By Lindsay Morris
Thinking about getting pregnant after 40? While fertility naturally declines with age, there’s still a lot you can do to improve your chances. From understanding the truth behind AMH levels to making smarter choices around diet, exercise, sleep, and stress—this guide breaks down what really matters when trying to conceive in your 40s, with fertility expert-backed insights.
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The internet is overflowing with fertility advice—some helpful, some downright misleading. Sifting through myths to find real, evidence-based information can take hours. And for women over 40, time isn’t always a luxury. It’s no wonder so many TTC women (those who are trying to conceive) cling to the first search results they find—only to end up frustrated when pregnancy doesn’t happen. Meanwhile, headlines about celebrity pregnancies at advanced ages—like Hillary Swank welcoming twins at 48 or Cameron Diaz having children at 47 and 51—fuel unrealistic expectations about what’s naturally possible.
“I think there’s a lot of information out there that’s misleading,” says fertility doctor Aimee Eyvazzadeh, M.D. “And that makes us think that women over 40 are actually more fertile—that’s not true.”
Instead, she says, most women who do get pregnant after age 40 are doing so by medically assisted means. In Swank’s case, she revealed that she’d frozen her eggs, while Diaz reportedly turned to surrogacy after unsuccessful in vitro fertilization (IVF) attempts.
“A lot of women over 40 are actually getting pregnant with donated eggs, donated embryos, and people aren’t talking about that,” says Eyvazzadeh. “There’s a difference between 40 and 43 versus over 45. So I’m seeing more patients than ever over age 45, and I’m asking them things like, ‘What do you think your chances of pregnancy are?’ And they’re saying things like, ‘50%,’ but it’s more like less than 5%.”
The reality? Like products at the store, a woman’s eggs have a shelf life. But can anything improve your chances of conception after 40? We dug into the research to separate fact from fiction.
Claim: High AMH Levels Guarantee Conception—Even Over 40
If you’ve investigated fertility testing, you’ve probably heard that a high AMH (anti-Müllerian hormone) level can indicate strong chances of pregnancy, but does that hold true at an advanced maternal age?
Egg quality declines with age, beginning as early as age 32. Around this time, women begin to experience a gradual rise in the circulating level of follicle-stimulating hormone—which benefits mature eggs—and a drop in AMH and inhibin B—hormones that reflect the number of remaining eggs. Together, these changes signal a decline in fertility.
“Unfortunately, we see rapid changes very quickly over the age of 40, especially in as little as six months or one year,” Eyvazzadeh says. “So, let’s say an egg at 42 might have a 15% chance of being genetically normal, and at 44 has a 4% chance of being genetically normal.”
That’s why many fertility clinics offer an AMH test, a simple blood draw that can help women visualize their ovarian reserve better. As a diagnostic tool, it can help fertility specialists customize treatments to improve a woman’s odds of getting pregnant.
Still, even though there is evidence that AMH can provide a glimpse at how your eggs are aging, research indicates that it’s not a reliable predictor of natural pregnancy, regardless of age.
“Having a high AMH and lots of eggs is not interpreted in the same way when you’re over 40 compared to someone who is 30,” adds Eyvazzadeh. “When your AMH is high over 40, it still means that you still have the eggs of a 40-year-old. You might have more eggs than the average 40-year-old if your AMH is high. But that doesn’t imply somehow that you have the eggs of a 30-year-old.”
She recalls one patient, a 47-year-old with an unusually high AMH level for her age. “The OB-GYN said, ‘Oh, you should be able to get pregnant. No problem.’ The reality is that the likelihood is still close to zero because she has 47-year-old eggs, and the likelihood that a 47-year-old egg is genetically viable is close to zero.”
It’s important that patients understand the whole picture, so they can avoid false reassurance and feel empowered to make timely, educated fertility treatment decisions. AMH can help you plan fertility treatment, but it won’t predict natural conception.
Claim: Ovulation Tracking Can Help You Get Pregnant
The internet is full of conception calculators and fertility trackers. While TTC, these can be helpful tools in pinpointing the window when you are most likely to get pregnant based on the timing of your last menstrual period.
Several companies offer at-home fertility tests, including continuous hormone monitors and LH (luteinizing hormone) test strips, to help identify your peak ovulation days. And you can invest in a basal body temperature (BBT) thermometer to identify when you’re most fertile and time your intercourse accordingly. Prior to ovulation, BBT is typically between 96 degrees Fahrenheit and 98 degrees Fahrenheit. But it typically shifts with a half-degree to one-degree Fahrenheit rise in temperature 24 hours after you’ve ovulated.
