During this milestone session, our 500th webinar, we’ve discussed IVF and fertility treatments for women over 40. Dr Esther Marban, Fertility Expert at Clinica Tambre, Spain, shared her invaluable insights and expertise on this crucial topic as well as answered the most interesting questions.
Advanced Maternal Age is typically defined as getting pregnant at 35 years old or older. We know that at this age, older patients may have decreased egg quality and reduced ovarian reserve, and it all happens when age increases. Apart from that, we know that age may increase the chance of carrying a baby with chromosomal disorders, such as Down syndrome.
In addition, it’s also important to note that age is related to increased fetal risks, such as miscarriage, stillbirth, and abnormal growth, and maternal risks such as high blood pressure, diabetes, and premature birth. These risks are even higher in twin pregnancies, so that’s something that we should consider.
It’s also important to see how increased maternal age can have an impact on the chance of having healthy embryos. In this slide, you can see how maternal age affects the percentage of euploid (genetically normal) embryos we expect in the laboratory. It also has an effect on the miscarriage rate and live birth. You can see how live birth starts decreasing as the miscarriage rate increases and the number of euploid embryos also decreases.
We mentioned that Advanced Maternal Age may have consequences, and now we are going to talk about the potential treatments and the different options we can offer to our patients. The first one, which is the most common one, is the in vitro fertilization (IVF) treatment. How does it work? Normally, the treatment starts by stimulating the ovaries using medication to encourage them to work as much as possible. In more than 90% of the treatments, we prefer using the ICSI (Intracytoplasmic Sperm Injection) technique, where a single sperm cell is injected into the cytoplasm of a mature egg. This technique helps ensure successful fertilization.
There are different stages of embryonic development. The first stage shows the signs of fertilization, and as the days progress, you can observe cell division and embryo quality. It’s important to perform single embryo transfer at the blastocyst stage to reduce the risks associated with multiple pregnancies. We always avoid transferring embryos on day two or day three, as the chances of successful implantation are higher with blastocysts.
If you’re considering adding pre-implantation genetic testing (PGT), it’s essential to understand that it may not be suitable for all patients. This discussion pertains to a particular group of patients: those facing advanced maternal age. In this group, there’s an elevated risk of non-implantation due to factors related to the embryos.
When the initial stage of the treatment proves ineffective or a patient experiences multiple failed attempts, alternative options, such as egg donation, should be considered. The World Health Organization (WHO) defined egg donation as a fertility treatment designed for women unable to produce their own eggs or at high risk of transmitting genetic diseases.
The main indications for egg donation include premature ovarian failure, where the patient no longer menstruates, making egg donation the ideal solution. Additionally, many patients with failed IVF treatments, often linked to low-quality and low-quantity eggs, are primarily caused by age-related factors. Other cases may involve problems that pre-implantation genetic screening cannot diagnose, making egg donation a viable option.
The egg donation process comprises two key components: the donor’s contribution and the steps undertaken by the recipient patient. The donor undergoes ovarian stimulation, similar to that experienced by the patient. The selection of a suitable donor involves two steps, beginning with a consideration of general characteristics, followed by facial biometry using a computer program called Fenomatch.
It’s crucial to recognize that egg donation in Spain is always anonymous. Patients are unable to select specific donor characteristics, and both the donor and the recipient remain unknown to each other. The recipient patient prepares her uterus for the embryo transfer following the donor’s ovarian stimulation. Embryos are created in the laboratory, similar to traditional IVF, with the key distinction being the ovarian preparation by the patient to optimize her uterine conditions. After this preparation, the embryo transfer follows the same process as traditional IVF.
In terms of success rates, it’s crucial to understand the differences. While the implantation rate with the patient’s own eggs decreases with age, the egg donation treatment maintains a consistent pregnancy rate and implantation rate, regardless of age.
It’s essential to consider that although the implantation rate remains consistent with donor eggs, the associated pregnancy risks could increase with the patient’s age. Pregnancy in one’s 40s is different from pregnancy at almost 50, and age-related risks must be taken into account.
The cumulative implantation rate increases as the patient undergoes more embryo transfers. In conclusion, a precise diagnosis and specific tests are essential for a correct assessment. While age is a contributing factor, it’s not the sole determinant, and other factors need examination. Both male and female factors should be evaluated. For advanced maternal-age patients, IVF combined with pre-implantation genetic testing can enhance the implantation rate, reduce miscarriage rates, and expedite the path to pregnancy. Egg donation may serve as a solution for many patients following previous failed attempts attributed to age, low ovarian reserve, or poor egg quality. In advanced maternal age cases, it’s advisable to opt for a selective single embryo transfer to minimize risks during pregnancy, especially in egg donation treatments.- Questions and Answers