For women over 40 trying to get pregnant, the Center for Human Reproduction believes in an urgent and individualized treatment approach, as time is a critical factor for those facing diminished ovarian reserve (DOR), a common condition in this age group. The sooner treatment begins, the better the chances of pregnancy. While various infertility treatments are available, not all are suitable for women over 40 with DOR. In most cases, standard IVF and donor eggs offer significantly higher pregnancy success rates than options like “mini IVF” or IUI, which have much lower chances of success. At CHR, standard IVF doesn’t mean a one-size-fits-all approach; rather, it reflects a proactive and aggressive treatment strategy designed to maximize each woman’s chance of pregnancy.
Egg Retrieval for IVF in Women 43+: "Overcooked" Eggs are Common
For most women looking to get pregnant with their own eggs after age 40, IVF with ovarian preparation and ovarian stimulation is the quickest and most reliable treatment option. Older women attempting IVF need to be treated differently from younger women. For instance, they need larger doses of fertility medications to produce a good number of high-quality eggs. At CHR, women over 40 typically get DHEA supplementation to readjust their ovarian environment to a more youthful, androgen-rich state even before the IVF cycle begins. This allows eggs to undergo a healthier maturation process. Once the ovarian stimulation commences, physicians at CHR tailor the protocols to the needs of each patient and her ovaries. You will not find a one-size-fits-all protocol here at CHR. Taking a personalized approach to IVF has resulted in impressive pregnancy rates at CHR, even for women at very advanced maternal ages up to age 47, as well as for those with severely diminished ovarian reserve.
DHEA supplementation was first introduced into fertility care by CHR physicians and has since spread worldwide with remarkable results. The major benefits of DHEA for fertility include:
We have seen many women who were advised by other fertility centers that their only chance of conception was with egg donation, but then successfuly conceive under our care using their own eggs. For women with DOR, DHEA supplementation combined with IVF protocols developed at CHR has proved a life-changing treatment option.
One of the recent innovations in fertility treatment at CHR is the early egg retrieval technique, which has significantly improved success rates for patients over 40, especially those over 43. CHR physicians observed that eggs retrieved from older women were often "overmature," leading them to experiment with retrieving eggs earlier. This approach resulted in a mix of fully mature and relatively immature eggs. The immature eggs were matured in the lab through a process called in-vitro maturation (IVM), which dramatically increased pregnancy chances, sometimes doubling or tripling them based on the patient’s age. CHR physicians closely monitor each patient’s ovarian response and carefully determine the optimal timing for egg retrieval to maximize IVF outcomes. This approach has since evolved into the Highly Individualized Egg Retrieval protocol, where each patient’s hCG trigger is tailored to their specific needs for the best possible results.
At CHR, we believe that egg donation should be a last resort, allowing women to explore other fertility treatment options first if that is their choice. In our experience, many women who could still conceive with their own eggs, given the right treatment, are often pushed into using donor eggs prematurely. In fact, one-third of women who came to CHR after being advised to pursue egg donation have successfully conceived with their own eggs after treatment with us. However, for many women over 40, egg donation remains an excellent option, offering significantly higher pregnancy rates than IVF with their own eggs. To support this, CHR maintains a large and diverse pool of egg donors, allowing us to match most patients with a suitable donor quickly. For those who choose egg donation, our egg donor program provides a wide range of options to meet their needs.
Some fertility centers steer older women toward low-intensity IVF cycles, such as mini-IVF or natural-cycle IVF, which use lower doses of fertility medications and aim for fewer eggs. The reasoning behind this approach is that a milder stimulation may result in better-quality eggs. However, this claim is not supported by medical literature. In fact, research shows the opposite: low-intensity IVF cycles reduce pregnancy chances, particularly in women over 40. Additionally, while mini-IVF is often marketed as more cost-effective, CHR’s analysis has shown that the overall cost until a successful pregnancy is achieved is no less than standard IVF. This is because fewer standard IVF cycles are needed for a successful outcome compared to low-intensity options.
Low-intensity IVF should be considered experimental, and for older women with diminished ovarian reserve (DOR), there is little time for trial and error with treatments like mini-IVF or intrauterine insemination (IUI), which offer lower chances of success. We also caution against routine preimplantation genetic testing for aneuploidy (PGT-A). While PGT-A is promoted as a way to improve pregnancy rates by screening out chromosomally abnormal embryos, research, including studies from CHR, has shown that PGT-A can actually lower pregnancy chances, especially in women over 40 or with DOR. This testing may lead to the discarding of embryos that could have developed normally.
If you are over 40 and trying to conceive, concerns about pregnancy complications are natural. Women in this age group are at higher risk for Down syndrome, with the American College of Obstetricians and Gynecologists reporting a 1 in 85 chance for mothers aged 40. There is also an increased risk of gestational diabetes, high blood pressure that can lead to preeclampsia, and a higher likelihood of miscarriage or stillbirth, resulting in lower live birth rates. Additionally, women over 40 may face complications such as premature labor or the need for a cesarean section. These concerns are often heightened for first-time mothers, leaving many wondering how to ensure a healthy pregnancy and delivery.
At CHR, the health of both mother and baby is our top priority. Our approach involves highly individualized, proactive care tailored to the needs of women over 40. We start by discussing the potential risks and then develop a personalized plan to minimize those risks while closely monitoring early pregnancy. Each patient is connected with an obstetrician who will continue their care once CHR’s role concludes. For particularly high-risk patients, a maternal-fetal medicine expert may be added to the care team to provide specialized oversight throughout the pregnancy. Frequent visits to the obstetrician and a careful, preemptive approach are critical for managing these risks. Genetic counseling can help address age-related concerns and offer insights into family history and genetic testing options. This ensures a comprehensive approach to care from conception through delivery.
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