IVF success rates in women over 43

Researchers in a 2020 study report on IVF outcomes for women over 43, including pregnancy and live birth rates following day 3 embryo transfer.

Fertility decreases with age. This is thought to be largely due to aneuploidy, where embryos have the incorrect number of chromosomes. This can cause imbalances in the expression of genes on those chromosomes and can lead to embryos failing to develop.

Making matters worse, in many women in their 40’s, even getting a blastocyst can be challenging because of reduced numbers of eggs retrieved, and an increased frequency of embryo arrest. Egg donation or embryo donation are viable options, but this isn’t acceptable for many.

The need for accurate statistics might help manage expectations for IVF, and currently is only offered by national registries which are a mix of all clinics and stimulation protocols, making drawing conclusions difficult. So having controlled conditions to see what the success rates look like is important.

Machado Fernandez et al. (2020) aimed to determine the IVF success rates women beyond 43.

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Results

833 women >43 were included in this study.

Overall, for women >43:

• The average number of eggs collected was 5
• The average number of mature eggs was 4
• 14.4% became pregnant
• 5.4% had a live birth

They broke success rates down by specific age groups.

For the average number of eggs collected:

• Age 43: 5
• Age 44: 5
• Age 45: 3
• Age >45: 2.5

There was no difference in the number of mature eggs between the age groups.

In terms of how many were transferred (most were day 3):

• 22.7% transferred one embryo
• 23.9% transferred two
• 23.5% transferred three
• 29.9% transferred more than three

For pregnancy rates:

• Age 43: 13.4% (78 out of 580 women)
• Age 44: 7.3% (14/192)
• Age 45: 2.6% (1/39)
• Age >45: 9.1% (but only 2 out of 22 women)

For miscarriage rates:

• Age 43: 64.1% (50 out of 78 women)
• Age 44: 50% (7/14)
• Age 45: 100% (1 out of only 1)
• Age >45: 50% (1 out of only 2)

For live birth rates:

• Age 43: 4.8% (28/580)
• Age 44: 3.6% (7/192)
• Age 45: 0% (0/39)
• Age >45: 4.6% (1/22)

Conclusions

This study represents one of the largest investigations on IVF success rates in women 43 and older using their own eggs.

Overall, live birth rates were around 5% and miscarriage rates were as high as 60%.

Reference

Fernandez AM, Drakopoulos P, Rosetti J, Uvin V, Mackens S, Bardhi E, De Vos M, Camus M, Tournaye H, De Brucker M. IVF in women aged 43 years and older: a 20-year experience. Reprod Biomed Online. 2021 Apr;42(4):768-773. doi: 10.1016/j.rbmo.2020.12.002. Epub 2020 Dec 9. PMID: 33771464.

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About Embryoman

Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.

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