Consider the fact that at age 39-43 years, the birth rate per cycle of treatment with injectible fertility drugs alone, or in combination with intrauterine insemination (IUI) is about 2%. With IVF, the birth rate is 10-15 times higher when performed in an IVF program of excellence. It follows that for women in whom the “biological clock” is ticking, IVF is the treatment of choice.

In more than 80% of cases, embryo quality is a function of the chromosomal integrity of the egg rather than the sperm. Age progressively increases the threshold risk of numerical chromosomal egg/embryo abnormalities (aneuploidy), which is synonymous with egg/embryo “incompetence” (inability to propagate a viable pregnancy). In fact, by age 39-43 years, more than 85% of a woman’s eggs will be aneuploid, resulting the embryos they propagate being”incompetent”. To make matters worse, as a woman ages beyond 39 years, she gets closer to the menopause. During this transition she progressively builds resistance to fertility drugs as well as a reciprocal decline in the number of eggs likely to be available at the time of egg retrieval. Thus, with fewer eggs available and a growing percentage of these being aneuploid (“incompetent”) the smaller will be the number of “competent” embryos available for transfer to the uterus. To add to the problem; there is virtually nothing that can be done to avoid the inevitable age-related decline on IVF outcome.

The only way to increase the overall likelihood of successful IVF in older women is by:

1. Minimizing the compromising of egg development in the course of controlled ovarian hyperstimulation (COH) by customizing the protocols to meet individual needs (avoiding a “one size fits all” approach)
2. Increasing the number of embryos available by banking and stockpiling them over several cycles, and then
3. Identifying the “competent” embryos for selective transfer to the uterus by testing them with comparative genomic hybridization (CGH). Thus as women approach 40 years of age, they are under time pressure. The sooner they make the decision to proceed to IVF, rather than waste valuable time on other (lesser) treatment options, the better. The fact is that once on the move, the biological clock can unfortunately not be reset.For women over 43 years, IVF with egg donation remains a treatment of choice.