Improve Ovarian Reserve to Get Pregnant After 40: A Functional Fertility Approach

Quick Scan: 3 Key Points

1. Ovarian reserve reflects communication, not destiny
   AMH, FSH, and AFC measure quantity but say nothing about the health of the egg or the environment the egg is developing in.

2. Your whole body affects ovarian reserve
   Thyroid, adrenal stress, nutrient levels, gut infections, inflammation, and vaginal microbiome imbalances are all proven to influence egg development.

3. Eggs respond to change
   Research shows mitochondrial support, improved thyroid function, reduced inflammation, and microbial balance can improve ovarian response within 90 days.

Many women over 40 are told the same story. Your ovarian reserve is low. Your AMH is too low. Your FSH is too high. Your only option is IVF with donor eggs.

But ovarian reserve tests do not measure egg quality. They do not tell you whether your body can respond. They do not reflect the deeper imbalances that influence hormonal communication, follicle growth, and the cellular environment that supports conception.

This is where the functional fertility lens changes everything.

What Ovarian Reserve Really Measures

AMH, FSH and AFC tell clinicians how the ovaries may respond to stimulation. They do not measure the genetic or metabolic potential of the egg itself.

AMH naturally declines with age, but that does not mean pregnancy is impossible.
Studies confirm that women with low AMH can still conceive naturally.

Study highlight:
A 2017 study in JAMA found that women with low AMH had similar natural conception rates as women with normal AMH when age was controlled.

This is why functional fertility focuses on what is influencing egg development rather than fixating on the number.

The Functional Factors That Influence Ovarian Reserve After 40

1. Cellular Energy and Mitochondria

Eggs contain more mitochondria than any other cell in the human body.
Mitochondria produce the energy needed for the egg to mature, divide and fertilize.

Relevant research:
• Mitochondrial dysfunction is strongly linked with age-related decline in egg quality (Bentov & Casper, Fertility and Sterility).
• CoQ10 has been shown to improve ovarian response in women with diminished ovarian reserve.

Supportive nutrients:
CoQ10 in the ubiquinol form
Magnesium glycinate
B vitamins
Antioxidants such as pomegranate, berries, and leafy greens

Avoid:
Over fasting, under eating, and high-burden stress practices that deplete cellular energy.

2. Thyroid Health and Hormone Communication

The thyroid sets the pace for reproduction.
Low thyroid function slows follicle maturation and disrupts ovulation.

Optimal TSH for fertility is below 2.0 mIU/L.

Women with elevated antibodies or borderline thyroid function often see improvements in AMH, ovulation, and progesterone once thyroid function is corrected.

Research link:
Thyroid antibodies are associated with impaired ovarian reserve and higher miscarriage risk (Thyroid Research Journal).

Key nutrients to support thyroid health:
Selenium
Zinc
Iron and ferritin
Vitamin A and iodine (when appropriate)

A common theme in Fab Fertile clients:
Non celiac gluten sensitivity contributing to autoimmune thyroid activation.

3. The Adrenal System and Stress Chemistry

Chronic stress flattens cortisol rhythms.
This reduces LH and FSH signaling, both required for follicle development.

What we see repeatedly:
Women with diminished ovarian reserve (DOR) often have adrenal patterns showing low morning cortisol, high evening cortisol, or a completely flat curve on DUTCH testing.

Support includes:
Consistent meals
Stable blood sugar
Improved sleep routine
Adaptogens such as ashwagandha or rhodiola
Mind body practices
Nervous system regulation

4. Gut Health, Immune Function, and Ovarian Reserve

The gut shapes estrogen metabolism, nutrient absorption and inflammation.
Hidden infections are extremely common in women with low AMH and high FSH.

Recurring findings in GI MAP tests:
• H pylori
• Candida or yeast overgrowth
• Overgrowth of opportunistic bacteria
• Parasites
• Low stomach acid
• Poor protein absorption

Why this matters:
High inflammatory load disrupts follicle development
Low stomach acid leads to nutrient deficiencies that impair egg maturation
Immune activation can interfere with implantation

Research:
H pylori is associated with impaired nutrient absorption, including iron and B12, both needed for ovarian function.

