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Thursday, 31 August 2017

Can I get pregnant with my own eggs after menopause? + other questions on IVF answered

These days we hear a lot about miracle babies and childless couples being blessed with kids in their 60s and 70s. Most newspapers that carry such news also claim that the couple conceived naturally and gave birth to a healthy baby. Well, natural conception is possible until a particular age or before a woman hits menopause. Beyond that, couples might need to take help of assisted reproductive techniques or IVF procedures if they are planning a baby. There are a lot of misconceptions that people have regarding IVF procedures.  To break these myths and misconception we had a detailed discussion with Dr Sandeep Mane, The Origin International Fertility Centre, Mumbai, here is what he had to say.

Is there a cut-off age for doing IVF with one’s eggs?

A woman’s natural egg reserve, especially for Asian women, tends to drop after 40 or 45 years of age. There are no procedures or techniques to revive eggs or provide a woman with more number of eggs. However, for some women, this reserve might get exhausted early, like in their 20s or thirties. There could be various reasons for this. When a woman opts for an IVF procedure, tests are done to see if her egg reserve is exhausted.
In general, every month a woman releases one or more eggs from ovaries which increase her chances of pregnancy. However, if conception has not taken place normally, hormonal injections are used to release more eggs from her ovaries. But beyond 45 or 50 years of age when a woman’s natural egg reserve is exhausted, even IVF procedures cannot help her to conceive with her own egg, unless she has frozen her eggs before. In such cases, looking for an egg donor is advisable. For a menopausal woman who wishes to get pregnant, this is an ideal option. Here is everything you need to know about freezing of eggs.

Even if a couple in their 50s, 60s or 70s wants a baby with the help of IVF,  what are the chances that the pregnancy would be healthy?

With age, pregnancy becomes challenging. There are laws in the making which are yet to decide on a cut-off age for couples to get pregnant. But a pregnancy in 50s and 60s is not unheard of; of course, a pregnancy in 70s is out of the question even with assisted reproductive technologies (but not impossible). The simple reason to avoid late pregnancies is that bringing up a child beyond a certain age becomes challenging. Apart from that, the pregnancy itself could be risky and there can be postpartum issues that the mother and child have to face.
When a couple opts for a pregnancy at a later stage in life, there are three things that need to be taken into consideration: sperm health, quality of eggs and the viability of the womb. In men, even at the age of 50 or 55 sperms might be healthy for conception. In women, most of them might have hit menopause by then. The ovaries will have exhausted its eggs, there would be a dip in the female hormones and the womb would have shrunk. Taking all these things into consideration, conception becomes difficult. She will need donor eggs to continue with her pregnancy or retrieve her frozen eggs, if any. However, the womb can be reactivated with hormonal injections to get back to its pre-menopausal state and carry the pregnancy to term. But if the woman is having other health problems like blood pressure, diabetes or thyroid this can make the pregnancy risky. An incompetent womb, too many failed IVF cycles might be indications that she needs to look for a surrogate to carry her pregnancy to term.

Why do some younger women need donor eggs to conceive?

Sometimes a woman’s egg reserve might get exhausted early in her 20s or 30s. There could be various reasons for it, like, receiving less number of eggs during the formative period in the womb, the hereditary tendency of early menopause, infections like tuberculosis that can scar the ovaries, surgeries during childhood for conditions such as ovarian cysts or torsion of ovaries, etc. There cannot be a single cause that can be pinpointed; these are some of the possible causes. In such cases, a donor egg is needed to help the woman conceive.

What are the other situations when a couple might need donor eggs?

There are two prime scenarios when a couple might need to seek donor egg: a. if the woman’s egg reserve is exhausted or are weak and b. when IVF have failed beyond three cycles. However, a doctor decides this after undergoing a number of tests and procedures. If a couple is unable to conceive, blood tests and sonography are done to ascertain the problem. If the first line of tests and sonography shows that the woman has weak eggs or her eggs aren’t suitable for fertilisation, she might need to seek donor eggs.
If there is a possibility that she can conceive with her eggs, medications are prescribed to help attain hormonal balances and ovulation to help the couple conceive. If that fails to give results, the second step is to do an IUI or intrauterine insemination, where sperms are placed inside a woman’s uterus to facilitate fertilisation. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilisation. Beyond that, a laparoscopy is done to understand where the problem lies and then the couple is counselled for an IVF. If more than three IVF cycles fail,  the need for donor eggs might arise.

What tests are done to assess the quality of the woman’s egg to check if they are fertile enough for conception?

Two tests namely the AMH blood test and advance sonography are done to check for the quantity and quality of the eggs and the ovarian reserve.

What happens during an IVF cycle?

For a woman to get pregnant, it is necessary that her hormones are in tandem with her cycles and leads to ovulation, that is, for an egg to release from the ovary once a month. Sometimes this natural process might not yield results and a couple might seek IVF treatment. In an IVF treatment, high doses of hormonal injections are given to release eight or 10 eggs which are then retrieved and united with the partner’s sperm to form an embryo in a laboratory set-up. Of the resulting embryos, two or three can be inserted into the womb to increase chances of pregnancy. The rest can be frozen to be used later in case an IVF cycle fails. The duration of an IVF cycle is of four weeks or a month.

What if IVF cycles fail?

There are chances of IVF failures. However, a couple can try for three IVF cycles before exploring other options. If a woman’s womb is incompetent to continue the pregnancy, then an option like surrogacy is suggested.

When is the option of IVF surrogacy laid out?

You need a sperm, an egg and a healthy womb to help you carry the pregnancy to term. However, if a woman’s egg reserve is exhausted, she might have to borrow eggs from a donor. The eggs will be fertilised with the partner’s sperms to form an embryo which needs to be inserted into the womb for a fetus to grow and develop. If the woman’s womb isn’t capable of carrying the pregnancy to term or she is physically unfit to carry a pregnancy, she might need a surrogate mother to help her with the pregnancy and carry it to term.
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