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IVF and Menopause

In Vitro Fertilization (IVF) is a process through which an egg is fertilized by a sperm outside of the woman’s body.

After some days (2-6) of maturation, the egg is implanted in the woman’s uterus. IVF can be used in different cases such as infertility, gestational surrogacy, or after the menopause.

Although the menopause is a barrier for further conception, IVF has given women the opportunity to conceive in their fifties. IVF also gives women with onset early menopausal a chance. Women whose uteruses have been appropriately prepared, can receive embryos that originated from an egg of an egg donor. Therefore, even though these women do not have a real genetic link with the child, they have a physical link through pregnancy and childbirth. In most cases the father of the child can be the woman’s male partner. Even after the menopause commences, the uterus is actually fully capable of carrying out a successful pregnancy.

Unlike the ovaries, the uterus does not diminish with age and it’s reproductive ability has been widely demonstrated.

IVF is even more important for those women who experienced premature menopause, known also as premature ovarian insufficiency (this is usually applied for women whose period stop before their thirties). We all know what happens during the menopause, and the results of hormonal changes reflects in the fact that you don’t produce anymore eggs. Early menopause therefore leads to an impairment of conceiving (associated with all the other health risk in this premature hormonal change). 

One of the most asked questions is usually whether IVF/fertility drugs can induce early menopause?The answer is Absolutely not.The general theory is that because the fertility drugs stimulate the ovaries to mature and release 10 to 15 eggs (instead of the one egg released during the body’s natural ovulation) they may lead to “running out of eggs” earlier. This is false. In a normal cycle, in your fertile window, your body produces 10 to 20 egg follicles each month. As the cycle progresses, one of these follicles will become “dominant” and fully mature to produce the egg that will be released that month. The rest of the immature eggs will be lost with the menstrual cycle. Fertility drugs work by stimulating the follicles that your body has already produced, so that more of them come to maturity. This ovarian stimulation simply utilizes more of the eggs that would normally have been lost in that menstrual cycle. It does not in any way deplete your natural “egg supply”. 

Another pivotal question is: Can women conceive after menopause?

Yes.With the help of IVF, women who have gone through menopause can still get pregnant. You will need to use donor eggs, but chances are that you can still carry and deliver a healthy baby. In regard to this subject, an article was published in 2016, in which a team of researcher tried to analyse the possibility of getting a natural pregnancy, in women with premature menopause, by using their own eggs. The team of researchers used Ethinyl oestradiol (which is an oestrogen)to lower follicle stimulation hormone (FSH) and restore sensitivity of follicles to mild FSH stimulation. The results were very good. Three out of five women had a live baby. One woman conceived twice and delivered twice. The live delivery pregnancy rate per transfer was 20%. On top of that is possible to freeze eggs beforehand if you plan to have children later in life. Therefore also feasible, or at least possible, to conceive without a donor egg even at this stage of life 

In addition, there is no difference in the IVF success rate for women that Chose this treatment due to Premature Ovarian Failure than someone with physiological. 

All this being said that there are a few considerations that need to be taken into account. Pregnancy is never without risk and pregnancy related risks increase with age. Even pregnancy related complications increase with age. Some risks that can be encountered include:

  • miscarriage or stillbirth
  • an ectopic pregnancy where an egg implants outside the womb
  • high blood pressure leading to preeclampsia that can cause brain injury, impaired kidney and liver function, blood clots, fluid on the lungs, and other serious complications.
  • placental abruption where the placenta detaches from the womb, leading to fetal growth problems.
  • placenta previa where the placenta lies unusually low in the womb and could potentially create problems during delivery
  • low birth weight of the baby
  • premature birth of the baby
  • caesarean delivery
  • multiple pregnancies, particularly if a woman has undergone IVF

Moreover, there is an increased risk of chromosomal abnormalities in children born to older mothers, using their own eggs (which age exactly as your body does). In fact, usually women choose donor eggs to maximise the chance of delivering a healthy baby.

So, to conclude, during perimenopause it is possible to become pregnant with the woman’s own egg, but with increased risk. It would probably be safer to use donor eggs. During menopause, if it is necessary to undergo IVF treatment, both scenarios are not without risk as every pregnancy carries some element of risk. Both scenarios are not riskless, as pregnancy has some risk. It is amazing to have the opportunity to conceive later in life, but it has to be done carefully under the help and guidance of a specialist in this field.

Guest post by Dr Ornella Cappellari

RESOURCES

Clin Exp Obstet Gynecol. 2016;43(2):181-3.

In vitro fertilization (IVF) outcome in women in overt menopauseattempting to induce follicular maturation by follicle stimulating hormone (FSH) receptor down-regulation.

Check JH, Wilson C, DiAntonio G, DiAntonio A.

Maturitas. 2011 Nov;70(3):216-21. doi: 10.1016/j.maturitas.2011.07.003. Epub 2011 Aug 2.

Fertility after age 45: From natural conception to Assisted Reproductive Technology and beyond.

Forman EJ1, Treff NR, Scott RT Jr.

J Assist Reprod Genet. 2009 Sep-Oct;26(9-10):511-4. doi: 10.1007/s10815-009-9351-5. Epub 2009 Oct 22.

In vitro fertilisation (IVF) with donor eggs in post-menopausal women: are there differences in pregnancy outcomes in women with premature ovarian failure (POF) compared with women with physiological age-related menopause?

Ameratunga D1, Weston G, Osianlis T, Catt J, Vollenhoven B.

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