5. Vaginal Microbiome Imbalances That Block Fertility

The vaginal microbiome directly affects conception success.
A healthy microbiome is Lactobacillus dominant, which keeps the pH low and inflammation minimal.

When it is not:
Ureaplasma, Mycoplasma, Gardnerella, and BV organisms can cause low grade inflammation in the uterus and tubes.

Research:
Studies link Ureaplasma to lower fertilization rates and increased risk of early embryo loss.

Clinical reality:
This is rarely part of standard fertility workups, yet we see it constantly in clients who have had failed IVF or recurrent biochemical pregnancies.

6. Nutrient Status and Detoxification

Women over 40 commonly show:
• Ferritin below 50
• Vitamin D below 40
• High homocysteine
• Low magnesium
• Low zinc
• Imbalanced copper
• Exposure to metals such as aluminum, arsenic, or mercury

Each of these affects egg health, follicle quality, and implantation.

Balanced minerals are essential for hormone communication.

Fab Fertile Case Studies

Case Study : Natural Pregnancy at 43 with Low AMH and High FSH

Chronic gut infections, adrenal insufficiency, thyroid imbalance, and food sensitivities.
After a complete functional reset, she conceived naturally even after being told donor eggs were her only option.

Next Steps in Your Fertility Journey

Subscribe to Get Pregnant Naturally for evidence-based guidance on functional fertility, and share this episode with anyone on their fertility journey.

Not sure where to start? Download our most popular guide:  Ultimate Guide to Getting Pregnant This Year If You Have Low AMH/High FSH it breaks everything down step by step to help you understand your options and take action

For personalized support to improve pregnancy success, book a call here.

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Timestamps

00:00 What low ovarian reserve really means after 40

Why AMH and FSH do not predict your ability to conceive and why your fertility is not defined by these numbers.

01:00 AMH, FSH and AFC explained for women over 40

How ovarian reserve tests measure quantity, not quality and why functional fertility looks deeper.

02:00 Case study: Diminished ovarian reserve at 41 with autoimmune clues

A real example of low AMH and Hashimoto’s with gut infections that resulted in a natural pregnancy.

04:00 Mitochondria and egg energy after 40

How mitochondrial function influences egg maturation and which nutrients support better ovarian energy.

05:00 Thyroid health and why TSH must be optimal to conceive

The full thyroid picture and why ferritin, antibodies and gluten sensitivity matter for ovarian reserve.

07:00 Mineral balance and heavy metals that affect ovarian reserve

How magnesium, copper imbalance and toxic metals influence egg quality and hormone stability.

08:30 Adrenal stress and cortisol patterns that lower ovarian signaling

How chronic stress suppresses FSH and LH and what adrenal patterns look like on testing.

10:00 Gut health, estrogen metabolism and inflammation

How dysbiosis, leaky gut and yeast overgrowth interfere with follicle growth and hormone balance.

11:00 Vaginal microbiome and hidden infections linked to failed implantation

Why Ureaplasma, Mycoplasma and high pH environments reduce embryo success and implantation.

13:00 Case study: Natural pregnancy at 43 with DOR

A woman with low AMH and high FSH who addressed gut, adrenal and thyroid imbalances and conceived naturally.

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TRANSCRIPTION

[00:00:00] If you're over 40 and you've been told that ovarian reserve is low, you've likely heard discouraging words like your only option is IVF with donor eggs, or your time has run out. Today's episode, we're talking all about how to improve ovarian reserve to get pregnant after 40. We're talking about ovarian reserve actually means why it doesn't tell the full story.

How a functional fertility approach can help support a quality hormone balance and your chances of natural conception or IVF. Even after 40, your body can respond and understanding the underlying imbalances can give you a roadmap to improve ovarian function and reproductive potential. Let's go. Welcome back.

I'm Sarah Clark, founder of Fab Fertile. For over a decade, my team and I have helped hundreds of couples improve their chances of pregnancy success, whether naturally or through IVF. We specialize in supporting those with low EMH, high FH diminish ovarian reserve, premature ovarian sufficiency, and recurrent pregnancy loss through functional lab testing and personalized for fertility strategies.

