How old is too old for successful in vitro fertilization (IVF)? The question of whether to establish an IVF age cutoff is controversial throughout the infertility community, and there are passionate arguments on both sides. With more individuals and couples delaying parenthood, it's an important discussion.
The Society for Assisted Reproductive Technology reports cumulative live birth rates using IVF and the patient's own eggs as 13.4 percent at age 41 to 42 and 4.1 percent for patients older than 42. But that doesn't tell the whole story. Age impacts fertility and maternal health in many ways. Learn how these factors shape the debate of establishing an age cutoff for IVF.
How Parental Age Affects Pregnancy Odds
Advanced reproductive age for women is generally defined as 37 and older. As a woman ages, fewer eggs become available for recruitment and maturation. More important than quantity, however, is a woman's egg quality — whether the eggs are genetically normal. While an older woman may have a bountiful ovarian reserve, those eggs are more likely to have chromosomal abnormalities.
Advanced reproductive age for men is generally considered over 40 or 45 years old. Unlike women and eggs, men never stop producing sperm except in cases of disease or structural damage. Similar to the connection between maternal age and oocyte health, however, older men often produce more sperm with chromosomal abnormalities (specifically diploidy) and decreased vitality.
The Argument for Allowing IVF for Older Patients
The Ethics Committee of the American Society for Reproductive Medicine (ASRM) reports that opponents of IVF for older women frequently cite two reasons: the potential "futility" or "very poor prognosis" of fertility treatments, and an older mother's capacity to carry a healthy pregnancy and raise a child.
Most fertility clinics set an age limit, often between 42 and 45 years old, for a woman to use her own eggs. However, the ASRM committee opinion concludes that "limited treatment may be provided after a process of explicit education and examination of values."
This treatment may be successful. Frontiers in Endocrinology points out the many current and emerging options for helping patients achieve pregnancy at advanced reproductive age, including IVF protocols that maximize ovarian response, egg freezing and preimplantation genetic testing.
The journal Menopause found that having children later may actually extend a woman's life span. A study published in Population and Development Review found that children also benefit from their mother's choice to wait: Out of a sample of more than 1.5 million people born between 1968 and 2013, children born to mothers over 30 — and even over 40 — enjoyed better long-term physical health and educational success.
The Argument for an IVF Age Cutoff
On the other side of the debate, the same ASRM committee also concludes that providing IVF treatment is not ethical if a provider does not believe it will be successful. Clinicians should be upfront about the risks of pregnancy at a later reproductive age, including miscarriage, complications and genetic abnormalities.
The likelihood of older mothers to achieve a live birth without severe complications has been heavily researched. Numerous studies find that advanced maternal age puts both the mother and child at risk for everything from preterm delivery to preeclampsia and death.
The ASRM sets a hard line in Fertility and Sterility: "Embryo transfer should be strongly discouraged or denied to any woman over age 50 with underlying issues that could increase or further obstetrical risks, and discouraged in women over age 55 without such issues."
Both sides of this debate have strong arguments, and it's unlikely the controversy will clear up any time soon. More research and discussion are needed on the impact of age on the success rate of fertility treatments and maternal and child health.