Trying to Conceive at 38, 40, 42: What Actually Changes Each Year

Quick Answer: How Does Fertility Change at 38, 40, and 42?

At 38, your monthly chance of natural conception is approximately 15-20%, with egg quality and ovarian reserve beginning measurable decline. By 40, monthly conception probability drops to 10-12%, with chromosomal abnormalities affecting roughly 50% of eggs. At 42, natural conception chances fall to 5-8% per month, with 75% of eggs showing chromosomal issues. However, individual fertility varies significantly, these are population averages, not individual predictions. Understanding your specific ovarian reserve through AMH testing and antral follicle counts provides far more actionable information than age alone.

The conversation around fertility and age often reduces complex biology to fear-inducing statistics and panic-driven timelines. You've likely heard about the "fertility cliff" at 35, the dire warnings about pregnancy after 40, and the pervasive narrative that waiting past your early 30s to conceive represents a catastrophic mistake.

The reality is far more nuanced. While biological clocks are real, they don't tick at identical rates for every woman. Fertility does decline with age, but understanding what specifically changes at 38, 40, and 42 empowers you to make informed decisions about your reproductive timeline, pursue appropriate interventions, and approach trying to conceive with both realistic expectations and actionable strategies.

This guide examines the biological mechanisms behind age-related fertility decline, breaks down the specific changes occurring at each milestone age, explores what modern reproductive medicine can and cannot overcome, and provides evidence-based approaches for optimizing fertility in your late 30s and early 40s.

The Biological Foundation: Why Fertility Declines With Age

Before diving into age-specific changes, it's essential to understand the two primary biological factors driving fertility decline: ovarian reserve depletion and egg quality deterioration.

Ovarian Reserve: The Numbers Game

Unlike men, who continuously produce sperm throughout their lives, women are born with a finite number of eggs approximately 1-2 million at birth. This ovarian reserve steadily depletes through a combination of ovulation and atresia (the natural death of eggs that are not ovulated).

By puberty, only about 300,000-400,000 eggs remain. From menarche through menopause, women will ovulate approximately 400-500 times, but thousands of eggs die each month through atresia regardless of whether ovulation occurs. This means your ovarian reserve is constantly declining, accelerating significantly after age 35.

The depletion isn't linear, it follows an exponential curve, with the rate of loss increasing as you age. Research tracking ovarian reserve through antral follicle counts (AFC) shows that the decline steepens considerably in the late 30s. A woman at 25 might lose 1,000 eggs monthly through natural attrition, while a woman at 40 could lose several thousand monthly as the remaining eggs undergo accelerated atresia.

This numerical decline matters because it affects not just how many opportunities you have to conceive, but also the hormonal environment supporting conception. As ovarian reserve diminishes, follicle-stimulating hormone (FSH) rises in an attempt to recruit eggs, sometimes leading to irregular cycles, shorter cycles, or anovulatory cycles where ovulation doesn't occur at all.

Egg Quality: The Chromosomal Challenge

Perhaps even more significant than the quantity of remaining eggs is the declining quality of those eggs. Egg quality refers primarily to chromosomal integrity, whether an egg contains the correct number of chromosomes (23) to combine with sperm's 23 chromosomes and create a chromosomally normal embryo with 46 chromosomes.

The mechanism behind egg quality decline involves the aging of cellular machinery, particularly structures called spindles and cohesins that manage chromosome separation during egg maturation. Eggs spend decades arrested in a suspended state of cell division, waiting to complete their development when ovulation occurs. During this prolonged arrest, the proteins holding chromosomes together gradually deteriorate.

When an older egg attempts to complete maturation, these aged structures may fail to separate chromosomes correctly, resulting in aneuploidy, an abnormal number of chromosomes. Most aneuploid embryos fail to implant, and many that do implant result in early miscarriage. Some aneuploid embryos, like those with an extra copy of chromosome 21 (Down syndrome), can result in live births but carry genetic conditions.

The relationship between maternal age and aneuploidy is exponential, not linear. At 25, approximately 25% of eggs are chromosomally abnormal. By 40, that number rises to roughly 50%. At 42, approximately 75% of eggs show chromosomal abnormalities. This dramatic increase in aneuploidy drives much of the age-related decline in both conception rates and live birth rates.

