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Getting Pregnant After 40

How to get pregnant over 40? World-renowned ovarian aging expert Dr. Norbert Gleicher discusses the relationship between FSH levels and age, and how this affects a women’s ability to become pregnant after 40.

A large majority of new patients who we see come to CHR from all over the world because they were turned away by colleagues, for High FSH or other reasons. FSH increases as women get older and therefore to assume that what represents a normal FSH level for young women, let’s say for a 21-year-old, is the same as what represents a normal FSH level for a 43-year-old, simply does not make sense. Yet that is how medicine and our specialty has been proceeding for the last 30 years. When you have a universal cut-off and you say FSH up to 10 is normal for everybody, that is basically what you’re saying and we, a few years ago, established what we call “age-specific FSH levels” and we therefore, today in our practice, use those to determine whether a woman has normal ovarian reserve or not. There is no one level of FSH where pregnancy becomes impossible, it all depends how old the patient is. The younger the patient the higher FSH levels will she tolerate, in other words the younger the patient, the better our chances will be to still achieve pregnancy with use of a woman’s own eggs even if her FSH is high. Therefore if a woman in her 20s has an FSH in the 20s, not great, but she still likely will end up conceiving, at least at CHR, with our treatment approach. The same high FSH level in a 43 or 44-year-old is much more ominous, therefore what represents a maximum FSH level is relative depending on the age and other surrounding factors. Approximately one-third of women who come to us, because they were told that their only chance of pregnancy is through donor eggs, leave us pregnant with use of their own eggs. A minority but still quite a significant portion of patients with very very poor ovarian reserve and usually quite high FSH, with appropriate treatment at CHR, will still have a very decent pregnancy chance. That obviously leaves approximately two-thirds who will end up needing donor eggs but for that one-third it makes one hell of