Fertility Over 35: How to Support Your Hormones and Preserve Your Options

With more women excelling in their careers and embracing personal growth, it’s no surprise that many of us are delaying pregnancy until our thirties or forties. Thankfully, outdated terms like “geriatric pregnancy” (once used to refer to pregnancy in women over 35) has been replaced with “advanced maternal age,” But the message that fertility “falls off a cliff” after age 35 continues to reverberate.  For many women, this creates a sense of urgency, as if they’re racing against the clock with every passing year. But with advancements in science, medicine, and technology, does the conventional narrative still hold true today?  In this article, we’ll discuss why your fertility isn’t determined by your age, and how your overall systemic health – from your thyroid health to your blood sugar levels – can influence your chances of conceiving. 

Debunking the “Fertility Cliff” Narrative: The Reality of Fertility in Your 30s and 40s

One question I hear frequently from my patients is, “Does my fertility really decline at 35?” The answer is yes, there are physiological changes that occur. In addition to a natural decline in the number and quality of eggs, examples of common challenges impacting fertility after 35 include:1

• Irregular cycles
• DNA damage
• Genetic mutations
• Mitochondrial dysfunction
• Ovarian fibrosis and inflammation
• Decreased sexual activity

So does that mean you can’t or shouldn’t get pregnant after 35? Absolutely not. Many women in their late 30s and 40s have healthy pregnancies.  The so-called “fertility cliff” is more of a gradual slope. A landmark study found that while fertility does decline with age, 82% of women aged 35 to 39 conceive within a year of regular unprotected intercourse, compared to 86% of women aged 27 to 34.2 The “drop” is not as drastic as often portrayed. Successful conception for women over age 35 may hinge on optimizing the follicular environment—the fluid “home” surrounding the egg—to support better outcomes. This is where natural interventions shine. We cannot change the chronological age of an egg, but we can significantly impact the biological environment in which it matures.

A Proactive Approach to Supporting Your Hormones After 35

If you’re trying to conceive after 35, it’s best to start taking proactive steps to support your hormonal health as early as possible. Here are some of my top recommendations.

Hormone Testing and Monitoring

Don’t guess—test. I recommend getting a full hormonal panel and monitoring it over time to identify trends. Here are examples of tests I recommend:

• Ovarian reserve testing: Ovarian reserve testing combines blood tests (to measure follicle stimulating hormone (FSH) and antimüllerian hormone (AMH)) with a transvaginal ultrasound (to count the number of follicles). It provides a useful quantitative measure of your ovarian reserve. Experts recommend ovarian reserve testing for women over 35 who have not conceived after 6 months of trying or are at higher risk of diminished ovarian reserve.3 

It’s important to note that the AMH test does not predict factors like exact egg quantity, egg quality, or your ability to conceive. AMH and FSH levels are not indicative of fertility in women with no history of infertility.4  If your AMH is on the lower end, take it as a sign to be proactive and focused, not a reason for despair.

• Thyroid-stimulating hormone (TSH): Fertility and thyroid health are inextricably linked. For general health, a TSH up to 4.5 is “normal.” However, for fertility and preventing early miscarriage, the American Thyroid Association recommends TSH levels below 2.5 mIU/L.5

Environmental and Lifestyle Factors

There are also many environmental and lifestyle factors that can influence fertility. Here’s what I I recommend to help you optimize yours: 