Trying to Conceive at 38: The Transition Begins

At 38, most women still have regular menstrual cycles and may not yet feel the dramatic shifts that characterize later ages. However, biological changes are already well underway, making 38 a critical inflection point for fertility.

What the Statistics Show

Women trying to conceive at 38 have approximately 15-20% monthly probability of pregnancy, compared to roughly 25% for women in their early 30s. This translates to about a 75% chance of conceiving within one year of regular, well-timed intercourse, compared to approximately 85% for younger women.

These population-level statistics mask significant individual variation. Some 38-year-old women have ovarian reserve and egg quality comparable to women five years younger, while others show more advanced reproductive aging. Individual assessment through ovarian reserve testing provides far more actionable information than chronological age alone.

The Biological Reality at 38

Ovarian Reserve: At 38, ovarian reserve typically shows measurable decline compared to earlier reproductive years, though individual variation is substantial. AMH (anti-Müllerian hormone) levels, a marker of ovarian reserve, generally begin dropping more noticeably in the late 30s. While a 25-year-old might have an AMH of 3-4 ng/mL, a 38-year-old might see levels around 1.5-2.5 ng/mL, though this varies enormously between individuals.

Antral follicle counts, another measure of ovarian reserve performed via ultrasound, typically show 8-15 follicles at 38, compared to 15-25 in the early 30s. These diminishing numbers reflect both the absolute reduction in egg quantity and the ovarian environment's reduced responsiveness to hormonal signals.

Egg Quality: Chromosomal abnormality rates begin accelerating at 38, with approximately 35-40% of eggs showing aneuploidy. This means that even with successful fertilization, a significant proportion of embryos will be chromosomally abnormal and unlikely to result in pregnancy or will end in early miscarriage.

For women trying to conceive at 38, this translates to:

• More cycles may be needed to achieve pregnancy compared to earlier years
• Miscarriage risk increases to approximately 20%, compared to 15% in the early 30s
• The window for achieving multiple pregnancies narrows considerably
• Time becomes more critical, each year of delay carries greater biological significance

Cycle Changes: Many 38-year-old women still experience regular 28-30 day cycles, but subtle changes may emerge. FSH may begin rising, particularly in early cycle days, as the body works harder to recruit eggs. Some women notice cycles shortening to 26-27 days as the follicular phase (the time from menstruation to ovulation) compresses.

Luteal phase defects, where the post-ovulation phase is too short to support implantation, become slightly more common. Progesterone levels may decrease, potentially affecting the uterine lining's ability to support early pregnancy.

Strategic Approaches at 38

Immediate Action Timeline: Unlike in your early 30s, where trying for a full year before seeking evaluation was standard advice, 38 represents an age where shortening that timeline makes sense. Current fertility guidelines recommend seeking evaluation after six months of unsuccessful attempts for women 35 and older, but many reproductive endocrinologists suggest that women at 38 consider baseline fertility testing even earlier.

Baseline Fertility Assessment: Before or shortly after beginning to try to conceive, comprehensive fertility testing provides invaluable information:

• AMH testing: Provides a snapshot of ovarian reserve
• Day 3 FSH and estradiol: Offers insight into ovarian responsiveness
• Antral follicle count via ultrasound: Gives a visual assessment of remaining egg supply
• Thyroid function: TSH should be optimized for fertility (generally below 2.5 mIU/L)
• Prolactin levels: Elevated prolactin can interfere with ovulation
• Vitamin D status: Adequate levels support reproductive function

For partners, a semen analysis should be completed early, as male factor contributes to approximately 40% of fertility challenges, and age affects male fertility as well, though less dramatically than female fertility.

Optimizing Natural Conception: At 38, optimizing the basics of natural conception becomes increasingly important:

Precise ovulation tracking: Rather than relying solely on calendar methods or standard ovulation predictor kits, consider more precise ovulation tracking methods. Quantitative hormone testing that tracks the actual LH surge and estrogen rise provides more accurate identification of your fertile window.

Timing intercourse: The highest probability of conception occurs with intercourse in the three days before ovulation, with the day before ovulation showing the highest conception rate. Understanding your fertile window and targeting these specific days maximizes each cycle's potential.

