Getting Older, Getting Pregnant

As women age, egg quantity and quality decline, making conception more difficult. Although a natural pregnancy after 40 is still possible, some women will require fertility treatment to get pregnant. In vitro fertilization (IVF), often considered the gold standard of assisted reproductive technology (ART), can help women of advanced maternal age (AMA) have a healthy baby.

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The science of aging

As most women are well aware, fertility declines with age, decreasing gradually at age 32 and more rapidly after age 37 and beyond. The average woman is born with 6-7 million eggs. That number drops significantly to 300,000-500,000 eggs at puberty, 25,000 eggs at age 37, and just 1,000 eggs remain at age 51, when menopause typically occurs. In addition to a decrease in quantity, egg quality also declines with age, leading to an increased risk of chromosomal abnormalities and miscarriage.

What is IVF?

Various fertility treatments are available. Depending on the woman’s age and any underlying fertility problems, different approaches may be recommended. With traditional IVF, the woman is given hormone medication to stimulate egg growth. Once the eggs reach the optimal size, an egg retrieval is scheduled. The eggs can then be frozen for future use or combined with sperm to create an embryo. That embryo is then transferred into the uterus in hopes of implantation. Different add-on services, such as intracytoplasmic sperm injection (ICSI) and pre-implantation genetic testing (PGD), can further boost the chances of success.

Assessing fertility

Women over the age of 40 often have a limited number of eggs and a shorter timeline in which to achieve a pregnancy. For these reasons, success matters. The fertility doctor should conduct a thorough evaluation using blood work and ultrasound before recommending a specific fertility treatment. Blood work can evaluate follicle-stimulant hormone (FSH), luteinizing hormone (LH), and progesterone levels. Blood work can also typically rule out any vitamin deficiencies or thyroid problems. An ultrasound can help evaluate the ovaries and uterus for any abnormalities. Sometimes, ultrasound can also be used to assess ovarian reserve.

Which approach is best for AMA?

Women over 40 just starting a fertility journey may be advised to continue trying naturally if initial bloodwork and ultrasound results come back normal. If hormone levels are off or egg quantity is low, fertility interventions will likely be recommended. The good news is that for women over 40 who decide to pursue IVF, a baby is still possible. Recent estimates show that women aged 41-42 have an overall success rate of 9.2% when using personal eggs. If donor eggs are used, the chance of a baby is even higher. With IVF, the 40s remain a great time to get pregnant.