Hi everyone! If this is the first time you’re watching the show or reading a post, then welcome. I’m Dr. Aimee and I’m a fertility expert practicing in the San Francisco Bay area. I’ve worked with hundreds of women over 40. I’m hoping what I share as my tips for IVF after 40 are helpful to you, regardless of where you live or who your doctor is.
Here’s what you need to know when it comes to doing IVF over 40:
- Know Your Levels. Track and trend them over time.
I’m not just talking about your AMH, FSH, Estradiol levels. It’s also important to understand your follicle count. It is so important for you to know what’s going on with your body. Knowledge is power, especially when it comes to your fertility. You want to be able to understand how your levels are changing over time. In my experience, patients may do better with IVF when their AMH is lower, but if you don’t have a baseline of how they’ve changed over time then you’ll not be able to make the most informed decision.
2. Getting your levels checked doesn’t mean you have a problem. It simply means you want to understand your body.
Checking your fertility levels is smart. So is talking about the family size you want — that’s true if you’re partnered or not. Please don’t waste time. So often we thoroughly plan other parts of our lives (our careers, vacations, etc.), yet we fail to plan out our fertility future. What does your future family look like? How many kids do you want? What’s it going to take to get that?
Lastly, see a fertility doctor like me. I am that super annoying overly-positive doctor who will never say no to anyone that’s over 40 and has an egg. I believe every woman has the chance to get pregnant and I will do everything in my power to try and make that a reality.
Why do I feel this way? Well, if a guy can be 75 and get a 25-year-old pregnant, then who am I to tell a 42-year-old woman that she’s simply too old. That’s simply not fair. I’m here to guide you. To tell you what your real chances are based on the information we collect about your body, and to guide you through an IVF cycle and hopefully, it will work. If not, we’ll talk about what we’ve learned and what we’re going to do next.
3. So often, women over 40 don’t realize they need help until after they’ve miscarried. I see it all of the time. Well-intentioned OBGYNs tell patients that after a miscarriage it’s a sign that they CAN get pregnant, and that they should continue trying for another year. They tell people that after a miscarriage getting pregnant will be easier. I’m telling you — that is just not how it works. If you’re struggling, if you’ve had a miscarriage, or had your levels checked then go see a fertility doctor. Even if you don’t want to do IVF, this is the time to preserve your fertility. I believe all people are fertile. I hate the word infertility. I see you as a fertile person that can achieve a healthy pregnancy with your eggs. If you believe it too then I will hope, and work with you, to achieve it one way or another.
4. Recognize that you’re not alone in wanting to get pregnant naturally. Nobody wants to see me as their doctor, but when you’re over 40 it’s time to get serious and I want you to consider what I have to talk to you about in tonight’s show.
It’s why I like to share this IVF attrition pyramid. Know your IVF pyramid. Not what happened with your friends, but what does your cycle pyramid look like before you go through IVF? I want you to have a clear set of expectations of what can happen.
Give yourself time to try. Or not. I know some women that are over 40 and automatically want to use donor eggs. That’s okay too.
The reality is when you’re over 40 your chances of conceiving are lower. A woman at 40 has 3% of her eggs left. That’s the reality. Each cycle your chances are 5% or less of getting pregnant depending on your age. By the time you’re 45 your chances are 1% per cycle.
But once again. If you want time to try then give yourself that time to try. Then realize there’s no emergency if you’re not successful.
Give yourself time to heal. If a cycle doesn’t work, then take a break.
Be open to other options. Watch movies, read books, read articles. There are so many ways of being a parent if your eggs run out.
Ultimately you want to find the right path for you.
5. Ovaries are ready for other options, but you may not be. This happens frequently. Patients come to me and want to do more things, but there may not be another thing you can do with your own body. We need to lift each other up and talk to people about the reality of what’s happening. If you’re over 40 and have gotten pregnant then I encourage you to share how it happened.
There are many celebrities over 40 that are getting pregnant. There may be more than meets the eye. Don’t live your life according to what you infer may be happening with other people. Live your life according to what you know about yourself, and what you can do with your own body. Comparison when it comes to anything is the enemy of joy. That’s especially true (and misleading) when it comes to your fertility.
6. Know what’s okay to say and feel.
For example. You may say/think:
I’m really mad I waited too long to have a baby. I thought I had to have the house and the job, and the man. Now, I realize all I needed was the eggs.
I’m really mad at myself for not freezing my eggs.
I’m really mad at my husband for making me wait until I was 40 to start trying. I kind of hate him right now.
