Each day at CHR, we meet women over 40 who want to get pregnant but fear their time to have a baby has come and gone. Fortunately, we’re able to tell them that modern infertility treatment has pushed back the age at which having a baby is possible, and a good number of these women can and will become pregnant.
But couples can take advantage of these medical advances only if they start pursuing timely treatment tailored to their age. Too often, we meet women over 40 who have undergone fertility treatments like LI-IVF, PGS, and IUI — treatments which only waste valuable time for women out of their thirties. And in fertility treatment, time is everything.
Three Treatments NOT to Try
1. Low-intensity IVF (“LI-IVF” or “mini-IVF”)
CHR considers all women over 40 to have diminished ovarian reserve (DOR) — that is, their ability to produce good-quality eggs is low, and this ability only declines with age. Compared to younger women, women above 40 produce eggs that are fewer in number and poorer in quality. For this reason, many infertility treatments that are effective for younger patients can be detrimental to older women because they waste a great deal of time and have low success rates. LI-IVF is one of them.
LI-IVF uses lower doses of medications (for ovarian stimulation, for instance) and aims for a smaller number of eggs than standard IVF. Because this approach limits medication usage and minimizes the cost of medications and monitoring, it was once greeted with enthusiasm as a lower-cost alternative to standard IVF.
Digging deeper, though, research by CHR and others has found that since LI-IVF yields fewer eggs, fewer embryos become available for implantation, and rarely are any left over to freeze for use in future cycles. For a woman over 40, this is disastrous: not only is there the distinct possibility that multiple cycles will be required (thus negating the cost savings), the procedure wastes precious time at a point when a woman's ovarian reserve is low and getting lower.
2. Preimplantation genetic screening ("PGS")
PGS, which screens embryos for chromosomal abnormalities prior to implantation, is another treatment unadvisable for older women. Again, women with few embryos must value each one highly. The limiting of embryos through screening, combined with the damage caused (however minimal) by manipulating an embryo as part of a diagnostic biopsy, will reduce pregnancy chances in women with diminished ovarian reserve.
3. Intrauterine Insemination (“IUI,” or “artificial insemination”)
IUI is ineffective in women over 40 for a different reason. IUI may direct sperm in the right direction, but as a woman gets older, the availability and the quality of her eggs decreases, making the likelihood of the sperm creating a successful conception low.
The Most Effective Treatment for Women over 40: DHEA and IVF
Whereas IUI is ineffective because of poor egg quality, and mini-IVF is ineffective because of low egg yield, a treatment of “standard” IVF (which yields a greater number of eggs) combined with DHEA supplementation (which improves the quality and quantity of eggs) has been found to significantly improve pregnancy chances for women over 40.
The CHR spearheaded research into DHEA’s use in fertility treatment, which has proved to be remarkably effective and is now used by over a third of IVF centers worldwide. The basic science behind DHEA supplementation is straightforward: research has shown that eggs that have not yet undergone the maturation process (are in "storage," if you will) do not age. It is only when those eggs mature in an aged ovarian environment that their quality diminishes. Since DHEA is a key ingredient in producing an ideal ovarian environment, supplementing standard IVF with DHEA is the ideal way to achieve pregnancy after 40.
If you are over the age of 40 and have been advised to undergo one of the treatments listed above, we encourage you to seek out a second opinion from a reputable fertility clinic.
For more information about getting pregnant over 40 please visit CHR's website www.centerforhumanreprod.com/pregnancy_over_40.html or FOLLOW them on Twitter at @infertilityNY