• Maintain healthy blood sugar levels: If there is one factor that may be more impactful than chronological age for egg quality, it’s blood sugar regulation. Research indicates that high-glycemic diets can impair reproductive function and egg maturation.6 Chronic hyperinsulinemia (high insulin) and frequent glucose spikes create oxidative stress that damages the mitochondria within the oocyte (the egg). Focus on a diet that prioritizes protein and healthy fats to stabilize insulin. Obesity and high body fat percentages are linked to poorer reproductive outcomes. 
• Stay active: It’s important to stay active to maintain a healthy body weight and muscle mass. But try to avoid overtraining. Regular vigorous exercise (activities that cause considerable sweating and shortness of breath) may negatively impact fertility in healthy women trying to conceive. Excessive high-intensity exercises can be perceived by your body as a stressor, causing your period to stop (a condition called functional hypothalamic amenorrhea).7 However, women who are overweight and have PCOS are encouraged to do regular vigorous exercises or resistance training.8
• Avoid ALAN (artificial light at night): Exposure to artificial light at night can lead to severe disruptions in your body’s natural light-dark cycle, also known as your circadian rhythm. These disruptions can suppress the production of melatonin, the hormone mainly known for regulating the sleep-wake cycle. But research shows that melatonin also influences critical reproductive processes, including ovulation and oocyte protection.9,10 Try to reduce your exposure to artificial light a few hours before bed. 
• Reduce alcohol consumption: Excessive alcohol consumption has been shown to increase chronic inflammation, gut dysbiosis, and harm your cells’ antioxidant defenses. All of these can lead to abnormal function of your reproductive organs.11 According to a 2022 research review, women who consume 7 alcohol drinks a week are 7% less likely to conceive after fertility treatment.12 
• Learn to manage stress: Chronic stress can deplete your adrenal reserves and may lower DHEA (dehydroepiandrosterone) levels. DHEA is a precursor to sex hormones, which means it is critical to monitor its levels for follicular health. Scientists have also linked chronic stress to disruptions in the hypothalamus-pituitary-ovarian (HPO) axis, which can lead to ovulatory dysfunction.13 This means learning effective stress management techniques is crucial for your fertility. 
• Audit your environment: Endocrine-disrupting chemicals (EDCs) are structurally or functionally similar to estrogens, which means they can “fool” your body into responding inappropriately. Some EDCs can block the effects of a hormone. While it may not be possible to avoid toxins completely, there are things you can do like using clean beauty and personal care products.

It’s encouraging to know there is so much within your control to help support a healthy pregnancy.

Targeted Supplementation and Herbal Support

In my practice, I recommend specific nutrients and nourishing herbs to support your reproductive system. Here are a few of my favorites:

• DHEA: If testing shows that you have low DHEA levels, a DHEA supplement may be a game changer. Studies show that DHEA supplementation may improve egg quality, increase pregnancy likelihood, and reduce the chances of pregnancy loss.14 
• Vitamin D: Vitamin D acts more like a multifunctional hormone than a vitamin. A growing body of research suggests that vitamin D may play a key role in female reproductive health.15 Researchers have also found that women with sufficient vitamin D levels are more likely to conceive (through both natural and assisted means) than those who are deficient in vitamin D.16
• Maca (Lepidium meyenii): Maca is well known for its adaptogenic properties that support the endocrine system, thereby helping to support hormonal balance.17 Studies show that maca acts on the hypothalamic-pituitary-adrenal (HPA) axis, which means it doesn’t directly affect estrogen and testosterone levels in the blood.18
• Shatavari (Asparagus racemosus): A cornerstone of Ayurveda, shatavari is a valued herb for promoting general and female reproductive health.19 As a rejuvenating herb, shatavari may help regulate hormonal balance, support adrenal function, and enhance stress resilience.20

As always, consult a healthcare practitioner before starting any supplements or herbs.

The Importance of Muscle Mass

In 2025, researchers at McGill University published an article with their discovery of a line of communication between skeletal muscle and the pituitary gland. Myostatin, a protein that regulates muscle mass, was shown to directly promote FSH synthesis, which in turn supports ovarian function.21  This study adds to a growing body of research underlining the importance of maintaining lean muscle mass in women. Muscle mass isn’t simply about fitness; it’s necessary for your overall health, including ovulation. It’s especially important for women over the age of 30, when muscle mass naturally begins to decline (a condition known as sarcopenia).

PCOS: Beyond the IVF Narrative

If you’re experiencing acne and your periods are arriving every 40 days or more, these are classic signs of polycystic ovary syndrome (PCOS), a leading cause of infertility. Many women are told that if they have PCOS, IVF is their only path to motherhood. This is simply not true. PCOS is primarily a metabolic and hormonal imbalance. This means that it can be highly responsive to healthy lifestyle changes. By addressing insulin resistance, reducing androgen levels, and using targeted nutritional therapy, we can often restore regular ovulation. Research shows that lifestyle modifications are the first-line treatment for PCOS and can effectively restore fertility without the need for invasive procedures.22

Your Path Forward: Take a Proactive Approach to Your Fertility With a Women’s Hormonal Health Expert in Boston

Fertility over 35 isn’t a lost cause. It’s an opportunity to be informed and empowered. Remember, fertility is much more than age. Factors like gut health, sleep, stress, lifestyle, and more all play important roles.  If you’re feeling overwhelmed in your efforts to conceive, consider working with a specialist who can create a personalized plan for you. I’ve helped women across the country optimize their chances of conceiving and feel more confident along the way.  If you’re interested in learning more about my approach and how I might be able to support you, schedule a complimentary 15-minute consultation with me today.