I think a lot of women over 40 have found themselves saying this. It’s okay to say this.
But what I want you to do right now is to let that go. Take a deep breath in… and…out.
Replace it with this:
I waited until the right time for me to have a baby. It was really important for me to make sure that I had everything in place. Now that I do, I am ready for all the ways that I am meant to be a parent.
Can you say that? I waited for the right time. It is so important for you to hear that. Let go of the anger. Let go of the shame. Whenever you get a snarky comment just tell people that this was the right time for you. It doesn’t matter what they think. It matters that you’re at peace. That’s all!
On the topic of being mad at your husband. Let’s get his sperm enrolled in a good boot camp. Ice for the balls, alcohol free-beer, and plastic cigars for “smoking”. This will get his sperm in tip-top shape! I’m joking, but I’m also not…
7. Know that sperm matters as much as eggs.
You want to do sperm deep dives — look at the DNA fragmentation, understand the quality, and think about the lifestyle factors that could be impacting the overall sperm health. In short, you want to do all of the same work for the sperm quality that you’re doing for your egg quality.
There are things that men can do to improve their sperm counts. Not so much for eggs.
8. Think about other things to improve your chances of a successful IVF cycle: Egg Whisperer DIET, Considering PGT, and Implantation Testing.
Egg Whisperer DIET. Diagnosis, IVF cycle, Endometrial testing, and then Transfer. Part of the Diagnosis is getting your TUSHY checked.
I ask my patients to consider Pre-Implantation Genetic testing to tell us if an embryo has normal chromosomes or not.
Finally, testing before implantation occurs can help us ensure the implantation is as successful as it can be in an IVF cycle.
9. Think about working with a surrogate.
I ask all of my patients over 40 to think about the idea of working with a surrogate. It doesn’t mean you need to. However, if I have one embryo with a patient and it’s taken 3 cycles to get the embryo, then it’s very important we use it wisely. You want to at least talk about the idea of a surrogate. Why? If you transfer the embryo and it doesn’t work, then you don’t want to regret having not known about the possibility of using a surrogate.
10. Assemble your fertility TEAM.
Therapist, Eating/Exercise, Acupuncture, and Meditation
I want you to feel positive and fertile. I think acupuncture can help with some of the emotional elements that come along with IVF.
Supplements. Here are some of the supplements I recommend to my patients. I also offer HGH — yes, the same you’ve heard in the news with Lance Armstrong. But it can actually help with DNA repair and healing in the body. One of the things we want to help improve is the DNA of the egg. It’s why I sometimes have women take it leading up to a cycle.
11. Preserve your fertility & consider embryo banking.
I have patients who’ve had one baby at 40 and then they come back in three years and they’re mad. They wonder why someone didn’t tell them to freeze eggs or embryos at that stage when they still had eggs.
Do investigative work. Talk to your doctor. Find out if you should do more preservation before you do an IVF transfer.
12. Know what you may be more likely to experience with IVF over 40.
You may have cysts. As your FSH levels are fluctuating then you may see a cyst at the start of your cycle.
Sometimes doctors may want to put you on birth control pills. There are very good reasons to be on it. To keep your cycle on cycle day 1. To shrink a cyst. To plan them around a business trip or your doctor’s schedule. I personally work when your ovaries work. So 7 days a week, but not every doctor does that. Know what your situation is and set expectations accordingly.
Implantation testing. Consider going through any and all testing before you transfer. This is true if it’s your first transfer or if you’re coming back to your doctor three or four years after your first child through IVF. Especially since you’re older you’re going to want to test everything again.
13. If you’re 45 and you’ve just had a baby. The one thing you want to do is try and live forever, as healthy as you can be.
One of the ways that I do that for my patients is that I offer them cancer screening. Breast cancer is as common as the need for IVF in women of a certain age. Talk about colonoscopy, mammograms, and more with your doctor. Talk about your health before, during, and after an IVF transfer.
I want to close with one important message.
As a fertility doctor, one of the most important parts of my job is helping women close to menopause grow their families.
Helping them with IVF cycles until they are successful sometimes means also using an egg donor.
Women over 40 who are doing IVF should hear that. Knowing that sometimes your success may involve an egg donor is something that’s important to hear at the beginning.
Part of my role as your doctor is to make you feel healthy, fertile, young, and as normal as possible. This is very important.
As always, I encourage you to reach out here in the comments or email me directly: [email protected], if you have any questions. Or if you have a suggested topic for a future show.
You can also catch more of me and topics like this through The Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!