Deciding to start a family is an exciting yet highly personal decision. Many people delay trying to get pregnant until later in life. You may have decided to wait because of your career, life goals, relationship status, or simply because you weren't ready.
If you're over age 40 and want to get pregnant, you likely have questions about your chances of pregnancy. Fertility treatments, like in vitro fertilization (IVF), can help couples and individuals finally become parents. However, how do you know if you should use your own eggs or when to consider donor eggs?
In this article, we'll look at some challenges of getting pregnant after 40 and when to consider an egg donor.
The Challenges of Getting Pregnant After 40
Being over 40 doesn't mean you can't build the family you desire. However, fertility does decline with age. So, if you're struggling with infertility, you're not alone.
Statistics show that the odds of getting pregnant decrease significantly as time goes on. The chances of getting pregnant naturally each month for women over 40 are only about 5%. About 22% of all women struggle with infertility after age 35, and up to 29% by 40. Over 40, the likelihood of a successful pregnancy decreases every year, so it would make sense not to delay any attempts at conception and to pursue a fertility evaluation and treatment early on.
So why, exactly, does fertility decrease as time goes on? There are several reasons this occurs.
Uterine, Hormone, and Menstrual Changes
Issues like endometrial polyps and fibroids can increase with age, potentially contributing to infertility. Decreased ovarian sensitivity to certain hormones can also play a role, as well as changing hormone secretion levels.
Diminished Ovarian Reserve
However, the main reason women struggle more over age 40 with fertility is the natural decline in both egg number and egg quality. Every woman is born with a limited supply of oocytes (immature eggs), which she will have for her lifetime. Women typically have 1-2 million oocytes at birth. The amount of eggs decreases with age, falling from 500,000 by puberty to 25,000 around age 37.
Some women may experience a low egg count, also known as diminished ovarian reserve. While all women have some decline in fertility with age, for some, it happens sooner than for others. If there are a lower number of eggs in your ovarian reserve, it could decrease your odds of conceiving. However, your egg count is not the only factor in fertility.
How do you know if you have a low ovarian reserve? Usually, there are no symptoms other than having difficulty getting pregnant after trying for months or even years. Some people can experience irregular menstruation, hot flashes, and vaginal dryness. Low egg count can be caused mainly by aging but also by some cancer treatments or autoimmune disorders.
Egg Quality
The quality of your eggs also contributes to infertility. As a person ages, the eggs that are ovulated are more likely to be genetically abnormal, which of course, means that it will be more difficult to achieve pregnancy. Since the quality of your eggs is closely tied to how genetically normal they are, having a high number of abnormal eggs makes it harder, on average, to end up with a normal egg that can fertilize and end with the successful birth of a child. This is also why we see higher miscarriage rates as women age.
Despite these challenges, there are also effective ways to treat infertility and achieve pregnancy after 40.
Paths To Getting Pregnant After Age 40
At Advanced Fertility Care, we offer several fertility treatments to help you start a family.
Intrauterine Insemination
Intrauterine insemination (IUI) is a treatment where sperm are collected from either a donor or a partner, then isolated, washed, and concentrated. Then, they're placed into the uterus around the time of ovulation. Typically, our patients undergo treatment with fertility drugs in combination with IUI. This is meant to help bodies ovulate more than one egg each cycle, giving you more chances that month of getting pregnant. While IUIs have a lower success rate than in vitro fertilization, that does not mean IUI won't work for you even if you're over 40. For those at 40, IUI is considered to have about an 8-10% success rate compared to 15-20% success found with IVF.
In Vitro Fertilization
In vitro fertilization (IVF) is another method that involves fertilizing eggs with sperm in a laboratory, then transferring the best resultant embryo into the uterus using a thin tube. First, eggs are extracted from the ovaries, typically after taking fertility medications. The eggs are then isolated and fertilized in a laboratory, becoming embryos.
One of the real advantages of IVF is what is known as preimplantation genetic testing or PGT.
• With PGT, a few cells from the part of the embryo that eventually becomes the placenta are removed and sent for genetic (chromosome) testing.
• With PGT, we can identify which embryos have the right number of chromosomes and which ones have an abnormal number of chromosomes. If an embryo has an abnormal number of chromosomes, it won't result in a pregnancy, or if it does, it would be very likely to miscarry.
• PGT also helps us identify embryos with an abnormal number of chromosomes that can result in a live birth. The one everyone is aware of is Down Syndrome. This type of thing is seen more often in women over 40.
Suppose we can identify an embryo that is chromosomally normal with PGT. In that case, your success rates can be as high as 70% when you have your embryo transfer, and you have to worry less about things like Down Syndrome during pregnancy. Success rates aren't 70% for everyone with IVF because many patients will do the IVF but won't end up with any normal embryos.
IVF can have excellent success rates. However, the success of IVF often depends on factors such as egg quality and your response to ovarian stimulating medications. So how do you know when to consider using donor eggs instead of your own?
When Should You Consider Donor Eggs?
It's entirely possible to get pregnant using your own eggs over 40. Yet, for some people, there seems to be an egg quality or quantity issue that we can't overcome. This is especially true for women over age 43 or 44. Donor eggs in this situation could greatly increase the chances of getting pregnant through IVF.
It may be worth considering using an egg donor, especially if you have a diminished ovarian reserve or demonstrated poor egg quality. Ovarian reserve testing is one way to estimate whether your ovaries match your age which would give us a good indication of how you might respond to fertility treatment. Some testing results might indicate that it is unlikely that fertility treatment will increase the chances of you getting pregnant using your own eggs.
At Advanced Fertility Care, we offer an in-house Donor Egg program which provides those in need of an egg donor a variety of high-quality egg donors available for matching. Preview our available egg donors here.
Ovarian Reserve Testing
Ovarian reserve testing can help determine how many eggs you may have left. Screening for diminished ovarian reserve can tell you whether the ovarian stimulation medications used in IVF treatments might work for you. A low egg count could mean your ovaries won't respond as well to these treatments, decreasing your chances of pregnancy.
Ovarian reserve testing can also help guide your decision to undergo fertility treatments, as it may suggest how likely you'd be to get pregnant without some kind of fertility treatment.
To test your ovarian reserve, your provider performs blood tests to assess your levels of certain hormones. Your provider may also perform a vaginal ultrasound to look at your ovaries and count the number of follicles you have. The number of follicles you have in your ovaries at the beginning of a menstrual cycle represents the number of eggs that are available to your body for fertility treatments. The higher the follicle count, the more eggs we have to work with.
While ovarian reserve testing doesn't definitively say whether or not you'll be able to conceive, it can help you decide if using an egg donor may be a better option than pursuing an IVF cycle with your own eggs. If the tests reveal a diminished ovarian reserve, you may consider using a donor to increase your chances of getting pregnant through IVF.
Advanced Fertility Care is Here to Support Your Fertility Journey
No matter your situation, our caring and professional team at Advanced Fertility Care is here to support you in getting pregnant. We offer IUI, IVF, a donor egg program, and more at several locations. Building a family is within reach, even if you're over 40.
To learn more or to schedule a consultation, contact us today.
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