“I think they help women time intercourse,” says Eyvazzadeh. “As far as whether they truly improve chances and improve fertility… Well, you can make an argument that if you understand when you’re ovulating and timing sex better, then yeah, you might be giving yourself a higher chance of pregnancy.”
Claim: Fertility Supplements Can Help You Get Pregnant
Fertility supplements crowd store shelves, promising to boost your chances of conception. So are any of them worth adding to your cart?
Eyvazzadeh recommends CoQ10, resveratrol, NAD+ (nicotinamide adenine dinucleotide), and prenatal supplements containing vitamin D and fish oil.
Research suggests that CoQ10 may help women with diminished ovarian reserve improve fertility treatment outcomes by enhancing egg and embryo quality, supporting a better hormonal response, and reducing the time and amount of medication needed for ovarian stimulation. There is also some evidence that resveratrol may support healthier ovarian function, which could, in turn, improve a woman’s chances of conception and her ability to maintain a healthy pregnancy.
In one study involving mice lacking CD38—a molecule that breaks down NAD+—researchers found that the rodents had more primordial follicles, the immature egg cells females are born with. This translated to a longer ovarian lifespan, greater fertility, and more babies.
Other nutrients may also play a role. For example, physicians often recommend that women trying to get pregnant begin taking vitamin D, in preparation for its increased demand during pregnancy. Additionally, one study showed that, after controlling for factors such as age, obesity, race, previous pregnancies, and vitamin use, women who took omega-3 fatty acid supplements, including fish or flaxseed oil, were approximately 1.5 times more likely to conceive naturally than those who did not.
Lastly, the Centers for Disease Control and Prevention (CDC) advises women who want children to take about 400 micrograms of folic acid daily to help prevent neural tube defects (NTDs), serious congenital conditions affecting the brain, spine, or spinal cord.
“As far as whether they can improve fertility and egg quality, I don’t think it’s fair to tell someone that supplements have that much power, that they can improve things,” says Eyvazzadeh. “They can certainly support your egg health and support the mitochondria in the cells of your ovaries and uterus.”
Claim: You Can Eat Your Way to Better Fertility
We’ve seen headlines about so-called fertility diets and foods that will help you get pregnant faster. But is there any truth behind the hype around what to eat for conception?
While no meal plan guarantees a successful pregnancy, eating anti-inflammatory foods, such as vegetables, fruits, whole grains, nuts, seeds, lean proteins (like poultry and fish), and healthy fats (like avocados, nuts, and seeds), can make your body more hospitable for conception, says Eyvazzadeh.
“Inflammation can impair fertility,” she says. “So, if let’s say you’re inflamed or you’re overweight, you might have higher glucose levels and insulin resistance going into a pregnancy. That is not optimal because it can cause an increased risk of pregnancy complications.”
For example, she explains, women over 40 have a higher likelihood of experiencing pregnancy complications like preeclampsia and gestational diabetes, both of which studies have linked to pro-inflammatory diets.
Marked by high blood pressure and potential organ damage, preeclampsia typically begins after 20 weeks of pregnancy but can also occur after delivery. If left untreated, it can lead to seizures, stroke, premature birth, or even death for the mother and baby.
Formerly called toxemia, the condition is estimated to occur in between 5% and 7% of all pregnancies. That relative risk increases with age—by 30% for pregnant women between 40 and 44, and more than doubles between 45 and 59.
An 2022 study published in the Journal of the American Heart Association revealed that women who reported following an anti-inflammatory Mediterranean-style diet had a 20% or greater reduced risk of developing preeclampsia—even after adjusting for socioeconomic status and existing health conditions.
An anti-inflammatory diet can also reduce your risk of gestational diabetes (also known as gestational diabetes mellitus), a condition in which your body becomes less responsive to insulin, a state known as insulin resistance. As with preeclampsia, the rate of gestational diabetes also rises with advanced maternal age, affecting about 12% of women aged 35 to 39 and just over 15% of women over 40.
In one study, published in November 2021 in the European Journal of Nutrition, researchers found that a pro-inflammatory diet is associated with a 27% higher risk of gestational diabetes. Total fat, saturated fats, and trans fats also appeared to contribute to the disease.
Claim: Exercise is Bad for Fertility
A common fertility myth is that exercise can disrupt implantation, and therefore, women who want to get pregnant should avoid working out.
It’s simply false, says Eyvazzadeh. “I don’t think that exercise is dangerous. What’s dangerous are the messages that women hear that they should not exercise and that they should, for example, keep their heart rate nice and low. I want patients to strength train, lift weights, stretch, and do cardio.”