This episode is for you as if you're [00:01:00] 40 or older. You're trying to conceive naturally, or with IVF, and you've been told your A MH is low. And your FSH is high. You've had failed IVF cycles, early miscarriages, poor egg quality, and want to understand what else you can do. You're looking for a functional fertility framework that focuses on improving egg health.

Hormone communication and overall reproductive vitality, not chasing lab numbers. Thanks so much for listening. I'm so thankful that you're here. Make sure you hit subscriber follow, and if you know someone else who's on the fertility journey, please share this podcast with them. We're talking about how to improve ovarian reserve and get pregnant after 40, so ovarian reserve.

So we look at the A MH, the FSH, and the Anterial follicle count. Reflects a quantity but not quality. A MH does naturally decline with age, but that doesn't mean that pregnancy is not possible. We see it all the time where a MH actually goes up, people get pregnant. It's used to see how well you'll do A IVF.

So we don't wanna be blind to the A MH number, but we don't hang our hat on it. We need to look beyond it. We. The focus should be to shift [00:02:00] from a count to a potential and the health of the egg in the cellular environment. So a functional fertility and our F fertile method. It looks beyond the hormones to factors like inflammation, thyroid balance, gut health, been banging on about inflammation, thyroid, gut health, nutrient status, and nervous system regulation.

That's what's gonna help. Improve your A quality in your forties or at any time have you been told you have poor a quality. But today we're talking about in the forties, and so I'm just thinking of a client here. She was 41 with diminished ovarian reserve. She had autoimmune issues. We see this all the time, the Hashimotos.

I'm like, how's your health? They're like I feel great, healthy. Oh, I also have an autoimmune disease. It's not a, oh, I also, that's a huge clue. Even though maybe you've got it under control and you feel good, it could still be some inflammation in your body and that's why your body is not feeling safe to procreate.

She had autoimmune issues, Hashimoto's, a lot of food sensitivities, so it's not about taking your favorite foods out forever. We, [00:03:00] in conjunction heal the gut. You can bring most of the foods back in gut infections. She had that h pylori from passing infections back and forth via saliva, so h pylori will lower your stomach acid.

Not absorbing all those nutrients. You're well fed, but malnourished, and we see you and your partner. If one person has h pylori and all of us have it, but if it isn't a virulence factor, it's overgrown. That can be why you're not absorbing all those nutrients needed to make hormones. Low protein intake and absorption.

She had heavy metals. We do hair, tissue, mineral analysis to be able to see if you got mercury or aluminum or arsenic or uranium. We see those all the time exposed to heavy metals. It's not about you doing some crazy chelation or detox. We need to do things in a gentle manner to be able to help restore balance.

And in this case, she got pregnant naturally at 41. So there's things we can do. We don't just say, ohoh, we have diminished ovarian reserve and the ovarian health is bad. And oh, we better rush to IVF. No, we look beyond that and we don't look at the body in [00:04:00] the silo. It's all connected. We need to look at the cellular energy of the mitochondria.

So eggs contain thousands of mitochondria and that fuel maturation division. So as we age, the mitochondrial efficiency declines, we can support it. A lot of you are taking the coq 10 or ubiquinol. You're taking some magnesium, you're taking some methyl folate, B vitamins. But we see the magnesium low. We see the fact that your B12 absorbing all your B vitamins, we like the B12, 800 to 900.

Maybe yours is high 'cause you're not absorbing it or it's too low. So being able to support that, looking at bringing in some antioxidant rich foods, some berries, leafy greens, so to protect against oxidative damage. And we don't want it over fasting or undereating. A lot of us are doing that long fasting window and getting shaky or hungry, and that can be disrupting your ovulation and slow follicle development.

We don't wanna be doing these things that are good for men. Cold plunges. No, it could be too harsh or if [00:05:00] your adrenals are compromised. And the theme we see here with poor egg quality, ovarian, low ovarian reserve, low A MH, diminished ovarian reserve, premature ovarian deficiency, the adrenals impact the thyroid impacting the A MH and the fational follicle count.

