Your guide to IVF over 45

  • Guides
29 Jun 2024

You're not alone

Considering IVF over 45 can feel daunting, but you’re not alone. Many women are successfully navigating this path, and with the right support and expertise, so can you. At Procriar, we understand the unique challenges and questions that come with pursuing fertility treatments later in life. Our goal is to provide you with compassionate, professional guidance every step of the way. 

Key considerations for IVF over 45

Embarking on the journey of IVF over 45 involves unique challenges and important decisions. Understanding crucial factors such as regulations, pre-IVF testing, treatment protocols, and success rates can help you make informed choices and navigate the process with confidence.

Regulations and guidelines

The age limit for IVF treatments varies by country. In the UK, for example, private clinics typically set the age limit for assisted reproductive technology (ART) between 43 and 45, while the NHS usually caps it at 42-43. In Portugal, however, there are no specific age regulations for IVF, allowing treatment up to just under 50 years old. 

Many clinics across Europe, including Procriar, are well-equipped to offer IVF to women aged 45 and over. Thanks to advances in egg donation and personalised patient care plans, turning 45 doesn’t necessarily mark the end of your fertility journey.

Pre-IVF Testing

For patients aged 45 and over, we begin with a series of tests to assess the feasibility and potential success of the treatment. This starts with an ovarian reserve evaluation to determine if using your own eggs is viable and to plan the most effective ovarian stimulation strategy. 

Understanding ovarian reserve evaluation

An ovarian reserve evaluation is a set of tests used to check how many viable eggs a woman has left in her ovaries. You might wonder why this is important. Unlike men, who produce sperm throughout their lives, women are born with all the eggs they will ever have. Over time, this supply naturally decreases.

As a woman gets into her 40s, especially the mid to late 40s, the number of eggs she has left is much lower, and their quality is often reduced. This makes it harder to conceive naturally or through fertility treatments like IVF.

Why check your ovarian reserve?

Knowing how many good eggs you have left helps doctors understand your fertility potential. This information is crucial for planning the best approach to treatment.

How does an ovarian reserve evaluation work?

The evaluation typically involves several key tests:

Anti-Müllerian Hormone (AMH) Test:

What It Measures: The levels of AMH in your blood.

Why It’s Important: AMH is made by the ovarian follicles and indicates how many eggs are left. Higher AMH levels generally mean a better egg supply.

Antral Follicle Count (AFC):

What It Measures: The number of small follicles in your ovaries, seen via a transvaginal ultrasound.

Why It’s Important: Each follicle can potentially release an egg. This count gives a visual estimate of your egg supply.

Follicle-Stimulating Hormone (FSH) Test:

What It Measures: The levels of FSH in your blood on the third day of your menstrual cycle.

Why It’s Important: High FSH levels may indicate a lower egg supply, as your body is working harder to stimulate the ovaries.

Estradiol Test:

What It Measures: The levels of estradiol in your blood, usually on the third day of your menstrual cycle.

Why It’s Important: High estradiol levels can sometimes hide high FSH levels, providing more context for assessing ovarian function.

Understanding your ovarian reserve helps us to plan and maximise the chances of a successful pregnancy.

Other pre-IVF tests

To ensure the safety of a potential pregnancy, we thoroughly check the uterus, examining its structure to confirm it can support a pregnancy. We recommend a pap smear to identify any abnormalities in the cervix that could affect your health or the pregnancy.

We also suggest a mammogram to screen for any breast health issues, as addressing these is important before starting treatment. These tests, along with other general health checks, allow us to create the safest and most effective treatment plan for you.

By taking these steps, we aim to ensure your body is ready and healthy for pregnancy, giving you the best chance for a successful and safe journey to parenthood.

Tailored treatment protocols

At Procriar, we believe in customised treatment plans. For older patients, we might recommend dual stimulation protocols to accumulate eggs before fertilisation. Dual stimulation protocols involve two rounds of ovarian stimulation within the same menstrual cycle, which means we stimulate the ovaries to produce eggs twice instead of once. 

What is ovarian stimulation?

Ovarian stimulation is a process used in fertility treatments to encourage the ovaries to produce multiple eggs in one cycle. Normally, a woman’s body releases one egg per menstrual cycle. However, with the help of fertility medications, we can stimulate the ovaries to produce several eggs at once. This is achieved by administering hormone injections that mimic the body’s natural reproductive hormones.

By producing multiple eggs, we increase the chances of retrieving viable eggs for fertilisation, which is especially important for older patients or those with a lower ovarian reserve. This process is carefully monitored with ultrasounds and blood tests to ensure the ovaries are responding well and to adjust medication dosages as needed.

The dual stimulation approach can help increase the number of eggs collected, providing a better chance of success with fertilisation and improving the overall chances of achieving a pregnancy.

