Fertility After 40: A Realistic and Hopeful Guide

If you're trying to conceive after 40, you've probably encountered two extremes. One says it's nearly impossible and you should have planned better. The other says 40 is the new 30 and celebrity pregnancies prove age doesn't matter.

Neither is helpful. Neither is true.

Here's what we've learned from working with women in their 40s for over two decades: fertility after 40 is harder, but it's far from impossible. And what you do with the time you have matters enormously.

What Are the Chances of Getting Pregnant After 40?

We're not going to pretend age doesn't matter. It does.

Egg quantity declines with age. By 40, you have significantly fewer eggs than you did at 30 or even 35. The rate of chromosomally normal eggs also decreases, which is why miscarriage rates are higher and it often takes longer to conceive.

But here's what gets lost in the statistics: many women over 40 do conceive, both naturally and with assistance. A 2012 study in Fertility and Sterility found that among women 40-43 undergoing fertility treatment, those who optimized modifiable factors like weight, sleep, and stress had significantly better outcomes than those who didn't address these factors.

Research published in Human Reproduction found that healthy lifestyle factors were associated with a 40% reduction in infertility risk, regardless of age. The effect was even more pronounced in older women.

The statistics describe populations, not individuals. Your outcome depends on your specific situation, your health, your egg quality, and factors that numbers alone can't capture.

Why Egg Quality Matters More Than Quantity

For years, the conversation about age and fertility focused almost entirely on egg quantity. But what we've seen clinically, and what research now confirms, is that the environment matters as much as the eggs themselves.

Your ovaries aren't just storage containers. They're living ecosystems. The follicles developing right now are influenced by blood flow, inflammation levels, hormonal signaling, and the health of the surrounding tissue. Two women the same age with the same AMH can have completely different outcomes depending on the state of that environment.

A study published in Nature Aging in 2024 demonstrated that the ovarian microenvironment changes with age and directly affects egg quality. The researchers found that supporting this environment could improve outcomes independent of egg quantity.

This is where your choices make a real difference. You can't add eggs to your reserve, but you can change the conditions in which your remaining eggs develop. For more on this, read our article on how to improve egg quality.

The 90-Day Window

The egg that will ovulate three months from now is developing right now. It takes approximately 90 days for a follicle to mature from recruitment to ovulation. During that window, the developing egg is influenced by everything happening in your body.

At 40 and beyond, this window becomes even more important. You may have fewer eggs, but you can focus on optimizing the conditions for the eggs you do have. This is something you can actually affect.

How to Improve Fertility After 40

Sleep

Sleep is when your body does hormone regulation, cellular repair, and detoxification. Poor sleep increases inflammation, disrupts FSH, and creates conditions that work against fertility.

Most women in their 40s have accumulated years of sleep debt. They've adapted to functioning on six hours or less. But adaptation isn't the same as thriving. If you're not sleeping deeply, not waking rested, your hormones and fertility are affected.

Research in Fertility and Sterility found that women who slept less than seven hours had lower rates of conception and poorer IVF outcomes. This is foundational. We address it first.

Nervous System Regulation

If you've spent decades building a career and managing responsibilities, your body has likely adapted to chronic stress. You've been running on cortisol so long it feels normal.

Chronic stress shifts resources away from reproduction. It affects hormonal signaling, blood flow to reproductive organs, and the conditions for implantation. For women over 40, who may already have fewer eggs to work with, this matters even more.

Your nervous system can shift. Acupuncture, breathing practices, and reducing sources of chronic stress all help. Women often notice changes within weeks: better sleep, less anxiety, feeling more like themselves. When your body feels safe, it's better able to support conception.

Inflammation and Blood Flow

Your follicles need oxygen, nutrients, and hormones delivered through good circulation. Chronic inflammation creates oxidative stress that affects developing eggs.

Inflammation accumulates over time. By 40, many women have years of inflammatory patterns from diet, stress, digestive issues, or underlying conditions. Addressing inflammation through anti-inflammatory eating, supporting digestive health, and reducing inflammatory triggers can improve conditions significantly.

Acupuncture increases blood flow to the ovaries and uterus. Research published in the Journal of Endocrinological Investigation demonstrated measurable improvements in uterine artery blood flow following acupuncture treatment. Movement helps too. These shape the environment where your eggs are maturing right now.

