IVF after 40: how to get pregnant the first time

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A woman’s age is one of the key factors influencing the likelihood and successful course of pregnancy. Over time, female reproductive function fades, and errors accumulate in the genetic code of germ cells. Because of this, the likelihood of successfully becoming pregnant and bearing a healthy child is greatly reduced. This applies to both natural pregnancy and artificial insemination. Is it worth doing IVF after 40 years and what are the real chances of becoming a happy mother at this age? Although the effectiveness of reproductive technologies is individual for each woman, there are still some general principles by which they work. This means that we can at least roughly determine how advisable it is to carry out in vitro fertilization after 40 years.

Is it possible to give birth after 40 with IVF?

World statistics show that approximately 40% of women under the age of 35 become pregnant at the first attempt at in vitro fertilization; between 35 and 40 years, this figure drops to 20-30%, and after 40 years, successful IVF occurs only in 5-12% of cases. There are quite a lot of cases of successful conception, pregnancy and birth using IVF by women over 50 years of age. However, in the vast majority of cases, their fertilization was carried out using donor eggs.

The influence of age on women's fertility consists of the following factors:

Depletion of ovarian reserve. Each woman has a limited resource of germ cells in the ovaries, from which fertile eggs mature. This reserve is gradually depleted due to monthly ovulation, which occurs even if she does not have sexual intercourse. The ovarian resource is also affected by the lifestyle a woman leads, her exposure to various stress factors, etc.
Hormonal changes. With age, the functioning of the female endocrine system also changes, including the glands that produce sex hormones. Because of this, the function of the ovaries gradually fades away, and the uterus over time becomes less adapted to implantation and bearing a child. Even with successful conception and implantation of the embryo, the likelihood of a successful pregnancy decreases - it often ends in spontaneous abortion or fading.
Accumulation of genetic errors. Over time, chromosomal errors accumulate in germ cells. As a result, eggs in women over 40 years of age either become unsuitable for fertilization or increase the likelihood of genetic abnormalities in the fetus.

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Due to these natural limitations inherent in female physiology, the use of IVF after 40 years of age is prohibited by law in many countries. In Russia there is no such ban - in fact, a woman of any age can undergo in vitro fertilization. However, the doctor himself has the right to decide whether it makes sense to use this expensive technology in each specific case, having assessed the patient’s real chances of successfully conceiving and bearing a child.

A decline in fertility may not only occur with age. Many young women experience problems with sexual function even before the age of 35. However, in this case it is worth talking about the influence of any diseases or external negative factors (stress, poor nutrition, etc.). At the same time, the decline of reproductive ability after 35 years is a physiological norm.

IVF after 40 years with a donor egg

Due to the fact that the main reason for unsuccessful IVF attempts after 40 years in the natural cycle is a decrease in the quality and quantity of fertile eggs, one of the main ways to overcome infertility at this age is the use of donor oocytes. In this case, three main conditions must be met:

There is fertile sperm from a spouse or male donor for fertilization;
The patient has no contraindications to the use of donor material;
There are suitable donor eggs available or a donor willing to share them.

It is necessary to understand that even the use of high-quality genetic material from a donor of reproductive age who does not have health problems does not provide a 100% guarantee of success at the first attempt of in vitro fertilization. The fact is that after 40 years, in a woman, the functions of not only the ovary, but also the entire reproductive system - the uterus, appendages, fallopian tubes, endocrine glands responsible for the production of sex hormones, etc., decline. Accordingly, even a healthy embryo may not take root. in the patient’s body, and even with successful implantation, the pregnancy may with a high probability be interrupted or freeze.

“Delayed” pregnancy as a method of combating infertility after 40 years

Another way to get pregnant at a late age without using donor genetic material is IVF after 40 years with your own egg, extracted from the patient during her fertile period and frozen for storage. This reproductive technology is often turned to by women who want to have a child in the future, after arranging their personal lives, careers, etc. In this case, in vitro fertilization is divided into two stages, widely separated in time:

Preparation of genetic material. At this stage, the patient undergoes a preliminary examination, then ovarian stimulation to obtain a large number of oocytes. The germ cells are frozen at ultra-low temperatures in liquid nitrogen and stored in a cryobank.
Fertilization. At this stage, the woman again undergoes a diagnostic examination to identify possible contraindications that have appeared in her during the time that has passed since receiving the germ cells. Her oocytes stored in a cryobank are thawed, examined for possible damage, and then fertilized with the sperm of a sexual partner or donor. The resulting embryos are transplanted into the expectant mother, who carries and gives birth to the child naturally.

The advantages of the “delayed motherhood” program over IVF using a donor egg are obvious. Firstly, the patient is not only the legal, but also the biological parent of the unborn child. Secondly, donating your oocytes to a cryobank is much easier and cheaper than finding a suitable donor. Modern cryopreservation technologies make it possible to preserve genetic material indefinitely without the risk of damage. The chances of IVF after 40 years with your own frozen egg are the same as when using “fresh” ones.

