Everything You Need to Know About Aging and Fertility

Recently, Love and Science had the honor of returning to my alma mater, the University of Notre Dame, to speak on a topic that is often difficult to discuss openly—aging and fertility. As physicians and professionals, we know all too well the quiet pressure that can build as we become more aware of time’s passing. The concept of the “biological clock” can stir feelings of urgency, uncertainty, and even panic—emotions that are rarely addressed but deeply felt.

However, Love and Science is here to tell you that all things are possible, and with the help of a fertility coach, some fine-tuning and optimization, and maybe an REI, we can all achieve parenthood and a successful outcome. 

How Common is Infertility?

According to most experts, one in every six couples will experience infertility. Additionally, one in every four female physicians and one in every female three surgeons will suffer with infertility, often in silence. For this reason, it is important that we share with one another openly and start adapting a healthy mindset about our own fertility. Embracing our circumstances and trusting the process is a great place to start. One way we can start to trust the process is by optimizing our natural fertility. 

Optimizing Our Natural Fertility

Timing is one of the most important factors in optimizing natural fertility. To increase the chances of conception, it’s essential to know when ovulation occurs and to time intercourse accordingly. We encourage cycle tracking as a first step—this can include using a period tracking app, becoming familiar with changes in cervical mucus, and most importantly, utilizing ovulation predictor kits (OPKs) to pinpoint your most fertile days.

Because sperm can live inside the reproductive tract for up to five days, we generally recommend having intercourse every other day during the fertile window to maximize the likelihood of fertilization.

In addition to timing, optimizing natural fertility also involves supporting your overall health by minimizing lifestyle factors that can negatively affect reproductive function. Several key areas can influence fertility, and paying attention to these can make a meaningful difference:

• Smoking – Known to accelerate egg loss and reduce sperm quality.

• Marijuana use – Can interfere with sperm quality, hormone regulation and ovulation.

• Weight – Both underweight and overweight individuals may experience hormonal imbalances that affect ovulation, sperm health, getting pregnant and staying pregnant.

• Caffeine – Excessive intake may be linked to reduced fertility; we recommend moderation (generally less than 200mg per day).

• Sleep – Poor sleep can disrupt hormonal balance and increase stress. Aim for 7–9 hours of quality sleep per night.

• Stress – Chronic stress may interfere with ovulation and libido. Incorporating stress-reducing activities like meditation, exercise, therapy and/or coaching can be beneficial.

• Nutrition – A balanced diet rich in whole foods, antioxidants, and key nutrients supports hormonal health and reproductive function.

Taking small, consistent steps to improve these areas is just one of the ways in which we can reach our goals. 

When to See a Specialist

Though there are ways in which we can work on optimizing our natural fertility, sometimes we must accept some help, and that’s okay! As a general rule of thumb, it’s best to seek out an REI if you have been trying to conceive for over a year under the age of 35 or after 6 months if you are over the age of 35. Additionally, you want to seek some guidance if you have any risk factors for infertility, including irregular menstrual cycles, have had multiple abdominal surgeries, or have a history of pelvic infections. 

If and when we choose to seek support from a reproductive endocrinologist (REI), one of the first steps typically involves assessing ovarian reserve through a series of tests. These markers give us insight into the quantity of remaining eggs, and help guide fertility treatment decisions. Here’s a breakdown of the most common tests:

• Anti-Müllerian Hormone (AMH)
  AMH is produced by the granulosa cellsin your ovaries and is a strong indicator of your egg reserve. While levels vary with age, an AMH level below 1 ng/mL may suggest diminished ovarian reserve and potentially lower responsiveness to fertility treatment.

• Follicle-Stimulating Hormone (FSH)
  Measured early in the menstrual cycle (typically on day 2 or 3), FSH helps stimulate follicle growth. Elevated FSH levels can indicate that the body is working harder to recruit eggs, which may reflect a reduced egg supply.

• Antral Follicle Count (AFC)
  Performed via transvaginal ultrasound, this test counts the small (antral) follicles present in the ovaries at the beginning of a cycle. A higher number generally suggests a better response to treatment and a more robust ovarian reserve.

• Estradiol (E2)
  Also measured early in the cycle, estradiol helps interpret FSH levels. Elevated estradiol on cycle day 2 or 3 can suppress FSH artificially, potentially masking an underlying issue with ovarian reserve. Additionally, a low estradiol tells us that the test is well-timed and we can interpret it with confidence. 

Depending on your results, your REI will recommend the best course of treatment, tailored just for you. Sometimes, treatment includes ovarian stimulation, typically with medications like letrozole, clomiphene, or gonadotropins. If the underlying issue is due to a fallopian tube or uterine abnormality, surgical options are sometimes available and can often come with success, depending on the particular situation!

But What About Stress?

As mentioned earlier, our mindset plays a critical role in optimizing our overall well-being and fertility. Stress, in particular, can have a profound impact—not only on our quality of life but also on our physiological functioning.

Chronic stress may lead to relationship strain, emotional exhaustion, and heightened vigilance. This hypervigilance can elevate cortisol levels over time, leading to increased heart rate and blood pressure. These stress-related changes can interfere with the hormonal signaling between the hypothalamus and pituitary gland, which is essential for regulating ovulation.

One suggested theory is that prolonged exposure to high stress and cortisol levels may also reduce uterine receptivity, making it more difficult for an embryo to implant successfully. We believe the connection between mind and body is undeniable—and managing stress is a powerful, proactive step in your fertility journey.

How Coaching Can Help

Imagine this: we have been working together for three months, and you are calm and grounded. You trust the process and you finally feel at peace. You fully believe you will be successful in building your family and you feel closer to your partner (if you have one) than you ever have. You are growing and finding your authentic voice and setting necessary boundaries and the pain of isolation finally has gone away. 

This is what is possible with fertility coaching. We can work together to welcome in your greatest good and help you reach your goal of parenthood. Dr. Erica Bove is a double board-certified REI and currently the only REI fertility coach in the world. She is excited and ready to bridge you to parenthood, and her method works.  

To learn more about working with Dr. Erica Bove, click here!