A recent article in Fertility and Sterility (Vol 117, No 4, April 2022) focused on the success rates of infertility treatment in women over age 40. At Indiana Fertility Institute, we do not have set age limits for allowing couples to pursue conception, but we do stress realistic expectations, and this article reinforces those expectations.
“The reality of reproductive success rates clashes with the high expectations of many patients undergoing IVF treatment, particularly in poor responders.”
An early study reported on success rates in 2,705 women undergoing day 3 transfers in IVF cycles in women over 40. “The live birth rate per cycle start was 14% at the age of 40, declining to 1%-2% at the age of 44-45, and 0% over the age of 45.” With multiple IVf cycles this same group had a cumulative IVf success rate (after an average of 2.3 IVF cycles) of 28% at age 40 and 0% over age 45.
The most important factors in this age-related decline are ovarian reserve, the number of eggs remaining in the ovaries (assessed by measuring the hormone AMH), and the chances of a genetically normal conception. One study showed that the chances of a euploid (genetically normal conception) were 18% at age 44 and 5% at age 45. If a genetically normal embryo was transferred the chances of success were 57%. The percent of women who will have a euploid embryo after age 44 is extremely small.
A predictive model using 4,570 women with infertility 38 and over, if 4 mature oocytes could be retrieved the “cumulative live birth rate was only 16% in women aged 38-39, 12% in women aged 40-41, 5% in women aged 42-43 and 1% in women 44 and older”. If 12 eggs were retrieved, these numbers improved to 36% for ages 38-39, 24% for ages 40-41, 12% for ages 42-43. Measuring AMH is the best indicator we have for prognosticating the number of eggs that might be retrieved and the implications of their particular AMH level will be discussed with each couple.
IVF can be difficult from an emotional, physical, mental and financial perspective. We believe all couples should have a chance to pursue IVF should they so desire, but believe even more firmly that all couples must be apprised of their realistic chances of success, and of the other options available that might offer them a much greater chance of success.