Fertility treatment for women over 40
March 3, 2012
It is well known that a woman’s fertility begins to decline as early as the age of 30. A woman in her 40s has only a 10% chance of getting pregnant per cycle. After the age of 45, spontaneous pregnancy is extremely rare. Unfortunately, however, more and more women are shifting their desire for children to this stage of life.
Often only very late, after several years of trying to „get pregnant in the normal way“, many of these women find themselves with their partner at the fertility specialist clinic. It is usually difficult for the treating doctor to convince the women to undergo an effective method of fertility treatment as soon as possible. Every day we see women who, despite the relative time pressure (if they even want to acknowledge it!), resist effective treatment. Their idea of being treated as discreetly and „naturally“ as possible, almost hormone-free and cost-effective, is in principle understandable and must be respected by the treating doctor.
However, the fertility specialist is also obliged to inform the affected couples that the desired procedure comes with potentially huge disadvantages.
In a recent retrospective study from McGill University Montreal, Canada, the effectiveness of „conventional“ fertility treatments was compared with this very group of patients (Amir Wiser et al. Ovarian Stimulation and intrauterine insemination in women aged 40 years and more; Reproductive Medicine Online 2012, 24).
In 247 women >40, with reduced ovarian reserve or just „unexplained infertility“ (unprotected intercourse for >1 year without an apparent cause of infertility).
The effectiveness of insemination treatments (after clomiphene and gonadotropin stimulation-FSH) was compared in these two groups with that of conventional treatment IVF.
In this study, none of the women who were inseminated with clomiphene were pregnant; however, of those who were inseminated with FSH, 2.6 were % pregnant and gave birth to their child.
The IVF-group had a clinical pregnancy rate of 16.9 % and a „baby take home rate“ of 13.7 %.
Even though this study has some substantive shortcomings and the number of patients is not very large, a clear trend can be IVF observed towards significantly better efficacy.
Many investigators have already reached similar conclusions, such as Corsan et al. (1996),
Hull (et al. 1996), Spandorfer et al. (2007), Tan et al. (1992) and Templeton et al. (1996).
In summary Patients and therapists can only be urged not to waste unnecessary time on cycle monitoring/traffic to the optimal place (traffic after „egg retrieval injection“) and inseminations after clomiphene stimulation. How quickly has a year passed here, a year in which the woman has aged a little more and her fertility has continued to decline. Even the best treatment center has great difficulty in producing a pregnancy, at least with her own eggs, in women over 43/44/45.