Lifestyle optimization: While lifestyle factors cannot overcome significant age-related fertility decline, they support optimal function:

• Maintaining a healthy BMI (18.5-24.9) is associated with better fertility outcomes
• Nutrition that supports fertility includes adequate protein, healthy fats, and antioxidants
• Moderate exercise (5-7 hours weekly) supports fertility, while excessive exercise (>10 hours weekly) may interfere
• Limiting alcohol consumption improves egg quality and conception rates
• Managing stress, though not causative of infertility, supports overall hormonal balance

When to Consider Fertility Treatment: If natural conception hasn't occurred after 4-6 months of well-timed intercourse, or if fertility testing reveals diminished ovarian reserve or other issues, consulting a reproductive endocrinologist makes sense at 38. Time is increasingly valuable, and treatments like ovarian stimulation with IUI or IVF can significantly improve monthly pregnancy probability.

Trying to Conceive at 40: The Statistical Shift

At 40, the psychological weight of the "big 4-0" often doesn't match the biological reality, your fertility at 40 is quite similar to your fertility at 39 or 41. However, population-level statistics do show more pronounced decline, and the two-year window from 40-42 represents a period of particularly rapid fertility change.

What the Numbers Tell Us

Monthly pregnancy probability for 40-year-old women attempting natural conception drops to approximately 10-12%, compared to 15-20% at 38. The cumulative probability of pregnancy within one year falls to roughly 50-65%, meaning that without intervention, about half of 40-year-old women will not conceive within a year of trying.

However, these statistics deserve important context. Much of the published data on fertility at 40 comes from historical populations without access to modern fertility awareness methods, ovulation tracking, or early intervention. Women today who actively optimize timing and pursue appropriate treatment earlier in their attempts often achieve better outcomes than these historical averages suggest.

The Biological Picture at 40

Ovarian Reserve: By 40, ovarian reserve shows marked decline compared to earlier reproductive years. AMH levels typically fall to 0.5-1.5 ng/mL, though individual variation remains substantial. Some 40-year-old women maintain AMH levels closer to 2 ng/mL, while others have already entered very low reserve territory.

Antral follicle counts generally range from 5-10 follicles, compared to 15-25 in the early 30s. This reduced follicle pool means fewer opportunities for successful conception and reflects the ovarian environment's diminished capacity to respond to fertility medications if treatment becomes necessary.

FSH levels typically rise more noticeably by 40, often exceeding 10 mIU/L on cycle day 3, compared to the ideal of less than 10. Elevated FSH indicates that the pituitary gland is working harder to stimulate the ovaries to recruit eggs, suggesting diminished ovarian responsiveness.

Egg Quality: The chromosomal abnormality rate reaches approximately 50% by age 40—a critical threshold where half of all eggs contain the wrong number of chromosomes. This dramatic increase in aneuploidy explains much of the fertility decline at this age.

For women trying to conceive at 40, this translates to:

• Significantly more cycles needed to achieve pregnancy with a chromosomally normal embryo
• Miscarriage rates rising to approximately 30-35%
• Increased time to conception even with perfect timing
• Greater benefit from fertility treatments that can overcome the numbers game through producing multiple eggs per cycle

Cycle Irregularity: At 40, menstrual cycle changes become more common and noticeable. Cycle length may become less predictable, with some cycles shortening to 24-26 days and others lengthening unexpectedly. This variability reflects irregular ovulation—some cycles may involve no ovulation at all (anovulation), while others show delayed ovulation.

The luteal phase may shorten, sometimes to just 10-11 days, potentially insufficient for implantation. Progesterone production may decrease, affecting the uterine lining's receptivity. Some women begin experiencing perimenopausal symptoms like hot flashes, night sweats, or mood changes, though perimenopause at 40 is relatively uncommon—most women don't enter perimenopause until their mid-to-late 40s.

Strategic Approaches at 40

Immediate Fertility Evaluation: At 40, fertility evaluation should begin immediately when deciding to try to conceive, rather than after any period of unsuccessful attempts. Comprehensive testing including AMH, FSH, antral follicle count, and partner semen analysis provides critical baseline information that informs your approach.

Understanding your specific ovarian reserve is essential at this age because it fundamentally changes the recommended strategy. A 40-year-old with robust ovarian reserve (AMH above 1.5, AFC above 10) may reasonably try natural conception for 3-4 months with optimal timing before pursuing treatment. A 40-year-old with diminished reserve (AMH below 0.7, AFC below 5) should likely consider moving to assisted reproductive technology more quickly.

