Pregnancy After 40 with Low AMH and High FSH

Introduction:

In recent years, we have witnessed a shift in women's choices as they embrace the opportunity to pursue various dreams and aspirations before starting a family. Many women dedicate their early years to building fulfilling careers, traveling the world, and nurturing creativity. This empowering journey can sometimes mean the decision to begin a family is made later in life. So much so that over the past few decades, there has been a notable trend of increasing maternal age (1).

For women over 40, the prospect of pregnancy may seem daunting, but the good news is that conception and pregnancy are entirely possible! While it's natural to be mindful of the changes our bodies experience as we age, there is no need to lose hope. By approaching this chapter with confidence and thoughtful preparation, women can navigate the complexities of aging and hormonal shifts with ease.

This blog post delves into pregnancy after 40, exploring the relationship between menopause and adrenal function. We will discuss common symptoms, lifestyle, and dietary strategies that can improve fertility and increase the chances of a successful pregnancy. We will also explore personalized testing approaches to optimize fertility and support the body through this journey.

Understanding Female Fertility for Women 40 and Over:

As women age, the dynamics of their menstrual cycle undergo significant shifts, marking transitions from the childbearing years into climacteric and menopause. During the childbearing years (approximately ages 10-40), the menstrual cycle operates through a finely orchestrated interplay of hormones, including GnRH, LH, FSH, estrogen, and progesterone, culminating in ovulation and the possibility of conception (2). However, as women approach their 40s, the onset of climacteric begins, characterized by a gradual decline in ovarian function and hormone production (3). This phase may lead to irregular cycles, hormonal imbalances, and fluctuations in menstrual patterns (3). Menopause, occurring within the climacteric years (typically between ages 40-55), marks the cessation of menstruation, with hormonal changes persisting over several years until climacteric is complete (3).

While discussing these shifts, it is important to acknowledge that symptoms of adrenal dysfunction can mimic those of menopause or perimenopause, further complicating matters. Adrenal dysfunction can worsen hormonal imbalances. A common pattern we observe is low AMH (Anti-Mullerian Hormone) and high FSH (Follicle-Stimulating Hormone), which can lead to symptoms similar to menopause, such as irregular periods, mood swings, ETD (Ear fullness, Tinnitus, and Dizziness), and hot flashes. This can make the diagnosis and treatment of fertility-related concerns more complicated (4). This misunderstanding often deters women from pursuing conception, as they mistakenly believe they are no longer capable when, in reality, adrenal dysfunction could be the underlying issue.

Preparing for Conception Over 40:

While fertility declines with age, proactive measures can enhance the chances of conception and promote a healthy pregnancy journey.

Key areas of focus include:

1. Diet: Transitioning to a nutrient-dense diet rich in whole foods, and essential nutrients supports hormonal balance and reproductive health. Adopting a well-rounded diet tailored to support hormonal health is paramount when it comes to enhancing fertility, especially for women over 40. Start by prioritizing nutrient-rich foods that provide a wide array of vitamins, minerals, and antioxidants essential for reproductive function. Consider an anti-inflammatory diet or elimination diet. 

Incorporate foods rich in omega-3 fatty acids, such as fatty fish like salmon, mackerel, sardines, flaxseeds, chia seeds, and walnuts. These healthy fats not only support overall health but also play a crucial role in regulating inflammation and hormone production, which can positively impact fertility (5).

Include a variety of colorful fruits and vegetables in your meals to ensure adequate antioxidant intake. Berries, citrus fruits, leafy greens, and bell peppers are excellent sources of vitamins C and E, which help combat oxidative stress and protect egg health (6). Additionally, incorporating these fiber-rich foods into your diet will support sufficient fiber intake, aiding in regularity and the expulsion of toxins from the body.

Consider supplementing with CoQ10 Ubiquinol, a powerful antioxidant that has been shown to improve egg quality and enhance fertility in women over 40 (7). Additionally, folate, a B vitamin essential for DNA synthesis and cell division, is crucial for reducing the risk of neural tube defects in early pregnancy (8). Leafy greens, legumes, fortified grains, and citrus fruits are excellent dietary sources of folate.

