By Dr Fessy Louis T
The first IVF (IVF) baby, Louise Joy Brown, was born on July 24, 1978. Since then, millions of IVF babies have been born. IVF, or in vitro fertilization, means the fusion of egg and sperm outside the body. We stimulate the ovaries to produce multiple eggs with the help of drugs and administer drugs to prevent ovulation, and when the eggs are mature before ovulation, we take them out of the body and fuse them with the sperm.
The success of IVF mainly depends on the quality of the eggs and sperm and, ultimately, the quality of the embryos. Female age is the most important determinant of egg quality. Male age also affects sperm quality, but lifestyle factors and comorbidities play a more important role.
female age
As women age, both the quantity and quality of their eggs decline, which in turn affects their chances of achieving a successful pregnancy or live birth through IVF treatment. The most favorable success rates with IVF are typically seen in women in their 20s and 30s.
Most women experience menopause around age 50, but biological infertility occurs about 10 to 12 years before menopause. Fertility decline becomes most pronounced in the early 30s, with a more rapid decline occurring a few years later, around age 37. Several factors contribute to this decline, including reduced ovarian reserve, decreased oocyte quality, lower rates of embryo implantation, and changes in the hormonal environment that lead to ovulatory dysfunction and uterine problems. Additionally, older women are more susceptible to developing conditions such as endometriosis, fibroids and pelvic infections.
The averages for the percentage of assisted reproductive technology (ART) cycles that result in live births are 31% in women aged less than 35 years, 24% in women aged 35 to 37 years, 16% in women aged 38 to 40 years, 8% among women aged 41 to 44 years, and 3% in women aged 43 years and older with their own eggs. The ideal age for IVF for women using their own eggs is younger than 35. After this age limit, the IVF treatment success rate drops dramatically.
The risk of chromosomal problems increases with a woman’s age. The chance of having a child with Down syndrome increases with time. The risk is about 1 in 1,250 for a woman who conceives at age 25 and increases to about 1 in 100 for women who conceive at age 40.
If there is a family history of early menopause, women are at greater risk of premature ovarian failure, leading to an early decline in ovarian reserve and a lower chance of getting too few and poor quality oocytes for IVF cycles, even at a younger age. They should start fertility testing and treatment sooner.
Elderly women and patients with premature ovarian failure may have successful IVF treatment with eggs from a young donor.
For IVF, the highest age restriction for women is 50 years while the upper age limit for men is 55 years in India as per the ART Act 2022.
male age
Semen parameters also decline with age, but have a greater effect on quality. As age increases, sperm morphology and the DNA within the sperm is affected, leading to poor quality embryos, which leads to early miscarriages or IVF failure. Sedentary lifestyles, smoking, alcoholism and stressors can all lead to poor quality sperm. But even if the number of sperm with normal morphology is lower in the semen of elderly men, we can still get some good sperm and do IVF with a good chance of pregnancy.
Preconditions for IVF
Women should be devoid of any comorbidities to get the best results from IVF treatment. Uncontrolled diabetes mellitus can decrease egg quality and cause early miscarriages. Uncontrolled thyroid disease also affects the outcome of IVF on all levels. Obesity or underweight also affects success, so weight should be in a healthy range. If the uterus has fibroids, adenomyosis, septum, etc., then the chance of implantation and pregnancy decreases. With endometriosis, the quality of eggs becomes worse and continued pregnancy becomes difficult. The overall body condition must be good to carry a pregnancy to 9 months. If a woman has diseased fallopian tubes (eg, hydrosalpinx, history of previous ectopic pregnancy, salpingectomy, etc.), embryo implantation may also be hampered.
Men should adopt good lifestyle-related habits such as quitting smoking, abstaining from alcohol, excessive coffee or any other recreational drug intake. Comorbidities should be treated with appropriate and regular medications and frequent follow-ups to verify good control.
Cryopreservation of oocytes/embryos
If a woman wishes to delay or postpone pregnancy due to delay in marriage, carrier restrictions or medical conditions, she may opt for oocyte or embryo cryopreservation through IVF treatment. When we cryopreserve oocytes or embryos, the aging process of the cell is stopped. Therefore, the woman’s age at the time of oocyte cryopreservation is the crucial parameter for a future pregnancy with preserved oocytes or embryos.
The author is Professor and HOD, Dept. Reproductive Medicine and Surgery, Amrita Hospital, Kochi.
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