As more people are choosing to become parents at an older age, preconception care and supporting fertility becomes more and more crucial. Miscarriage rates for women increase with chronological age, with about 20% of pregnancies resulting in miscarriage in a woman’s early 30s, 33% of pregnancies of women over 40 resulting in miscarriage, and greater than 50% resulting in miscarriage for women over 45.
What is the risk for women of having kids at an older maternal age? A big piece of fertility is looking at a woman’s ovarian reserve – the reproductive potential left within the ovaries based on the number and quality of eggs remaining. The ovarian reserve decreases as we age, but there are also hormonal changes as women move into their forties that can herald the beginnings of perimenopause, which can change cycle length and regularity, as well as the endometrial environment to sustain a pregnancy. There are also higher rates of Down syndrome and autism, developmental delays, and food allergies in children born to older parents.
But it’s also not all risk or bad news – women who give birth after 40 have higher rates of education and are not as likely to experience the “motherhood penalty” of lost wages incurred by younger moms. Older mothers are more likely to read to their children, and they are 58% less likely to get ovarian cancer than women who never had children.
So if the modern woman wants to have children at an older age, what is happening with fertility as we age and how can it be supported? Women are born with a set number of eggs, and as we age, there is a decline in the total number of eggs and the percentage of genetically normal eggs. A big piece of this is due to oxidative stress and damage from free radicals on the remaining eggs that can cause genetic mutations as we get older. Because the amount of oxidative stress affect the quality of eggs in women (and sperm in men), it is important to look at nutritional status, environmental exposures, and overall stressors that can contribute to oxidative stress.
For preconception care, optimally, I like to begin 3-4 months before conception or starting IVF, as the window of maturation for eggs and sperm is about 4 months. This allows time for the necessary fertility support to reach the next round of egg and sperm to give the DNA in the egg and sperm its highest integrity.
Much of the support that is needed in women that are wanting to conceive at an older age is extra antioxidant support, limiting toxic exposures, and hormone balancing. During a fertility consult, we look at all these pieces and do lab testing to see what areas may need extra support. We go over specific recommendations that can include nutritional guidelines like amounts of vegetables and organic options, adding in supplemental antioxidants that can include nutrients like coQ10, NAC, and herbs like green tea, and hormone support that can either be herbal and/or adding in the use of bio-identical hormones. Depending on the woman, her history, and her body’s needs, there are a variety of nutrients, herbs, and treatments we can use to support her fertility. In this way, each woman can be prepped and supported as much as possible to ensure the greatest success of conceiving a healthy, happy baby.