There is a general misconception that women at any age who need babies can decide to wake up at any time of their life and do IVF to have their babies; according to a popular fertility expert, this is not so. And it is the major reason most women are disappointed after having a failed IVF circle.
In this interview with Dr Abayomi Ajayi, the MD of Nordica Fertility Center, he reveals how women that are over 40 can have successful IVF sessions, what they need to know and the practical steps and guides needed. He also itemized some of the dangers attributed to getting pregnant late either naturally or via IVF. But is that to say it’s all doom for women over 40? Does that mean their chances and hope of carrying their babies have been dashed?
Read on to know what Dr Abayomi has to say. City People’s Brands Editor, DAMILARE SALAMI 08155134152 engaged him and below are excerpts, enjoy.
There is this general conception that it is better for women to have their babies before they hit age 40. Why do you think that this is a correct notion?
All of the people because of what they are made to believe especially in this day of social media think that they can just have IVF even when they are over 40 years, but this is not true. The same law that applies to natural conception applies to IVF. So whilst a woman who is age 30 has about 30-35 chance of conception, it’s about 5 per cent in women over 40. And whilst a woman who is 30 has a 1 in 385 chance of having a chromosomally abnormal baby, a woman that is 40 and above has 1 in 66. So, these are some of the things we need to look at when we talk about down syndrome and other chromosomal abnormalities, they are commoner in women who have children at over age 40. These are some of the things we need to consider when we are talking about women waiting till after age 40 to have their children. When we look at some of these moves, it is not very good, so the old teachings still stand that women should still try as much as they can to have children and raise their families as early as possible.
This doesn’t mean that men are not completely spared too. By the time a man reaches the age of 45, the sperm counts too will start having some changes that may reduce its chances of being able to fertile an egg and produce a baby. From all that has been said now, are we saying that women from age 40 will not be able to have children, no, that’s not what we are saying. We are saying that she might be able to have children naturally, but 50 per cent of them will not succeed. And if she tries to have IVF, there are two things that she might have to contend with, either she’s using her own eggs which have a chance of 5 per cent for age 42 or about 10 per cent for age 40 if we try what we call egg pulling to get more eggs, if the IVF centre has a good freezing system, they can combine two or three cycles together to make one before they do the transfer. And also, there’s something they call pre-genetic screening which can be done to be able to determine which of the eggs or embryos are viable; and of course, she can use donor eggs.
There are two types of donors; it can be a known donor which the patient will provide by herself or an unknown donor which the clinic provides for the patient. One of the things that you can do to save you from this stress is to do egg freezing so that we can prevent some of these stories that touch the heart.
Is it all gloom and doom for people that are over 40? Well, no. one of the excuses people have for delaying starting a family is that they say they are more financially stable, more emotionally stable and they can make better parental decisions. While this may be true, we have to understand that before you can make any parental decision, you have to first become a parent. That’s why we are looking at some of the hurdles you might need to scale through before you become a parent.
What are the risks associated with women that are pregnant at over 40?
Anytime a woman that is over 40 is pregnant, it is considered to be a high-risk pregnancy because of the risks that can be involved, for example, high blood pressure, preeclampsia, gestational diabetes, placenta accidents, both the abruption and the Previa. And that’s why the incidents of cesarean sessions are much more increased in women that are over 40.
What should women seeking to get pregnant at over 40 do?
The first thing they need to attend to is their lifestyle. They need to eat healthy diets, this is very important and they must also keep a healthy body mass index. They must also as much as possible avoid alcohol and cigarette smoking. Moderate exercising will also be beneficial. Before getting pregnant, she must also be prepared because we talked about all the risks that can happen in pregnancy. So for such people, pre-conception care is very important. This is to assess their state of health because pregnancy also comes with its own challenges. We have to be sure if the patient has some underlining ailments that will also need to be catered to during the pregnancy. This is the time to discuss her medications too and other options available to her as a person or with her husband as a couple. These are the things that need to be considered when we are talking about women that are over 40 and are trying to get pregnant.
Dr, you also mentioned egg freezing as a possible solution. What is the viability of an egg that has been frozen for more than 10 years?
Nice question. The way eggs are frozen is just like having your meat in the freezer. If you have a constant power supply, the meat will still be good even if it may not be as tasty as you expect, it will still be edible and safe for consumption. The same thing is applicable to egg freezing, it is like you stock nature. The reason we age is that we are proteins that have been denatured, what we do with freezing is that we stop the eggs from progressing so they are stuck where they are and as they are. The oldest that we have now is about 17 years of storage and when it was used, it was still very active. So it’s quite possible that the eggs can be used as long as they are being frozen and all the conditions are met.
Doctor, what are the challenges with donor eggs and the certainty that these donor eggs will work?
Unfortunately, this is the question that I am asked all the time. One thing about IVF is that nobody can ascertain anything. In IVF, we always say that the success rate is cumulative. So for such a person, the ideal thing is that we advise her to do 2 or 3 cycles; usually about 2 cycles. If you are 40, from 2 cycles, your chances become about 75 to 80 per cent which is a very good chance of taking a baby home. What I tell people all the time is that the reason you are doing IVF is to take a baby home and not to have positive pregnancy tests. So, your chances of taking babies home really become very significant but for some, they might need up to 3 cycles. There’s no certainty even when you use donor eggs, because sometimes also, the problem is not only with the eggs. Don’t forget that by the time a woman is about 40, the chances that she would have done this myomectomy thing is higher and that might affect even the lining of the uterus, so it now becomes double trouble. It’s not only the egg quality now but also the endometrium that is not up to par. And that’s why we tell people that their success rate is individualized. Once the laboratory, the clinic and every other process work well, it is now left to you carrying the pregnancy as an individual or as a couple. And if you talk about the challenges, of course, everybody wants to have genetic children but really and truly, the first challenge you are going to be facing is the fact that this person is not going to be having her own genetic child. Therefore, you need to counsel them in making this decision before such a decision is made.
Also, there are other things that we can do with the donor eggs, we can still do pre-implantation genetic diagnosis, to diagnose if there is any disease the mother is carrying. And we have to be careful with that because we have to look at both the woman and her husband because sometimes we have observed that the donor might even be cleaner than her husband. When we look at genes, we find out so many things that we don’t even know about. All of us appear to be normal but even in our normalcy, we still carry about 8-10 transported genes. Some people will prefer using known donors because of their familiarity with them but the truth is that you may appear to know them but you can’t know the diseases they are carrying that they may not even be aware of, and that’s one of the things the genes are exposing us to now. One of the most difficult people to counsel are people who just had a failed cycle, using donor eggs. When probably she used her eggs and it failed and you advised using donor eggs and it failed again, usually they are one of the most terrible people you can counsel and rightly so because they have this notion that I’ve used donor egg, so why should this fail? But you need to understand the technology about what happens between the endometrium and the embryo, a lot of things can still go wrong.
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