If it turns out that using your own eggs is not viable, either due to a reduced number of eggs or issues with egg quality, we understand this can be a difficult and emotional realisation. In such cases, we offer highly personalised egg donation treatments. These treatments are tailored to your specific medical history and fertility challenges, ensuring you receive the best possible care and support. Using donor eggs can significantly improve the chances of a successful pregnancy, providing a hopeful path forward when other options are limited.

Genetic testing and advanced techniques

For patients over 45, we recommend PGT-A testing because there is an increased risk of genetic abnormalities in the eggs, known as aneuploidies. PGT-A, or Preimplantation Genetic Testing for Aneuploidies, helps us identify embryos with the correct number of chromosomes. This testing is important because having the correct number of chromosomes significantly increases the chances of a healthy pregnancy and reduces the risk of miscarriage.

As women age, their eggs are more likely to have chromosomal abnormalities, which means they might have too few or too many chromosomes. This can affect the embryo’s ability to develop normally. By using PGT-A testing, we can examine the embryos before they are implanted to ensure they have the right number of chromosomes, giving you a better chance of a successful pregnancy.

Having honest conversations about the viability of using your own eggs versus donor eggs is crucial. As women age, the quantity and quality of their eggs decline, which can make it harder to achieve a successful pregnancy with their own eggs. In some cases, using donor eggs, which come from younger, healthy women, may offer a better chance of success.

At Procriar, we support you through these decisions with compassion and understanding. We are here to provide the information and guidance you need to make the best choices for your fertility journey, ensuring you feel supported every step of the way from start to parenthood.

Success rates and recommendations

Using your own eggs at 45 has a 2-3% success rate, which can be quite low. In some cases, it may even be impossible due to a diminished ovarian reserve. We understand this can be disheartening news, and it’s important to approach this part of the journey with compassion and understanding.

On the other hand, egg donation offers a significantly higher success rate, ranging from 60-70%. This option provides a hopeful alternative, as the success rates are much more promising. With cumulative pregnancy rates exceeding 90% after multiple embryo transfers, using donor eggs can greatly increase the likelihood of achieving a successful pregnancy.

What do we mean by egg donation?

Donor eggs are eggs that come from a young, healthy woman who donates them to help another woman conceive. This option is often recommended when a woman’s own eggs are not viable due to age, diminished ovarian reserve, or other medical reasons.

How does the donor egg process work?

  1. Selection of a donor: The process begins with selecting a suitable egg donor. Donors undergo thorough medical and psychological screenings to ensure they are healthy and capable of producing high-quality eggs. At Procriar, we offer open-ID donors, meaning you can access detailed profiles of potential donors.
  2. Ovarian stimulation: Once a donor is selected, she undergoes ovarian stimulation, a process where hormone injections are used to stimulate the ovaries to produce multiple eggs in one cycle.
  3. Egg retrieval: The eggs are then retrieved from the donor’s ovaries through a minor surgical procedure.
  4. Fertilisation: The retrieved eggs are fertilised with the intended father’s sperm (or donor sperm if needed) in the laboratory to create embryos.
  5. Embryo transfer: After a few days of development, the healthiest embryos are selected and transferred into the recipient’s uterus, where they can implant and develop into a pregnancy.

Addressing concerns about genetics

We understand that using donor eggs can bring up concerns about the genetic connection to your child. Here are some important points to consider:

  • Genetic Matching: At Procriar, we carefully match donors to recipients, considering physical characteristics and other preferences to help ensure a resemblance.
  • Nurture and Parenting: Genetics is just one part of what makes a family. The love, care, and nurturing environment you provide play a significant role in your child’s development and identity. Your bond with your child will be built on shared experiences and the unique relationship you develop together.
  • Epigenetics: Research shows that the environment in the womb, provided by the mother carrying the baby, can influence gene expression. This means that even with a donor egg, the mother carrying the pregnancy can impact the child’s development in significant ways.

Open-ID egg donation

At Procriar, we offer open-ID egg donation. This means a child conceived through egg donation has the right to know the identity of their donor once they turn 18 years old. This option provides transparency and the possibility for the child to learn more about their genetic background when they are older, which can be an important factor for many families. Open-ID donation also allows recipients to access detailed profiles of potential donors, ensuring a closer match in physical characteristics and other traits.

Choosing to use donor eggs can be a positive and hopeful step towards achieving your dream of parenthood. With high success rates and the potential for a strong emotional bond with your child, donor egg treatment offers a viable and rewarding option for many couples.

Procriar: Leading IVF Clinic in Europe

Procriar, based in Porto, is renowned for its progressive approach to IVF, especially for women over 45. Led by the esteemed Dr. Joana Mesquita Guimarães, Procriar offers a patient-first practice with expertise in open ID egg donation and personalised care. Ready to take the next step? Connect with us for expert answers, education, and world-leading treatment. 

And finally: best of luck from the Procriar team—we’re here to support you every step of the way.


Learn more about how we can help

Arrange a free call with one of our expert Care Advisors today and learn more about how we can help you to achieve your dream of a family.