Pregnancy after 40
IVF Pregnancy Rates for Women after 40
It is now for quite some years that CHR has been serving the by far oldest patient population of any IVF center in the U.S. that is reporting annual outcomes to either the Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technology (SART). Over the last 10 years, CHR’s average patient age has been slowly but progressively increasing. The increase observed between 2016 and 2017 was, however, unexpected: Within that one year, the median age of CHR’s patients increased by one full year, jumping from age 42 to age 43.
CHR's excellent IVF pregnancy rates in women over 40, many of whom had severe diminished ovarian reserve (DOR, or low functional ovarian reserve, LFOR), are among the best in the world. Women over age 40 now constitute almost 60% our IVF patients, and we have accumulated enough clinical expertise in this patient population to achieve some remarkable success. In fact, our oldest patient who conceived with her own eggs was just a few weeks shy of age 48. (She delivered a healthy daughter in 2017.)
Table 1 below summarizes CHR’s 2017 autologous fresh IVF cycles (cycles using the patients' own eggs) stratified by age. Absence of pregnancies in age groups 42 -43 are, likely, a statistical artefact due to smaller patient numbers in these age groups than in preceding years, as other IVF centers have started treating women 42-43. The age group above 44, indeed, includes women up to age 52 who were able to produce transferrable embryos with their own eggs.
|Age Group||Clinical Pregnancy Rates|
How Pregnancy Rates were Calculated – and Why
Because CHR’s patient population is so severely adversely selected by age as well as functional ovarian reserve, 15% of started IVF cycles did not reach embryo transfer during this study year, meaning that these patients had no chance of pregnancy. As we explain below, in patients with poor prognoses, the number of embryos available for transfer becomes a crucial predictor of pregnancy and live birth chances. This is why we are presenting the statistics for only patients who reached embryo transfer (i.e., had at least 1 embryo available for transfer). Here reported outcomes, therefore, must be further reduced by 15% to see IVF cycle outcomes with reference point cycle start (i.e., by “intent to treat”).
Assessing IVF Pregnancy Chances for a Specific Patient
Above age 43, the number of available embryos for transfer becomes a very important predictor of pregnancy and live birth chances. We’ve reported in a number of medical journal articles that this oldest patient population needed at least three embryos to reach a “reasonable” pregnancy chance with IVF, which we define as a chance in the low double digits. Only a relatively small minority of women in this extreme age group meet this requirement. Therefore, the large majority who produce only 1-2 embryos for transfer greatly dilute total pregnancy rates for this age group as a whole. In other words, if you are able to produce more than three transferrable embryos after age 43 in an IVF cycle, your success rate is likely higher than the rate shown for the entire age group.
This means that women at these ages must be counseled properly with correct information: They must understand that their pregnancy chances will be in the low single digits with one embryo for transfer. With two embryos, they will be in the higher single digits; with three or more embryos, their pregnancy chances will reach double digits. Pregnancy rates in this age group, overall, will be quite low, and their live birth rates will be further reduced by an approximately 50% miscarriage rate.
CHR’s Approach: Highly Individualized Egg Retrieval (HIER) and More
Particularly of note for women over 40 trying to get pregnant with her own eggs, a few years ago CHR introduced a new protocol for women over 43 that drastically improved pregnancy rates, where eggs are retrieved earlier than in a typical IVF cycle. Since then, we have further refined this approach, which culminated in the introduction of Highly Individualized Egg Retrieval (HIER) program in 2017.
Considering the incredible increase in adverse selection in CHR’s patients in 2017 based on age and poor functional ovarian reserve, CHR’s outcomes must be considered beyond exceptional. If they were viewed without an explaining commentary, they would be considered to reflect outcomes of a good IVF center. That they were achieved in the oldest IVF patient population of any IVF center in the U.S., and that over 90% of CHR’s patients before reaching out to CHR already had failed IVF cycles at other centers, make these results, however, rather exceptional.
HIER, as well as our philosophy of not cancelling IVF cycles even when just a few eggs develop during stimulation, and not using embryo selection methodologies like blastocyst culture and PGS/PGT-A in poor-prognosis patients, contributed greatly to these exceptional outcomes. CHR is looking forward to 2018 fully expecting even more challenges, as the center’s patients will, undoubtedly, continue to get older and more challenging.
Read more about Getting Pregnant over 40
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
Last Updated: October 8, 2018