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Examinations for IVF after 40 years

Diagnosis plays an important role in ensuring the success of in vitro fertilization at this age. A patient over 35-40 years old undergoes a comprehensive medical examination, including standard procedures:

Blood tests - general, biochemical, for infections (HIV, syphilis, hepatitis), hormone levels, antibodies, etc.;
Urine tests - general and biochemical, for hormone levels (in particular, FSH and AMH);
Examination of a vaginal smear or cervical scraping for oncological cytology and microflora;
Ultrasound examination of the pelvic organs, EEG, cardiography, mammography.

In addition, a patient whose age has exceeded 35-40 years undergoes additional studies - in particular, preimplantation genetic diagnosis of oocytes or embryos to exclude or identify possible hereditary diseases. Based on the results of these examinations and the woman’s medical record, the doctor can prescribe other diagnostic procedures, as well as involve highly specialized specialists to solve possible problems.

In addition to the patient herself, her sexual partner/spouse is also examined. Due to the fact that germ cells are only extracted for fertilization, its diagnosis is much simpler and includes the following procedures;

blood tests - general, biochemical, for infections;
general and biochemical urine analysis;
spermogram (sperm quality test).

The last procedure is to study the fertile properties of the ejaculate - the number of sperm, their motility, morphological structure, etc. If the quality of the sperm is low, the doctor prepares it by increasing the concentration of germ cells. In some cases, the most mobile and healthy sperm is selected and forcibly implanted into the egg. These activities can significantly increase the chance of successful conception.

Is pregnancy possible from mucus secreted before ejaculation?

This substance, called pre-ejaculate or pre-semen, is produced by the bulbourethral glands located at the base of the male organ. Its purpose is to facilitate intimate contact.

The mucus contains a small amount of sperm. Although their concentration is quite low, conception is possible. Therefore, interrupted intercourse, in which pre-ejaculate enters the female genital tract, is considered one of the most unreliable. If a woman is not infertile, she can become pregnant.

Features of IVF in women after 40 years

Due to the fact that the physiology of women in late life is different compared to early periods, the process of in vitro fertilization also has its own characteristics:

due to depletion of the ovarian reserve, she is prescribed a relaxed protocol for ovarian stimulation or this procedure is completely excluded;
preliminary medical examination is carried out more thoroughly and includes additional diagnostic procedures;
As a rule, only one embryo is implanted per attempt to eliminate the risk of multiple pregnancies, which are more difficult in later life;
After implantation, the patient must be prescribed maintenance hormonal therapy, since the production of her own hormones, which are responsible for the normal course of pregnancy, is reduced.

Otherwise, the procedure is approximately the same as standard. However, for women over 40 years of age, the number of attempts at fertilization is limited, which generally reduces the chance of a successful pregnancy.

First IVF

Most women entering the IVF protocol want to get pregnant immediately, on the first try. However, the first IVF is not always successful.

Only about 40% of married couples become pregnant immediately. The remaining 60% have to try again. Moreover, such a percentage of IVF from the first time is observed only in young people.

With age, the effectiveness of the procedure decreases.

How much does IVF cost?
Where to do IVF in Moscow

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What does success depend on?

For pregnancy to occur, a number of processes must be ensured, namely:

maturation of eggs;
their fertilization;
correct transfer into the uterine cavity.

Unfortunately, even if all these conditions are met, there is no guarantee that the embryo will necessarily implant into the endometrium. Doctors cannot have a strong influence on this process.

It is only possible to eliminate the main obstacles that reduce the chance of implantation of a fertilized egg into the uterine mucosa.

For this purpose, timely removal of synechiae, adhesions, polyps, treatment of endometritis or other pathologies is carried out.

But all this cannot ensure 100% success.

If implantation is successful, there is a possibility that the embryo will be rejected by the woman’s body. Or the embryo itself will stop developing. This will happen in case of defects in the genetic material of the germ cells or the embryo itself.

Also, the success of the IVF procedure on the first attempt depends on:

woman's lifestyle;
qualifications and experience of reproductologists and embryologists;
embryo culture conditions;
accuracy of compliance with medical recommendations.

But even if all these conditions are met, one cannot definitely expect that the first IVF protocol will result in pregnancy. You need to be prepared for several attempts at once.

Why doesn't IVF work the first time?

There are many reasons why pregnancy may not occur following IVF. The first time is not always successful, and here's why:

after stimulation and fertilization of eggs, low-quality embryos can be obtained, the subsequent transfer of which may not lead to pregnancy;
the endometrium may not be prepared to receive an embryo.
The qualifications of the doctor performing the transfer are of great importance!

In some cases, during IVF, the result turns out to be negative the first time due to the fault of the patient, who may:

independently replace medications prescribed by a doctor with others that, in her opinion, are similar;
not taking medications on time deliberately or due to forgetfulness, confusing dosages or times of taking medications;
lead an unhealthy lifestyle, be exposed to stress, overwork, and abuse alcohol during the period when the embryo is transferred.

