Many women know little about their own reproductive systems and are often surprised when infertility issues arise. Often there is time to fix those issues, but even more often, a woman over 35 might find herself running a race with her biological clock.
I think that information about fertility postponement and the limited success of IVF in women over 35 should be much more present in big media, to help women make an informed decision on when (if at all!) they want to become pregnant. This is even more important for those who wish to be genetic parents and find important to be BIOLOGICAL mothers and fathers.
Many women over 35 mentally heavy rely on technologies. Even if they don’t openly talk about it, there is often a hope present to get pregnant naturally (and if this fails, there are IVF, ICSI and other fall-back solutions).
However, many of the assisted reproductive technologies don’t make women to GENETIC mothers and this is often overlooked by those who don’t know much about getting pregnant over 35.
So here is in short what recent technologies really can do for women over 35.
Methods are not equally affordable (or even allowed!) in all Western countries, but assuming you are living in the US, here is the list of currently open possibilities:
1. OOCYTE DONATION (egg donation). This method leads by far to highest pregnancy rates (40% or more) and they are unaffected by the age of a recipient-women by up to her late 40-es and higher. The reduction in success rates beginns approximately at age 48 but pregnancy still remains possible for another decade or longer. Only, here is important to understand that egg donation automatically means for a mother NOT being genetically related to the child, which makes some women feel uneasy about.
2. Another alternative with high success rates but again not granting a genetic parentship is EMBRYO DONATION. Many couples who undergo IVF don’t need all the embryos which were produced. When one such a couple achieves a desired number of children, they can donate extra embryos to the couples who can’t produce any. While this is a phantastic option which enables that even severely infertile couples get pregnant and build families, it again means no genetic contribution of EITHER OF THE PARTNERS to the child, which may be a tough issue for some to deal with.
3. Paradoxically, the best technological opportunities are open to those who need them least: young women with a lot of eggs and high ovarian reserve. For women from this age group who wish to postpone motherhood and care very much about being genetic parents, technologies can be very helpful.
OOCYTE KRYOPRESERVATION (egg freezing, vitrification) is a method to preserve their fertility and beat up the biological clock for many years, possibly even a whole decade or longer. Egg freezing has long been considered an experimental technique, but in the last years, oocyte kryopreservation pregnancy rates are becoming similar to those achieved with fresh eggs. This fact alone makes it an attractive option for young women who don’t have a partner or want to focus on their carreer. They can freeze eggs when they are still young (best is in their mid-20es) and later, when they want to build a family, those eggs can be thawed and fertilized. In this scenario, the women herself remains a genetic mother to her child, regardles of the father she choses to fertilize her thawed eggs with.
Another extension of this method would be freezing embryos INSTEAD of eggs on the first place. But, this would then mean dealing with certain questions which can feel overwhelming for a young women.
Given that embryos thaw better then eggs (meaning result in by far more live births), young women could decide to have their eggs fertilized and then store them for the future use. Only, they would probably need to do so using sperm from an unknown donor, but cause if they don’t, they will lose much of the authonomy of deciding on using embryos later on.
To me, the best method that reproductive technologies have to offer is egg freezing. The time has come to change the way how women think and deal with their eggs and this method should be popularized as to reach large population of young women out there (who then can put pressure on their insurances, or even parents and relatives, to cover the costs of egg freezing).