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40+ and on the TTC Journey? Here’s What “It Starts with the Egg” Recommends.


Even before many families decided to put off having children because of the COVID-19 pandemic, birth rates in the US have been declining steadily in the last decade. However, this overall decline of birth rates is more nuanced when we look at what’s happening to women in different age groups. CDC’s data shows that birth rates have been declining for women in their teens to early 30s, women in their late 30s and 40s are actually seeing a more or less steady increase in birth rates since at least 2005. In fact, births among women 40-44 have been steadily increasing for over 30 years.

It’s not hard to see why: Many of us start our careers in fields and roles that demand – rightfully or not – far more from us than would allow for raising children. We spend more time finding the right partners. Many feel socially and economically more prepared for a parenthood in their 40s.

However, women in their 40s do face particular challenges when it comes to reproductive health. Studies show that it becomes progressively harder for women to get pregnant after about age 35, and once pregnant, complications become more common with age. As high-achieving planners, many women who pursue a pregnancy in their 40s do everything they can to prepare for a healthy pregnancy.

One of the books they turn to the most is Rebecca Fett’s “It Starts with the Egg.” Updated in 2019 with more recent research, it’s an evidence-based yet approachable and actionable guide to egg health and reproductive health for women. One in three women who go through IVF in the US read the book; 7 years after the publication of its first edition, the book is still a #1 best-seller on Amazon in the “fertility” category.

Many of the book’s recommendations are universal, like reducing exposure to endocrine-disrupting chemicals. The recommendations become more granular, however, when it comes to supplement plans for women in different situations. To simplify things, here, we put together four supplement-focused recommendations from “It Starts with the Egg” specifically for women who are coming to the journey later in life.


1. Prenatal vitamins, minerals and antioxidants

OBGYN doctors recommend prenatal vitamins to every woman who is planning to get pregnant or actively trying (in addition to women who are already pregnant or nursing, that is). “It Starts with the Egg” highlights a few prenatal nutrients that are important:


  • Folate: It’s the B vitamin that supports healthy development of the baby’s brain. Recommendations vary, but Rebecca recommends at least 800 mcg/day of methylfolate (an active form of folate that’s naturally found in food).
  • Vitamin B12 and B6: Rebecca highlights these two other B vitamins for the preconception period, summarizing a few studies that suggest a possible correlation between consistent intake of these two B vitamins and normal ovulation and conception.
  • Zinc, selenium, iodine: While there is a wide range of minerals involved in reproductive processes, Rebecca mentions zinc, selenium and iodine in particular. All three are involved in the proper functioning of the thyroid glands, which play a surprisingly wide-ranging role in women’s reproductive processes, from hormonal regulation to egg maturation to thickening of the endometrium.
  • Antioxidants: “Although ovarian follicles naturally contain a whole host of antioxidant vitamins and enzymes, these are often diminished” in women in their 40s, points out Rebecca. To support a healthy antioxidant defense system for women 40+, “It Starts with the Egg” recommends a few antioxidants, including 500 mg of Vitamin C and 200 IU of Vitamin E per day.



2. CoQ10 to support egg health

Beyond the prenatal vitamins, “if you are going to add just one other supplement, make it Coenzyme Q10 (CoQ10)” to support egg health, advises Rebecca. Studies have suggested that CoQ10 levels decline with age, after peaking at around age 20. For women over 40, Rebecca’s recommendation is CoQ10 in the ubiquinol form at 200 to 400 mg per day.


3. DHEA to support ovarian health

Although the science behind DHEA and ovarian health still remains controversial, based on a review of scientific literature, Rebecca concludes that DHEA is “one of the most powerful tools we have” to support reproductive health for women after 40. Since DHEA is a hormone and have a potential for side effects in some women, Rebecca’s first recommendation is to have your DHEA-S and testosterone levels tested, then discuss adding DHEA to your preconception routine with your doctor if you are below the lower half of the normal range. (Here’s our explanation on why doctors test DHEA-S, not DHEA, when women take DHEA for reproductive health.)


4. Vitamin D to support overall reproductive health

Unrecognized deficiency of Vitamin D is one of the four unexpected obstacles to pregnancy that “It Starts with the Egg” points out. It’s a very common condition, especially in the northern climate during winter – in the US, nearly 1 in 5 have inadequate level of Vitamin D in the blood, while about 1 in 10 are outright deficient. Rebecca’s recommendation is to ask your doctor to have your Vitamin D levels tested, and supplement with 4,000 -5,000IU/day if you fall below the 40 ng/mL level or don’t know your status.



For a full list of recommendations that go beyond supplements, the reason behind her recommendations and what situations they apply to, we highly recommend turning to “It Starts with the Egg.” An Amazon reviewer called it “worth its weight in gold” – and we tend to agree. 

As always, please reach out with questions. We are with you.



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