Sometimes there are no visible reasons for the failure of the first IVF. It’s just not provided by nature that every embryo that enters the uterine cavity immediately implants into its wall with the subsequent onset of pregnancy.

How to increase the likelihood of pregnancy?

If a woman wants to increase her chances of successful IVF the first time, she and her doctor can take some steps that will facilitate this.

Go to a good clinic.
Different reproductive centers report different statistics on the effectiveness of assisted reproductive technologies. You need to pay attention to this indicator. At VitroClinic, successful first IVFs account for about 40% of all protocols. In many other centers in Russia, only 35-38% of cycles are successful. The effectiveness of the procedure largely depends on the professionalism and experience of doctors, the quality of medical equipment and consumables. Therefore, the best thing you can do to increase your chances of successful IVF on the first try is to go to a good clinic.
Perform the necessary additional procedures.
There are procedures that can increase the chances of success. They are performed as part of IVF. Among them:
- assisted hatching – makes it easier for embryos to implant into the uterine mucosa;
PIXIE is a technique that allows you to select the best, more mature sperm, with a high probability of carrying high-quality genetic material;
preimplantation genetic diagnosis (PGD) – makes it possible to identify genetic mutations and chromosomal abnormalities, selecting the best embryos for transfer.

The need for certain procedures is determined by a fertility doctor and agreed upon with the couple.

Transfer two embryos.
Usually only one embryo is transferred into the uterine cavity. But you can transfer two at once, and this will increase the chances of pregnancy.
It should be understood that if both embryos take root in the uterus, then you will have twins. The risk of multiple pregnancy when transferring two embryos is about 10%.
Lead a healthy lifestyle.
Not only during the IVF protocol, but also every day, a woman should monitor her health. Smoking, alcohol, stress, occupational hazards - all this reduces the chances of achieving pregnancy the first time.
Contact the clinic as soon as possible.
Many couples delay too much in going to a reproductive medicine clinic. Even after several years of fruitless attempts to conceive, they are still waiting for pregnancy to occur.
Sometimes this happens. But usually in such situations, infertility can only be overcome with medical help.
If you use the waiting strategy for too long, diseases of the reproductive system will progress. Age also increases, which is another factor that reduces the chances of success of the first IVF procedure.
Therefore, you need to contact a reproductive medicine clinic after 12 months of regular attempts to conceive a child (recommendations of the World Health Organization). If you are over 35 years old or you already know that you have diseases of the reproductive system, you can apply earlier - after 6 months of ineffective attempts to get pregnant.

Ethical problems of using IVF at a late age

If from a medical point of view, artificial insemination at a late age is quite possible, then from the ethical side of this issue everything is ambiguous. In many countries, IVF after 40 years of age is not allowed to be performed in clinics, and where this is legally permitted, many medical institutions themselves refuse to provide such a service. And there are reasons for this:

after 40 years, a woman’s body is significantly weakened, various chronic diseases appear - IVF, even with gentle ovarian stimulation, can cause great damage to her health, even death;
if the patient’s own eggs, obtained from her at a late age, are used, then the risk of hereditary pathologies in the unborn child increases, and the likelihood of miscarriage or miscarriage also increases.

In other words, the risks for both the expectant mother and her potential baby become too high and unjustified from an ethical point of view. Even the statistically significant positive results of IVF after 40 years do not outweigh them and in many countries are considered an insufficient basis for lifting these restrictions.

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In our country, the legislation in this regard is more liberal - a woman at any age has the right to receive appropriate medical care if she wants to undergo in vitro fertilization. However, in addition to legislation there is science and common sense. Obviously, at the age of 60 or more, the chances of successfully conceiving and bearing a child are vanishingly small, even compared to the likelihood of IVF after 40 years. Therefore, the medical institution has the right to refuse to carry out the procedure without referring to the law. Consultations are held with women at a later age, during which they are informed about possible risks and chances of success, and are offered alternative options (adoption, surrogacy, etc.) that will help avoid unnecessary expenses.

How to improve program effectiveness

You have the power to increase the chances of success of your in vitro fertilization program. To do this you need to follow some recommendations.

Lead a healthy lifestyle. This is one of the fundamental factors and answers to the question of how to make successful IVF.
Give up bad habits. Alcohol and nicotine have the most negative impact on a woman’s reproductive capabilities.
Limit your coffee consumption to two cups per day. However, the drink should not be strong.
Eat right. Food should be varied, rich in proteins and vitamins, and not too fatty. It is better to postpone any diets for the future.
Be careful when taking medications. You should not use drugs that are contraindicated during pregnancy. If you have a cold, you do not need to self-medicate and take medications without consulting a doctor.
Strictly follow all doctor's orders and follow all his instructions.
Protect yourself from stress and negative emotions. Believe in an excellent result, since the success of IVF on the first try is not least due to a positive attitude!