44 Year Old Woman Has Faith That She Will Conceive - Fact or Fiction?

Recently on the All Expert's site, I had an interesting comment from 44 year old woman who feels that RE's are unfairly pessimistic towards "older women" who come to them for infertility evaluations and treatment. I want to publish her point of view because it is a valid one and to point out that there is reason for optimism. It also brings to mind the recent publicity on 41 year old Celine Dion, the feature article in People magazine (Feb. 10, 2010) and her appearance on the Oprah Winfrey show. Celine has admitted publicly that she will not give up despite her age, four failed IVF cycles, and a recent miscarriage, championing the cause for those women like her who wish to conceive past the age of 40.

Comment:

I know what the stats say but I am a 44yr who went into an ivf specialist who did an iui and advised me even as he was doing it that it won't work nor will the ivf if I tried and advised me to just get a donor egg. Well, I did get pregnant on the first try even if I miscarried. I am now trying iui with injectables since I was advised by the new specialist it would work better than an ivf at this point. All my labs each time are consistent with that of a younger woman of childbearing years. Why are you guys so pessimistic for older women? Why do you suppose I got pregnant right away the first time?

I started my period at fourteen and I don't know if it has anything to do with it. I think that sometimes IVF clinics tend to cherry pick their cases to increase the level of "success" stories they can tell. I think it only fair that you fight just as hard for older patients before nudging us to donor eggs..after all the whole point of my husband and me trying to conceive is to see a by product of the two of us, otherwise we can as well adopt. I am just as confident that this cycle will work too, but when I read what you say, it's easy to loose hope but I am a faith filled woman. Pls let older folks out there know their situation is not as hopeless as stats make it sound, at least that has not been the case for me thus far.

Answer:

Thank you for your letter, although it is not a question for me to answer.

I am sorry that your RE was so pessimistic with you. However, there are two sides to this. First, we base our recommendations on statistical chances. Our purpose, as your consultant, is to give you the best and most accurate advice that we can. We cannot predict outcomes, only give you the "statistical" chances. Because IUI is a "natural" procedure, the chances of pregnancy are based on your natural pregnancy rates, which is less than 0.5% per month in your age group. That is NOT a 0% rate, so there are some 44 year olds that get pregnant naturally and with IUI and IVF. It is just a reflection of the possibilities. Part of that decreased pregnancy rate is a very high risk of miscarriage, as you experienced. That is due to old eggs leading to abnormal embryos. Nature (your body) realizes that it is an abnormal embryo and thus stops the pregnancy leading to a miscarriage. Despite the fact that you became pregnant, you need to be prepared to possibly undergo several miscarriages before being successful.

But you are correct. There are always exceptions to the rule. In fact, in November 2009, the New York Post reported a case of a woman who was 49 years old, the doctor using an egg that was retrieved & frozen from her at 48 and who successfully delivered the child conceived by IVF (Dr. Zhang of NYC see related link: http://bit.ly/5PX4k9). It took her two years of many, many IVF cycles, but her perseverance paid off. She is now the oldest woman to conceive with IVF using her own eggs, and I am sure that she was advised to use donor eggs all along the way.

Now the other side of why we advise, as we do, is because we want you to have success, NOT because we want higher statistics or make more money. I'm sure there are doctors who are unscrupulous, but most of us are not. Our mission is to help our patients get pregnant, and for you to have the highest chances of having a successful pregnancy. In addition, we also get criticized by patients, and the press, when we let patients do lower level treatments, such as IUI, for several tries and they are unsuccessful. We are then scolded for allowing the patient to attempt a procedure that would not have worked so that time was wasted. We should have "urged" or "made" the patient go directly to IVF, these patients say. Then they say that "they were not told" that the success rates were too low and that we let them try that procedure because we just wanted to take their money. I have read about MANY such cases in print and on the internet.

In general, we are NOT advising that the case is hopeless, and I know that patients don't want to hear that as well. We are advising what would give the patient the highest success rate, so that they don't get disappointed, which takes its emotional, as well as, financial toll. In my practice, I have let patients as old as 47 years old try both IUI and IVF, with very clear counseling regarding their chances for success. I do not tell them what to do. I let them choose, just as you have done. You became pregnant in your first IUI cycle, which is a triumph. That means that you still have good ovarian function, a key component to getting pregnant. The goal is to get a good egg so that you can have a successful pregnancy. IVF is more suited to this because we are able to get lots of eggs out at one time. That is why it is suited for the "age related egg factor." In an IUI cycle, you are not stimulated to the maximum point (for good reason), so the chances of getting a good egg are reduced (3-5 eggs). Whereas, with IVF, if you respond well, we can get 10-20 eggs out at a time, increasing the chances that we will find a "good" egg in that group.

If, despite all the information and knowledge you have acquired, you feel that IUI is the best route for you to take, then GO FOR IT and give it your best shot. Feel comfortable with this decision and don't doubt or regret it because you made the decision you thought was best for you. Each and every infertility patient has to do this as well.

I wish you the best of luck,

Sincerely,Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

www.montereybayivf.com