Maximizing Natural Conception Odds: If your fertility assessment shows reasonable ovarian reserve and no other significant factors, natural conception remains possible, but optimizing every variable becomes critical:

Precise ovulation prediction: At 40, the traditional ovulation predictor kits that only detect LH may miss nuances of your cycle. Quantitative hormone tracking that measures both LH and estrogen provides more reliable identification of your actual fertile window, which may not occur at the "typical" cycle day 14.

Preconception optimization:

• Ensure TSH is optimized (ideally below 2.5 for fertility)
• Check vitamin D levels and supplement to reach 30-50 ng/mL
• Consider CoQ10 supplementation (200-600mg daily), which some research suggests may support egg quality, though evidence is limited
• Ensure adequate folate intake (400-800 mcg daily) before conception
• Address any underlying health conditions that affect fertility

When Treatment Makes Sense: Given the relatively narrow window for conception success at 40, most reproductive endocrinologists recommend moving to treatment relatively quickly if natural conception isn't successful within 3-4 months of optimal timing.

Treatment options at 40 include:

• Ovarian stimulation with IUI: Can improve monthly pregnancy rates to 15-20% by producing multiple eggs and ensuring sperm placement
• IVF with PGT-A: Allows creation of multiple embryos, testing for chromosomal normalcy, and transfer of only normal embryos, dramatically improving implantation rates
• Egg freezing: If conception isn't urgent but you want to preserve current fertility potential for future use

The IVF Consideration at 40

For many 40-year-old women, IVF represents the most efficient path to pregnancy, particularly if diminished ovarian reserve is present. However, realistic expectations are essential.

Success rates for IVF at 40 vary significantly based on ovarian reserve and individual response to stimulation. National averages show approximately 20-25% live birth rate per IVF cycle at age 40, but this drops dramatically for women with very low ovarian reserve and remains higher for women with robust reserve.

The primary value of IVF at 40 is overcoming the egg quality challenge through numbers and testing. By stimulating production of multiple eggs (typically 5-12 at age 40, compared to 15-25 in younger women), retrieving and fertilizing them all, and testing resulting embryos for chromosomal normalcy through preimplantation genetic testing (PGT-A), you can identify which embryos have the best chance of resulting in pregnancy.

Without PGT-A, transferring embryos at 40 means approximately 50% of transfers involve chromosomally abnormal embryos that won't implant or will end in miscarriage. With PGT-A, only normal embryos are transferred, dramatically improving implantation rates per transfer, though not all IVF cycles will yield normal embryos to transfer.

Trying to Conceive at 42: When Biology Requires Intervention

At 42, natural conception becomes significantly more challenging, though certainly not impossible. This age represents a point where the biological realities of fertility decline intersect most acutely with modern reproductive technology's limitations and possibilities.

The Statistical Reality

Monthly natural conception probability at 42 drops to approximately 5-8%, translating to roughly 30-40% cumulative probability of pregnancy within one year of attempts. Miscarriage rates rise to 40-50%, meaning that even when conception occurs, the likelihood of live birth decreases substantially.

These statistics reflect the dramatic increase in egg chromosomal abnormalities at this age, with approximately 75% of eggs showing aneuploidy. This means only 1 in 4 eggs has the correct chromosome number, creating a profound numbers challenge even when ovulation occurs regularly.

The Biological Landscape at 42

Ovarian Reserve: By 42, ovarian reserve typically shows substantial depletion. AMH levels often fall below 0.5 ng/mL, with many women measuring undetectable levels (below 0.16 ng/mL). Antral follicle counts typically range from 3-7 follicles, compared to 15-25 in the early 30s.

FSH levels commonly exceed 12-15 mIU/L on cycle day 3, with some women showing levels above 20 mIU/L, indicating significantly diminished ovarian reserve. These elevated levels reflect the pituitary gland's increasingly desperate attempts to stimulate the ovaries to recruit eggs.

