IVF over 40: transparency and different advice needed

While IVF success rates for women up to the age of 38 are still improving, beyond this age the chance of having a baby with your own eggs declines rapidly. If you are considering IVF over 40, Dr Nausheen Mawal, Consultant Gynaecologist and IVF Specialism Lead Clinician at Bourn Hall Norwich has some advice.

“We are always very realistic with patients about their chances of successful pregnancy. Although IVF success rates for women aged 38 to 43 with their own eggs are still good – with a 20 to 25 percent chance of a pregnancy – this is half that expected of a woman under 35.

“As a consequence we offer different types of advice and therapy for women in their late thirties and early forties in order to boost their chances of success. With any fertility treatment the sooner you start the better, so if you really want to give it your best shot don’t put it off any longer.”

Kirsty with her son Jenson and Dr Nausheen Mawal
Kirsty with her son Jenson and Dr Nausheen Mawal

Dr Mawal has been a speaker at the Fertility Network UK support group meeting  ’40 and over’ – more information about the group which meets monthly is available here.

Check your egg store

In order to give the best advice, the first step is an AMH (Anti-Mullerian Hormone) test to measure the woman’s ovarian reserve. This will give an indication of the reserve pool of eggs left in the woman’s ovaries (not the exact number) and what to expect from ovarian stimulation for egg collection and IVF.

Even if the AMH level is low, if other factors look good and the patient wants to try, then ovarian stimulation might still be possible, although it maybe necessary to use a higher dose of drugs. Where a woman is going use her own eggs for IVF treatment, she will go through a cycle of ovarian stimulation. In other cases we may advise the use of donor eggs.

For older women, Bourn Hall may use a different approach. Instead of down regulation it may use a higher dose of Gonal-F, starting at the beginning of a menstrual cycle. When the largest follicle reaches a diameter of 14mm, another drug (Cetrotide) is then added to the regime to prevent ovulation. This protocol gives better results in some older women. See our “How IVF Drugs Work” leaflet for more.

Adjuvants may help

There are also some adjuvant therapies that are recommended for some older patients. These are treatments that seem to be beneficial although there is little hard scientific evidence available yet. They are often drugs that have been approved for other conditions and have also been observed to help in reproductive medicine.

Dr Mawal explains: “Adjuvant therapies such as small doses of aspirin, herparin or immune treatments seem to provide a better outcome for some patients and we advise these on occasion depending on the individual.”

Kathleen overcame PCOS to have a baby with her own eggs at 40

Once the eggs are collected and fertilised, the embryos are incubated for a few days. For some women a good embryo is selected and transferred to the womb within a couple of days after the eggs are collected. For others the embryos may be grown on in the incubator until Day 5, when the embryos should reach the blastocyst stage, thus ensuring that the ones with the very best chance of implantation are selected.

Embryos that divide in a precise even pattern appear to be the ones most likely to implant normally and become babies. So when the embryologist selects which embryos to transfer to the woman’s womb, she or he is looking for an embryo that meets these criteria.

IVF over 40

Traditionally the embryos are observed under direct vision through the microscope, but this requires removing them from the incubator. Bourn Hall was one of the first clinics in the UK to introduce Eeva (Early Embryo Viability Assessment) and GERI, a computer vision software system which images and records information about each developing embryo every few minutes without disturbing them. It provides a complete visual history of the embryo and can be used to predict at an earlier stage, which are capable of reaching blastocyst and assists the embryologist in deciding which embryo(s) to select for transfer in that cycle of treatment.

“IVF is a science, but patient care is equally important and feeling secure and cared for can also improve the outcomes. The treatment we advise is appropriate for the individual and their circumstances and our focus is on giving them the best possible chance of success,” says Dr Mawal.

More information

Some of the specialist treatments discussed here may be appropriate under certain circumstances. They are not offered routinely as there is a lack of scientific evidence over their efficacy.  More information is available from the HFEA about the Add On Treatments. 

To read Kathleen and Paul’s story click here.

If you would like to discuss this further do get in contact.  

Related articles