Is ‘mild’ IVF justified in women over 40?

Dear Prof Winston
I am now 41 and my husband 46. We have this year undergone mild IVF. We have not been successful and have been looking for someone who would offer us an independent consultation to give us their opinion on how likely more IVF would be to assist us.
My test results over the last year or so are –
AMH 31 and 36.3 pmol/L.
LH 2.6 and 3.8 iu/L.
FSH 2.2, 4.9 and 4.0 iu/L.
Serum TSH level 2.35miu/L.
Serum Free T4 level 12.7 pmol/L.
Serum Progesterone 44nmol/L.
Oestradiol 140pmol/L
HSG X-ray – normal
Transvaginal 3D ultrasound – follicles, blood flow – good. Lining – excellent.
I took Gonal 150IU for 6 days.
On the 5th and 6th day I took Centrotide 0.25mg
On the 7th day took 250iu Ovitrelle.
Produced 16 eggs
And then 5 embryos (4 were frozen)
Two days later began taking Utrogestan 200 capsules three times a day and Clexane 40mg once a day.
Continued through transfer and until we got negative pregnancy test.
For the second and third transfers we developed the embryos into blastocysts to check viability.
I took the Utrogestan and Clexane (20mg now) as before, along with levothryroxine (for slightly under active thyroid) and Prednisolone.
Negative pregnancy tests.
For our fourth go we transferred at the embryo stage having had an endometrial scratch the month before. I came off the Levothryroxine (as thyroid showing normal).
Negative pregnancy test.
With our 5th and final embryo we are considering assisted hatching but can see no mention of it on Create’s website and they are not forthcoming with an estimation on the number of procedures they have performed. We are thinking of transferring the embryo elsewhere but do not know where to go.
My husband’s results
Vol 2.5ml
Concentration 70
Total no. 175
Progressive 45%
Non progressive 1%
Non-motile 54%
Normal 8%
Liquefaction complete
Viscosity normal
We would be grateful for any advice and will donate to Genesis Research Trust now. We understand that what we are looking for is a consultation. Are you able to suggest any place where we could get good advice that is not a clinic with their profits to consider.
Kind regards

Dear F&F,

I think there is little justification for ‘mild IVF’ in women over the age of 40. The best survey I have seen, published in Japan in a large study of several hundred patients, showed that this approach was not particularly helpful and in my view usually results in under-collection of eggs. In the Japanese study, very few pregnancies were achieved and the miscarriage rate was around 50% or more. However in your case you do seem to have responded well though I would hardly call this level of stimulation slight. But I have to ask, am I right in assuming that all the embryos you have had transferred come from the same stimulation cycle? If so, it could well be (as I have said elsewhere on this website) that the eggs you had collected all suffered from a similar failure to mature properly – or some other defect. So it is quite possible that, even though your embryos developed to the blastocyst stage they were of suboptimal viability. And no matter how they looked down a microscope, this gives no serious indication of whether they were in optimal condition.

Even though you have favourable blood tests and quite a good response to stimulation, I must remind you that the chance of IVF success in any one fresh cycle of IVF in somebody of your age group will be no more than about 3 – 4% and a little lower with a frozen embryo from that cycle. As I was the person who was responsible for the first assisted hatching, I would advise you not to consider it. I am very dubious as to whether it helps unless you have problem with the zone pellucida, the shell surrounding the egg and embryo. I regret I cannot recommend a clinic for reasons which I have repeatedly emphasised on this website.

I hope this is helpful,
Robert Winston