Underlying Health Factors

Certain conditions become more common in your 40s and affect fertility. Thyroid dysfunction, even subclinical, can interfere with ovulation and implantation. Insulin resistance affects hormone balance and egg quality. Vitamin D deficiency is widespread.

Many women have never had these factors thoroughly assessed, or were told their labs were "normal" when they were actually suboptimal for fertility. A comprehensive workup looking at thyroid function, blood sugar regulation, inflammatory markers, and nutrients can reveal issues that are addressable once identified.

Can You Get Pregnant Naturally After 40?

Yes. Women over 40 conceive naturally every month. If you're ovulating regularly and have no other fertility factors, natural conception is possible. It may take longer, and the chances each cycle is lower than at 35, but it happens.

The question is whether you have time to try naturally or whether intervention makes sense given your timeline and circumstances.

If you're 40 or 41 and have been trying for three to six months without success, getting a fertility workup is reasonable. Not because natural conception is impossible, but because you want information. Understanding your ovarian reserve, your partner's sperm quality, and whether there are any obstacles helps you make informed decisions. If your AMH is a concern, read our article on low AMH and fertility for perspective on what that number actually means.

If you're 42 or older, most reproductive endocrinologists recommend moving more quickly to IVF if that's a path you're open to. This isn't about panic. It's about recognizing that time matters and intervention may improve your odds.

IVF After 40: What to Expect

IVF success rates decline with age, primarily because of egg quality. But women over 40 do have successful IVF cycles. The key is optimizing conditions before and during treatment.

We work with many women over 40 preparing for IVF. The focus is on the months before the cycle: reducing inflammation, supporting blood flow, regulating the nervous system, addressing sleep and stress. Women often respond better to stimulation and produce better quality embryos after this preparation.

We also support women during IVF cycles with acupuncture around retrieval and transfer. For a detailed look at how acupuncture supports each phase of IVF, read our article on acupuncture and IVF.

Some women over 40 will consider donor eggs. This isn't a failure. It's a path to parenthood that many women take, and we support women through this decision as well.

What This Looks Like in Practice

A woman came to see us at 43. She'd done two IVF cycles already, both with disappointing results: three eggs the first time, two the second, no viable embryos from either. Her doctor suggested donor eggs. She wasn't ready to give up on her own eggs yet.

When we talked, a pattern emerged. She'd been experiencing hot flashes and night sweats for the past year, which she'd dismissed as just perimenopause. Her periods had become lighter and shorter. She was drinking four cups of coffee a day to compensate for her exhaustion. She hadn't exercised in months because she didn't have the energy. Her diet was haphazard, often skipping meals and then eating whatever was fast.

Her body was already in a stressed, depleted state before the IVF medications even entered the picture.

We worked together for four months before her next cycle. We addressed the hormonal shifts with Chinese herbs. We reduced her coffee to one cup and focused on stabilizing her blood sugar with regular meals. Acupuncture twice weekly, focused on building her reserves and calming the hot flashes. She started walking daily and going to bed earlier.

The hot flashes reduced significantly. Her energy improved. Her periods became slightly heavier, a sign of better blood flow and hormonal support. She said she felt like she'd gotten some of herself back.

Her third IVF cycle retrieved five eggs. Three fertilized. Two made it to blast, and one was chromosomally normal.

That embryo is now her son.

Her situation was difficult. At 43 with a history of poor response, the odds weren't in her favor. But changing the conditions changed what was possible.

Read stories from women we've worked with →

A Word on Expectations

Fertility after 40 is harder than at 35. Not everyone who tries will succeed. Some women will need donor eggs. Some will face losses along the way.

But we've also seen too many women count themselves out based on statistics alone, or rush into treatment without preparing their bodies, or give up after one failed cycle.

Your body is more responsive than you've been led to believe. The environment you create for your eggs matters. Preparation matters. Support matters.

The question isn't whether success is guaranteed. It never is, at any age. The question is whether you've given yourself the best possible chance.

Your Next Step

If you're trying to conceive after 40 and want support, we can help you understand where you are and what to focus on. Whether you're trying naturally, preparing for IVF, or weighing your options, we'll create a plan tailored to your situation.

Learn more about our Fertility & Health path or contact us at 212.432.1110 or info@fafwellness.com.