Dear Professor Winston, I am 42 years old and my husband is 52 years old. We have been trying to conceive for 2 years. In this time, I have had 2 miscarriages both occurring at 6 weeks. My last miscarriage was 18 months ago and we have had no luck since. We have been in the care of a private fertility clinic and had an array of tests, all have come back normal and indeed better than normal for our ages. I ovulate every month, I have more than average egg reserves and quality reserves for a woman of my age. The fertility clinic, based on these results, do not recommend any fertility treatment for us. Which is greatly frustrating and disappointing. Our understanding is the rate of success, with intervention, is so small, we have as much chance of conceiving naturally. If we were much younger, I could accept this, but we are not and we are painfully aware time is quickly running out for us. I need to do something, hope is what is killing me. I can cope with drugs, treatments etc… I cant sit back and have my hope crushed month after month. I would like to ask your opinion and if you agree with the clinics approach. Thank you for taking the time to read this. Warm regards, N
Reply…

Dear N,

I am very sorry you are in this situation but it sounds to me as if you are in the hands of a highly responsible clinic run by ethically centred clinicians. There is no shortage of clinics who would offer you IVF, but I personally doubt this is to your advantage. Let me explain why I say this.

Assuming there is no identifiable bar to getting pregnant – usually a poor sperm count, an abnormal uterus, or adhesions around the tubes (all of which can be identified by tests e.g. sperm samples, womb x-ray, laparoscopy) your infertility is indeed very likely to be age-related. As women get older their eggs are likely to have genetic or chromosomal abnormalities more frequently. This results poorer chances of conception and when conception does occur, a much higher chance of miscarriage, usually around 6 – 9 weeks. This basic problem is not treatable, but IVF actually increases, not decreases, the risk of having abnormal eggs and therefore embryos, because of the hormones used. And many private clinics sell all kinds of embryo screening for people like yourself but the current evidence is that this (especially embryo biopsy) reduces the chance of a normal pregnancy by half). It isn’t entirely clear whether it reduces the risk of miscarriage.

Statistically, your best chance of a pregnancy is to have sex as frequently as possible, enjoyably. I would strongly not recommend timing intercourse. The experience in my clinic was always that this was a better bet than the misery and expense of IVF treatment. I fully understand that you may not accept my advice, but I must emphasise that the statistical chance of getting pregnant and having a baby after three IVF cycles in your case is probably no more than 10% at best, and natural sex at regular intervals is more effective.

I would add one thing, though. It would be well worthwhile checking to see if your chromosomes and those of your husband are normal. If there is an abnormality of these, then there are forms of IVF which will give you a better chance of a live birth.

My best wishes
Robert Winston

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