Nutrition, Egg Quality, and IVF for Women Over 40: Ft. Prima Pharmacy

Prima sat down with Dr. Norbert Gleicher, a pioneering fertility specialist and one of the first-generation IVF doctors in the United States, to discuss nutrition, immune health, and what patients can do to maximize their chances of success—especially those who've already gone through several IVF cycles. 

There’s a lot of conflicting advice online about fertility treatment. When you’ve already gone through your first cycle (or few) of IVF, there’s a lot of advice to sift through about what your next steps should be on your fertility journey.

 Prima is  committed to connecting patients with trusted experts who can cut through the noise and provide evidence-based guidance. That's why they spoke  with Dr. Norbert Gleicher, Medical Director and Chief Scientist at the Center for Human Reproduction in New York City.

Dr. Gleicher has guided thousands of patients along their fertility journeys, most of whom did not have a straight forward path to pregnancy. As one of the earliest physicians in the IVF field, he established one of the first IVF clinics in the US. He now sees patients from all over the world at CHR, most of whom are coming to his office after having already gone through multiple rounds of IVF. 

Preparing for Your Next Cycle: Egg Quality 

The number of mature, chromosomally normal eggs a patient has is one of the first steps to address in her fertility journey. Yet when it comes to egg quality, many patients hear, "there's nothing you can do." Dr. Gleicher challenges this fatalistic view. “It’s true that women are born with all or almost all of their eggs,” he acknowledges. “And those eggs initially sit on the other cortex of the ovaries in a very primitive format. And then after menarchy, some of these eggs are recruited out of this sedentary state and start a short journey in the ovary.” Eggs undergo a maturation journey within the ovary that can last 8-16 weeks, called folliculogenesis in scientific terms. "It is during that journey that the ultimate quality of the egg becomes determined," Dr. Gleicher explains. "The environment of the ovary during that journey determines most of the ultimate quality of that egg."

By the time a patient undergoes an IVF cycle, there's little that can be done to improve their quality, there's a crucial window of opportunity before that point. But, some advance preparation can make a difference. This means that dietary and lifestyle interventions can potentially impact egg quality, but patients need to think months ahead, not days or weeks.

Understanding Immune Health and Pregnancy

For patients who have had long standing difficulties conceiving, Dr. Gleicher tends to look first at their immune system, something he believes is vastly under appreciated in the fertility field.

"I would not call pregnancy an endocrine condition, but I would call it an immune condition," Dr. Gleicher explains. "The first thing that needs to function well in order for a woman to conceive is not her endocrine system—it's her immune system."

This perspective changes everything about how we think about fertility treatment. According to Dr. Gleicher, when an embryo attempts to implant, there's a crucial "conversation" between the embryo and the maternal immune system. A healthy immune system will recognize a good embryo and reprogram itself to accept what would normally be rejected as foreign tissue.

However, women with hyperactive immune systems—whether due to autoimmunity, inflammation, or allergies—struggle with this reprogramming process. This can lead to both difficulty conceiving and higher miscarriage rates. Exploring what medical treatments and lifestyle changes can improve the immune system is a constructive next step for many fertility patients.

The Anti-Inflammatory Diet: When Nutrition Becomes Medicine

Patients looking to improve their immune systems in preparation for pregnancy can help their situation through diet. While Dr. Gleicher is cautious about prescribing one-size-fits-all dietary recommendations, he does see clear evidence for anti-inflammatory diets in specific cases. "The only real hard data that I am familiar with that would suggest a specifically outlined diet will help is in women who have evidence for inflammation in their body," he notes.

For these patients, a diet that avoid inflammatory foods can help strengthen the body’s immune system prior to and during IVF. In these cases, Dr. Gleicher recommends eliminating wheat/gluten, avoiding dairy products, and minimizing your sugar intake. However, for patients who don’t have these food sensitivities, an overly restrictive diet may cause more stress than benefits.

Rather than imposing restrictive rules on everyone, he suggests patients pay attention to their bodies: "Stay away from whatever gives you indigestion. If there is a food that makes you gassy or crampy or gives you brain fog, we all know those foods. Those are the foods that are usually inflammatory for that patient."

For patients who want to quantify their inflammation levels, blood tests can measure markers like C-reactive protein, IL-6, and ESR (sed rate).

The Problem with "Unexplained Infertility"

Lifestyle factors can make a difference in a patient’s fertility journey, but ultimately they may need deep medical expertise to become pregnant. Finding out the underlying reason for a patient’s difficulties conceiving is critical for deciding the right treatment path. 

"The first thing we tell a patient who comes with a diagnosis of unexplained infertility is this diagnosis does not exist," he states firmly. "If you're willing to dig deeper, you will find out that in the end, there's almost nothing unexplained."

This perspective is particularly relevant for patients who've been through multiple failed cycles. Dr. Gleicher is consistently amazed by how many patients come to his clinic without a clear diagnosis, despite having undergone numerous treatments at other facilities.

His advice is for patients to keep pushing for answers. Understanding the root cause of infertility is essential for developing an effective treatment plan.

Age and Androgens: A Surprising Connection

One of Dr. Gleicher's specialties is working with patients who are above the age of 40. While the average age for IVF patients across the US is 36, the median age for patients at the CHR is 45. While the chances of conceiving decline with age, Dr. Gleicher insists that conceiving a healthy pregnancy with your own eggs beyond the age of 40 is possible- of course, under the right medical guidance.

Many of his patients have been told that their fertility issues are simply due to age, but Dr. Gleicher digs deeper. He's found that many older patients actually suffer from premature ovarian aging, which often correlates with low androgen (male hormone) levels.

"Ovaries need good androgens in order to make good eggs," he explains. "Many of those women just need to raise their androgen levels once they have the diagnosis."

Some patients even conceive spontaneously while waiting to start their next IVF cycle, simply by addressing this underlying hormonal imbalance.

The Bottom Line: Healthy Living as Foundation

While Dr. Gleicher provides specific guidance for certain conditions, his overarching message is refreshingly straightforward: "In principle, if you want to get pregnant, eat healthy, live healthy, exercise, maintain your weight."

He elaborates, “The fundamentals matter: we all know that grilled fish is healthier than hamburgers, and that green salads beat bacon meals. But for patients dealing with inflammation, immune dysfunction, or hormonal imbalances, more targeted interventions can make a real difference.”

Looking Forward

Dr. Gleicher's insights remind us that fertility treatment isn't just about following protocols—it's about understanding each patient's unique physiology and addressing the root causes of their fertility challenges. Whether you're just starting your fertility journey or you've been through multiple cycles, the key is finding practitioners who are willing to dig deeper and understand your unique needs.

Prima is committed to connecting patients with this level of expertise and evidence-based care. Because when it comes to building your family, you deserve the treatment plan and care that’s right for you.