Successful IVF after 40 years: what the outcome depends on

With age, reproductive function in women decreases. The reason for this is a progressive decline in ovarian reserve. Starting from 32-35 years old, the quantity and quality deteriorate, and the number of viable eggs decreases. As women age, the likelihood of conceiving a child naturally decreases. On the other hand, the chances of achieving positive results with IVF after 40 are quite high. We will discuss the factors that influence success and how to prepare properly for achieving a pregnancy.

Characteristics of IVF in Women Over 40

The doctor will recommend the most suitable technique for the couple in cases where infertility is identified and cannot be treated by other means. For healthy partners over 40, IVF may also be indicated to perform preimplantation genetic diagnosis of embryos. This analysis identifies potential genetic and chromosomal pathologies and helps minimize the risk of a child developing Down syndrome and other disorders. For patients over 40, the doctor takes the following factors into account: 

• The decreased effectiveness of hormonal stimulation, which is performed to mature a larger number of viable eggs 
   
• The reduced number of healthy embryos obtained that are suitable for transfer to the uterus 
   
• The higher probability of using the ICSI procedure for successful fertilization of the egg 
   
• Possible difficulties with embryo implantation.

What Do the Statistics Say?

The chances of becoming pregnant on one's own in the month following regular unprotected intercourse vary depending on the woman’s age: the highest probability of conception success was recorded 

• in girls aged 20, at about 25 %; 
   
• between 30 and 35 years old, this figure drops to 15 %; 
   
• at 40 years and older, the probability is about 5 %. 
   

For women aged 38 to 40, the probability of a successful pregnancy after using assisted reproductive techniques (ART) is about 22 %, at 42 years, the value decreases to 12 %, after 42 years between  3-4 % and at 44 years less than 2%.
It is also important to remember for patients considering conception that with age, the risks of developing chromosomal abnormalities in the embryo increase. In women under 30, about 30 % of eggs have chromosomal abnormalities, at 40 years, this is about 60 % and at 44 years up to 90 %.

IVF After 40 with Your Own Eggs

The doctor selects the best ART technique for the patient, taking into account her health status and other factors. One of the protocols using the patient's own oocyte may be prescribed: IVF with stimulation. To obtain a high number of eggs in a single cycle, the doctor prescribes a course of hormonal medications; IVF in a natural cycle after 40 years is used if hormonal medication is contraindicated or in cases where stimulation does not yield the desired result; IVF with Oocyte Maturation involves collecting immature oocytes from the ovarian follicle and maturing them outside the woman's body, subsequent fertilization using the ICSI method and transferring the selected embryo according to a natural cycle; IVF using the patient's own cryopreserved oocytes. For example, if the patient plans to cryopreserve her eggs before age 35 in anticipation of a later pregnancy.
 

IVF with Egg Donation

This solution is recommended for women with a low ovarian reserve, lack of ovulation, and high risks of developing genetic or chromosomal disorders. Using a donor's egg allows for successful results even above 45 years old. The course of the procedure depends on the chosen option: Either the transfer of a previously frozen donor egg; Or the recovery of a fresh oocyte, which requires synchronization of the donor and recipient cycles. A few days before the planned transfer, the woman will be prescribed hormonal treatment to stimulate the thickening of the endometrium to increase the chances of implantation.

Why Doesn't the Embryo Implant During IVF?

In some cases, several cycles may be necessary to achieve a successful pregnancy. A negative result after IVF may be due to the transfer of embryos of unsatisfactory quality. To avoid this, it is advisable for patients over 40 to rely not only on a visual examination of the development of fertilized oocytes but also to plan for PGT (Preimplantation Genetic Testing). The result can also be negative in the case of insufficient endometrial thickness. A reproductive specialist monitors the growth of cells in the inner layer of the uterus and prescribes hormonal medications that help thicken it to the desired size. It is also possible to postpone the transfer to be within the optimal implantation window, especially during irregular cycles. An experienced doctor will discover the patient's characteristics and individually calculate an appropriate date. Another cause of failure is the presence of a too-dense protein membrane of the embryo. For successful implantation in the uterus, the blastocyst must shed its protective layer. To assist the embryo, the doctor will perform a hatching procedure by making small incisions in the membrane before transferring the blastocyst to the uterus. Endocrine problems, immunological disorders, and inflammatory processes in female reproductive organs are also negative factors for successful implantation. It is important to undergo a complete examination before IVF to exclude such factors.

How to Increase Your Chances of Success

If, when trying to conceive on their own at 35, the diagnosis of infertility is established only after six months of unsuccessful attempts at natural conception, it is advisable for women over 40 to seek advice from a gynecologist or reproductive specialist immediately. And if during the examination the doctor reveals indications for IVF, it is important to start preparations as soon as possible. It is necessary to normalize sleep, nutrition, physical activity, and stop consuming alcohol and smoking. Obesity can become an obstacle to the success of IVF, so a woman should normalize her weight. It is also important to ensure the prompt treatment of detected diseases and to follow the recommendations of a reproductive specialist regarding taking certain medications. The cryopreservation of oocytes performed by a woman before the age of 35 can increase her chances of conception in a later pregnancy.