Fertility Treatments after the Age of 40: Is the “Biological Clock Really Ticking?

Fertility Treatments after the Age of 40:  Is the “Biological Clock Really Ticking?”

In the last year a group of national and international experts in women's health and mental health gathered together to write an educational book that is scheduled to be published in March, 2014. The book title: “Women’s Reproductive Mental Health across the Lifespan” discusses the women's reproductive years from birth until menopause from a psychological as well as medical perspective. The book addresses the physiological /medical aspects that women face throughout their reproductive lives. The book discusses issues such as the adolescence period, eating disorders, pregnancy and postpartum depression.

When discussing fertility treatments after the age of 40, one of the biggest and controversial issues are whether there are any specific fertility treatments that work better in women of  older reproductive age. One of the biggest limitations to fertility treatments as women get older are the decreased number of eggs as well as the decrease in the quality of the eggs http://www.center4fertility.com/video/player/51126-ovarian-reserve-test. There is also a significant increase in genetic abnormalities within the eggs. In fact after age 40 more than 80% of the eggs/ embryos are not genetically normal which is the main reason for the low pregnancy rate and the high risk of miscarriage in women after the age of 40

What are the most efficient fertility treatments for women after the age of 40?

·         Clomid: Clomid http://www.center4fertility.com/other-services/ovulation-induction is an ovulatory induction agent that is used mainly in women who do not ovulate regularly due to hormonal imbalance especially in conditions such as Polycystic ovarian syndrome (PCOS). As women get older their cycles also become more irregular, but mainly due to a decreased number of eggs and not due to hormonal imbalance such as in women with PCOS. Clomid is a very non efficient treatment for women after the age of 40 with a success rate of less than 10%.

·          Controlled ovarian hyperstimulation (COH) –  COH is a fertility treatment in which we stimulate the ovaries to grow more than one follicle with the use of hormones.  The result is the release of more than one egg that can be fertilized by the sperm. This COH treatment is usually combined with the use of an intrauterine insemination (IUI) http://www.center4fertility.com/other-services/intrauterine-insemination.  The success rate of this cycle after age 40 is very low due to the fact that the cycle only increases the number of eggs that are ovulated, but does not address many obstacles to fertility that happen as women age such as the successful fertilization of the egg, the migration of the embryo to  the uterus etc.

·         In Vitro Fertilization (IVF) http://www.center4fertility.com/in-vitro-fertilization– during the IVF treatment, the ovaries are stimulated to grow multiple eggs. The eggs are then retrieved transvaginally and fertilized with sperm. The resulted embryo/embryos are then transferred transvaginally back to the uterus.  The embryos can also be examined for chromosome abnormalities with the use of  preimplanattion genetic screening (PGS) http://www.center4fertility.com/gender-selection  technology so  only “normal/healthy” embryos can be transferred back to the uterus. There are many different types of IVF protocols such as “traditional IVF”  or Natural or mini IVF http://www.center4fertility.com/in-vitro-fertilization/mini-natural. The IVF protocol needs to be tailored to the patient's underlying diagnosis and condition. While IVF should not be used as a treatment of choice for all women after age 40, it is one of the most efficient treatments for women after the age of 40. It is important to point out that even treatment such as IVF can have a very low success rate once women reach a specific age in which other treatments such as the use of an egg donor http://www.center4fertility.com/egg-donationmight be more suitable.

If you have more questions or would like more information on the best fertility treatments after the age of 40, please contact the center for fertility and Gynecology at paula@center4fertility.com