The American College of Obstetrics and Gynecology (ACOG) recommends that women moderately exercise for a minimum of 150 minutes each week while on their TTC journey. Research shows that being overweight or obese can negatively affect fertility and pregnancy outcomes, and a high BMI (Body Mass Index) may put a woman at higher risk for complications during fertility treatment and pregnancy.
Additionally, there is evidence that excess weight may impact more than just egg quality—it can also negatively affect the uterine environment (the endometrium), making embryo implantation more difficult and potentially compromising a woman’s ability to sustain a healthy pregnancy.
“I have this 10-minute mile fit rule,” says Eyvazzadeh. “I encourage my patients to be as fit as they can be and use their ability to run a 10-minute mile as a gauge. So, if they’re not 10-minute-mile fit, they need to get to that point because pregnancy is certainly like a marathon, which they should be training for.”
Eyvazzadeh recommends that women maintain a BMI of over 19, while keeping in mind that fitness is all about balance. “If you exercise excessively, are extremely lean, and don’t have enough body fat, that might impact the strength of your ovulation. If your body is stressed too much from exercising, then you might actually stop ovulating.”
Research shows that excessive exercise reduces the pituitary gland’s ability to release the amount of LH and follicle-stimulating hormone (FSH) necessary for ovulation. Moderate exercise, on the other hand, helps with hormone regulation and overall health. Consult your healthcare provider to determine the right amount of physical activity for your body type and individual health needs.
Claim: Relax and You’ll Get Pregnant
We know that stress can play a big role in your mind-body health. But did you know it can also factor into your ability to get pregnant? That was the key finding of the LIFE Study, published in Human Reproduction in 2014. It was the first U.S. study to link stress hormones found in saliva with how long it takes to get pregnant and the first in the world to show an association between stress and infertility.
Between 2005 and 2009, researchers enrolled 501 couples at sites in Michigan and Texas. For up to 12 months, they tracked the couples’ efforts to conceive and any resulting pregnancies. Female participants provided saliva samples the morning after enrollment and again after their first study-observed menstrual period. These samples were tested for cortisol and alpha-amylase, two biological stress indicators. Participants tracked their menstrual cycles and recorded daily data in journals and questionnaires, allowing researchers to measure the time to pregnancy.
Of the 401 women who completed the study protocol, 347 (87%) became pregnant and 54 did not. After adjusting for factors such as age, race, income, and lifestyle behaviors (including alcohol, caffeine, and cigarette use), researchers found that women with the highest levels of alpha-amylase had a 29% lower chance of conceiving compared to those with the lowest levels. No association was found between cortisol levels and fertility outcomes.
Eyvazzadeh recommends that women embrace mindfulness and meditation to counter stressors. “Sirius XM has a really helpful guided meditation channel,” she says. “I also tell my patients to get the Oura Ring. I think most Target stores have an Oura Ring station where they can get fitted for the ring and buy one. It has really nice meditations as well.”
Still, stress relief can only take you so far on your TTC journey. It won’t override biological factors like age, egg quality, or underlying medical conditions.
Claim: Better Sleep = Babies
We know relaxation and stress can affect fertility, but how does sleep factor into pregnancy after 40?
A study published in May 2022 in Scientific Reports showed that sleep falls off a cliff at age 40 before picking up again after 50. That doesn’t bode well for women trying to get pregnant in their 40s.
“It’s really important to get good sleep and have a normal circadian rhythm,” says Eyvazzadeh. She encourages her patients to aim for at least seven hours.
One factor hindering slumber? Sleep-disordered breathing (SDB). An estimated one billion people globally between the ages of 30 and 69 are estimated to have obstructive sleep apnea (OSA), the most common type of SDB.
Two studies published in the Journal of Clinical Endocrinology & Metabolism demonstrated a strong link between SDB and polycystic ovary syndrome (PCOS)—a leading cause of infertility. In fact, premenopausal women with PCOS were found to be 30 times more likely to have SDB than those without the condition, with 44% of obese women with PCOS showing signs of obstructive sleep apnea (OSA), compared to just 6% of reproductively normal women.
Why does this matter? OSA can contribute to insulin resistance and reduce glucose tolerance, already major concerns for women with PCOS. These metabolic abnormalities may also interfere with hormone balance and ovulation, potentially making it even harder to get pregnant.
Insomnia can also play a role. The CDC reports that in 2020, nearly 18% of adults reported trouble staying asleep most days or every day of the past month. Older adults were more likely to experience sleep difficulties—21.8% among those aged 45 to 64 compared to 13.8% in the 18 to 44 age group.
