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Age and IVF Success

A blog by Dr. Jeffrey Klein, RMA of New York, May 4, 2015

It is widely known that as a woman’s age increases, her fertility declines, and as a result many couples are hesitant about embarking on the in vitro fertilization process. The journey can be challenging, expensive, and fraught with emotion. But as our technology has improved over the last several years, the impact of the mother’s age has become much less of an issue, though it certainly remains an important consideration.

The biggest issue facing women who are older than 35 is a decline in the quality and quantity of their eggs. There is a natural increase in the number of eggs that are chromosomally abnormal, or aneuploid, and this means that they are less likely to successfully produce a healthy, viable embryo. Add to that the fact that the number of eggs that remain in the ovarian reserves also decreases, making fewer eggs available for harvesting during the IVF process, and you have arrived at the primary reasons why advanced maternal age is associated with reduced fertility, as well as increased risk of miscarriage. However, technological advances have helped to overcome some of these limitations. IVF success rates have steadily improved over the years for women of all reproductive ages. In addition, our ability to test embryos for chromosomal analysis is greatly refined. We can now sample embryos at the blastocyst stage after 5 to 6 days of culture, enabling us to sample cells that are destined to become placental cells versus a day 3 embryo biopsy where we were relegated to removing a cell from an 8 cell embryo. The risk for harm to the embryos is thus negligible with blastocyst biopsy when compared to earlier biopsy. More significantly, we can now analyze all 23 chromosome pairs with high accuracy, when test of old were limited to 10-12 chromosomes and were fraught with high error rates. The net result is a greatly improved ability to screen embryos for chromosomal abnormalities, which are felt to be the primary cause of the age-related decline in fertility and increase in miscarriage rates.

For women with severely diminished egg reserve, where egg donation is the only option, we have also made advances. In particular we now offer use of both fresh and frozen banked eggs for use which may greatly reduce wait times to find a suitable donor. The advent of egg freezing technology naturally extends to fertility preservation. Women who are anticipating postponing their family planning may now freeze and store their eggs while they are young for future use.

In addition to the issue of egg quality, it is also important to remember that there are other issues that may affect the success of the IVF process in mature mothers. The overall health of the mother is always a critical factor in the ability to successfully complete a pregnancy, and underlying medical conditions such as cardiovascular disease, diabetes and hypertension, which sometimes accompany aging, need to be kept in mind. Any woman considering a pregnancy needs to be aware of their overall health and should undergo a thorough physical examination with all appropriate diagnostic testing by their physician in order to be aware of any conditions that might lead to complications in their pregnancy.

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