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The major problem for the older woman is that time is at a premium! She simply cannot afford to waste her precious time on ineffective treatments; and it is better for her to move on to IVF sooner rather than later!Older women present doctors with many challenging problems. For one, they usually respond poorly to ovarian stimulation, and pregnancy rates with treatment are lower. They also have an increased risk of having a miscarriage - and in women over 41 years of age, this risk can be as much as 50%! Moreover, as a woman ages, she has an increased risk of having medical problems in her pregnancy, because of preexisting medical problems such as diabetes and hypertension.
An especially thorny issue is the increased risk of birth defects because of aging eggs. As eggs get older, they have an increased risk of harbouring chromosomal errors, and this increases the risk of the baby having a chromosomal error, such as trisomy 21 (Down syndrome). Most clinics will offer prenatal diagnosis (such as chorion villus sampling, and amniocentesis) to these women to screen for birth defects during pregnancy - but since some of these procedures increase the risk of a miscarriage, the couple often find themselves on the horns of a dilemma - and it is hard for them to decide whether to do the test or not to.
What is the oldest age at which an infertility specialist should accept a woman for treatment? Is there a particular age at which a woman should be denied treatment? If so, then why? and what should this age be? and who should decide? "Menopausal mums" have grabbed much media attention, and have raised a number of controversies - which still remain unresolved.
Much research is going on to try to increase the pregnancy rates after IVF in older women. One high tech option is to screen the embryos for aneuploidy (an abnormality in chromosomal number) using FISH (fluorescent in situ hybridisation) for preimplantation genetic diagnosis, a technique in which embryos are biopsied and their chromosomes analysed using DNA probes. If only chromosomally normal, healthy embryos are transferred back, then researchers feel that embryo implantation rates and pregnancy rates will be higher. Another option is assisted zona hatching, using chemicals or a laser, to create an opening in the zona (shell) of the embryo. Scientists feel that this technique can allow the embryo to "hatch" and thus escape from the zona and implant into the uterine lining more easily. However, the clinical benefit of these procedures is still unclear.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