The practical impact of low ovarian reserve at 42 manifests in several ways:

• Fewer eggs available for ovulation or retrieval during IVF
• Reduced response to fertility medications
• More cycle-to-cycle variability in ovarian function
• Increased likelihood of cycle cancellation during IVF if inadequate eggs develop

Egg Quality: With 75% of eggs showing chromosomal abnormalities, the egg quality challenge at 42 is profound. This means:

• Most fertilized embryos will be chromosomally abnormal and unable to result in pregnancy
• Miscarriage rates approach 50% when pregnancy does occur
• Multiple embryos may need to be created and tested to identify even one chromosomally normal option
• Some IVF cycles may yield no normal embryos despite multiple eggs retrieved

Cycle Changes: At 42, menstrual cycle irregularity becomes increasingly common as the transition toward perimenopause approaches. Some cycles may be anovulatory, where no egg is released despite menstruation occurring. Others may show very short follicular phases, with ovulation occurring on cycle day 8-10 instead of the typical day 12-14.

The luteal phase often shortens further, sometimes to just 9-10 days, making implantation more challenging. Progesterone levels may decline significantly, requiring supplementation even for natural conception attempts.

Some women at 42 begin experiencing more noticeable perimenopausal symptoms, though full perimenopause typically doesn't begin until the mid-to-late 40s. Hot flashes, night sweats, mood changes, and sleep disruption may emerge, though these vary dramatically between individuals.

Strategic Approaches at 42

Immediate Comprehensive Evaluation: At 42, beginning with comprehensive fertility testing is essential before attempting natural conception. This evaluation should include:

• Complete ovarian reserve assessment: AMH, day 3 FSH and estradiol, antral follicle count
• Thyroid optimization: TSH ideally below 2.5 for fertility attempts
• Prolactin screening: Elevated levels can interfere with ovulation
• Partner semen analysis: Male age also affects fertility, and identifying male factor issues early prevents wasted time
• Genetic carrier screening: Given the increased risk of chromosomal abnormalities, understanding both partners' carrier status for genetic conditions informs family planning decisions

The results of this testing fundamentally inform your approach and timeline. A 42-year-old with reasonable ovarian reserve (AMH above 0.7, AFC above 5) has meaningfully different options than a 42-year-old with severely diminished reserve (AMH undetectable, AFC below 3).

Natural Conception: Realistic Expectations: While natural conception at 42 is possible, realistic expectations are essential. Even with perfect timing, monthly pregnancy probability remains low (5-8%), and miscarriage risk is substantial (40-50%).

For couples choosing to attempt natural conception at 42:

• Limit natural attempts to 2-3 months with optimal timing before moving to treatment
• Use precise ovulation tracking to ensure perfect timing during these attempts
• Consider this period as both an attempt at conception and a trial of cycle regularity
• Understand that time spent on unsuccessful natural attempts is time during which fertility continues declining

Fertility Treatment at 42: The Primary Path

For most 42-year-old women, assisted reproductive technology represents the most realistic path to pregnancy. Treatment options include:

IVF with Own Eggs: Remains an option if ovarian reserve testing shows sufficient follicles, but realistic expectations are critical. Success rates per cycle at 42 drop to approximately 10-15% live birth rate nationally, with significant variation based on individual reserve and response.

The process typically involves:

• Ovarian stimulation to produce multiple eggs (typically 3-8 eggs retrieved at age 42)
• Retrieval of mature eggs
• Fertilization with sperm
• Culturing embryos to blastocyst stage (day 5-6)
• PGT-A testing to identify chromosomally normal embryos
• Transfer of normal embryo(s)

The primary challenge at 42 is that many cycles may not yield chromosomally normal embryos. With 75% of eggs abnormal, retrieving 6 eggs might result in 4-5 fertilized embryos, 2-3 blastocysts, and 0-1 normal embryos after testing. Some women require multiple egg retrieval cycles to bank enough normal embryos for a reasonable chance at pregnancy.

Egg Banking Strategy: Given the numbers challenge at 42, some women pursue multiple "back-to-back" egg retrievals, freezing all embryos without testing or transfer, to accumulate a larger pool. After several retrievals, all embryos are tested together, and only then are transfers attempted. This approach acknowledges that a single retrieval at 42 may yield insufficient embryos for even one successful pregnancy, let alone multiple children.

Donor Eggs: A Shift in Approach: For many women at 42, particularly those with severely diminished ovarian reserve or after unsuccessful IVF attempts with own eggs, donor eggs offer dramatically higher success rates, typically 60-70% live birth rate per transfer cycle.

Donor egg IVF bypasses the egg quality and quantity challenges entirely by using eggs from younger donors (typically aged 21-30). The resulting pregnancy is carried by the intended mother, and many women find this maintains important aspects of the pregnancy experience and bonding, even though the genetic contribution comes from the donor.

