The human reproductive system really is quite annoying isn’t….? Let’s face it, what woman is really ready to settle down and have children in her early 20’s, when her eggs are “in their prime”? What about having fun, and dating, and travelling, and having a career?
It is of no surprise then, that more and more women are choosing to have children later in life. But what are the chances of a woman conceiving in her 40s? We turned to the team at Vida Fertility and asked them the questions you want the answers to….
Why is harder for a woman in her 40s to conceive?
The ovarian reserve: let’s talk about quality.
When a woman is trying to get pregnant, especially in her 40’s, the first thing to consider is her ovarian reserve. The ovarian reserve provides information about the fertility and reproductive capacity of a woman. Defined by the number and quality of oocytes left in her ovaries, it determines the capacity of the ovaries to provide oocytes capable of fertilising. However, ovarian reserve decreases with time, especially after the age of thirty-five, which reduces the chances of a potential pregnancy. While one is naturally more concerned with egg quantity, egg quality is an equally, if not more, important factor. Indeed, egg quality refers to whether an egg is genetically “normal” or abnormal. Poor quality and abnormal eggs are more likely to cause infertility, miscarriage or genetic disorders which can make pregnancy more challenging. And over 40, let’s say that the eggs a woman has left in her ovaries have a poor quality compared to the ones she was developing in her 20s or 30s.
Even though it is the main factor, the ovarian reserve is not the only one that can make getting pregnant difficult at this age. Every woman is different and may have other medical conditions that will make it even harder. They are not necessarily directly related to their age. We are talking about ovulation problems, blocked fallopian tubes, endometriosis, PCOS, thyroid or blood conditions and more.
In my 40s, can I conceive naturally? Is it possible with IVF using my own eggs?
Let’s be honest, if we only consider her age, the average percentage of natural pregnancy for a woman of 40 to 42 years old is less than 5-10% in every cycle. Through IVF with her own eggs – without genetic testing – these chances rise between 10-30%. Using PGT-A, success rates are over 65% but still… you have to keep in mind that for this case, embryo transfers are only possible by definition in case of having an euploid blastocyste.
Nevertheless, figures based only on age are not a good indication. This can give hope or discourage a woman who compares herself to others when each case is different. Women should always ask their fertility specialist about HER chances to get pregnant, taking in account all her medical history, and her partner’s if applicable. We tend to forget about sperm quality and preparation and its role is as important as the egg’s in the fertilization process.
So, what ART treatments are highly recommended over 40?
“Doing an IUI after 40 would be playing Russian roulette. There is obviously no zero chance of success, but it is not something we advise our patients to do. It is too risky and requires too much time, money and emotion”, explains Dr Spies. At this age, the two best options, depending on each woman of course, are IVF with PGT-A, which is a genetic testing checking the number of chromosomes of an embryo, or egg donation. Most of our patients come for these two treatments actually.”
In fact, using a donor egg dramatically increase your chances of conception. Dr Spies clarifies: “The donors are in their twenties. This means that you have the same chances with them as you would have had at their age. It doesn’t erase other factors like the male factor or endometrial problems, so, again, it’s complicated to give a figure, but, if you take a full set egg donation with 3 consecutive transfers, your chances of getting pregnant are more than 90%.”
I’m in my 40s and want to become a mum, what should I do?
What you should not do is waste time. As a clinic specialising in the care of international patients, at Vida Fertility we understand that our patients’ first step is to make an appointment with their GP or gynecologist. This can already take some time and they usually try it in their home country. It takes time to find a specialist, to do the tests, the first cycles, before they realize that they need treatment suitable for a woman over 40, usually abroad in specialized clinics
What you should do first is have a full fertility check-up and make an initial appointment as soon as possible with a fertility specialist. “The first thing I do is complete the medical history of both partners and do a general examination, which I do for any woman of any age. These include checking her ovarian reserve and hormones (E2, P4, FSH, LF and AMH). I also check other parameters like thyroid or blood coating, karyotype, etc., says Dr Katharina Spies. Keep in mind that if the tests show a low AMH, I do not immediately suggest egg donation. The recommendation for egg donation is always the result of a combination of different factors: AMH, age, antral follicle count (AFC) and other factors such as sperm quality and other medical conditions.”
Women over the age of 40, whether single or in a relationship, are the main patients of fertility clinics and are on the rise. They did not want to become mothers before, they were waiting for the right partner. Usually, they had children in a previous relationship and now want a baby with their new partner.
There are many reasons for a “late pregnancy” and each woman has her own one.
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