the number of eggs you have in your reserves.
The aim shouldn't be about improving your AMH number. It should be to understand what that number means for you and make decisions based on your wider fertility picture. Then work on supporting your body in order to try and support the quality of the eggs you have.
What should I actually investigate after 40?
You don't need every fertility test available simply because you're over 40.
But we also wouldn't want somebody in their 40s to spend month after month making lifestyle changes without first understanding their fertility picture.
Depending on your individual circumstances, these are some of the areas that may be useful to discuss with your GP, fertility consultant or clinic.
Depending on your semen analysis, symptoms and medical history, a clinician may recommend blood tests to look at hormones involved in sperm production and reproductive health. These can include testosterone, FSH and LH. Hormone testing isn't necessary for every man, so your doctor or fertility specialist can advise whether it's appropriate for you.
It's important to evaluate what is happening for both partners as quickly as possible, so fast and sensible decisions can be made. IVF is not always the immediate answer.
You can read more about what you can do before IVF here.
What can I do to support my fertility over 40?
You don't need to overhaul your entire life overnight. We appreciate the concern around time, but you also don't want to shock your body with too many extreme changes at once. Start with the areas that are relevant to you and aim for changes you can actually sustain and don't cause you more stress.
Eat well
There isn't one magical fertility diet. Aim for plenty of vegetables and fruit, wholegrains, good sources of protein and healthy fats, with a varied diet that provides the nutrients your body needs. A Mediterranean style pattern of eating can provide a useful framework without turning every meal into another fertility task. We also recommend starting the day with a healthy protein-rich breakfast.
Stop smoking
If you smoke, stopping is one of the most valuable changes you can make for your general and reproductive health.
Look at alcohol
There are guides that suggest to keep under a certain number of units, however we recommend to our clients that they consider caring for their body as as they would if they were pregnant, and try not to drink any alcohol if possible. That doesn't mean enjoying a glass of wine in the evening will be an issue. It's important to find a balance.
Move your body
Regular movement supports your general health and wellbeing. You don't need a punishing exercise programme because you're trying to conceive. Find something realistic that you can continue. Something that makes you feel good and doesn't cause additional stress or pain.
Prioritise sleep and recovery
If you're working long hours, exercising hard, researching fertility late into the evening and sleeping badly, adding another ten things to your fertility checklist probably isn't what you need. Rest matters too. Give yourself space. Take some time out before bed to fully wind down.
Give yourself some grace
This is so important. We understand it can feel like you're against the clock. You may feel stressed and be looking into your options. Perhaps trying lots of changes at once. Sometimes the best thing can be to pick fewer changes that are likely to have the biggest impact for you, and sometimes that can be looking after yourself physically but also mentally. Find time and space for yourself and for focus on this journey. You might want to try fertility reflexology to allow yourself some quiet healing time.
Do I need IVF because I'm over 40?
No. Being over 40 doesn't automatically mean that IVF is the right next step.
Whether fertility treatment is appropriate depends on your individual circumstances. But age does affect IVF success rates too, particularly when using your own eggs, which is why we believe it's important to have these conversations early rather than seeing IVF as something you can simply turn to later if everything else fails.
Current NICE guidance recommends taking ovarian reserve into account when discussing IVF. Access to NHS funded treatment can still vary according to local commissioning arrangements and eligibility. The important thing is to understand your options before you feel backed into a corner by time.
IVF over 40: what do the success rates actually mean?
IVF statistics can be confusing. You may see one clinic advertising a 40% pregnancy rate while another figure tells you your chance is much lower.
Often, those numbers are measuring different things. Before comparing IVF success rates, check:
- Is this a pregnancy rate or a live birth rate?
- Is it per treatment cycle, egg collection or embryo transfer?
- What age group does it relate to?
- Does it use the patient's own eggs or donor eggs?
These distinctions matter.
The latest HFEA data for 2024 shows that the average IVF birth rate per embryo transferred using patients' own eggs was 38% for patients aged 18 to 34, compared with 8% at ages 43 to 44. These are averages per embryo transferred, not an individual's chance of having a baby from starting an IVF cycle.
So don't let one percentage frighten you or reassure you without understanding what it's actually measuring. Also remember that everyone is different, and your changes of success might be higher with extra fertility and lifestyle support.
See the latest UK fertility treatment statistics from the HFEA
What if donor eggs have been mentioned?
Being told that donor eggs may give you a better chance of pregnancy can be incredibly difficult to hear. Even if you understand the medical reasoning, emotionally it can feel completely different.
You may find yourself grieving the genetic connection you had imagined having with your baby. You may wonder whether the baby would feel like yours, what you would tell them in the future, how your partner feels or whether you're ready to make such an enormous decision.
You don't have to immediately feel okay about donor conception. And you don't need to make the decision before you've had time to understand what it means for you. Specialist fertility or donor conception counselling can be particularly valuable here. We advise you don't make any decisions without consulting someone and learning more about it.
If donor eggs do become part of your journey, remember that pregnancy is still happening within your body.
Your body provides the environment in which the embryo implants and develops. You carry your baby, nourish them throughout pregnancy and give birth to them. Donor conception changes one part of the story of how your baby came to be. It doesn't make you any less their mother.
What support is available if we're considering donor conception?
If you've arrived on this page simply looking for information, we hope it's helped you feel a little clearer about what matters and what doesn't. But if you're juggling AMH results, scans, supplements, natural conception, IVF decisions and a growing sense that you're running out of time, sometimes it helps to have somebody bring the whole picture together.
Our approach isn't about promising to reverse age or telling you that fertility treatment isn't necessary. It's about using the time you have well, and considering what is more important to spend both your time and your money on.
We can help you understand your fertility information, look at your cycles and wider health, identify realistic lifestyle changes, consider both partners' fertility where relevant and support you emotionally while you decide what happens next. For some women, that means a period of trying naturally with fertility coaching and reflexology. For others, their results mean that we would encourage them to speak to a fertility clinic sooner rather than spending months trying to optimise everything first.
And if IVF or donor conception becomes part of your journey, we can continue to support you alongside your medical care.
Fertility Investigation Session
If you have results but aren't sure what they mean, or you feel as though you've collected lots of pieces of fertility information without anybody looking at the whole picture, an investigation session gives us time to go through your journey in detail.
We can look at what has already been investigated, discuss areas that may warrant further questions and help you feel clearer about what you want to do next.
Fertility reflexology
Fertility reflexology can provide regular time to slow down and feel supported while you're trying naturally or preparing for fertility treatment.
Your sessions are tailored to where you are in your fertility journey and can sit alongside the medical fertility care you're receiving.
Fertility Over 40 FAQs
Male fertility problems are more common than many people realise. Male factors are involved in around half of couples experiencing fertility difficulties, either as the main factor or alongside female fertility issues. Yet fertility investigation can still feel disproportionately focused on the woman.
This is why we strongly believe fertility should be looked at as a couple wherever possible. If you've been trying to conceive without success, understanding the male fertility picture is just as important as investigating female fertility. A semen analysis is usually the starting point, but depending on the results and your circumstances, there may be reasons to look further.
