Navigating IVF: A Comprehensive Guide for Patients Over 38

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A Comprehensive Guide for IVF and Patients Over 38Navigating fertility and motherhood beyond the age of 38 presents a complicated situation composed of biological, emotional, and practical considerations. With advancing age comes a decline in ovarian reserve and egg quality, heightening the challenge of conception both naturally and through assisted reproductive technologies like IVF. These fertility issues are followed by an increased risk of pregnancy complications. In the realm of fertility treatment, older patients may require tailored approaches such as different ovarian stimulation protocols and preimplantation genetic testing to optimize outcomes.

In this comprehensive interview with Dr. Ruth Sánchez from the Fertility Clinic UR Vistahermosa, we try to give you interesting insights into key aspects of IVF tailored specifically to address the unique challenges and considerations faced by patients over 38.

Dr. Ruth Sánchez - UR VIstahermosa

Dr. Ruth Sánchez – UR VIstahermosa

What are the success rates of IVF with own eggs for patients over 38

How do the success rates compare to younger age groups?

The success rates of in vitro fertilization (IVF) with a woman’s own eggs generally decline with age due to factors such as decreased ovarian reserve and egg quality. For patients over 38 years old, the success rates of IVF with their own eggs tend to be lower compared to younger age groups.

Exact success rates can vary depending on factors such as the individual’s health, fertility history, and the specific clinic and treatment protocols used. However, as a general guideline, the pregnancy rates per IVF cycle published by the SEF (Spanish Fertility Society) generally fall into the following age categories:

  • Under 35 years: Pregnancy rates per IVF cycle tend to be higher in this age group, with a probability of success that can exceed 40-50% per cycle, depending on various factors.
  • 35 to 39 years: In this age group, pregnancy rates per IVF cycle generally decrease compared to younger women. The probability of success per cycle can be between 30-40%.
  • From 40 to 42 years: Pregnancy rates per IVF cycle decrease significantly in this age group. The probability of success per cycle may be lower, around 10-20%.

How does age affect egg quality and quantity?

Age has a significant impact on both the quality and quantity of a woman’s eggs.

  • Quantity (Ovarian Reserve): Women are born with a finite number of eggs, and this number declines over time. This decline accelerates as a woman reaches her late 30s and early 40s. This diminishing ovarian reserve is a natural part of aging and is influenced by genetic factors. As the number of eggs decreases, fertility declines, and the chances of conceiving naturally or through assisted reproductive technologies like IVF decrease.
  • Quality: Egg quality also declines with age. This decline in quality is primarily due to changes in the genetic material within the egg (chromosomes). Older eggs are more likely to have chromosomal abnormalities, which can lead to failed fertilization, miscarriage, or genetic conditions like Down syndrome in offspring. Additionally, older eggs may have compromised mitochondrial function, which can affect their ability to support embryo development.

Overall, age is a critical factor in female fertility, and women are most fertile in their 20s and early 30s. As women age, their reproductive potential decreases, and the risks of infertility, miscarriage, and chromosomal abnormalities in offspring increase. While advancements in reproductive medicine can help overcome some age-related fertility challenges, age remains one of the most important factors influencing a woman’s reproductive health.

Are there any additional IVF techniques or protocols that may increase the outcome for patients aged 38 and older?

For patients aged 38 and older undergoing IVF, there are several additional techniques or protocols that fertility specialists may consider to potentially increase the chances of a successful outcome. These techniques are often tailored to address the specific challenges associated with advanced maternal age. Some of these techniques include:

  • Preimplantation Genetic Testing (PGT): Preimplantation genetic testing for aneuploidy (PGT-A), formerly known as preimplantation genetic screening (PGS), involves analyzing embryos for chromosomal abnormalities before transfer. This can help identify chromosomally normal embryos, potentially increasing the chances of implantation and reducing the risk of miscarriage, which is particularly relevant for older patients who have a higher likelihood of producing chromosomally abnormal embryos.
  • Extended Embryo Culture: Extended embryo culture involves culturing embryos in the laboratory for a longer duration before transfer, typically to the blastocyst stage (around day 5 or 6). This allows embryologists to select the embryos with the highest developmental potential for transfer, which may increase the chances of implantation.
  • Time lapse incubators: The main advantage of Time-Lapse systems is that they allow the complete embryonic development to be analysed using videos, without removing them from the incubator. In this way, laboratory staff can select the embryos most likely to implant and give birth without altering their culture conditions.
  • Individualized ovarian stimulation protocols: for example, mild ovarian stimulation which involves using lower doses of medications. This approach may be gentler on the ovaries and may be preferable for some older patients.
  • Ovarian rejuvenation: consists of the administration of a small volume of enriched plasma into each ovary, in a procedure similar to that of an oocyte puncture. This technology is based on the principles of Regenerative Medicine, whose objective is to restore “the biological environment” and increase the number of mature eggs.
  • Use of Donor Eggs: For patients with significantly diminished ovarian reserve or poor egg quality due to advanced age, using donor eggs from a younger, healthier donor offers higher success rates compared to using the patient’s own eggs.

There are discussions regarding the PGT-A for older patients. What is your approach to using a PGT-A as one of the options for patients aged 38 and older?

