IVF over 40: transparency and different advice needed

Check your egg store

In order to give the best advice, the first step is an AMH (Anti-Mullerian Hormone) test to measure the woman’s ovarian reserve. This will give an indication of the reserve pool of eggs left in the woman’s ovaries (not the exact number) and what to expect from ovarian stimulation for egg collection and IVF.

Even if the AMH level is low, if other factors look good and the patient wants to try, then ovarian stimulation might still be possible, although it maybe necessary to use a higher dose of drugs. Where a woman is going use her own eggs for IVF treatment, she will go through a cycle of ovarian stimulation. In other cases we may advise the use of donor eggs.

For older women, Bourn Hall may use a different approach. Instead of down regulation it may use a higher dose of Gonal-F, starting at the beginning of a menstrual cycle. When the largest follicle reaches a diameter of 14mm, another drug (Cetrotide) is then added to the regime to prevent ovulation. This protocol gives better results in some older women. See our “How IVF Drugs Work” leaflet for more.

Once the eggs are collected and fertilised, the embryos are incubated for a few days. For some women a good embryo is selected and transferred to the womb within a couple of days after the eggs are collected. For others the embryos may be grown on in the incubator until Day 5, when the embryos should reach the blastocyst stage, thus ensuring that the ones with the very best chance of implantation are selected.

Embryos that divide in a precise even pattern appear to be the ones most likely to implant normally and become babies. So when the embryologist selects which embryos to transfer to the woman’s womb, she or he is looking for an embryo that meets these criteria.

IVF over 40

Traditionally the embryos are observed under direct vision through the microscope, but this requires removing them from the incubator. Bourn Hall was one of the first clinics in the UK to introduce Eeva (Early Embryo Viability Assessment) and GERI, a computer vision software system which images and records information about each developing embryo every few minutes without disturbing them. It provides a complete visual history of the embryo and can be used to predict at an earlier stage, which are capable of reaching blastocyst and assists the embryologist in deciding which embryo(s) to select for transfer in that cycle of treatment.

“IVF is a science, but patient care is equally important and feeling secure and cared for can also improve the outcomes. The treatment we advise is appropriate for the individual and their circumstances and our focus is on giving them the best possible chance of success,” says Dr Mawal.

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