Trying IVF after 35 can feel like a different journey — but the right medical strategy and lab techniques can make a real impact.
In this live session, Dr Kristýna Frühaufová, PhD, Head Physician at GYNEM Fertility Clinic, explains why success rates change with age, how clinics tailor stimulation for women 35+, and which modern tools (like PGT-A, time-lapse, sperm selection, and emerging AI) may help improve outcomes.
Hosted by Barbara Scott (Chair of the Association of Reproductive Reflexologists, Founder of Seren Natural Fertility, and author of Reflexology for Fertility), this webinar offers clear, science-based guidance for international patients exploring IVF later in life.
There are some studies, but so far, AI does not work in the way we would ideally imagine for embryo selection. We know that during embryo development, certain features may suggest genetic abnormalities, but the embryo may still be of good blastocyst quality.
We do not yet have a reliable pattern that would allow us to identify specific genetic issues purely based on embryo development. To create such software, thousands of embryos would need to be monitored in time-lapse systems and genetically tested, ideally with multiple biopsies. This would mean destroying embryos, which is not ethically acceptable.
Research is ongoing, often using embryos that are already destined to be discarded and where patients have given consent for scientific use. However, collecting sufficient data takes a long time. AI in this area is still very much in its early stages.
We know that approximately 80% of chromosomal abnormalities originate from the egg. From a genetic perspective, sperm has a much smaller influence on chromosomal abnormalities.
However, sperm quality does affect fertilisation and early embryo development. There is a pattern showing that when embryos fail to develop beyond day three, sperm quality is often a contributing factor.
Different energy sources are required for early embryonic development and for blastocyst formation. Sperm therefore has a stronger impact on embryo development than on chromosomal normality.
Yes, absolutely. Male health and sperm quality are important, and optimising male health can positively influence outcomes.
Yes. Every patient presents with a unique combination of factors, and treatment must always be individualised.
This is difficult to answer without knowing the full background. Generally, for patients with good ovarian reserve, we often choose a short antagonist protocol, which allows us to obtain a good number of eggs while reducing the risk of ovarian hyperstimulation.
The medication doses depend on body weight, hormonal profile, antral follicle count, age, and previous treatment history. Without this information, it is not possible to give specific advice.
This is a very complex situation, and without the full history, it is difficult to be specific. In PCOS patients, egg quality can sometimes be compromised because although many eggs are produced, their quality may be lower. Age is also an important factor.
In such cases, I would usually start with minimal to low-dose stimulation, potentially over a longer period, to avoid retrieving too many eggs and instead focus on quality. Triggering strategy is also important, and a double trigger may help optimise egg maturity.
If adenomyosis is present and advanced, we often freeze all embryos and prepare the uterus later using downregulation before embryo transfer.
This depends on why the ovary was not accessible. If adhesions are present, it may not be possible to mobilise the ovary sufficiently.
Sometimes, during egg retrieval, changing the patient’s position can help improve access. In other cases, fibroids may obstruct access. If adhesions are severe and access is essential, laparoscopic surgery may be considered to restore normal pelvic anatomy.
In selected cases, transabdominal egg retrieval may also be possible, but specific conditions must be met.
At our clinic, treatment is offered up to the age limit defined by legislation, which is before the 49th birthday. We know that the uterus also ages, although not as significantly as the ovaries.
There are age-related changes in uterine blood flow and placentation, which reduce success rates compared to younger women.
Correct fertilisation is usually identified by the presence of 2 pronuclei around 17 hours after fertilisation. However, variants exist, and embryos with 1 or 3 pronuclei may still be genetically normal.
Time-lapse systems allow continuous monitoring and retrospective review, which reduces the risk of misinterpretation. With standard incubators, embryos are only briefly observed, so interpretation can be more challenging.
In some cases, a normal euploid embryo may still develop from an atypical pronuclear observation.
There is missing information, but if endometriosis is active, surgery may be considered before embryo transfer to improve implantation chances.
After a preterm delivery, progesterone support may be extended beyond the first trimester. Cervical history is also relevant. This situation requires a detailed individual assessment.
This is a very difficult situation. Estradiol priming can help prevent premature FSH rise and optimise follicle growth.
The follicle count is limited, and age remains the most important factor. Supplements and lifestyle optimisation may support egg quality, but they cannot reverse age-related changes. We cannot improve past ovarian ageing.
Male age does affect sperm quality, particularly DNA quality. It does not have as strong an impact on chromosomal abnormalities as female age, but it may be associated with a slightly increased risk of rare conditions.
If standard sperm parameters are normal, no additional testing is required. If abnormalities are present, DNA fragmentation testing can be helpful.
If ovarian reserve is sufficient, a long protocol can be considered. In women with diminished reserve, downregulation may suppress ovarian response too much.
Given repeated miscarriages, PGT-A should be considered to distinguish genetic causes from uterine factors. In adenomyosis, adding letrozole to downregulation may be beneficial, as it affects adenomyotic tissue.
