Fertility for the Over-40s: Understanding your individual chance of success
We were disappointed to read in the press earlier this week that there were concerns about women over 40 being exploited by the IVF industry. The LWC’s Fertility for the Over-40s programme has been running successfully at our LWC London Bridge clinic for over five years and has proved increasingly popular. This is a trend that has been seen across the country with figures released by the ONS in the last fortnight showing that conception rates in women over 40 are increasing and have more than doubled since 1990.
As part of our dedicated programme for women over 40 we offer a number of treatment options including IVF Lite, IVF with Preimplantation Genetic Testing for Aneuploidy (PGT-A) and egg donation which, depending on the patient’s age and individual medical history, can be discussed with a fertility specialist to provide the best chance of having a baby. The clinic also offers specialist pregnancy care to patients over 40 to monitor and care for the pregnancy throughout its early stages especially for women of an older maternal age when the obstetric risks may be greater.
We spoke to Professor Nick Macklon, Medical Director of the LWC to understand why fertility declines and to learn more about the treatment options available to women over 40.
Fertility for the Over-40s
Women are increasingly delaying having children so more and more are seeking fertility treatment later in life and in to their forties. Unfortunately, over 40, their chances of conceiving are lower than if they had tried for a baby in their twenties or thirties. Women are born with a fixed number of eggs and eventually this store of eggs runs down as they approach the menopause. As well as a woman’s number of eggs declining as they age, the quality of the eggs also decreases. This leads to an increased amount of chromosomal abnormalities in the eggs which in turn can increase the risk of miscarriage and babies born with genetic conditions (such as Down syndrome).
“The key aspect for any fertility patient over 40 years old is to make sure they are fully informed of their individual chance of success from the treatment options available to them.” says Professor Macklon. “It is important that the patient has a detailed conversation with a fertility specialist to discuss their individual circumstances before starting any treatment.” To understand a woman’s fertility better, a fertility health check may be suggested including hormone tests and a pelvic ultrasound scan to assess the womb and ovaries. However, unfortunately there is no test to assess the quality of eggs and the age of the female patient will determine her likely chance of any treatment working.
Studies have shown that women react differently to their ovaries being stimulated. For women over 35, and especially those over 40, the number of eggs collected for IVF may be fewer and the quality lower. IVF Lite uses a lower dose of medication than standard IVF meaning that nature can determine which eggs reach maturity. With less exposure to high levels of hormones, the quality of the eggs collected may be higher and the womb will have a more natural environment ready for an embryo to implant.
Results from our IVF Lite programme in Wales show success rates of up to 35% for women between the ages of 39-43. Due to the lower levels of stimulation in IVF Lite, less eggs are collected and therefore less embryos created. Patients should plan to undertake a number of IVF cycles and consider a cumulative chance of success.
IVF with Pre-implantation Genetic Testing for Aneuploidy (PGT-A)
Many IVF cycles fail because the embryos are genetically abnormal (chromosomally unbalanced). An abnormal number of chromosomes (aneuploidy) means that embryos are unable to implant or develop into a healthy pregnany or live birth. Studies have found that as the age of the female patient increases, the greater the number of chromosome abnormalities in their eggs and resulting embryos.
“PGT-A helps the embryology team to select embryos that have the best chance of implanting.” says Professor Macklon, “It can benefit women over 40 provided that there are enough embryos to choose from. If there is only one embryo created, then PGT-A can have limited value.” Following IVF, day 5 embryos (blastocysts) are biopsied and the cells sent to a laboratory to be genetically tested. Any embryos that are found to be “normal” can then be transferred in a later frozen embryo transfer one at a time.
The LWC’s IVF Select programme has seen high success rates (up to 60%) for women over 40 who use PGT-A as a method of embryo selection. However, the number of patients is small, and the success rates are based on patients who have a normal (“euploid”) embryo to transfer.
“Increasingly donor eggs are becoming a more effective way of overcoming age-related infertility.” says Professor Macklon. Technology in the IVF laboratory has improved which means that donor eggs can now be successfully frozen using the fast-freezing method of vitrification and then thawed when patients need them. Donor eggs via our partner clinic the London Egg Bank are donated by women who are under 35 which means that the chances of success are high. Frozen donor eggs from a large variety of donors are available via the London Egg Bank’s online catalogue without a wait.
For women over 40, and particularly women over 43 who will have limited success with their own eggs, IVF treatment with donor eggs can increase their chance of success up to 50-60%.
For more information about the LWC’s Fertility for the Over-40s programme, please come along to one of our regular free open days. If you are interested in finding out more about your own fertility to understand your individual chance of success, please contact us to arrange to meet a fertility specialist.