We know that there are many factors affecting the success of IVF treatments. These factors influence the outcome to varying degrees. As you can read in many places and often hear from doctors, female age is the most important among these variables.

So how does female age fundamentally affect this? It’s not just about leading to a decrease in the number of eggs, as one might first think. While this is important, it is not the fundamental issue.

As age increases, the likelihood of problems occurring during egg formation rises, and there is an increased chance of chromosomal issues in the eggs. For example, about 70% of the eggs produced by a 40-year-old woman have chromosomal problems. This reflects in treatment outcomes as a decrease in pregnancies, an increase in miscarriage rates, and a rise in problems such as Down syndrome in ongoing pregnancies.

What can be done in this situation?

Although there is no clear black-and-white distinction, the general approach can be determined according to the woman’s ovarian reserve. Of course, it is possible to achieve success with the traditional “collect eggs and perform fresh transfer” method. However, if we want to exceed the chances provided by this method, we need to utilize some special techniques. I will not discuss the techniques that are still in the experimental stage here.

If the ovarian reserve is good, performing chromosomal screening on the embryos (PGS, PGT) should be considered. The general logic is this: If there is a high likelihood of forming many embryos, we may struggle to select the best ones just by looking at their images. At this point, we rely on comprehensive genetic tests performed on the embryos to determine which embryo has the potential to create a healthy baby with high reliability. This means that our chances of having a healthy baby per transfer increase. It also causes less psychological, physical, and financial strain on the couple.

If the ovarian reserve is diminished, creating an embryo pool increases pregnancy rates per transfer. Instead of transferring a single embryo, selecting the best one from, for example, 5 embryos is responsible for this increase. To achieve this chance, it is necessary to perform egg retrievals two or more times and to freeze and accumulate the embryos. This method is more advantageous psychologically and financially compared to the collect-transfer method each time. It should also be noted that even if the couple has only one embryo, chromosomal testing can be performed on a suitable quality embryo.

In addition to all this, it should not be forgotten that there is an upper limit to female age in IVF treatments.