Mothers Over 40

Portrait of a beautiful middle aged pregnant female smiling on the couch

The debate surrounding the fertility of older mothers has raged on in recent weeks. Enough now, we get it! Yes, delaying motherhood can be catastrophic as fertility plummets after 39. However as Robert Winston, the IVF pioneer and broadcaster, pointed out at The European Society of Human Reproduction and Embryology’s annual conference in Lisbon, there are also benefits of delaying having a baby. Lord Winston said older mothers, who have had time to gain skills and education, as well as build strong relationships, can provide children with a more stable upbringing. So concerned are we to point out the negatives that we fail to notice that there are also positives to being a more mature mother. Women of 40 and upwards have a plethora of reasons for delaying motherhood. Whether it is due to demanding careers, further education, financial circumstances or relationship stability, some women have been in the position to have children earlier. Berating them is not constructive. The press has ensured women are aware of the facts so instead of fear-mongering maybe it is now time to support and learn from women who have left motherhood till later in life.

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Right Place, Right Time

career change now is the right time

For the first time a new test has been developed that tailors the timing of IVF treatment to a woman’s individual cycle. The scientists behind the technique believe that IVF frequently fails because the embryo is transferred at the wrong time, missing a crucial fertility window. The new test pinpoints a woman’s optimum time for treatment and in pilot studies the approach significantly boosted success rates.

There are more than 60,000 IVF cycles in Britain each year, but just 24% of these treatments lead to live births. Clinics currently check the visual appearance of the womb lining using ultrasound, giving a general indication of health. In the pilot study, the test was given to 85 women who had each experienced on average five rounds of IVF that had failed at the implantation stage. When the gene analysis was used as a guide, 33% of those treated had a successful implantation simply by just changing the day.

Nick Macklon, professor of obstetrics and gynaecology at the University of Southampton, believes that issues linked to the womb lining explain around two-thirds of cases of recurrent implantation failure, with around one-third of cases being due to embryo abnormalities. He asserts that these tests could significantly improve success rates.

Progress

EGG_2565177b Yesterday the UK government set out new draft regulations which will allow donor DNA from a ‘second mother’ to be implanted into a defective egg. Mitochondrial donation, known as the “three-parent” baby technique, was deemed not to be a genetic modification that would, as critics feared, lead to the “slippery slope” of designer babies. MPs discussed the issues of medical ethics and scientific terminology at length and reached a pleasing decision.
Mitochondria is a part of the cell cytoplasm outside the central nucleus where chromosomes are located. They convert glucose to something called ATP, which is the universal energy currency of each and every cell in the body. Around one in every 200 babies born in the UK has a severe mitochondrial disease. Although rare, the disorders can be passed to future generations through the maternal line. Examples of mitochondrial diseases include conditions that cause muscle wasting, nerve damage, loss of sight and heart failure.
This is a brilliant development for families affected by mitochondrial diseases. I am thrilled that those with genetic abnormalities will have the opportunity to have the healthy children they so desperately want.

Fresh or Frozen?

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Having had a fresh embryo transfer in my first pregnancy and a frozen embryo transfer in my second I am interested in whether one is preferential to the other. Traditionally, women undergoing IVF have a fresh embryo transfer for their first attempt and then, if there are a surplus of embryos left, then those can be frozen. This allows the woman a chance to use the frozen embryos for a second pregnancy, like in my case, and also a second attempt at the first pregnancy if unsuccessful with the fresh ET. Additionally, women who are at high risk for ovarian hyperstimulation syndrome (OHSS) during the fresh IVF cycle can freeze all their embryos and do a frozen embryo transfer at a later date.

Previously, many centres had FET success rates that were about 10% less successful than their fresh ET. That has changed due to:

  • The frozen embryo transfer pregnancy success rates being influenced by the method of freezing embryos which is far quicker than it used to be.
  • Fast freezing that leads to approximately 90% of embryos surviving the thaw process.  The survival is because there are minimal ice crystals forming with vitrification and minimal cellular degeneration to the embryo.
  • The frozen embryo transfer success rate being influenced by the quality of the embryos frozen. Some IVF centers freeze all the remaining embryos while others will only freeze those of good quality.  The better the quality of the embryos at the time of freezing, the better the freeze-thaw success.
  • Some IVF centers are doing embryo banking cycles with Preimplantation Genetic Screening (PGS).  They biopsy the embryos and test them for genetic abnormalities, and freeze them.  Once they have enough genetically normal embryos then they transfer these.  This is good for woman with recurrent pregnancy loss or advanced maternal age.

So the evidence suggests that like peas fresh is as good as frozen!