Research shows that women are more likely than men to experience sleeplessness, largely due to hormonal changes. Reproductive transitions like menstruation, pregnancy, and menopause can disrupt sleep patterns and may even impact fertility.
“I tell my patients to take three milligrams of melatonin per night if they need it to help them sleep,” Eyvazzadeh says. “I encourage patients to use blackout curtains in their rooms, and I’m all about weighted blankets and weighted eye masks, which can also help with healthy sleep.”
Claim: Exposure to Toxins Reduces Egg Quality
Fertility is influenced by several factors beyond genetics and lifestyle—the environment can also play a role. Science has shown that exposure to various toxins can affect egg quality and your ability to conceive.
Take pollution, for example. It isn’t just bad for the environment; it may hurt your chances of getting pregnant. Research indicates a link between pollution and infertility. For example, one study published in January 2024 in Scientific Reports tracked the adverse fertility effects of air pollution exposure on 511 Polish women aged 25 to 39. Researchers examined self-reported data, ovarian reserve assessment via ultrasound (measuring antral follicle count, which reflects ovarian reserve), and blood tests to measure AMH, FSH, and estradiol levels. They also analyzed air pollution exposure based on ZIP code–linked monitoring data. They concluded that pollutants such as fine particulate matter (PM2.5) and sulfur dioxide (SO₂) may negatively impact antral follicle count and AMH levels.
But it’s not just the air we breathe. The materials we use can also negatively affect fertility. Take, for example, ubiquitous plastics. An industrial chemical called BPA (bisphenol A) has been used since the 1960s to produce certain plastics and resins, which are commonly found in containers used to store food and beverages. While many manufacturers have phased it out, BPA remains a concern, especially since it’s been associated with a lower chance of the embryo attaching to the uterus during IVF. Check product labels to ensure your purchases are BPA-free.
Aluminum, commonly found in food preservatives, cookware, pharmaceuticals, and cosmetics, has emerged as a health concern due to its links to osteoporosis, cardiovascular disease, kidney dysfunction, and pulmonary tissue damage that may contribute to asthma and other respiratory conditions. Research also points to potential reproductive risks—particularly for men—as aluminum can accumulate in semen, with higher exposure levels associated with lower sperm counts. Pregnant women are advised to avoid consuming aluminum-containing antacids and using aluminum cooking utensils, as the element is known to cross the placental barrier.
“From the minute we’re a little egg in our mother’s ovary, we’re exposed to environmental toxins like plastics,” says Eyvazzadeh. “Some of the easiest changes someone can make are switching their plastic to glass, looking for toxins in their cookware, making sure their kitchen is well ventilated when cooking, and using aluminum-free deodorant.”
Claim: You Should Wait 6 Months Before Seeking Help
While 8 out of 10 couples will conceive within the first six months of trying, a woman’s fertility at age 40 drops to about half that of women in their late 20s or early 30s. A 40-year-old woman has a 10% chance of getting pregnant per menstrual cycle, but after 45, she’s not likely to conceive naturally.
“The concept that you should try for six months or try for a year, that’s more for people who are, let’s say, under 35,” says Eyvazzadeh. “But when you’re 40, because of the rapid changes that happen to our eggs, I don’t want patients to ever miss out on the opportunity to retrieve healthy eggs when they still have them.”
For patients who are at an advanced maternal age, she recommends seeking medical intervention immediately and considering whether they might be candidates for IVF treatment.
Bottom Line
While pregnancy after 40 presents real challenges, it’s far from hopeless. Dr. Eyvazzadeh has helped many women of advanced maternal age overcome the odds and conceive, achieving what was once considered medically improbable.
Eyvazzadeh had one patient who used donor eggs at 44 but later conceived naturally with her own eggs at 47. “Scientifically, the likelihood of that happening is close to zero—but it happens,” she says.
In another case, a woman who had been menopausal for a year, with no periods and an FSH over 80, called her from a drugstore bathroom, ecstatic over a positive pregnancy test.
“Those are extreme cases because the likelihood is never going to be zero,” she says. “As long as two people love each other, miracles can happen. It’s okay to be hopeful—but you also want to be practical.”
Pregnancy after 40 is possible, but recognizing the truth can help you make informed reproductive health decisions. By understanding what actually affects your chances of conception, you can take strategic steps—such as getting the right supplements, changing your diet, exercising, embracing mindfulness, adjusting your sleep schedule, reducing your exposure to toxins, and/or considering fertility treatments. Talk to a reproductive health specialist about the best approach for your TTC journey.