⏱ 3 Min Read

Getting pregnant after 35: tips from a fertility expert

Dr Karen Joash (as told to Eleni Stefanou)

Updated on
24 Apr 2024

About the expert

Dr Karen Joash is a leading obstetrician and gynaecologist based in London.

She is the lead for postnatal care at Imperial College Healthcare NHS Trust and has received national acclaim for her research and maternity initiatives.

If you're 35 or older, it can help to view pregnancy as a marathon you're preparing for. It's something you can achieve, but it may take longer and require more interventions to cross the finish line.

There's a common misconception that IVF and egg freezing have extended the fertility window for women when the reality is that, after the age of 35, egg quality diminishes significantly and pregnancy-related health risks increase. Here are five pillars to follow to improve your fertility and minimise pregnancy complications:

1. Pre-pregnancy counselling

Addressing your pregnancy plans with a healthcare provider is essential. Make sure you cover:

Blood tests

To assess your fertility, you should have a thyroid function test (your TSH levels should ideally be less than 2 to maximise the chances of a successful pregnancy). Also look at follicle-stimulating hormone (FSH), luteinising hormone (LH) and prolactin.

You can take an anti-müllerian test to check your total egg reserve, but be warned: this doesn't assess egg quality.

If you have a history of anaemia, make sure you check your iron levels.


You need to be aware of any conditions that may impact your fertility so that you're not spending time trying to get pregnant when there's an underlying issue that needs resolving. Your healthcare provider should perform an ultrasound scan to check your:

  • Ovaries for the presence of cysts

  • Uterus for fibroids or polyps

Medical history

While taking your full past medical history is standard practice, family history often isn’t looked at closely enough. What concerns doctors most in pregnancy is a family history of:

  • Clots in the legs or lungs

  • Recurrent miscarriages

  • Raised blood pressure in pregnancy

  • Diabetes in pregnancy or type 2 diabetes generally within the family

  • Mental health disorders in pregnancy

  • Cardiac illnesses or sudden deaths

If your healthcare provider is aware of these issues, they may conduct further investigations or perform a risk assessment in order to factor this information into your pregnancy plans.

2. Nutrition

Try your best to cut down on processed foods. These contain chemicals and additives that cause inflammation, affect gut health and can impact your vaginal microbiome. Opt for a high-antioxidant diet by eating rainbow foods, embrace fermented foods and consider taking a probiotic for a while to improve your gut and pelvic health.


While a nutritious diet will go a long way in boosting your health and therefore fertility, the following supplements are recommended to support you:

  • Vitamin D is directly linked to fertility and supports overall health.

  • Folic acid and omega-3 support anti-inflammatory processes (folic acid also helps to prevent neural tube defects in the baby).

  • Choline is mandated for pregnancy in America. It works like folic acid and omega-3 to enhance brain function and development, but also supports the uterine lining and placenta formation.

  • DHEA and B vitamins have also been linked to pregnancy.

  • Women, particularly those with PCOS, may benefit from Coenzyme Q10, which is really important in egg quality, and myo-inositol which makes the ovary more sensitive to release the egg.

3. Exercise

Studies show that women who exercise have a lower risk of miscarriage, better pregnancy outcomes and easier deliveries with a lower risk of preterm birth, gestational diabetes, and hypertensive disorders of pregnancy. (!)

You can mitigate the physical effects of pregnancy with a good foundational baseline of cardiovascular health. Find something that suits you - it can be ballet, yoga, pilates, hiking, weight training all the way to boxing and cycling.

4. Air and water quality

We know that air pollution can affect both egg and sperm quality because of endocrine-disrupting particles that enter the body. In fact, the decline in sperm quality is linked to postcode areas with high outdoor air pollution.

If you run outside you may choose to go through a park instead of running along a busy road. Indoors, you may choose to reduce gas cooking and cook more with the oven or grill. You could also get an air filter or, if you can't afford one, hang charcoal air purifying bags around your house to absorb some of those particles.

Microplastics and pesticides in water are also linked to fertility, so avoid drinking from plastic bottles. Instead, use glass or metal bottles.

5. Mental health

Never underestimate the impact stress can have on fertility. Stress reduction will help regulate your hormones, which is why we sometimes see people get pregnant on holiday.

Specialists to speak to

Gynaecologist: While your GP can request blood tests and an ultrasound to check your ovaries and uterus, a gynaecologist will be able to offer more specialised and tailored guidance. You can avoid long waiting times by speaking directly to a gynaecologist through Bloomful.

Hormone or PCOS expert: If your hormone levels are imbalanced, a gynaecologist should be able to advise you, however, you may want to consult with a doctor who specialises in PCOS, if you suspect or have been diagnosed with it. PCOS is a leading cause of infertility.

1. Book that pre-pregnancy consultation

Set yourself up for success by identifying any issues that need to be addressed ahead of time.

2. Embrace rainbow foods

A healthy diet will support your fertility as well as your health and the health of your baby.

3. Reduce your exposure to endocrine disruptors

Think about where and how you might come into contact with air pollution and microplastics and take feasible steps to minimise your exposure.

4. Take care of mind and body

Identify the forms of movement you enjoy, along with the stress management tools that work for you, and integrate these into your weekly routine. This will improve fertility by reducing stress levels and help safeguard your health during pregnancy.


(1). Physical activity and pregnancy outcomes: An expert review (Published: 2023 Authors: Emily L. Gascoigne, Carolyn M. Webster, Anne West Honart et al)

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