The Older Woman & Infertility: Hope for them

September 13, 2021

Age is an important factor in fertility, and chances of conception decrease with advancing years, usually after the thirties. The reason why fertility decreases with increasing age is the diminished number of eggs left in the ovary. Unlike men, who produce new sperm daily throughout most of their lifetime, women are born with all their eggs in two baskets (ovaries). To be more precise, a woman is born with about one to two million immature eggs, or oocytes, in her ovaries. At puberty it is around 400,000 eggs.

Relatively little or no follicles remain at menopause, which usually begins when a woman is between 45-55 years of age. The remaining eggs are unlikely to mature and become viable eggs because of the hormonal changes that come along with menopause.

Most infertility specialists define an older woman as one who is more than 35 years, but this is an arbitrary number. A woman's fertility does not fall off at a particular age, but starts declining gradually after the age of 30. After 35, the drop is fairly dramatic; and after 38, it's even more so. However, there is no magic number at which fertility disappears and this decline is a progressive irreversible process.

The Older Woman and Infertility

It is now possible to find out the reserve eggs in a woman by doing one blood test called as Anti Mullerian hormone (AMH). Low levels of AMH (which are produced by "good" follicles [bags of the eggs]) suggest a poor ovarian reserve. However, just because a test result is normal it does not mean that the quality or number of the eggs produced will be good.

Infertility and the Midlife Crisis

Much research is going on to try to increase the pregnancy rates after IVF in older women. One high tech option is to screen the embryos for aneuploidy (an abnormality in chromosomal number). If only chromosomally normal, healthy embryos are transferred back into the uterus, then researchers feel that embryo implantation rates and pregnancy rates will be higher. But this needs production of more eggs & more embryos. This is unlikely in an older woman. Another option is assisted zona hatching, using a laser, to create an opening in the zona (shell) of the embryo. Scientists feel that this technique can allow the embryo to "hatch" and thus escape from the zona and implant into the uterine lining more easily. However, the clinical benefit of these procedures is still unclear.

A very effective option for older woman whose own eggs do not grow well is that of using donor eggs or donor embryos. However, this is obviously a very sensitive emotional issue, and each couple needs to make their own decision. While using donor eggs and embryos does dramatically improve pregnancy rates, it is often an option many couples find hard to come to terms with.

The good news is that success rates with donor egg IVF and donor embryo IVF are very high!

Age of the recipient woman does not matter with donor egg IVF.

• The age of the woman who is donating the eggs is very important;
• The age of the uterus carrying the embryos is not important.

Sometimes a young patient can have poor quality of eggs. Some of the women reach menopause earlier and if it occurs for a woman less than 35 years of age, it is called as premature menopause or also called as Premature Ovarian Insufficiency (POI). Even for these women, donor egg and her husband’s sperm can be fertilized and made to grow into an embryo. This embryo can result in pregnancy and develop in her own uterus.

IVF with donor eggs at the Advanced Fertility Center of Manipal (Manipal Assisted Reproduction Centre called as MARC) has a success rate of 60%. The process of IVF is like same as any IVF procedure except the eggs are from a donor.

How are egg donation procedures done with fresh eggs and how is the timing of IVF with donor eggs done?

An appropriate egg donor is chosen by the MARC team and thoroughly screened for infectious diseases and genetically transmissible conditions. Donors are compensated appropriately for going through the treatment. Donors will be anonymous to the recipient couple. The donor is stimulated with injected medications to develop multiple egg development. This allows us to perform in-vitro fertilization with her eggs and the sperm of the infertile woman's male partner.

Egg donation process

When the donor's follicles are mature, an egg aspiration procedure is performed to remove the eggs from her ovaries. The eggs are then fertilized in the laboratory with the sperm of the infertile woman's male partner.

• Egg donation is most commonly done using fresh eggs.
• However, egg freezing technology has improved greatly over the past several years.
• However, freezing of extra embryos gives good success rates also.

Timing of donor egg fertilization with the recipient's uterine receptivity

Getting the proper timing in IVF with donors & the recipient is critical for a successful donor egg IVF cycle which is planned by the team.

The embryos develop in the laboratory for 3 to 5 days. Then, an embryo transfer procedure is done which places the embryos carefully in the recipient woman's uterus where they will get implanted and develop on to a successful birth in a large number.

Manipal Assisted Reproduction Centre (MARC) is headed by Prof. Pratap Kumar and the Chief Embryologist is Prof. Satish Kumar Adiga who have been into IVF technology from the year 1998. The first IVF baby of MARC was born in 1999. Over 10000 babies are born from MARC services.

The usual question my patients ask me is:

Why not get 100% success? To this my answer is “Nothing in medical practice is 100% successful. Moreover, in the field of fertility the process of implantation of the embryos is not understood. Failure can take place even if we put back excellent embryos to the uterus. However, recent technologies are a boon to infertile couples.

For Feedback and queries, please send an email to: marketing.kh@manipal.edu or call 08202922686

 

 

 

 

By Prof Pratap Kumar
Prof Pratap Kumar is the head of Reproductive Medicine & Surgery at Kasturba Medical College & Kasturba Hospital, Manipal Academy of Higher Education, Manipal.
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