2. Exercise: Regular low-intensity physical activity, including yoga, walking, and strength training, aids in hormone regulation, stress reduction, and detoxification (9, 10, 11). Exercise and perspiring fosters circulation, which is essential for reproductive health and toxin elimination (12).

1. Stress Management: Chronic stress negatively impacts fertility by disrupting hormone balance and suppressing ovulation (13). To promote emotional well-being and fertility, incorporate stress-reduction techniques such as mindfulness, meditation, and relaxation (14).

1. Charting Your Cycle: Tracking menstrual cycles and ovulation patterns enables accurate timing of intercourse, optimizing the chances of conception. Understanding fertility signs empowers women to identify fertile windows and plan conception attempts effectively.

1. Herbal Supplements: Herbal supplements, such as Vitex, maca, and shatavari, can help regulate hormone levels and support fertility (15, 16, 17). Balancing hormones is essential for ovulation, conception, and maintaining a healthy pregnancy.

1. Sleep: Research has shown a growing connection between sleep deprivation and infertility in both men and women (18). Enhance fertility by ensuring you get a restorative eight hours of sleep each night (18).

Personalized Testing for Enhanced Fertility Support:

In addition to lifestyle modifications, personalized testing provides valuable insights into individual health needs and fertility factors.

Consider the following testing approaches to tailor your fertility journey:

1. Food Sensitivity Testing: Identifying and eliminating food sensitivities reduces inflammation and supports digestive health, which is crucial for hormone metabolism and fertility.

1. GI Mapping: Comprehensive stool testing assesses gut microbiome health, impacting hormone balance and overall wellness. Addressing gut imbalances can enhance fertility outcomes.

1. Genetic Testing: Genetic analysis identifies underlying genetic factors influencing hormone metabolism and fertility. Understanding genetic predispositions guides personalized treatment strategies for optimal fertility support. At Fab Fertile, we employ a specific type of genetic test for expectant mothers, offering insights into critical biological pathways affecting maternal and fetal health and their impact on significant birth traits.

Conclusion:

Pregnancy after 40 presents unique challenges and uncertainties, but with informed guidance and proactive measures, women can confidently and optimistically navigate this journey. By addressing symptoms, adopting a holistic approach to fertility, and embracing personalized testing, women can optimize their chances of conception and embark on a path toward a healthy pregnancy and motherhood at any age. Remember, each woman's fertility journey is unique. With the proper support and preparation, the possibility of conception after 40 becomes a tangible reality. For more on this topic check out this episode of the Get Pregnant Naturally podcast.

References:

1. Bouzaglou, A., Aubenas, I., Abbou, H., Rouanet, S., Carbonnel, M., Pirtea, P., & Ayoubi, J. M. B. (2020). Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications?. Frontiers in medicine, 7, 208. https://doi.org/10.3389/fmed.2020.00208

2. Thiyagarajan DK, Basit H, Jeanmonod R. Physiology, Menstrual Cycle. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500020/

3. Blümel, J. E., Lavín, P., Vallejo, M. S., & Sarrá, S. (2014). Menopause or climacteric, just a semantic discussion or has it clinical implications?.Climacteric : the journal of the International Menopause Society, 17(3), 235–241. https://doi.org/10.3109/13697137.2013.838948

4. Huecker MR, Bhutta BS, Dominique E. Adrenal Insufficiency. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441832/

5. Al-Safi, Z. A., Liu, H., Carlson, N. E., Chosich, J., Harris, M., Bradford, A. P., Robledo, C., Eckel, R. H., & Polotsky, A. J. (2016). Omega-3 Fatty Acid Supplementation Lowers Serum FSH in Normal Weight But Not Obese Women.The Journal of clinical endocrinology and metabolism, 101(1), 324–333. https://doi.org/10.1210/jc.2015-2913