When considering the use of preimplantation genetic testing for aneuploidy (PGT-A) for patients aged 38 and older undergoing IVF, it’s essential to approach the decision with careful consideration of various factors, including the patient’s reproductive history, preferences, and potential risks and benefits.

It is important to evaluate the patient’s individual circumstances, including their age, ovarian reserve, previous fertility treatments, and any known genetic or chromosomal concerns. We have to discuss with the patient the potential benefits and limitations of PGT-A in the context of the patient’s age and ovarian reserve. Emphasize that while PGT-A may increase the chances of selecting chromosomally normal embryos and the pregnancy rates, it does not guarantee pregnancy success. Additionally, PGT-A adds cost and complexity to the IVF process.

How does IVF treatment protocol differ for patients over 38 compared to younger patients?

Older patients may require a more aggressive ovarian stimulation protocol to stimulate the ovaries to produce a sufficient number of mature eggs. This may involve higher doses of fertility medications or different medication combinations compared to younger patients. However, some older patients may benefit from mild ovarian stimulation protocols to minimize the risk of ovarian hyperstimulation syndrome (OHSS) and to improve egg quality.

Given the higher likelihood of chromosomal abnormalities in embryos from older patients, preimplantation genetic testing for aneuploidy (PGT-A) may be recommended to screen embryos for chromosomal abnormalities before transfer.

Are there any additional or specific tests recommended for patients over 38 before starting IVF treatment?

The tests requested for women over 38 years of age do not differ from those requested for younger women. It is important to study ovarian reserve and other hormones such as thyroid hormones and vitamin D.

In addition to the basic ultrasound, viral serology, and karyotype tests, we recommend performing a genetic test called a recessive illnesses carrier test to find out if you are a carrier of any genetic disorder such as cystic fibrosis, thalassemia or fragile X syndrome that could be transmitted to your offspring.

How many cycles of IVF are typically recommended for patients over 38, and what factors influence this decision?

It can vary depending on several factors, including the patient’s individual circumstances, treatment response, and reproductive history. While there’s no set limit on the number of IVF cycles a patient can undergo, fertility specialists typically aim to balance the chances of success with the patient’s physical, emotional, and financial well-being.

There are some factors that influence the decision regarding the number of IVF cycles recommended for patients over 38 which are: ovarian reserve, egg quality, the reproductive history, the response to treatment and, of course, we should also consider financial and emotional factors.

Should I consider using donor eggs if I am over 38?

Deciding whether to use donor eggs is a highly personal and complex decision for anyone, especially for those over 38 considering IVF treatment. This decision should be made following the specialist’s recommendations regarding the possibility of pregnancy with your own eggs. If chances are very low, egg donation is a good alternative.

What are the success rates of using donor eggs for older women undergoing IVF?

The success rates of using donor eggs for older women undergoing IVF tend to be higher compared to using their own eggs, primarily because donor eggs come from younger individuals with better ovarian reserve and egg quality. While success rates can vary depending on various factors, including the age of the recipient and the quality of the sperm used, using donor eggs generally offers older women a higher likelihood of achieving a successful pregnancy and live birth.

The pregnancy rates per embryo transfer using donor eggs for women over 38 can be quite high, often exceeding 60% per embryo transfer.

What are the risks associated with IVF for older patients – 38 plus?

For older patients (aged 38 and above), undergoing IVF treatment carries certain risks and challenges, primarily due to age-related factors affecting fertility and pregnancy outcomes.
Due to the decrease of the ovarian reserve, this can result in fewer eggs retrieved during IVF cycles, lower fertilization rates, and reduced chances of embryo implantation.

Due to Lower Egg Quality: Older women are more likely to produce eggs with chromosomal abnormalities, which can result in failed fertilization, embryo implantation failure, miscarriage, or genetic conditions such as Down syndrome in offspring. All this translates into reduced IVF Success Rates.

Advanced maternal age is also associated with an increased risk of pregnancy complications, such as gestational diabetes, pregnancy-induced hypertension (preeclampsia), placental abnormalities, and cesarean section delivery.

Should I consider a tandem IVF cycle (own eggs plus donor eggs) if I am 38 or older?

If you have possibilities with your own eggs you should try first a cycle with them, and choose the cycle with donor eggs if there is no possibility to use your own eggs.

How many patients aged 38 or older are treated at your clinic? What type of treatment is usually chosen by them?

We do not have these statistics, as we treat each case individually and personalize strategies, protocols and recommendations. As already commented, especially for women over 35, it is important to study all factors before giving recommendations and establishing a treatment plan.

Can you see the increasing demand for IVF treatment in patients aged 38 or older? What is the reason?

Yes, the percentage of women who come to our center over 38 years of age is growing due to the delay in motherhood, the development of assisted reproduction techniques and egg donation programs.

What is the maximum age of patients treated at your clinic?

In Spain there is no established legal limit to carry out assisted reproduction treatments. However, the SEF (Spanish Fertility Society) recommends taking the average age of menopause (loss of fertility) in Spain as a limit for fertility treatments which is 51 years, so this is the limit that we set.

In conclusion, becoming a mother at the age of 38 or older can be challenging and requires special treatments, tailored to each patient’s needs. We hope that this interview gave you some necessary insights and answers to frequent questions on this topic.