Fertility Over Forty

Are women having babies later in life? Yes indeed.

In Europe, percentage of births to moms over 40 has increased from 1.6-3% since

the late 1980s.  In the US, 2.6% of births are to women over 40. In fact over 40 women are the only group whose birth rate is on the rise!

Women who give birth after 40 have higher rates of college education, are more likely to read to their children, are 58% less likely to get ovarian cancer than women who never had children, do not experience the “motherhood penalty” of lost wages incurred by younger moms.

The challenges for women over 40 are decline in the total number of eggs and quality of eggs, as well as the higher rates of Down syndrome, autism, developmental delay, and food allergies. Special considerations for older moms therefore include the ability to get pregnant, mom’s health and ability to sustain a pregnancy, and health of the offspring.

When I asses a fertility in women over forty,  a complete history and  appropriate lab work is critical, particularly labs for thyroid antibodies, fasting blood glucose, iron status, vitamin D levels, serum hormone panel at day 3 and day 21.

Ovarian reserve is the biggest concern to a woman’s fertility over the age of 40. It indicates reproductive potential—the number and quality of oocytes, response to ovarian stimulation, and likelihood of achieving pregnancy.

Aging’s Effects on Eggs and Supportive Naturopathic Measures

1. Decrease androgen production:

Age related decline in the ovaries’ production of testosterone results in increase insulin sensitivity. Note: Women with PCOS see less of a decline in ovarian response with aging.  Supplementation with testosterone is therefore beneficial.

Likewise, production of DHEA drops about 50% from age 25-45. In my experience low dose supplementation is a better option over high dosing which results in a high rate of side effects and only a modest ovarian response.

DHEA significantly lowers miscarriage rates, especially in women over 35 and markedly  improves anti-mulerian hormone (AMH) values.

Aromatase inhibitors are used to block the conversion of testosterone to estradiol. Naturopathic alternatives to the drugs Letrozole and Anastrozole include resveratrol, quercetin, visum, garcinia, green tea and grape seed extract. Noteable testosterone supporting herbs include tribulus and maca.

2. Oxidative stress:

With aging, ovarian tissue undergoes age-related changes at a different rate from other organ tissues.  Dysfunctional ovarian metabolism is the result of free radicals directly damaging ovarian fats, proteins and genetic material.

Strong scavengers of these specific radicals include melatonin, green tea, polyphenols, and N-acetyl cysteine.

3. Mitochondrial function

Ovarian cells depend on the mitochondria for their energy. The oocyte has the highest number of mitochondria of any cell.

Supportive measures here include, but are not limited to: CoQ10 & Alpha-lipoic acid – there is a significant age-related decline in ovarian tissue of both these nutrients with age.

Summary

Naturopathic Medicine offers a wide range of treatment options to help support the key parameters affecting fecundity over age 40. Using clinical signs and lab findings, we are able to determine treatment based on oxidative stress, mitochondrial dysfunction, low androgens and other challenges to fertility.

Whether the diagnosis is poor egg quality or Premature Ovarian Failure, Naturopathic Medicine can be utilized as sole therapy or adjuvant to fertility treatments.