IVF failure in over 40s

Dear Professor Winston,
Following the visit to the Fertility Show and speaking to a genuinely helpful lady on your stand who said we could email you directly we have decided to do just that. My wife S and I have now unfortunately gone through three unsuccessful IVF cycles which we have funded ourselves due to our ages. I am 41 and my wife 42. Due to my wife’s age and following various tests it was suggested that we use donor eggs, which S was devastated to hear yet we agreed to do, we were also told that her womb unlike her eggs would not be age dependant. On each cycle S was told her womb lining was quite thin however they had seen women get pregnant and have a baby with linings that were thinner. Two of the Cycles of treatment ended in miscarriage both at 6 weeks- all cycles were ICSI. During the most recent attempt my wife was give everything they could think of: *Cyclogest 400mg x15 *Aspirin 75mg *Progynova 2mg 3×28 *Prednisilone 5mg x28 *Clexane 20mg box of 10 *Estraderm 100mcg x8. Following the third attempt S was able to get an appointment for a hysteroscopy. This showed there was no scarring or abnormalities. We were kind of hoping that they would find something which would be treatable and give us the chance we needed. On each occasion following the sad news we saw a consultant at the clinic who told us that he didnt know why this has happened as S was clearly able to get pregnant and couldn’t give us any advice on what to do next. All he did say was that due to our age the chance of us having a baby and starting our own family was increasingly less likely. This has obviously left us with little hope of ever having a baby of our own. Coming from a Jewish home, family means so much to us and although we have 4 beautiful nieces and an amazing nephew who we love dearly it’s not the same as being able to have what we want more than anything which is to start a family of our own. Following the last cycle S said that she could emotionally and physically put herself through it again with the not knowing why this has happened. We have started thinking about adoption and following a conversation with Norwood it would be unlikely we’d be able to adopt a Jewish baby due to the way the system works. Surrogacy is also being thought about too. At the moment we feel like were in limbo, because we havent been given any clear advice or information about why these miscarriges have happened and at exactly the same time too, and its the not knowing one way or the other that is so difficult to deal with. I’ve included as much information as I can and really hope that its enough that you might possibly be able to help us either directly or suggest what we could do next, who you we could talk with or put us in contact with. We both will really appreciate absolutely anything you may be able to do for us. Kind regards and thank you so much for your time. A&S


Dear A&S

Dear A&S

I am really sorry I don’t have any particularly comforting news. It is a bit difficult to give you much concrete advice – for example, I have no information about your hormonal response to ovarian stimulation nor the number of follicles and eggs which were seen and retrieved in the previous cycles.

Nonetheless, even without this information, I think you may have to face the fact that the miscarriages are much more likely to be due to the quality of the eggs than the quality of the uterus. As women get a bit older, they don’t only become substantially less fertile, but they produce fewer eggs and eggs which are more likely to have defects. Consequently, because the eggs carry faults, miscarriage is much more likely – about 50% of pregnancies in your age group result in miscarriage and the chance of IVF working at all is only around 5%. I do not understand the rationale for all those drugs – they won’t change the thickness of the endometrium and it sounds to me if you have been in a commercial unit. Also, why do a hysteroscopy after treatment, rather than before it? If you have a thin endometrium, I suspect massive doses of progesterone (by injection!!) would be a better shot.

I fully appreciate the difficulty in finding a Jewish baby and, of course, there are various halachic opinions about donor eggs and about surrogacy. I am very unconvinced that surrogacy would be a good option particularly as you do not have really clear evidence that your problem is uterine. Also, you would need to formally adopt the baby and, unless, the mother was Jewish you could have problems with conversion later on. Of course, the same might apply to a donor egg though some Jewish authorities would not question the Jewishness of a baby if the bearing mother is halachically Jewish.

But in summary, I think this is much more likely to be age-related than anything else and therefore, taking lots of costly potions is unlikely to make a difference.

Best wishes
Robert Winston