How CHR Supports Women Over 40 With Fertility Challenges

As a woman gets older, her chances of getting pregnant naturally decline—first at 35, then again at 40. Her ability to produce eggs naturally declines, both in terms of quality and quantity. The possibility of eggs carrying an abnormal number of chromosomes increases, raising the risk of miscarriages—or in some cases, genetic diseases such as Down syndrome. For an increasing population of women that decide to have children later in their lives, this biological reality becomes a real challenge. Additionally, hormone cycles can dim, interfering with the natural menstrual cycle and mechanisms essential to conception. Faced with these challenges, many women turn to IVF as an alternative to natural fertilization. However, not all clinics are equipped to tackle these complications. Few clinics support women over 40 with the proper care and support that they need. However, this doesn’t mean that parenthood is out of reach. 

A Fertility Clinic That Specializes in Complex Fertility Cases 

The Center for Human Reproduction (CHR) specializes in treating complex fertility cases: patients with low ovarian reserve, PCOS, immune-related infertility, and those with a history of failed IVF cycles. While many IVF clinics treat women in their mid to late 30s, CHR works almost exclusively with older women. Over the last 15 years, CHR’s average patient age has slowly increased. Today our average patient age is 44, which is several years older than the national average patient age of IVF clinics. In fact, roughly 99% of U.S. fertility clinics are not designed to support women in this age group, as many turn patients away once they reach 40, and push them toward using donor eggs without trying other options. 

Complications that come with age require personalized care. However, cycle protocols at most fertility clinics are rarely individualized as standard protocols are faster and easier to manage. Patients often receive the exact same medications, dosages, and cycle timelines based on age regardless of their medical history. This leaves many women feeling like they’re out of options, when in reality, they just haven’t found the right clinic yet. 

For the last 30 years, CHR has forgone higher success rates to help these types of individuals who are disproportionately denied reproductive care. Many of our patients come to CHR after being told they are out of options or were advised to use donor eggs. At CHR, we give these women another chance—with treatment plans specially designed and backed by decades of experience. 

Our Personalized Evidence-Based Approach

At CHR, the patient comes first. Every aspect of treatment is tailored to the patient, from our research-based approach to choice of medications and the timing and structure of each cycle. If a cycle is unsuccessful, our team carefully reviews the outcome within a week and adjusts to improve the next attempt. With hundreds of published papers that have pioneered and changed the way fertility care is approached worldwide, our team of doctors and fertility specialists are deeply involved in ongoing fertility research and advocacy work, and we use that knowledge and passion to inform the care we provide every day to all our patients. Beyond our level of personalization, our deep pool of clinical and research experience is central to CHR’s approach and one of the reasons why so many of our patients are those who come to us despite being told they were out of options elsewhere. 

One key example of CHR’s dedication to individualized treatment is an originally developed method we developed called HIER, or Highly Individualized Egg Retrieval. Many fertility clinics worldwide use the same timing to trigger ovulation—usually when the follicles reach between 18 to 23 mm in size—no matter the patient’s age. But research at CHR has shown that as women get older, their follicles mature faster and need to be triggered earlier to protect egg quality. With HIER, we adjust the timing of the trigger based on each patient’s age and how their ovaries respond to treatment. In some cases, we may trigger as early as 9 or 10 mm. This approach has led our doctors to better egg retrieval outcomes for women in their 40s, and we’ve recently even applied it successfully to a natural cycle. Though CHR has used HIER routinely for nearly 10 years, only a small number of IVF clinics around the world have adopted this practice. Through this egg retrieval protocol that our team has developed, CHR gives women of advanced maternal age the opportunity to build their families.