The decision to pursue donor eggs is deeply personal and often emotionally complex. Many women experience grief over the loss of genetic connection to their child, while others feel relief at accessing a treatment with substantially higher success rates. Understanding all your fertility treatment options helps inform this significant decision.

Adoption and Child-Free Living: It's important to acknowledge that not all paths to family building involve pregnancy. Adoption offers another route to parenthood, while some individuals and couples ultimately decide that a child-free life aligns with their values and circumstances. Neither represents failure, both are valid choices that deserve consideration alongside medical interventions.

The Time Factor at 42

Perhaps the most critical consideration when trying to conceive at 42 is time itself. Each month represents not just another attempt at conception but another month of declining fertility. The difference in egg quality and ovarian reserve between 42 and 43 is more substantial than the difference between 35 and 36.

This temporal pressure creates difficult decisions:

• How long to attempt natural conception before pursuing treatment?
• How many IVF cycles with own eggs to attempt before considering donor eggs?
• When to accept that the current approach isn't working and shift strategies?

These questions don't have universal answers, they depend on individual reserve, financial resources, emotional reserves, and personal values. However, acknowledging that time is the most limited resource at 42 helps frame decisions appropriately.

Beyond the Numbers: Individual Variation in Fertility

Throughout this discussion of age-specific fertility changes, it's crucial to emphasize that population-level statistics don't predict individual outcomes. Fertility varies enormously between individuals at any given age.

Some 42-year-old women maintain ovarian reserve and egg quality comparable to many 38-year-olds. Others experience dramatically accelerated reproductive aging, showing significantly diminished reserve in their late 30s. Genetics, lifestyle factors, medical history, environmental exposures, and luck all influence individual fertility trajectories.

This variation is why fertility testing provides far more actionable information than chronological age alone. A 40-year-old with an AMH of 2.5 ng/mL and AFC of 15 has meaningfully better odds than a 38-year-old with an AMH of 0.5 ng/mL and AFC of 4.

Factors Influencing Individual Fertility:

Genetics: Family history of early menopause or premature ovarian insufficiency can indicate increased risk of accelerated reproductive aging. Conversely, family history of late menopause or easy conception at older ages may suggest better reserve.

Medical history: Conditions affecting ovarian reserve include:

• Previous ovarian surgery, particularly cystectomy for endometriomas
• History of chemotherapy or radiation to the pelvis
• Autoimmune conditions that can affect ovarian function
• Smoking, which accelerates ovarian aging by 1-2 years on average

Lifestyle factors: While lifestyle cannot overcome significant age-related fertility decline, healthy habits support optimal function:

• Maintaining healthy BMI (18.5-24.9)
• Regular but not excessive exercise
• Balanced nutrition with adequate protein and micronutrients
• Stress management
• Avoiding smoking and limiting alcohol

Partner factors: Male age also affects fertility, though less dramatically than female age. Men over 40 show increased DNA fragmentation in sperm, longer time to conception, and increased miscarriage rates. Understanding male fertility factors ensures a comprehensive approach.

The Male Factor: Partner Age Matters Too

While this guide focuses on female fertility and age, male fertility also declines with age, though more gradually and with greater variability. Men continue producing sperm throughout their lives, but sperm quality deteriorates with age.

Research shows that men over 40 experience:

• Increased DNA fragmentation in sperm
• Reduced sperm motility and morphology
• Longer time to conception (even with younger female partners)
• Increased miscarriage rates
• Slightly elevated risks for certain genetic conditions

For couples where both partners are over 38, the cumulative effect of both partners' age creates additional fertility challenges. This dual-age factor makes comprehensive evaluation of both partners essential, including not just standard semen analysis but advanced sperm testing like DNA fragmentation assessment when available.

The Emotional Reality of Trying to Conceive in Your Late 30s and 40s

The biological and statistical discussion of age-related fertility decline, while important, captures only part of the experience of trying to conceive at 38, 40, or 42. The emotional landscape deserves equal consideration.

Grief and Loss: Many women experience profound grief over their changing fertility, grief for the timeline they imagined, for the ease of conception they witnessed in others, for the larger family they may not be able to have. This grief is valid and worthy of acknowledgment, even while pursuing treatment or considering alternatives.

