Words by Davina Catt, UK Editor
Whilst seeking IVF advice and treatment for the mid-thirties age group is becoming mainstream, IVF over 40 years is still more of a grey area in the press. Success rates currently published by the NHS are pinned at 11 per cent for women aged 40 to 42 (it’s 19 per cent for age 38 to 39, for reference), but information on IVF over 40 (useful information) can be hard to dig out, in a basic Google search.
There’s lots of detail around celebrity success stories, and changes in NHS services, but not much about the developing science in this area, and improving outcomes.
Whether you’re going for IVF at 40 or 32, the essential treatment process doesn’t differ too much across the age categories. That said, specialist fertility clinics, such as our partner the Prague-based, Gynem Fertility Clinic, are constantly researching and advancing knowledge, specifically aimed at the over 40 years fertility age bracket.
Did you know that according to the Human Fertilisation and Embryology Authority, the proportion of IVF cycles for 40 years and over has doubled in the past decade to 21% in 2019? So regardless of success rates, you are absolutely not alone on this journey.
A realistic approach to IVF at 40 years (and over)
Success rates are important, however. It’s important to be realistic, not just to help you work out the best options, but also to help you prep for what happens if your cycle is unsuccessful.
Women over 40 have fewer eggs available, which often means fewer embryos will be created – this combined with the diminished quality of eggs leads to, on average, lower IVF success rates. NHS stats currently show 11% IVF success rate for women aged 40-42 and 5% for women aged 43-44 – these stats are based on women using their own eggs and their partner’s sperm and conducted through per embryo transferred measure.
According to experts at Gynem Fertility Clinic, the process used differs marginally for women aged 40 and over. But in general, your team will need to obtain more eggs, in order to produce that all-important blastocyst which is suitable for embryo transfer.
What is a blastocyst? In basic terms, it’s a cluster of cells developing from a fertilised egg, and the early stage of an embryo.
Current research shows that an embryo that survives for five days (i.e one which is better-developed) is more viable for implantation and an ongoing successful pregnancy. During IVF, the number of eggs needed to result in live birth of a healthy child is 10-20. For women aged 40+, we’d need 20 eggs as a minimum.
In the past, retrieving eggs has been a painful process for patients, largely involving a puncture to the vaginal wall. But advances in ultrasound technology – used as-standard by the most modern clinics like Gynem – are drastically improving the experience.
It’s important to remember that the blastocyst process is ultimately about quality not quantity – so one quality egg retrieval is better than twenty poor quality attempts.
How does egg quality affect the IVF process?
The egg quality is the first factor in determining the quality of the embryo – the IVF process aims to get multiple embryos so we can choose the best ones from the group to then transfer back to the uterus. A big part of the ‘egg quality’ formula involves the chromosomal status of the egg – and with age the rate of abnormalities in the eggs rises, so by 40 years around 60% are unusable.
Important factors in the success of the IVF treatment.
Head physician at the Gynem clinic, Dr Kristyna Fruhaufova, cites three main factors in IVF success.
- Many IVF treatments fail as the embryo doesn’t implant or the pregnancy ends in spontaneous miscarriage. This is due to many of the eggs being chromosomally abnormal.
Successful selection of the chromosomally normal embryos.
- Gynem Clinic uses their own Caremaps embryo selection technique, or can also use pre-implantation genetic testing (PGT-A) to identify the embryos with the highest potential for success.
The receptivity and health of the endometrium.
- When transferring an embryo, the endometrium must be in a receptive state to allow successful implantation. This period of receptivity is called the window of implantation, and it varies between different people.
Gynem Clinic puts together their own tailor-made treatment plans for IVF clients including tests to assess endometrial health and the best time for embryo transfer. Gynem is a one of a kind boutique fertility clinic that is there to guide and support you through each step of the process: ahead of the game in research and technology, all you have to do is contact the Gynem team who will happily run through your unique fertility history and the tests/techniques that would best suit you.
Tests and techniques available include:
Pre-Implantation Genetic Testing (PGT-A)
- A treatment which involves screening specifically for inherited monogenic diseases, which result from a mutation in a single gene. Blood samples are taken from both parents and a close relative to determine if an embryo carries that mutation.
Endometrial Receptivity Analysis (ERA)
- Helps to determine when a woman’s uterine lining is primed to receive an embryo, a time frame known as a window of implantation. The window lasts just a few days and if missed so is the opportunity for pregnancy: ERA analyses 248 genes within endometrial tissue to gauge a woman’s endometrial receptivity and time the embryo transfer correctly.
EMMA and ALICE tests
- These test for specific bacterial pathogens known to cause chronic endometritis, a condition in which the uterine lining is persistently inflamed and also examine the uterine lining at microbiological level, checking if bacterial floral levels are optimal for implantation. If pathogens are detected, treatment protocols can then be administered to restore microbial balances.
- ERA, ALICE, and EMMA all utilise next generation sequencing (NGS).
IVF treatment options:
There are options for those on the IVF journey: stimulated IVF cycle, native IVF or the last option, donors.
Use of donor eggs:
Using egg donors is an option that Gynem is open to looking at if your own eggs aren’t proving successful: all is not lost as this fertility route has a much higher success rate for those 40 years or over than the native IVF variant. (Egg donors are younger than 35 years) Most clinics also allow this approach for women up to around 50 years old.
Gynem offers two different egg donor packages: either offering one good quality embryo or at least two blastocyst stage embryos for transfer. If either minimum is not met, Gynem will provide a new cycle for free.
At Gynem you are in safe hands: with over 2,500 cycles completed, they have recorded pregnancy rates as high as 63% through egg donation and 52% through IVF. And roughly 70% of clients have embryos left for freezing.
In general, the current rate for IVF success stories currently stands at around 17% for women aged 40.
Whilst the IVF journey for 40 years and over is a complex one and it is important to remain realistic, the process has become a lot easier to navigate with new scientific research and developments, and bespoke fertility clinics such as Gynem, where experts are at hand to support you step by step through the process.
Gynem puts together tailor-made options after an initial free consultation. They also give you a 20% discount if you need a 3rd cycle. Gynem was founded in 2009 by Dr Milan Mrazek after three decades of intense study into fertility, with an aim to create a modern boutique clinic based on exceptional quality, great results and an individual service.