One of the main problems facing IVF patients over 40 years of age is the decline in ovarian reserves. Every woman is born with a finite number of ovarian follicles and while a very small number of these follicles succeed in becoming a mature egg, majority of the rest of the follicles never reach ovulation and are disposed with every menstrual cycle. Around the age of 37, the decline in ovarian reserves becomes very sharp.
As a woman gets older, declining ovarian reserves is not the only problem faced in fertility. As age gets older, so do the follicles in the ovaries. Therefore, another problem called "oocyte aging" becomes more pronounced. This is in fact one of the main reasons why women above the age of 40 are more likely to experience a miscarriage- An aging oocyte will be associated with a number of genetic problems, causing the baby to have genetic mutations, thus leading to a miscarriage.
At North Cyprus IVF Center, we offer a comprehensive treatment approach for 40+ patients, which combines a number of important considerations in terms of ovarian reserves and oocyte aging. Patients who still ovulate, and who still have a minimal level of ovarian activity are ideal candidates for our 40+ treatment program. It is important that the female patient still has at least 1/2 pre-antral follicles to be recruited via controlled ovarian hyperstimulation so that we can offer a chance of success with own eggs. For patients with no ovarian function, then using an Egg Donor becomes the only option.
#1- Cytoplasmic IVF Treatment: Patients who still have a few oocytes, but cannot get pregnancy with those oocytes due to oocyte aging can possibly benefit from our cytoplasmic IVF treatment. The principle here is, we use the genetic material from the patient, but we provide the non-genetic parts of the egg from an egg donor so that the patient's own eggs have a friendlier host for optimal growth. It is a known fact that the mitochondria found in the cell's cytoplasm is responsible for cellular energy production and cell growth. By providing the patient's eggs with donor mitochondria, we allow the eggs to grow more optimally and become more viable.
#2- PGS for Genetic Screening: While Cytoplasmic IVF Treatment will allow your eggs to be more viable with higher fertilization potential, it will not be able to eliminate potential genetic risks associated with the age of the patient. Therefore, pre-implantation genetic screening is a good idea to make sure only the genetically correct embryos are transferred into the uterus. Keep in mind that we are not aiming for just any pregnancy. We are aiming for a healthy and viable pregnancy.
#3- Embryo Batching: Given that IVF treatment after a certain age will only allow us to have just a few eggs, any method that will allow us to get more eggs will increase our chances of success. Therefore, while we will be providing your eggs with a better host for optimal growth via cytoplasmic transfer, we still need a certain number of eggs so that we can make sure in the end we have at least one well-grown, genetically correct embryo to transfer. Embryo batching is the key component of success in this age bracket. Combining two rounds of IVF cycles into one allows us to get double the number of eggs- Essentially, what we do is, we prepare you for one round of IVF cycle where we collect the eggs, infuse them with donor cytoplasm, fertilize into embryos and freeze. Once you are ready for the second round, we collect another set of eggs, repeat the same procedures and make a new batch of embryos. With the two sets of embryos at hand, we proceed with pre-implantation genetic screening (PGS) and select a chromosomally normal embryo for transfer, thus giving you the maximum chance of success possible using your own eggs.
We give your eggs the maximum chance of survival through cytoplasmic transfer - we collect two rounds of eggs to increase your likelihood of success by creating multiple embryos - We make sure the embryos to be transferred are chromosomally euploid through PGS testing. This is how we are able to offer you the maximum chance of success possible with your own eggs.
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Some clinics have cut-off age for accepting patients into their IVF program. While the age may vary from one IVF program to the other, most European clinics will have an age limit between 43 and 47. There are two main reasons for having a cut-off age.
1- Each woman is born with a certain set of ovarian reserves and starting with puberty, hundreds of potential oocytes are lost during a menstrual cycle. The reserves keep declining as the age of the woman advances and eventually the reserve finishes once the woman reaches menopause. The ovarian function tends to fall below 20-25% of its starting numbers at the age of 35, and beyond the age of 40, chances of pregnancy with own eggs become very slim. Having a cut-off age for IVF treatment where the patient uses her own eggs avoids a very high risk of a negative treatment outcome and disappointment.
2- Having a cut-off age means not admitting patients who are not likely to succeed, which means the fertility clinic can keep its success rates high.
Whether we agree with this or not is not the main point. The main point is, should there be a cut-off age for trying with your own eggs? The answer is not so simple. Patients may not be willing to give up on their eggs just yet regardless of what the statistics might be saying. If there is a 1% chance, it means 1 in every 100 women will achieve success with treatment. While unfortunately 99 others won't be so lucky.