Time Pressure: The awareness that fertility is declining rapidly creates intense psychological pressure. Each menstrual period can feel like a personal failure, and the urgency to conceive can overshadow other life experiences. Finding ways to maintain perspective and engage in life beyond trying to conceive becomes both more difficult and more essential.

Financial Burden: Fertility treatment is expensive, typically not covered by insurance in the United States, and the need for treatment increases with age. The intersection of declining fertility, time pressure, and financial constraint creates difficult decisions about how many treatment cycles to pursue, when to consider donor eggs, or when to accept that biological parenthood may not be possible.

Relationship Stress: The process of trying to conceive and pursuing fertility treatment places enormous strain on relationships. Scheduled intercourse, medical procedures, hormonal treatments, financial stress, and repeated disappointment challenge even strong partnerships. Acknowledging this strain and actively nurturing the relationship becomes critical.

Identity and Self-Worth: For many women, the struggle to conceive at an older age intersects painfully with questions of identity and life choices. Societal narratives that frame delaying childbearing as a mistake or that suggest career success somehow caused infertility add additional psychological burden to an already difficult experience.

It's essential to recognize that choosing when to pursue parenthood involves complex considerations of education, career, partnership, financial stability, and personal readiness. The fact that biology doesn't align perfectly with other life timelines represents a societal and medical challenge, not an individual failure.

Support Resources: Women trying to conceive in their late 30s and early 40s benefit from:

• Fertility counseling or therapy specializing in reproductive challenges
• Support groups (online or in-person) with others navigating similar experiences
• Clear, honest communication with partners about fears, grief, and hopes
• Setting boundaries around sharing fertility struggles with extended family or friends
• Engaging in activities and relationships unrelated to trying to conceive

Looking Forward: When to Reassess and Change Course

One of the most challenging aspects of trying to conceive at 38, 40, or 42 is determining when your current approach isn't working and requires reassessment. Clear decision points help prevent months or years of ineffective attempts while fertility continues declining.

Suggested Reassessment Timelines:

At 38:

• Pursue comprehensive fertility testing before or immediately when beginning to try to conceive
• If natural conception hasn't occurred after 4-6 months of optimal timing, consult a reproductive endocrinologist
• If evaluation reveals diminished ovarian reserve, consider moving to treatment within 2-3 months

At 40:

• Complete comprehensive fertility testing immediately
• If ovarian reserve is reasonable, limit natural attempts to 3-4 months before pursuing treatment
• If ovarian reserve is diminished, consider immediate treatment
• After 2-3 unsuccessful IVF cycles, reassess strategy and consider donor eggs

At 42:

• Complete comprehensive testing before attempting natural conception
• Limit natural attempts to 2-3 months maximum
• Consider immediate IVF consultation, particularly if testing shows low reserve
• After 1-2 unsuccessful IVF cycles, seriously consider donor eggs
• Establish clear boundaries around how long to pursue treatment before considering alternatives

These timelines aren't rigid rules, individual circumstances, financial resources, emotional reserves, and personal values all influence appropriate timelines. However, acknowledging that extended periods of unsuccessful attempts mean continued fertility decline helps frame realistic decisions.

The Bottom Line: Age, Fertility, and Realistic Hope

Trying to conceive at 38, 40, or 42 requires balancing realistic acknowledgment of biological limitations with appropriate hope that success remains possible. The key insights:

Biology is real: Fertility does decline with age, predictably and measurably. Understanding the specific mechanisms behind this decline, ovarian reserve depletion and egg quality deterioration, helps you approach conception with realistic expectations.

Statistics describe populations, not individuals: While average fertility at 40 or 42 is significantly lower than at 30, individual variation is enormous. Your specific fertility is better predicted by ovarian reserve testing than by age alone.

Time is your most limited resource: At these ages, each month represents meaningful continued fertility decline. This makes early comprehensive evaluation and willingness to pursue treatment when appropriate essential.

Modern reproductive medicine helps but has limits: IVF and other treatments can significantly improve monthly pregnancy probability, but they cannot overcome severely diminished ovarian reserve or the fundamental challenge of egg quality decline. Success rates decrease with age even with treatment.

Multiple paths to parenthood exist:

Biological parenthood with own eggs represents one path to family building, but donor eggs, adoption, and chosen child-free living are equally valid options that deserve consideration.

