Question explored with the scientific record
What can I do to improve chances of pregnancy at 44 years old
At 44, the biggest lever is not a supplement or a lifestyle tweak. It is getting to a fertility specialist fast and testing the embryos you make.
The single most useful thing in this retrieval is about the womb, not the egg. In a large group of women transferring genetically normal embryos, the older group still had lower live birth: about 40 in 100 versus about 47 in 100 [1]. The mechanism appears to be epigenetic: aging endometrium loses a mark called H3K27ac, which lowers the progesterone receptor and makes the lining less receptive [1]. That is a real, measured effect, though the "target" part is mouse work and years from being a treatment [1].
On the egg side, the retrieval is blunt. Most aneuploidy (wrong chromosome count) in older mothers comes from the egg itself, and screening embryos for normal chromosomes before transfer raised implantation in a small randomized pilot [3]. Paternal age matters far less than maternal age for success [2]. The ovulation drugs (letrozole, clomiphene, metformin) were all studied in PCOS women averaging late twenties, not 44-year-olds, so they do not answer your question [4][5][6].
| Group | Live birth per transfer |
|---|---|
| Younger women, normal embryos | about 47 in 100 [1] |
| Middle-aged women, normal embryos | about 40 in 100 [1] |
What this search did not surface: any trial of CoQ10, DHEA, or lifestyle change at 44. That absence is a gap in the search, not proof they fail.
My call: pursue IVF with chromosome screening and a receptive-lining workup now, and treat supplements as unproven. Confidence: moderate on the embryo-screening and lining points, low on everything else.
Sources used 6
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Endometrial aging is accompanied by H3K27ac and PGR loss
The study shows that endometrial aging in humans is marked by loss of the histone modification H3K27ac which correlates with and causally reduces progesterone receptor (PGR) expression, and that H3K27ac/PGR depletion impairs endometrial receptivity; this aging-like epigenetic/re…
DOI: 10.1038/s43587-025-00859-5 -
Paternal age and assisted reproductive technology: problem solver or trouble maker?
This narrative review synthesizes evidence on how paternal age affects semen quality, sperm genetics/epigenetics, ART outcomes, and offspring health, concluding that paternal age has limited or inconsistent impact on ART success compared with maternal age, but may influence seme…
DOI: 10.23736/S0031-0808.18.03512-7 -
24-chromosome copy number analysis: a comparison of available technologies
This narrative review compares available technologies for 24-chromosome copy number analysis in preimplantation genetic screening, evaluating their pros, cons, accuracy, scalability, and clinical applicability.
DOI: 10.1016/j.fertnstert.2013.07.1965 -
Clomiphene-Metformin in Comparison with Letrozole-Metformin in Overweight Infertile Women with PCOS
A randomized controlled trial comparing clomiphene citrate plus metformin versus letrozole plus metformin for ovulation induction in overweight infertile women with PCOS found no significant difference in ovulation or pregnancy rates over three cycles, though letrozole showed hi…
DOI: 10.31579/2578-8965/037 -
Meta-Analysis: Letrozole vs Clomiphene Citrate as Ovulation Induction in PCOS
In a meta-analysis of seven randomized controlled trials in 1,037 women with polycystic ovary syndrome, letrozole significantly increased pregnancy rate compared with clomiphene citrate (RR 1.42, 95% CI 1.02-1.99), while ovulation rate was slightly higher but not statistically s…
DOI: 10.25077/aoj.10.2.218-233.2026 -
Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline
This guideline evaluates the role of metformin in ovulation induction for infertile women with polycystic ovary syndrome (PCOS), concluding that while metformin increases ovulation rates, it is not as effective as clomiphene citrate or letrozole for improving pregnancy and live-…
DOI: 10.1016/j.fertnstert.2017.06.026