Consider the fact that at age 40-43 years, the birth rate per cycle of treatment with injectible fertility drugs alone, or in combination with intrauterine insemination (IUI) is about 2% and 10-15 times higher with IVF performed in an IVF program of excellence. It follows that for childless women for whom the biological clock is ticking IVF is the treatment of choice.
In more than 80% of cases, embryo quality is a function of egg, (rather than sperm) chromosomal integrity. Age progressively increases the threshold risk of numerical chromosomal egg/embryo integrity (aneuploidy), which in turn is synonymous with egg/embryo “incompetence” (inability to propagate a viable pregnancy. In fact, by age 40-43 years, >85% of a woman’s eggs will be aneuploid resulting the embryos they propagate being “incompetent”. To make matters worse, as a woman ages beyond 40years she gets closer to the menopause. During this transition she progressively builds resistance to fertility drugs as well as a reciprocal decline in the number of eggs likely to be available at the time of egg retrieval. Thus, with fewer eggs available and a growing percentage of these being aneuploid (“incompetent”) the smaller will be the number of “competent” embryos available for transfer to the uterus. To add to the problem; there is virtually nothing that can be done to avoid the inevitable age-related decline on IVF outcome.
The only way to increase the overall likelihood of successful IVF in older women is to:
- Avoid compromising of egg development in the course of controlled ovarian stimulation (COS) by tailoring (“customizing”) the protocols to meet individual needs (avoiding a “same size fits all approach,
- Maximize the number of “competent” embryos and stockpiling them over several cycles and then
- Identifying the “competent” embryos for selective transfer to the uterus by testing them through preimplantation genetic testing (PGT/PGS) using Next Generation Gene Sequencing (NGS)
Thus, as involuntarily childless women approach age 40 years of age, they are under the gun and the sooner they make the decision to proceed to IVF, rather than waste valuable time on other (lesser) treatment options, the better. The fact is that once on the move the biological clock can unfortunately not be reset.
For women over 43 years, using own eggs is associated with a very low yield of “competent, euploid embryos, making IVF with egg donation the preferred approach.