Decision between IVF and trying naturally aged 41

[turquoiseturtle]

Hello all,

I am facing a tricky decision which must be made immediately, and would welcome some perspectives. Did you choose in your early 40s between IVF and continuing to try for a baby naturally? What guided your decision?

Situation: I’m 41, no children, will be 42 in early June. I met my partner late in life. We both want to have a child and have been trying to conceive for the last 6 months. In this time I have got pregnant twice, but both ended in early miscarriage at 4.5 weeks (December) and 5.5 weeks (March).

I have just had a follow-up appointment with the fertility clinic to discuss whether IVF would help me conceive. In my area the cut-off date for NHS-funded IVF treatment is 42 years of age (one cycle). Our financial circumstances would make it difficult to afford private IVF.

The fertility specialist said that he did not think IVF would help in my case. Essentially he seemed to be saying that IVF was designed to solve a different problem from the one I have. I can conceive fairly easily, but am losing the pregnancies due to early miscarriage, which is almost certainly because of lowered egg quality at my age. IVF can help me to conceive, but it won’t do anything about the egg quality, so even if I conceive with IVF there’s still a high chance of miscarriage. There are also downsides as it is an invasive medical procedure with potential side effects.

The doctor said that I would have a good chance using IVF with donor eggs, but this is not something I’m ready for psychologically yet; also donor egg treatment is not available on the NHS.

However, despite all this, the doctor said that it would be possible for me to have one NHS-funded IVF cycle using my own eggs if I request it, but I would have to decide RIGHT NOW (in the next couple of days) in order to get the treatment completed before my 42nd birthday.

My cycles are regular, my hormone levels are normal and my ovarian reserve is very good for my age, suggesting that there is still a possibility of conceiving naturally (FSH 7.69, day 21 progesterone 36.2, anteral follicle count 19). However my egg quality probably isn’t great, and I have a slightly underactive thyroid which may have contributed to the miscarriages (TSH 4.0 when I last conceived, but T4 levels were normal). I have been on levothyroxine since January to try to lower my TSH.

My partner doesn’t think the IVF is a good idea, for a number of reasons, but says that he will support me if this is what I choose.

So the decision rests with me and I don’t know what to decide. I am going mad reading medical papers and trying to weigh up the odds, and I’m aware that my judgement is affected by stress, time pressure and the fact that having IVF feels like the one aspect of all this that is in any way within in my control (but the outcome, of course, is not!).

If anyone has been in a similar position I would love to hear from you. Many thanks for your help!

We had IVF although it was when I was 36-38. I already had one child, but then kept having miscarriages then couldn’t even get pregnant. I found the IVF pretty okay really. It’s an emotional rollercoaster, but physically it was fine.
My advice to you would be to ask if you can have ICSI rather than IVF only because that was what worked for me after several cycles that didn’t work. In ICSI the best sperm are selected, therefore giving more of a chance of success. You can either chose not to do the IVF and see what happens naturally, in which case you would never have the chance to do funded IVF again. Or, you could go down the IVF/ICSI route and be able to keep trying naturally if it doesn’t work.
I am now 43, and we would love another child. Unfortunately the funding in the country we are in ends on your 43rd birthday, so it is not an option for us. If it was then we would be doing it.
I am glad that we didn’t wait for longer before going down the IVF route - we were lucky and had a beautiful daughter from it. But you have to follow your gut feeling tbh. My husband did not want to do IVF but humoured me because he knew I needed to. He is forever thankful that I pushed him to do it...

If you can get IVF or ICSI free I’d do it, it is invasive but take the opportunity and go for it, it might be worth looking into a private consultation when you get pregnant in case there is any treatment that may help you to retain the pregnancy.

How long do you have to wait to actually start treatment though? I wouldn’t delay anything at this stage.

There is no harm is saying yes to the treatment for ivf now and continuing to try naturally. It appears that the consultant is looking at egg quality and that could well be the issue but I found with ivf (I had 2 attempts) all the tests helps to pinpoint any other issues. Have a read of a book called "it starts with an egg" there is good literature around to suggest changes you make to diet/vitamin supplements can help egg quality. The last 90 days of egg development are key so you could make changes now in readiness for ivf so you have done all you can but still continue to try naturally and see if you can get pregnant with "better" eggs so to speak if you look at some changes etc. I was also told egg quality was an issue but ivf and then icsi showed we also had some issues on my DH side. I was due for a third icsi with a new clinic who asked me to add to my vitamin supplements in readiness for the icsi and I fell pregnant naturally in this time - I was 38 when I conceived and 39 when I delivered. I had three miscarriages pre ivf so I can only attribute my successful pregnancy to the supplements. Good luck OP

I'm surprised he said you could have icsi, given many many ccg require you to have been ttc for a certain length of time (2 or three years) if your infertility is unexplained. I'm also surprised you've even had tests run or seen a consultant yet!!

Two thoughts: confirm you'd be eligible through the fertility fairness website which has links to each ccg's criteria to double check that you actually qualify for funding before you start down the rabbit hole. Second, have a read of 'it starts with the egg' as there are some things you might be able to do to improve egg quality.

Good luck!!

Thank you everyone for your advice and good wishes!

@physicskate - I've had tests run and seen a consultant because I self-referred for a private, self-funded consultation at the fertility centre after I'd been trying for only a couple of months. I did this basically because I was panicking about my age, and wanted to know if there was anything wrong that could be fixed.

The clinic have done an ultrasound for me, a sperm analysis for my partner, and requested my GP to run a spread of hormone tests and thyroid function tests. The clinic is the same as the NHS clinic, and I believe the tests are the same as those offered to pre-ivf patients on the NHS. The whole thing cost me £390, and it took about 2 months from contacting the clinic (November) to getting an appointment for the tests (January), and then 2 more months for a follow-up appointment (early April).

I consider it money very well spent, and would advise anyone trying to conceive at 40+ to get an early self-funded referral if they can afford it. If nothing else, it picked up this thyroid problem which I would not have found out about otherwise, as the NHS don't usually offer pre-conception thyroid screening.

The self-referral apparently counts as an NHS referral too, so I am now 'in the queue' since January. I too was surprised that I was even considered for NHS funding for ivf, as I though there was a rule that you had to have tried for 2 years. However the consultant seemed to think it would be possible, even in the short time frame - but with the message 'but it probably won't work and I don't recommend it'. I wasn't really expecting ivf to be an option, so am trying to get my head around all this!