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Fertility nutrition for women 35+

2 September 2020

Women are born with a fixed amount of eggs. As we age, fertility naturally declines as the quantity of eggs declines. At the age of 35 most people are still able to get pregnant naturally however, egg quality also declines as we age. The higher the egg quality the more likely the egg is to be fertilised and develop into an embryo, implant in the uterus and result in a pregnancy. We cannot increase the number of eggs or repair any damaged ones however, diet in the preconception period (3-4 months prior to conception) can help to protect healthy eggs and promote egg quality. Did you know it takes 90-100 days for an egg to mature before ovulation? So, the nutrition provided to the body and therefore the eggs in that time is crucial.

What dietary components can be influential at this time?

Folate and folic acid are both forms of Vitamin B9. Folate is the natural version found in food whilst folic acid is the manufactured version found in supplements. In addition to its well-established role in neural tube defect prevention, research suggests folate plays an important role in promoting egg quality, maturation and implantation. Folic acid supplementation has been shown to improve the environment for the developing egg and is associated with improved chances of pregnancy and reduced risk of ovulatory infertility. Unless your GP advises a higher dose, women trying to conceive should take a 400µg folic acid supplement daily, whilst including folate-rich food in their diet such as fortified breakfast cereals, leafy green vegetables, broccoli, peas and chickpeas.

Vitamin B12 is important for implantation and maintaining a healthy pregnancy. Research has also found that higher levels of vitamin B12 correlate with better embryos during IVF. The recommended intake of 1.5µg/day can be met through consumption of meat, eggs, dairy, fortified plant-based drinks or yoghurts and fortified breakfast cereals. Those following a plant-based diet may want to consider taking a Vitamin B12 supplement.

Omega-3 is an essential fatty acid and has been linked to improved egg quality and delayed ovarian ageing, incorporating it into the diet has been shown to improve egg quality in older females prolonging the female reproductive lifespan. Omega-3 fatty acids are found in oily fish such as salmon as well as flaxseeds. It can also be taken as a supplement, 450mg/day is the recommended dose – you want to see EPA and DHA on the label, as these are the fatty acids linked with the benefits discussed.

Oxidative stress and low antioxidant status are associated with infertility. As we age oxidative damage in cells accumulates, leading to increased reactive oxygen species in oocytes. Incorporating varied sources fruit and vegetables in the diet and consuming at least 5 portions per day will provide plenty of antioxidants in the form of vitamins A, C and E and carotenoids which can reduce inflammation and protect eggs from free radicals and improve quality.

Coenzyme Q10 is a compound found in most of the cells in our body and acts as an antioxidant. A decrease in coenzyme Q10 levels correlates with the observed age-related decline in fertility. Oral supplementation with 200mg Coenzyme Q10 has been found to support egg quality and improve oxidative metabolism in women over 35 years of age. Coenzyme Q10 can be found as ubiquinol or ubiquinone. Ubiquinol is the activated form and is argued to be the more effective of the two. No consensus currently exists however for a recommended dose as studies are limited.

Dehydroepiandrosterone (DHEA) is an essential prohormone and levels also decrease with advancing age. Pre-treatment with DHEA prior to IVF has been found to improve fertility in women over 35 years of age. However, DHEA is not suitable for everyone and in the UK DHEA can only be used under prescription from your doctor, so please discuss this with your fertility clinician.

There is evidence to suggest that obesity can decrease the quality of the egg due to the effects of inflammation and reactive oxygen species, where both maturation and metabolism of the egg can be affected. UK guidelines recommend a BMI of between 19-30kg/m2 to optimise fertility. Research also suggests that women with a BMI of over 30 undergoing IVF have smaller eggs that are less likely to fertilise normally. Weight management is therefore something to be mindful of when trying to conceive at any age.

Making a few changes as discussed above to optimise your diet can be a simple way to improve your chances of conception prior to any more invasive procedure. For any personalised advice it is recommended to seek guidance from a Registered Dietitian or Registered Nutritionist.

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