6. Safiyeh, F. D., Mojgan, M., Parviz, S., Sakineh, M. A., & Behnaz, S. O. (2021). The effect of selenium and vitamin E supplementation on anti-Mullerian hormone and antral follicle count in infertile women with occult premature ovarian insufficiency: A randomized controlled clinical trial.Complementary therapies in medicine, 56, 102533. https://doi.org/10.1016/j.ctim.2020.102533

7. Nie, X., Dong, X., Hu, Y., Xu, F., Hu, C., & Shu, C. (2023). Coenzyme Q10 Stimulate Reproductive Vatality.Drug design, development and therapy, 17, 2623–2637. https://doi.org/10.2147/DDDT.S386974

8. Medawar, G., Wehbe, T., & Jaoude, E. A. (2019). Awareness and Use of Folic Acid among Women of Childbearing Age.Annals of global health, 85(1), 54. https://doi.org/10.5334/aogh.2396

9. Mena, G. P., Mielke, G. I., & Brown, W. J. (2019). The effect of physical activity on reproductive health outcomes in young women: a systematic review and meta-analysis.Human reproduction update, 25(5), 541–563. https://doi.org/10.1093/humupd/dmz013

10. Kaya, Y., Kizilkaya Beji, N., Aydin, Y., & Hassa, H. (2016). The effect of health-promoting lifestyle education on the treatment of unexplained female infertility.European journal of obstetrics, gynecology, and reproductive biology,207, 109–114. https://doi.org/10.1016/j.ejogrb.2016.10.050

11. Simioni, C., Zauli, G., Martelli, A. M., Vitale, M., Sacchetti, G., Gonelli, A., & Neri, L. M. (2018). Oxidative stress: role of physical exercise and antioxidant nutraceuticals in adulthood and aging.Oncotarget,9(24), 17181–17198. https://doi.org/10.18632/oncotarget.24729

12. Nystoriak, M. A., & Bhatnagar, A. (2018). Cardiovascular Effects and Benefits of Exercise.Frontiers in cardiovascular medicine,5, 135. https://doi.org/10.3389/fcvm.2018.00135

13. Dong, Y. Z., Zhou, F. J., & Sun, Y. P. (2017). Psychological stress is related to a decrease of serum anti-müllerian hormone level in infertile women.Reproductive biology and endocrinology : RB&E,15(1), 51. https://doi.org/10.1186/s12958-017-0271-4

14. Nidhi, R., Padmalatha, V., Nagarathna, R., & Amritanshu, R. (2013). Effects of a holistic yoga program on endocrine parameters in adolescents with polycystic ovarian syndrome: a randomized controlled trial.Journal of alternative and complementary medicine (New York, N.Y.),19(2), 153–160. https://doi.org/10.1089/acm.2011.0868

15. Rafieian-Kopaei, M., & Movahedi, M. (2017). Systematic Review of Premenstrual, Postmenstrual and Infertility Disorders of Vitex Agnus Castus.Electronic physician,9(1), 3685–3689. https://doi.org/10.19082/3685

16. Antoine, E., Chirila, S., & Teodorescu, C. (2019). A Patented Blend Consisting of a Combination of Vitex agnus-castus Extract, Lepidium meyenii (Maca) Extract and Active Folate, a Nutritional Supplement for Improving Fertility in Women.Maedica,14(3), 274–279. https://doi.org/10.26574/maedica.2019.14.3.274

17. Pandey, S. K., Sahay, A., Pandey, R. S., & Tripathi, Y. B. (2005). Effect of Asparagus racemosus rhizome (Shatavari) on mammary gland and genital organs of pregnant rat.Phytotherapy research : PTR,19(8), 721–724. https://doi.org/10.1002/ptr.1590

18. Lateef, O. M., & Akintubosun, M. O. (2020). Sleep and Reproductive Health.Journal of circadian rhythms,18, 1. https://doi.org/10.5334/jcr.190