IVF for Women Over 40: Fertility Treatment Options

The IVF success rate depends on the age of the woman and the cause of infertility. The success rate reaches 70% for every embryo transfer attempt in women younger than 35 years. In vitro fertilization leads to a live-birth in 90% of cases if the couple does not give up.

All recent studies show that a woman can get back to her normal life directly after transfer. She can climb stairs, kneel to catch things from the floor, drive for a long distance, take a shower, sleep in any position, catch a flight…

This is the question that no IVF specialist can answer. If we knew the cause that will lead to failure, we would have solved it before transferring the embryos. We can only make assumptions about the causes. Embryo implantation in the uterus is a very complex process and multiple factors are involved. We can monitor and control all the factors we know about, like endometrial thickness, the timing of transfer and the absence of uterine problems. Other factors like immunity are known to play a role but cannot be controlled. The majority of factors remain unknown. Whether we like it or not, we always do our best but the final outcome is in God’s hands.

IVF is a multiple step procedure. The first step, ovarian stimulation, consists in daily hormonal injections for a period that varies between 8 and 12 days. Of course injections are burdensome, but some people require taking injections daily all their life so few days of injections are not a huge deal. The second step is oocyte pick up. It is performed under sedation and it is a painless procedure. The pain after the procedure is similar to regular period pain. The last step is embryo transfer, that takes less than a minute and that does not require any sedation as it is similar to any gynecological check up.

The urine pregnancy test cannot detect pregnancy very early. The pregnancy hormone, bhcg, appears in the blood before it appears in the urine. Blood test needs at least 12 days post-transfer to detect pregnancy. So there is no point in doing a home pregnancy test before that.

Definitely not! And this is a general misconception! Each day a different group of follicles starts growing in a woman’s ovaries. The recruitment of these follicles and their first phase of growth are independent from hormones. When these follicles reach a certain size, their growth becomes dependent on hormones. The biggest and strongest of these follicles starts “taking all the hormones” produced by the woman’s body and continues to grow alone while the other follicles do not have “enough hormones” and die. The injection of hormones used during ovarian stimulation saves these follicles from dying but does not lead to recruiting more oocytes from the ovaries.

Using ultrasound, the doctor can see the follicles and follow up on their growth. The follicles are not the eggs, they are the “bags” that contain the eggs and help them become competent. It is impossible to see the eggs by ultrasound. Some follicles are empty and that’s why there is very often a difference between the number of follicles seen by ultrasound and the number of oocytes retrieved during oocyte pick-up for IVF.

The goal of this step is to have a high number of eggs (more eggs = more embryos = more chances of having a baby). Each cycle, a woman generally ovulates only one egg. This egg can be of good or bad quality; it can get fertilized by the sperm or not; the embryo obtained can undergo normal early development or not; it can implant or not. Hence, when we undergo a burdensome IVF cycle, we stimulate the ovaries using hormonal injections in order to obtain the biggest number of eggs possible and have better chances in obtaining a good embryo that will lead to a pregnancy.

Thousands of clinical trials have been trying to answer this question. It is admitted that hormones that are injected during ovarian stimulation are not toxic and are unlikely to cause cancer. On the other hand it is strongly believed that hormones promote cancer in people that are suffering from it without knowing.