So we do things that are too harsh. It's, again, it's DIY. We're nourishing, we're gently supporting. We're doing this in a targeted manner, not just throwing spaghetti at the wall and guessing and taking a whole bunch of generalized supplements and wasting time Looking at the thyroid. The thyroid function slows egg maturation and implantation suffer.

I've said it once and I'll say it again. We see the thyroid, even though you've been told it's normal. We wanna have it to be optimal. It should be below two. You wanna look at the full thyroid panel, including your antibodies. You can add in some selenium or some zinc. We see a lot of people where the, they're anemic, so the iron is off, your ferritin is too low, and then that impacts your thyroid.

And so [00:06:00] if the thyroid antibodies are elevated, you have a known thyroid issue and you're on thyroid medication. We definitely need to take out gluten. Anyone on the fertility journey that has low AMH or high fsh, we see that theme of non-celiac gluten sensitivity. We need to take out. Gluten, maybe not forever, but if that was the thing.

But if you're like, I can't, I just want to have gluten, I need to have it, or I love bread. There's no way I can give it up. Food should not be addictive. And if your body's I need it, that could be the thing you're most intolerant to. So put a strong line in the sand. Send a message to hello@fabfertile.ca.

Subject line 10 day. Do the elimination diet, take out the top allergens for 10 days. Take out dairy and gluten for 60, 90. Days. If you wanna fast track this, we do our testing as part of our fab fertile method. We do food sensitivity testing so we can reduce inflammation in a targeted manner. Stool testing to be able to look at the DNA, the stool and be able to eliminate infections, [00:07:00] optimize and repair at the gut.

We do genetic testing. This is all shipped worldwide, so you can send me a message at hello@fabfertile.ca, subject line fertile, and we can talk about some options that are right for you. See if we can get the testing to you. We can get it to Canada, the us, most places in Europe, the UK we can get to, as well as Australia and New Zealand when we have the testing.

And then also looking at your blood work. We can make a targeted plan. We also do genetic testing. We use the Grow Baby test and that can really look to see your genetic snips and what are the specific diet, lifestyle, and supplements. We can use to then improve pregnancy outcomes, prevent gestational diabetes, prevent preeclampsia, especially if you've had pregnancy loss.

We need to see exactly what your body needs, not just guessing and taking a bunch of Brazil nuts or taking a whole laundry list of supplements and you just have expensive pee. So we gotta do this in a targeted manner, not waste time. We also do hair, tissue mineral [00:08:00] analysis. This can really help. With the ovarian reserve, so it's gonna look at your long-term mineral levels and toxic metal exposure if you've got low magnesium, which we see all the time, that's why one of our foundational supplements for you and your partner is magnesium glycinate.

You've got imbalanced copper that can impair estrogen detox and thyroid conversion. Maybe you've got elevated aluminum. Cook it with aluminum tin foil, mercury, amalgam fillings. Don't go on to a regular dentist and have those removed. There can be offgassing. We need to work with the biological dentist.

Be very careful with the mercury piece. Don't just run off and do that 'cause it could have some negative reactions in our body. If we have mercury amalgam fillings, that could be high mercury in our body, and that might be why it's not working. Also, another one where people tell me, my health is totally fine, but I just got these breast implants, you've got toxins in your body.

I see people tell me as soon as they got the breast implants in their health went down the tubes, all of a sudden their period [00:09:00] disappeared and all sorts of health issues or their health feels fine. There's nothing going on, but all of a sudden they got the low A MH. My health is totally great, but I've got low A MH and diminished ovarian reserved in my thirties.

What's changed here? Oh, I got breast implants. Okay. That might be it. Obviously getting the breast implants was a big decision, and then if we decide to remove them, we need to do it in the right way. But there's things we can do to nourish the system and we can see if there's toxins in the body, and that might be why you can't conceive.

Obviously people with breast implants go on to conceive. Those are some clues of doing this for over a decade that we see. So if there's toxins in your body and you're exposed to something, the body wants to survive that procreate. So we gotta rebalance the minerals and that improves your hormone stability and egg energy.

Look at the adrenals. If you've got your chronic stress, that's gonna raise chronic cortisol and that's gonna suppress your FSH and your lh. And so we do Dutch testing. I do caution just doing one Dutch test and thinking you've done all your [00:10:00] testing. No. This can help us in black and white, see which pathways the hormones are going down.