Your emotional wellbeing matters: The intense focus on achieving pregnancy can overshadow other life experiences and strain relationships. Actively maintaining perspective, seeking support, and nurturing life beyond trying to conceive is essential.

Perhaps most importantly, remember that whatever your age and whatever your fertility journey, you deserve compassionate care, honest information, and respect for your autonomy in making deeply personal reproductive decisions.

Your Next Steps: Creating Your Personal Fertility Plan

Based on your age and individual circumstances, here are recommended next steps:

If you're 38 and beginning to try to conceive:

1. Complete baseline fertility testing (AMH, FSH, AFC)
2. Optimize ovulation tracking (Track Your Ovulation with Oova) for perfect timing
3. Begin preconception optimization (nutrition, vitamin D, thyroid)
4. Set a timeline: evaluate after 4-6 months of optimal timing
5. Consult a reproductive endocrinologist if conception hasn't occurred by your timeline or if testing reveals issues

If you're 40 and trying to conceive:

1. Complete comprehensive fertility testing immediately
2. Limit natural attempts to 3-4 months with optimal timing
3. Consult a reproductive endocrinologist early in the process
4. Consider IVF if natural conception doesn't occur quickly, particularly if reserve is diminished
5. Understand your IVF options including PGT-A testing

If you're 42 and trying to conceive:

1. Complete comprehensive evaluation before attempting conception
2. Limit natural attempts to 2-3 months maximum
3. Consider immediate fertility treatment consultation
4. Set realistic expectations about success rates with own eggs
5. Be prepared to consider donor eggs relatively quickly if own-egg attempts aren't successful

Regardless of your age, tracking your hormones and cycles (Track Your Ovulation with Oova) provides invaluable information about your fertility and helps optimize timing for conception attempts.

Frequently Asked Questions

Can you get pregnant naturally at 40?

Yes, natural pregnancy at 40 is possible, with approximately 10-12% monthly probability and 50-65% cumulative probability within one year of trying. However, miscarriage rates at 40 are approximately 30-35%, meaning even when conception occurs, the chance of live birth is reduced. Women with robust ovarian reserve have better odds than population averages suggest.

What is a good AMH level for conceiving at 38, 40, or 42?

AMH interpretation depends on age and testing method, but general guidelines suggest: at 38, AMH above 1.5 ng/mL is reasonable; at 40, above 0.7-1.0 ng/mL suggests viable natural conception or IVF with own eggs; at 42, above 0.5 ng/mL may still allow for IVF attempts, though success rates decrease substantially. However, AMH is just one marker, antral follicle count and FSH provide additional important information.

How long should I try naturally before seeing a fertility specialist?

Current guidelines recommend seeking evaluation after 6 months of unsuccessful attempts for women 35 and older. However, many reproductive endocrinologists suggest that women at 40 or 42 consider baseline fertility testing immediately and limit natural attempts to 3-4 months (at 40) or 2-3 months (at 42) before pursuing treatment, given the rapid fertility decline at these ages.

What's the success rate of IVF at 40 and 42?

National averages show approximately 20-25% live birth rate per IVF cycle at age 40 and 10-15% at age 42. However, these rates vary significantly based on individual ovarian reserve, response to stimulation, and whether preimplantation genetic testing (PGT-A) is used. Women with robust ovarian reserve achieve better outcomes than these averages, while women with severely diminished reserve see lower success rates.

Should I freeze my eggs at 38 if I'm not ready to conceive yet?

Egg freezing at 38 can preserve some fertility potential for future use, but success rates are lower than egg freezing at younger ages due to both diminished quantity and quality. At 38, expect to retrieve 8-15 eggs per cycle, with approximately 60-65% of eggs surviving thaw and 35-40% showing chromosomal abnormalities. Most fertility specialists recommend freezing at least 15-20 mature eggs to have a reasonable chance at future pregnancy, which might require 2-3 retrieval cycles at age 38.

How does male age affect fertility when trying to conceive at 38-42?

Male fertility also declines with age, though more gradually than female fertility. Men over 40 show increased DNA fragmentation in sperm, reduced motility, and longer time to conception even with younger female partners. When both partners are over 38, the cumulative effect of both partners' age creates additional challenges. Comprehensive evaluation including semen analysis is essential for both partners.