Reproductive Partners Fertility Blog » advanced maternal age

If (insert name of actress or singer) can have a baby at (insert age over 42), why can’t I?

Dr. Arthur Wisot FACOG — Wed, 16 Jun 2010 16:57:13 +0000

That's a question I am frequently asked.

In an article in the June 21st issue of the medical journal US Weekly, "Baby After 40." they give examples of current and recent pregnancies as "Hollywood's 'miracle' moms beat the odds."

But can they beat the odds just because they are famous? I think not. For many of them the "miracle" is egg donation but they are not willing to admit it. Just look at our age related live birth success rates for the last 5 years at above age 40 and contrast those with egg donation in the next column.

When you see a pregnancy above age 42 it could be a miracle that beat the odds, but more likely it's egg donation.

I wish some of these famous people would come clean and admit it's egg donation because they do other women a disservice by giving them unrealistic expectations.

IVF or IUI for Women Over 40?

Dr. Arthur Wisot FACOG — Mon, 07 Jun 2010 19:53:35 +0000

Selection of a treatment method for women over 40 whose main limitiation in conceiving is their age can be difficult. If they are in the "unexplained infertility" group with open tubes, no significant gynecologic problems and a partner with normal sperm parameters the common choices are to try injectable fertility drugs (COH) with artificial insemination (IUI) or in vitro fertilization (IVF). A recent study in Fertility & Sterility compared groups of women aged 38-39 with a group over 40.

The women who were 38–39 years old had an overall live birth rate of 6.1% per cycle, with no live births occurring after the second cycle, and women over 40 years old had an overall live birth rate of 2.0% per cycle, with all births occurring in the first cycle. These data suggest that the efficacy of COH/IUI cycles significantly decreases with age, but women aged 38–39 years had reasonable success during the first two cycles. However, for women aged over 40 years, no benefit after a single cycle of COH/IUI was observed. Women over 40 years should be considered for in vitro fertilization as the first choice or after one failed COH/IUI cycle.

Does preimplantation genetic screening (PGS) improve IVF success rates in women over 35?

Dr. Arthur Wisot FACOG — Fri, 05 Mar 2010 18:56:46 +0000

Some fertility centers promote preimplantation genetic screening as a way of improving IVF success rates in women over 35 (defining advanced maternal age).

Now a study in the January 2010 edition of Fertility & Sterility shows that PGS does not significantly improve implantation, pregnancy or live birth rates. In this randomized control study from Belgium, the clinical implantation rate per embryo transferred was compared between the PGS group (analysis of chromosomes 13, 16, 18, 21, 22, X, and Y by FISH) and the control group without PGS.

No differences were observed between the PGS group and the control group for the clinical implantation rate, the ongoing pregnancy rate at 12 weeks and the live born rate per embryo transferred. A normal chromosome component was observed in only 30.3% of the embryos screened by PGS.

In this randomized controlled trial, the results did not confirm the hypothesis that PGS by FISH in 3-Day embryos results in improved reproductive outcome in patients with "advanced maternal age.".

In the future newer techniques of chromosome analysis such as comparative genomic hybridization (CGH) which can analyze all chromosome pairs and the ability to analyze blastocyst cells, freeze the embryos and transfer only chromosomally normal embryos may result in better outcomes and the need to transfer fewer embryos and reduce high-order multiple pregnancies as well.