Preparing for pregnancy after 40 is absolutely possible, but it requires more intentional planning than it would have a decade earlier. About half of women who want to conceive at age 40 will get pregnant naturally, but that number drops to roughly 20-25% by ages 42 to 43, and by 45, natural conception is rare. That accelerating timeline means the most important thing you can do is start preparing now and move quickly if something isn’t working.
Get a Fertility Assessment Right Away
The American College of Obstetricians and Gynecologists recommends that women over 40 talk to their OB-GYN about a fertility evaluation immediately, not after months of trying. This is different from the advice for younger women, who are typically told to try for six months to a year before seeking help. At 40, every few months matters because your egg supply and quality are changing rapidly.
The key test your doctor will likely order is a blood test that measures your ovarian reserve, essentially how many eggs you have left. This marker can be measured on any day of your menstrual cycle, which makes it convenient, and it correlates more closely with your remaining egg supply than older hormone tests. Your doctor may also order an ultrasound to count the small follicles visible on your ovaries, which provides another snapshot of your reserve. Together, these results help you and your doctor decide whether to try naturally, move straight to fertility treatment, or consider other options like egg donation.
Support Your Egg Quality
You can’t increase the number of eggs you have left, but there’s growing evidence that you can support the quality of the ones remaining. The biggest factor in age-related egg decline is energy production inside the egg cell. As eggs age, their tiny energy-producing structures become less efficient, which leads to more chromosomal errors during cell division. Those errors are the main reason miscarriage rates and certain genetic conditions increase with maternal age.
CoQ10, a supplement that supports cellular energy production, has been studied specifically in women of reproductive age with encouraging results. In studies of women aged 35 to 43, doses of 600 mg per day taken for at least two months before conception improved ovarian response, fertilization rates, and embryo quality. Some studies used higher doses (up to 1,200 mg per day for 12 weeks) in women with poor ovarian response. CoQ10 production naturally declines with age, which is part of why supplementation may help older eggs function better. Talk to your doctor about whether this makes sense for your situation and what dose to try.
Beyond supplements, a nutrient-dense diet matters. A Mediterranean-style eating pattern, rich in vegetables, whole grains, olive oil, fish, and legumes, has been linked to improved pregnancy rates in fertility treatment, with some studies showing roughly double the odds of a live birth compared to lower-quality diets. The strongest results have been in women under 35, but research in women over 35 still showed a modestly lower risk of failed pregnancy. Even without a dramatic fertility boost, this eating pattern supports the cardiovascular and metabolic health you’ll need for a healthy pregnancy.
Optimize Your Health Before Conceiving
Pregnancy after 40 places greater demands on your body, so the healthier you are going in, the better your outcomes. Start a prenatal vitamin with at least 400 micrograms of folic acid well before conception. If you have any chronic conditions like high blood pressure, thyroid disorders, or diabetes, get them well controlled now. Medications may need to be adjusted to ones that are safe during pregnancy.
Exercise is one of the most effective things you can do. Regular moderate activity (walking, swimming, cycling) improves insulin sensitivity, blood pressure, and circulation, all of which directly affect pregnancy health. If you smoke, stopping is non-negotiable: smoking accelerates egg loss and raises the risk of nearly every pregnancy complication. Alcohol should be eliminated once you’re actively trying, and limiting caffeine to about one cup of coffee per day is a reasonable target.
Weight also plays a role. Both significantly high and very low body weight can disrupt ovulation and increase pregnancy complications. If your weight is outside a healthy range, even modest changes (5-10% of body weight) can improve your chances.
Understand the Real Risks
Pregnancy after 40 carries higher rates of certain complications, and knowing what to watch for helps you prepare rather than worry. A large study comparing women 40 and older to younger mothers found that gestational diabetes occurred in 14.5% of older mothers versus 6.9% of younger ones, and preeclampsia (a dangerous blood pressure condition) affected 4.6% versus 1.5%. Cesarean delivery rates were also roughly twice as high. After adjusting for other health factors, being 40 or older independently doubled the odds of gestational diabetes and preeclampsia.
These numbers aren’t meant to scare you. They mean that the vast majority of women over 40 don’t develop these complications, but your prenatal care will be more closely monitored. Expect more frequent blood pressure checks, glucose screening, and ultrasounds. Starting pregnancy at a healthy weight and with good blood sugar control significantly reduces these risks.
Plan for Genetic Screening
Chromosomal differences like Down syndrome become more common with maternal age. At 40, the chance is roughly 1 in 100, compared to about 1 in 1,250 at age 25. Fortunately, prenatal screening has become remarkably accurate.
A simple blood draw as early as 10 weeks of pregnancy can screen for the most common chromosomal conditions with greater than 99% accuracy for Down syndrome and a false-positive rate below 1%. This noninvasive test analyzes fragments of fetal DNA circulating in your blood. ACOG now recommends that all pregnant women be offered this screening, and it’s typically discussed at your first prenatal visit. If a screening result comes back positive, a diagnostic procedure like amniocentesis can confirm the finding. Having this information early gives you time to prepare, plan, and make informed decisions.
Know When to Seek Fertility Treatment
If you’ve been trying for even a few months without success, don’t wait. At 40, the standard advice is to consult a reproductive endocrinologist right away rather than continuing to try on your own for months. Time is genuinely your most limited resource.
If you do need IVF, it’s important to have realistic expectations. For women aged 41 to 42, the national live birth rate per egg retrieval is about 9.4%, according to the Society for Assisted Reproductive Technology. That’s per cycle, so multiple rounds may be needed, and many clinics will discuss using donor eggs as an alternative that significantly improves success rates. Your fertility specialist can review your individual test results and help you weigh options that make sense for your timeline and priorities.
Don’t Overlook Your Partner’s Health
If you’re conceiving with a male partner, his age and health matter too. Sperm quality begins to shift after age 34, with noticeable declines in count, motility, and the percentage of normally shaped sperm by 40. Beyond 45, these changes become more pronounced, which is why major reproductive medicine organizations cap sperm donor age at 45.
Advanced paternal age also carries its own risks for offspring, including higher rates of autism, certain psychiatric conditions, and some skeletal disorders. These risks are small in absolute terms but increase gradually with a father’s age. Your partner can improve sperm quality by maintaining a healthy weight, avoiding excessive heat exposure to the testicles (hot tubs, laptops on the lap), limiting alcohol, and taking a basic multivitamin. A semen analysis is a quick, inexpensive test that should be part of any fertility workup, since male factors contribute to roughly half of all fertility challenges.