Pregnancy after 40
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Is Pregnancy After 40 Possible?
It is common for a woman to consider having a baby after 40. At CHR, we specialize in helping women over 40 become pregnant with their own eggs using a treatment plan best suited to their individual clinical circumstances. In 2012, nearly half of all of our patients were between the ages of 41-50, a year-over-year increase of about 25%. These numbers didn't come as a shock: our pregnancy success rates for this group of women are among the best in the world.
At the age of 42, I gave birth to a beautiful boy and a beautiful girl. They are now healthy, perfect and wildly energetic 14-month-old toddlers. They are the light of our lives. We are forever grateful to CHR for these miracles.
For women over 40, the most common cause of infertility is diminished ovarian reserve (DOR), a condition which is characterized by a low number of eggs in a woman's ovaries and/or impaired development of the existing eggs. A diagnosis of DOR in women over 40 needs to be made rapidly so that effective treatment can quickly follow.
As the center of last resort for women with DOR, CHR meets many women who have postponed treatment for DOR while "watching and waiting" or while undergoing endless tests at other fertility centers. Unfortunately, without treatment, the chances of pregnancy after 40 can only get worse with time. Not a day passes when we don't hear patients say, "Doctor, I wish I'd known about your center years ago, when I was doing such and such..."
With more than 30 years of experience in treating women over 40 who wish to get pregnant, in addition to its publication of hundreds of research studies published on this topic, the CHR is considered one of the world's leading centers for the treatment of DOR.
The American Society for Reproductive Medicine (ASRM) recommends that women over age 35 consult a fertility specialist after six months of regular, unprotected intercourse that does not result in pregnancy. Infertility is technically defined as failure to conceive in twelve months, but since the fertility window for older women is smaller, we recommend consulting with a doctor before that point.
The ability of the ovaries to produce good-quality eggs (and ultimately good-quality embryos) declines with age, and practically all women by age 40 have lost enough of their ovarian reserve (OR) to qualify for a diagnosis of DOR. At CHR, we consider all women above 40 to suffer from DOR and apply clinical protocols that individualize treatment to help women of advanced ages.
If you find yourself treated the same as the 25-year-old patient sitting next to you in the waiting room, we recommend that you reconsider your treatment plan. One of the many differences in treatment, for instance, is that older women require larger doses of fertility medications in order to produce a good number of good-quality eggs.
CHR can diagnose DOR relatively easily with a few blood tests that measure follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels. High FSH levels and low AMH levels indicate DOR and the need for aggressive fertility treatment. Following diagnosis, we recommend that patients proceed to treatment as quickly as possible to maximize their pregnancy chances.
The Importance of Urgent, Individualized Treatment
For getting pregnant after 40, CHR believes in an urgent and individualized treatment approach. Time is a very important factor with DOR, and the sooner treatment can be started, the higher a woman's pregnancy chances.
There are several available types of infertility treatment available to women over 40. However, it is important to keep in mind that even though these treatments may be offered by a clinic, they may not be the best option specifically for women with DOR.
In Vitro Fertilization ("IVF")
For most women looking to get pregnant with their own eggs after 40, IVF with ovarian stimulation is the quickest and most reliable treatment option. We recommend that older women attempting IVF be treated differently from younger women: for instance, they need larger doses of fertility medications to produce a good number of good-quality eggs. At CHR, women over 40 are typically supplemented with DHEA to readjust their ovarian environment to a more rejuvenated, youthful, androgen-rich ovarian environment that allows eggs to undergo a healthier maturation process that results in better pregnancy chances.
DHEA supplementation was first introduced into fertility care by CHR physicians and has since spread worldwide with remarkable results. The major benefits of DHEA for fertility include an increase in the quality and quantity of eggs and embryos, increased spontaneous pregnancy rates, increased IVF success rates, decreased miscarriage rates, and decreased chances for chromosomal abnormalities in embryos. There have been many women who had been advised by other fertility centers that their only chance of conception was with egg donation, who have conceived under our care using their own eggs. For women with DOR, DHEA supplementation combined with IVF protocols developed at CHR has proved a life-changing treatment option.
CHR believes that egg donation should remain the last recourse, and that women should be given other fertility treatment options first. In our experience, too many women who may still be able to conceive with their own eggs (given proper treatment) are pushed prematurely into egg donation. Indeed, fully one third of women who entered our center with previous recommendations of egg donation have conceived with their own eggs after treatment at CHR.
That said, for many women over 40, egg donation does remain a great treatment option, offering a much higher pregnancy rate than IVF cycles that aim for women to conceive with their own eggs. To serve our patients better, CHR maintains its own extensive and diverse pool of egg donors, and can match most women with an excellent egg donor within a short time frame.
What Not to Do: Mini-IVF and IUI
Some fertility centers steer older women toward various forms of low-intensity IVF cycles, including mini-IVF and natural-cycle IVF. These low-intensity IVF cycles utilize lower doses of fertility medications for ovarian stimulation and aim for a smaller number of eggs. The rationale often offered to support this approach is that a milder approach results in better quality eggs. However, this claim is unsubstantiated in the medical literature.
No research has been published to show that low-intensity IVF results in better quality eggs. In fact, all available research shows the opposite, that low-intensity IVF cycles clearly reduce pregnancy chances. As for the cost benefits claimed by mini-IVF, a recently published comparative cost analysis by CHR researchers demonstrated that, considering the cost of having a take-home baby, standard IVF cycles are no more expensive than low-intensity IVF cycles.
Given the absence of properly conducted studies showing results comparable to standard IVF cycles, low-intensity IVF cycles should be considered experimental. Older women have little time for experimentation, and therefore, women over 40 with presumed DOR should not waste their time on wait-and-see approaches and low-chance treatments like mini-IVF or, even worse, intrauterine insemination (IUI).
CHR's Pregnancy Success Rates for Women over 40
CHR's excellent IVF pregnancy rates in women over 40, many of whom had severe DOR, are among the best in the world. In 2012, our success rates were as follows:
For our detailed guide on interpreting IVF pregnancy rates at different fertility centers, please refer to our explanation of IVF success rates.
Schedule an Appointment or Get a Second Opinion
There are conflicting treatment approaches for women trying to get pregnant after 40. It can be difficult to figure out what you want or whether your current treatment path is right for you. CHR's physicians can help you at different points of your decision-making process. Fill out the form below to receive more information, or if you are looking for a second opinion consultation online, take advantage of our extensive second-opinion program that provides assessments and treatment proposals from three of the world's leading experts in ovarian aging.
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Written by Norbert Gleicher, MD
Last Updated: November 21, 2013