QuestionDear Dr Ramirez, I have just turned 40 years old and am trying to fall pregnant naturally for the past 5 years. I had severe endometriosis laparoscopically removed 2 years ago. I have had 2 chemical pregnancies in the last year. My husband and I don't want to do IVF (even though we have been advised that it is our best chance), we are hoping that the 2 chemical pregnancies are a good sign of our ability to get pregnant. I am also a heavy smoker. What are my chances of a live birth considering my history and the length of time I have been trying to conceive? Thank you, Sharon
AnswerHello Sharon from Australia,
As you know, age plays an important role in your ability to become pregnant. A woman is born with all her eggs and they age with her. Unfortunately, the lifetime of eggs is probably 42-43 years, so after 30 years old, the quality of the eggs deteriorate. This leads to an increased incidence of infertility and miscarriages, and was probably the cause of your two chemical pregnancies. We know that at 37 years old, only 20% of embryos formed are genetically normal. It is less at 40 years old. At 40, the natural chances of pregnancy is only 10% per year or less than 1% per month. The fact that you got pregnant shows that everything works in your body to complete the process in order to become pregnant, but that does not confirm that there is still a good egg present. I would presume, however, that there are good eggs present still, and in that case, you'll just have to keep trying until you are lucky enough to get one and get pregnant with it. Then the pregnancy should be successful. But the downside to that is with each month that passes, you are using up more eggs (lots get stimulated but only one ovulates), and more eggs are going bad.
IVF is recommended because it is a shortcut to finding the good egg. By stimulating the ovaries with fertility medications, more than one egg can be recruited and retrieved. That increases the likelihood, statistically, of finding a good egg. It too may take several tries but the statistics are better. In our program, for instance, the chances of pregnancy with IVF at your age is 61% per attempt.
Hope this helps,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf, and follow me on Facebook at http://bit.ly/9Iw9oV
