Motherhood after the age of 40 is becoming increasingly common. Social, personal and professional changes have led many women to consider motherhood at ages that, until recently, were considered clinically borderline. Although age remains an important factor, advances in assisted reproduction have improved the chances of achieving a healthy pregnancy after the age of 40.
Age and its impact on fertility: a necessary starting point
Ovarian reserve and oocyte quality naturally decline after the age of 35, and this decline becomes more pronounced after the age of 40. As a result, the probability of achieving a spontaneous pregnancy is reduced and, conversely, the risk of chromosomal abnormalities, abortions and obstetric complications increases.
However, the decline in natural fertility does not mean that there are no effective alternatives. Modern reproductive medicine offers options tailored to each woman's clinical and personal situation.
In vitro fertilisation (IVF) with own oocytes: possible, but with limitations
IVF with own oocytes can be a viable alternative in the early 40s, especially when the ovarian reserve is still good.
However, it is important to offer realistic expectations. Success rates with own oocytes decrease progressively with age, mainly due to an increase in chromosomal abnormalities in the oocytes. For this reason, it is recommended to perform a complete study of the ovarian reserve (AMH, antral follicle count and ultrasound evaluation) and to assess the viability of this option on an individual basis.
Likewise, performing a pre-implantation genetic test (PGT-A) can improve the probability of a successful pregnancy as it identifies chromosomally normal embryos.
Egg donation: the option with the best success rates after 40
Egg donation is the preferred technique when the ovarian reserve is low, the oocytes are not of sufficient quality or simply when the option with the highest probability of success is desired.
This treatment uses oocytes from young women, which allows embryos with high implantation potential to be obtained, regardless of the recipient's age. As a result, successful pregnancy rates remain high even in women over 45, when their general health status allows it.
In addition, egg donation is a particularly suitable option when there is a high risk of genetic disease transmission.
Embryo donation and embryo adoption
Embryo adoption is another possibility for women who wish to become mothers after the age of 40. It consists of the transfer of embryos donated by other couples or women who have completed their assisted reproduction treatment.
It is a simple procedure with a good success rate and, generally, a short waiting time.
Fertility preservation: a reproductive investment for the future
Although this option must be carried out before the age of 40, more and more women are choosing to vitrify their oocytes for future use. Thanks to this technique, it is possible to achieve pregnancy at a more advanced age using one's own oocytes obtained at a more favourable reproductive stage.
The importance of an individualised assessment
There is no single answer valid for all women. The decision on which technique to use depends on various factors such as ovarian reserve, general health, reproductive history or personal desires and expectations.
At Barcelona IVF , each case is studied individually in order to offer the strategy with the best chances of success, always with the utmost respect for each woman's time, circumstances and decisions.
Dr Cristina Guix
Gynaecologist specialist in fertility at Barcelona IVF
