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From the sounds of it, its an egg/genetics issue. At 40, the majority of your eggs are genetically abnormal. In the final analysis, its a matter of finding the "good" egg. At 40, you could try IVF several times before getting the "good" egg or you may never get it at all. If money and emotional strain of failed cycles are not a problem (and they always are a problem), I'd say keep trying. But, if you and your husband are willing to proceed using donated eggs, bang for the buck, it is the most likely way for you to get pregnant. When is enough enough? Most people your age move on to donor eggs after 1-2 failed cycles.

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Hi Dr. Smith,

Can you tell me roughly what the success rate is at 40
with IVF, and what is done to pick out the better eggs??
and at what stage should the embryos be at for the best results? I am planning to do my first IVF cycle and this is all new for me..

Thanks for any advice you can give!
Alexa

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Dr. Smith,
Can you tell what protocal is best for women at the age of 40? What do you recommend for women at this age with no known cause for infertility?

Thanks,
Ryley

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I can't recommend anything 'cause I'm not an RE (nor do I play one on TV). However, I will forward your question to Dr Jane Miller, the RE I work with. She will post an answer as soon as she has time.

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Alexa:

The success rate at 40 is quite variable and will depend greatly on the number of follicles that a patient develops and how many eggs are retieved from those follicles. At 40, the more the better, as it is numbers game to try to get genetically normal eggs. Live birth rates (which are very different from pregnancy rates at this age) for women age 40 range from 10-20%.

Nothing can be done to select better eggs. The only way to tell the quality of an egg is to fertilize it and watch the embryo develop - we assume a good embryo came from a good egg. In terms of selection of a good embryo (which is what I suspect you ment) the criteria for a Day 3 transfer is based on the number cells (should be an 8-cell embryo) and the degree of fragmentation (should be less than 10%). Embryo fragmentation is usually graded 1-5. In our program, all embryos are cultured to the blastocyst stage, the stage at which the embryo is capable on initiating implantation. Embryos cannot implant until they reach the blastocyst stage. Blastocysts are graded by the degree of expansion (not so important) and the number and apearance of the stem cells present inside the blastocoel cavity (very important).

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OK Folks over 40
In a nutshell: Everything Dr. Smith wrote is, unfortunately, true. And it's anything but fair!! It's a #s game and the more eggs that we can retreive, the more chances we'll have a good sperm-egg combination that can go the distance. BUT - you cannot overlook other "usual suspects". I often see (again unfortunately) "older women" who have been cycled at other programs Without the basics first: imaging of the uterus or even a comprehensive semen analysis!!It's as if the docs are thinking - it's not going to work anyway so why bother?!!The other really important piece of information in women over 40 is the autoimmune workup. Autoimmune factors are often acquired with age . I never cycle an older patient without first checking these tests because there is always a chance that a good embryo will not be able to implant or continue growth once implanted because of a "hostile uterine environment". Finally, I do get alot of women in their 40s - probably because I've lived through all this myself as a patient - including the humiliation and frustration - and ended up treating myself successfully. But , for the most part, if it's happened in infertility i've experienced it.
Good luck all!
Dr. Miller

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