Sunday, November 1, 2009

To Do Or Not To Do IVF at 42?


Dear Dr. Ramirez,

I am writing to you from New Hampshire. I am 42, FSH 6, and just completed my first failed IVF cycle using the microdose flare protocol, lupron plus 300 Gonal F and 300 Repronex, stimulated for 11 days. Ten eggs were retrieved, 3 fertilized with ICSI/AH (intracytoplasmic sperm injection/assisted hatching) and 3 were transferred on day 3. Although my RE noted that over 50% of the oocytes were abnormal (likely to be age related with large debris in the perivitelline space), she is now recommending a patch protocol, with the same meds/quantity used in the first cycle. Do you think it would be worth trying another cycle, or should I be realistic and go straight to donor egg or adoption?



The "age factor" is not an absolute, meaning there are pregnancies in your age group. What you need to decide is how much you want a child with your genetics and how much you want to try and can afford. In your age group the chances of pregnancy are approximately 25% per cycle. So, it means that you may need to try several times before you are successful. This could be up to 6 attempts before you would be successful with your own eggs. On the other hand, the pregnancy rates for donor are 63% in our program. The chances of pregnancy with one attempt are over 50% as well, so with donor eggs, you have a higher chance of becoming pregnant with fewer attempts. The downside is that the baby would not have your genetics. How important is that to you?

Many of my "older patients" will try up to three times, to convince themselves that they have given their best efforts then resort to donor after. I have had many older patients that have only had one egg produced, one retrieved, one fertilized and one transferred and gotten pregnant and had a baby. I cannot comment on your medication protocol since every patient is different and it is up to your RE to decide how you responded to the first cycle and how to "tweek" it.

How to proceed from here is purely a personal choice. In terms of my recommendations, if genetics is not a big concern, then if cost is an issue, go to donor, if it is not, then try at least three times with your own eggs. The good thing is that your ovaries are still responding well to stimulation. Getting a lot of eggs is the key to overcoming the "age" factor!

Good luck and don't lose heart!

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
check me out on Facebook and Twitter with me at @montereybayivf

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