Blog post written in collaboration with our partners EmbryoClinic
Getting pregnant in advanced maternal age isn’t as easy as some patients might think!
Yes, there are options available to help women at any age, but the success rates are not the same with different treatments and different age groups. For each case there is a specific meaning to the word “success”, which involve different factors. In any women of any age egg quality is very important, but particularly of advanced age this is guaranteed to decrease and is the main factor in deciding which type of IVF to go with:
- own eggs IVF
- egg donation IVF
Why does age matter? Egg quality and quantity (i.e., production) progressively get worse from your 20’s to your 30’s to you your 40’s and over. Regardless of the methods used, stimulation protocol, drugs administered, patient’s health condition and medical history, a female of 38+ years of age is an adverse factor for IVF success and pregnancy outcome in terms of miscarriages or complications with the gestation.
If age is an adverse factor, when is old too old? It depends, there are four age groups with different chances of conceiving. The first group covers women from 38 to 42 years of age. The second group covers women from 43 to 46 years of age. The third group covers women from 47 to 50 years of age. And the fourth group, exceptionally in Greece, covers women from 50 to 52 years of age for those who didn’t get to attend fertility treatment during the COVID-19 pandemic.
IVF using your own eggs (women aged 38 to 42) Doing IVF using your own eggs when you’re 38 to 42 years old has good, expected outcomes. This is a fine age group to attempt it. However, a careful evaluation of the patients’ profile is necessary due to the time limit imposed both biologically and legally. Patients must understand that they might not be able to afford to waste time and what realistic odds they can hope for. The best possible chance of success is calculated by accounting for individual characteristic, like hormonal screening, ultrasound results, any diagnosis, lifestyle details, and the male factor condition. Stimulation protocol is suited individually to each patient in order not to overstimulate them (e.g. using FSH hormone, sometimes using the add-on of LH or tablets of clomiphene, etc). Good indicators of high hopes include an adequate number of eggs and embryos – four or five oocytes, three heathy embryos to use. The number of embryos implanted depends on the quality of the embryo, on the patient’s wishes and on the characteristics they have. In summary, this is an overall fairly optimistic age group with moderate success rates (around 25% chance of pregnancy).
IVF using your own eggs (women aged 43 to 46) Doing IVF using your own eggs when you’re 43 to 46 years old is more complex, pregnancy loss and complications are much higher, the chances of birthing a healthy baby also decrease, so patients must understand that success rate is smaller (around 10 to 5%). Being above 45 isn’t a synonym of impossibility to conceive with your own eggs, but it has a very strong negative correlation to it.
IVF using your own eggs (women aged 47 to 50) Doing IVF using your own eggs when you’re 47 to 50 years old reports even smaller success rates and a realistic, well-explained understanding of the situation is essential for the patient’s mental health and well-being. Just because it is legal to go up to this age group it doesn’t mean that success rates are equally as high as in previous groups. There are success stories, but they aren’t the norm.
IVF using your own eggs (women aged 50 to 52) Doing IVF using your own eggs when you’re 50 to 52 is an exception imposed by COVID-19 restrictions. Again, hopes must be contained and clear. Most women on this age groups and even on the previous one normally has eggs that were collected when they were younger and are only now being used; if that’s the case egg quality is probably higher than if they were to be collected at a more advanced age.
IVF using donor eggs Now, when it comes to IVF with egg donation success rates are measured differently, because maternal age no longer influences egg / embryo quality. It might, nonetheless, affect other variables that lead to the outcome, like uterus quality, i.e. implantation environment quality, because with age the chances of developing fibroids, polyps, cancer increase. The truth is that you only one embryo to get pregnant, so sometimes the key is in why it isn’t implanting. This means that there is still a need to evaluate the patients and the donors. Donors have to fit certain parameters, one the most important ones being, again, age, being below 30 or 35. Patients have to go under a health screening (countries have specific regulations for this, but regulation also applies to the IVF criteria patients need to fulfil in order to be accepted into treatment). These two conditions – the pre-IVF phase testing – are to ensure that treatment is first of all safe and only then effective. The main advantage of donated eggs is that it negates the adverse effect of genetic inadequacies associated with advanced maternal age, however it’s not always successful or safe to perform.
When to switch to egg donors? Is it once your hit 40? No. Advanced reproductive age is one of the indicators that this might be the option to go with. The main indicator is menopause, meaning that you no longer produce eggs. Other indicators include (1) ovarian failure for other reasons due to premature menopause, secondary / surgical / medical cause (like a disease or procedure that rendered your ovaries unable to produce eggs), chemotherapy, radiotherapy, (2) poor oocyte / embryo quality, (3) recurrent IVF failure, implantation failure or pregnancy loss, (4) genetic disorders, and (5) endocrine disorders (hyper-gonad / hypo-gonad).
Using donor eggs had advantages and disadvantages The advantages might outweigh the disadvantages. Biologically, the advantages include higher success rates (50 to 70% per embryo transfer, depending on the number of eggs transferred – if 1 or 2), lower miscarriage rates due to younger donor age (below 30 or 35 years), thoroughly screened donor eggs (more so than own eggs), and lower physical complications rate because there is no need for stimulation, egg retrieval or risk of infection. Psychologically, the advantages include giving the option for people to match their phenotype to a donor’s phenotype to have a child that looks more similar to them, giving an experience that people can go through, meaning that they can get pregnant and give birth to their child, socially the parents can manage the situation as they please, telling or not to others how they conceived the child, and lastly this treatment option is legal, is regulates and is cost effective. The disadvantages, still, are worth mentioning: it can be psychologically, ethically and culturally difficult for the parents to accept the foreign genetic material, so the child doesn’t share their DNA, plus phenotype matching doesn’t ensure the child will look similar to the parents, there can also be difficulties finding donors of specific subgroups or with certain features, then there can also be stress associated to the donor’s performance (not everyone wants or gets to meet the donor), stress associated to the legislation of the country where the treatment is taking place, and stress associated with the affordability of this option.
Regardless of what type of IVF the patient chooses, if it was expected to work, meaning there were no indicators of poor-quality eggs, embryos, sperm, or implantation environment, it’s advised to wait a couple months in between transfers in order to recovery mentally, physically and analyse why it didn’t work. The last thing we want is to make patients go through a treatment we don’t have indication it’s going to have a reasonably good chance of working.
Forty-five is the new 35, perhaps 50 the new 40. With the advancement of technology and science what used to be headline news 10 or 15 years ago now is common practice in most clinics in Europe and in the world. Building a truthful relationship with you physician is of paramount importance before continuing or even starting treatment. Age is important but it’s a relative indicator that shouldn’t be interpreted alone.
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