You can see it. You're like, oh wait, there's my adrenals all flatlined. Or I should go up in the morning and then come down at night. Yours is just flatlined from chronic stress, and that can impact the ovarian signaling. All the stress you're under, especially if you're dealing with secondary infertility in your forties, you've got a child, you trying to have a second one.

Your postpartum period, you've vet a human, and now we need to nourish everything and bring him back into shape and then help. The adrenals. We need to work on your sleep. Having balanced meals, if you bring in some adaptogens, ashwagandha, or Rola, and some mind body tools. So the adrenal piece is key and we see it over and over again, and this can impact your ovarian reserve.

And so the gut and immune side of things. So the gut impacts estrogen, metabolism and inflammation. If you've got a leaky gut, which you can get through stress, through antibiotic use, being on the pill. Hormonal birth control. This can trigger immune [00:11:00] activation, interferes with the follicle growth.

Then you get in more of these gut infections. The chronic stress can predispose you to leaky gut. We need to be able to address those infections and get the body back online. And so if you've got overgrowth of bacteria or an overgrowth of yeast, that can impact your ovarian health and your eggs. So we gotta heal the gut, improve the nutrient absorption that's gonna calm the immune system.

Get the body back in shape. And then we work on the gut health, and then we do the vaginal microbiome because if you've got bacterial vaginosis, UTIs, thrush, pregnancy loss, anyone on the fertility journey, we do the gut work and then we do the vaginal microbiome. The vaginal microbiome directly impacts conception and implantation.

Before you do an IVF transfer, we've gotta do the vaginal microbiome, but we also have to do the gut microbiome beforehand. So if you've got some beautiful embryos in there waiting for you. We've gotta get the body in the best shape. So the healthy [00:12:00] environment is lactobacillus dominant, which helps keep the pH low and the pathogens in check.

The pH is high. Then the pathogens overgrow, and that could be why it's not working. We see people with uro, plasmas, mycoplasma, gardella. They can cause low grade inflammation, the uterus or the tubes, and so research links U plasmas to lower fertilization and early embryo failure. We see it all the time.

And if one partner has it, the other partner needs to be looked at. So we do vaginal microbiome testing as part of our fab fertile method. We ship that worldwide, identifies imbalances so they can be addressed before conception and before transfer so we can restore the lactobacillus and then that can reduce the risk of implantation failure and miscarriage.

This is key. Your fertility clinic may scan for uro plasmas. It is not routine. It's not part of the routine workup and it's routinely missed. Nutrient depletion, detox support. Many women over 40, they have low ferritin. [00:13:00] We like the ferritin between 80 to a hundred. They got low Vitamin D. We like that 60 to 80.

They have high homocysteine, so there's inflammation. You're not methylene your vitamins properly. All that can impact your egg health and implantation. So you've gotta support your detox pathways. Hydration fiber, B vitamins, reduce the toxins, kick out the plastics, eat organic food. You're gonna argue about organic food, then I'm not here to convince you if there's a guy wearing a plastic suit and a mask spraying our food, do you think that we should eat it?

Probably not. I don't wanna eat it, but you can do what you wanna do. Getting organic as much as possible. The Clean 15, you don't need to get organic, but I choose organic all the time, and I'm just happier with that. Is it perfect? No, I do the best I can. Synthetic fragrances. Don't expose yourself if you're spraying perfume all over yourself.

There's all kinds of fragrances now. Even at Sephora Clean Fragrances. You can look on the Think Dirty App or the Skin Deep Database. [00:14:00] Looking at some fragrances. So it's not about spraying yourself in all this synthetic perfume that then impacts your endocrine system. Everything we need to do here is to lower the body's inflammatory load.

So I'm just thinking of one of our clients, Vanessa, she had diminished ovarian reserve at 43, low am H and high FH. She joined our FAB program. We have an OB GYN with a functional medicine background, functional nutrition practitioners, fertility mindset coaches, and we shipped the test worldwide. So she had got infections.

There was adrenal insufficiency 'cause she was a teacher. We worked with a lot of teachers. There was thyroid imbalance, food sensitivities, got infections. And she got pregnant naturally after she was told that nothing was gonna work. And so looking at the nervous system, your hormones are gonna follow your nervous systems lead.