When it comes to using your own eggs, our clinic does not subscribe into age limitations. However, we make sure that you are well-informed about likely outcomes so that you can make your decision accordingly. For maximizing success wheh using your own eggs beyond a certain age, we have additional methods such as "Cytoplasmic IVF Treatment" that can potentially add a few percentages to your success statistics.
While we do not have an advertised age limit, we do not recommend IVF treatment using own eggs after the age of 47, which is the age of the oldest reported IVF pregnancy worldwide.
For more information on our recommendations for patients over 50 years of age, using donor eggs, please see our "IVF over 50" section.
In Vitro Fertilization (IVF) is a fertility treatment options for couples who cannot achieve and/or maintain a successful pregnancy, therefore, need medical assistance. There are various types of fertility treatments depending on whether the couple uses their own egg and sperm cells or require the use of an egg or a sperm donor. Patients in older age brackets have a few alternative options when it comes to a successful IVF treatment. North Cyprus IVF Center is one of the few clinics in the world offering flexible and customizable treatment options for patients based on their specific needs. Due to favorable laws in North Cyprus, our ISO certified and award-winning clinic can quickly adopt new technologies and new treatment methods as they become available while many other clinics may not be able to offer such treatments to their patients due to increase bureaucracy or very high costs of adopting these technologies. At North Cyprus IVF, we are happy to announce that we are one of the few clinics that can offer various options for patients in older age brackets, thus offering high IVF success.
IVF over 45 or even over 50 is possible. However, there are a few considerations that need to be made when offering treatment to women older than 45 years of age. It should be kept in mind that your overall health and well-being is our top priority and we would not be comfortable with offering any treatment that may put your own health at risk. Therefore, before proceeding with treatment, we ask that you have a standard health screening to make sure that you are fit for pregnancy. This screening would include a blood glucose and bloos pressure checks as well as other routine screenings such as complete blood count and liver/kidney function tests. Once we make sure that there are no problems to proceed, we will be able to design the most suitable treatment option for you.
It should be kept in mind that over 45 years of age, your ovarian reserves have highly depleted and the quality of any remaining reserves have been highly compromised. While it may still be possible to obtain and maintain a healthy pregnancy in such age brackets, it is very challenging and requires a careful treatment planning. In 45+ IVF patients, there are two groups of women; women who would like to be pregnant using their own eggs, and women who would like to use donor eggs for a successful pregnancy. Procedures will be different in both cases:
1- Women over 45 who would like to use their own eggs for pregnancy: In this group, the most important step is to make an assessment of the level of fertility. This assessment is made by hormone testing. In this age bracket, the standard FSH/LH testing may not produce accurate results, therefore, on top of the FSH/LH tests, we specifically ask for the Anti-Mullerian Hormne (AMH) test so that we can make an assessment of the ovarian reserves and proceed with treatment planning accordingly. Once we have made an assessment, we will be able to decide whether you have any oocytes in your reserves that can be recruited for ovulation. If there are, then we will be able to offer you a customized treatment program that will aim to maximize your chances of a successful outcome. For instance, if you have an acceptable level of ovarian reserves, but the quality may have been compromised due to oocyte aging, then Mini IVF or IVF with Cytoplasmic Transfer can be ideal treatment types for you. In highly depleted ovarian reserves with compromised oocyte quality, Mini IVF is not recommended but IVF with Cytoplasmic Transfer would still be an option.
2- Women over 45 who would like to use donor eggs for pregnancy: Treatment is much less complicated in this group of women. Since eggs from a young and healthy egg donor are used, pregnancy rates are much higher. Our egg donation program is an exceptional program with exceptionally high success rates due to a number of reasons, which are explained in a previous blog article by Dr. Savas Ozyigit himself. Women seeking IVF treatment with donor eggs would need to undergo the health screening mentioned above as well as a trans-vaginal ultrasound scan to make sure there are no visible problems that can interfere with a successful pregnancy. Hormone testing for ovarian assessment will not be necessary as ovulation induction will not be performed. Please see our donor egg IVF treatment section for more information on this treatment program.
Regardless of whether you are planning on using your own eggs or donor eggs for IVF treatment, a careful assessment and a careful planning are the key factors behind a successful IVF outcome. Feel free to contact our clinic for more information on treatments.
Dr. Savas Ozyigit
Egg donation in Cyprus, Gender selection in Cyprus and IVF treatments in North Cyprus in general: you will find information on new advances in IVF technology and latest IVF practices. All the blogs are personally written by Dr. Savas Ozyigit and his expert medical team.