Last week in the clinic, a 41-year-old patient came in clutching a thick stack of test results and sighed, "Dr. Ha, they say 35 is advanced maternal age—at my age, is there even any hope?"

Who would have thought that after just six months of TCM (Traditional Chinese Medicine) regimen, she conceived naturally and is now having smooth prenatal checkups? With over 40 years of medical practice, I’ve seen too many women over 35 trapped by "age anxiety": "My AMH is only 0.6—am I hopeless?" "Few follicles mean I’ll never get pregnant..."

In reality, age is just a number—what truly determines fertility is your "constitutional state." As I often say: "A 35-year-old with the constitution of a 25-year-old can still conceive; a 25-year-old with the constitution of a 45-year-old will struggle." Today, let’s discuss with older women TTC (trying to conceive) how TCM syndrome differentiation can help cultivate a "fertility-friendly constitution"—even with low AMH or few follicles, proper adjustment can help you hold your baby at 45.

Many assume difficulty conceiving at advanced age is due to "old eggs," but TCM focuses on the "state of Qi, blood, Yin, and Yang." After 35, the body’s Yang energy gradually declines. If you have these 3 constitutional types, pregnancy becomes naturally harder:

1. Kidney Essence Deficiency Type – Oocytes "Lack the Vitality to Mature"

Common symptoms: Scanty menstrual flow described as "mere drops", with cycles exceeding 35 days and dark brown in color; backache likened to "carrying stones", making simple tasks like tying shoelaces difficult; ultrasound shows few follicles, and when one does appear, it stagnates at 14mm; frequent nighttime urination, feeling the need to use the toilet again shortly after lying down.

For these women, their eggs resemble "seeds stored for too long" - insufficient kidney essence and inadequate nourishment naturally result in lack of vitality.

I often prescribe modified Zuogui Pills for regulation: prepared rehmannia root and Chinese yam to nourish kidney yin, plus deer antler glue to "seek yang from within yin", thereby replenishing kidney essence more effectively. Many patients report after one month that "backache has improved and nighttime urination decreased".

2. Spleen Deficiency with Phlegm-Dampness Type – Uterus "Like Soaking in a Muddy Swamp"

If you frequently experience delayed menstruation (even absent for two or three months), excessive white discharge resembling "tofu crumbs"; a swollen tongue with tooth marks on the edges and thick white coating like "spread cream"; soft abdomen with loose flesh, and stool that consistently sticks to the toilet bowl - you likely have this constitutional type.

These sisters don't have poor egg quality, but rather an unfavorable uterine environment. The spleen acts like a "water pump" - when spleen qi is deficient, the "pump" malfunctions, allowing phlegm-dampness to accumulate in the uterus, making embryo implantation difficult.

I often use Modified Ginseng and Poria Decoction: Codonopsis and Atractylodes to strengthen the spleen, Coix seed and Dolichos seed to remove dampness, with a small amount of cinnamon twig added to "warm yang and dissolve dampness," speeding up the elimination of phlegm-dampness. Many patients report clearer vaginal discharge and less sticky stools after treatment.

3. Qi Stagnation and Blood Stasis Type —— "Traffic Jam" of Qi and Blood

Menstrual cramps so severe you writhe in pain, with dark purple blood clots resembling "little stones"; breasts swelling painfully before periods as if "about to burst," accompanied by rib pain; thick purple veins under the tongue, facial pigmentation, and a constant feeling of "emotional congestion" - these are all classic symptoms.

For women with this condition, the pathways of qi and blood are "completely blocked," preventing even the healthiest eggs from reaching the uterus.

I recommend Xiaoyao San combined with Shixiao San for regulation: Bupleurum (Chaihu) to soothe the liver, Pollen Typhae (Puhuang) and Feces Trogopterori (Wulingzhi) to activate blood circulation, plus Curcuma (Yujin) to "unblock both qi and blood." Many patients report relief within 3 days, saying "my breasts aren't swollen anymore, and my chest feels unburdened."

Many sisters ask: "What should we pay attention to when preparing for pregnancy at an advanced age?" Actually, there are just 3 key points—if you get them right, conceiving may be easier than for younger women:

1. Don't blindly induce ovulation—prepare the "soil" before "sowing seeds"

Aging ovaries are highly sensitive, and blindly stimulating ovulation is like "picking unripe fruit"—it harms the ovaries and results in poor egg quality. It’s recommended to spend 3 months improving physical condition, regulating menstruation and Qi-Blood balance first, as this significantly increases the success rate of subsequent ovulation stimulation.

2. 10 Minutes of "Yang Nourishment" Daily Works Better Than Supplements

After age 35, when yang energy gradually declines, expose your back (where yang meridians converge) to sunlight for 10 minutes daily between 9-11 AM to replenish yang qi. A warm back translates to a warmer uterus, making it easier for embryos to "implant."

3. Avoid staying up late! Sleeping before 10 PM equals "nourishing your eggs"

The liver meridian is most active from 11 PM to 1 AM. Without sleep during this period, liver blood cannot be replenished, leaving eggs "malnourished." Among my older patients, those who consistently sleep before 10 PM demonstrate better follicle quality and more stable implantation.

Getting pregnant at an advanced age is like "renovating an old garden": it doesn't matter if the garden is old (older age)—with proper maintenance (adjusting your constitution), you can still grow good crops (conceive a baby). The key is not to be intimidated by the numbers and find the right approach to adjust step by step.

If you're also trying to conceive at 35+ and experiencing issues like scanty menstrual flow, poor follicles, or difficulty getting pregnant, feel free to share your situation with me. I can help diagnose and assess it for you.

Remember, age is just a number—physical condition is what truly matters. With the right adjustments, you can still successfully have a baby at 45!