If chronic stress, your biochemistry is gonna tell your body to conserve. Not conceive. So we need to dig into how the mind body can support and improve ovarian function. It takes 90 days for the eggs to [00:15:00] improve when you combine food sensitivity, gut testing, genetic testing, looking at the biomarkers, all your blood work, making sure optimal, not normal, looking at your partners semen analysis, including DNA, fragmentation, looking into his blood work too.

'cause if you're passing infections back and forth through the gut, through the seminal microbiome. This could be why that the embryos aren't implanting. This could be why it's not working. So we gotta focus on progress over perfection. Small changes can shift the hormone signaling and ovarian response.

The good news, even after 40, you can improve ovarian reserve and get pregnant. Improve egg health when you address the underlying imbalances, your cellular energy, the hormones, the gut, and the vaginal microbiome, and stress, all those systems. Can then help you get pregnant naturally or improve the chances of a successful IVF.

So if you're ready to get started and have my eyes on your specific situation, send me a message at hello@fabfertile.ca, subject line fertile, and I will send you options to help. I'll ask a few questions. [00:16:00] I'll see if we're in good fit. Thanks for listening. Take care.

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How to Get Started With Functional Fertility Support

Book your call here to get your personalized plan and options to help improve pregnancy success either naturally or with IVF treatment. 

Check out our Fab Fertile functional fertility program here and learn how to improve AMH levels naturally.  We work with couples that have low AMH, high FSH, diminished ovarian reserve, premature ovarian insufficiency, and recurrent pregnancy loss.

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FAQ: Ovarian Reserve After 40

Can you really improve ovarian reserve after 40

Yes. You can improve the internal environment that supports egg development, which often improves AMH, AFC, and overall ovarian response.

Does low AMH mean IVF will fail

No. AMH predicts response to stimulation, not the ability to achieve pregnancy.

How long does it take to improve egg quality

Eggs develop over about 90 days. Most women notice changes in their health over three cycles.

Should I still consider IVF

IVF can be helpful, but functional optimization first significantly improves success rates.

Do I need to test my partner, too

Yes. Gut infections, nutrient deficiencies and microbiome issues often affect both partners.

What if I have had multiple failed IVF cycles

This often signals underlying inflammation or microbial imbalance. Functional testing identifies these patterns.

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Key Takeaway

Even after 40, ovarian reserve can improve, and egg quality can strengthen when you address the underlying imbalances in the thyroid, adrenal, gut, immune, and vaginal microbiome systems. These systems determine whether the ovaries receive the right hormonal signals and whether your eggs have the energy needed to mature.

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Resources

📩 Get your free 10-day elimination diet plan! Email hello@fabfertile.ca with the subject line 10 DAY to receive your guide and take the first step toward reconnecting with your fertility.

5 Tips to Get Pregnant Even with Poor Egg Quality:  https://fabfertile.com/blogs/podcasts/5-tips-to-get-pregnant-even-with-poor-egg-quality

Why A Mineral Deficiency Matters When You Are Trying To Conceive:  https://fabfertile.com/blogs/podcasts/why-a-mineral-deficiency-matters-when-you-are-trying-to-conceive-with-terra-vitiello?_pos=1&_sid=ae769fc7d&_ss=r

DUTCH Test 101: Why It's Important For Fertility: https://fabfertile.com/blogs/podcasts/dutch-test-101-why-its-important-for-fertility?_pos=2&_sid=a6f8a8c87&_ss=r

Why Genomic Testing Can Help With Recurrent Pregnancy Loss, Birth Outcomes and Preconception Health: https://fabfertile.com/blogs/podcasts/why-genomic-testing-can-help-with-recurrent-pregnancy-loss-birth-outcomes-and-preconception-health?_pos=8&_sid=f28fd1802&_ss=r

Our favorite fertility tracker (use code FABFERTILE15 to save 15) - https://www.inito.com/en-us/?srsltid=AfmBOoo85sXu_esmFN5Kz6iysaTkBKgYl35Jubv-BaLkkxXVggdk6nes