Reproduction after 40

Mr. D. Marinos Tsirigotis MD. FRCOG, Surgeon-Gynaecologist, specializing in Reproductive Medicine, explains how easy or difficult it is to have children after the age of 40.

On the way to procreation

The modern lifestyle has radically changed. A vast percentage of women gives priority to career and extends their single lives, so that a family is created at a relatively older age. Nevertheless, the female fertility depends on many other factors and not only on the age, which is the catalyst for a successful fertilization. These factors are weight, smoking, eating habits, working conditions, the frequency and duration of sexual contacts, and, of course, the quality of the partner's sperm that should be taken seriously. No woman should consider fertility for granted, especially when after the age of 40, when the numbers of eggs in the ovaries are not only smaller but also qualitatively inferior. Even then, these difficulties should not discourage someone from getting pregnant.

Control Steps

Generally, the key factors of the female fertility are the correct functioning of the ovaries, uterus, and fallopian tubes. Some way of control needs to be performed quickly and safely:

• The hormonal control of ovarian function on the first day of the cycle, which will show the adequacy and quality of follicles remaining.
• The intravaginal ultrasound in order to determine the quantitative ovarian function, and the anatomy of the uterus together with the endometrium.
• The salpingografia that would highlight any tubal pathology.
• The monitoring cycle, and the time of ovulation (ultrasound, hormonal or with ovulation urine).
• The intake of folic acid, vitamins, and antioxidants in order to improve the cycle and the health of the mother together with the fetus.

Assisted Reproduction

If the pregnancy does not occur within 6 months or if there is the above pathology, then the women need to resort directly to IVF treatments. The treatments include medications to produce more than one egg (multiple ovulation), and are combined with the appropriate contact time or insemination. Insemination refers to sperm retrieval from the husband that is processed and input to the uterus. The above methods will increase the success rates up to 5 times.

If these methods do not work, these techniques should not be repeated because they would lead to "wasted" precious eggs, which would have better luck with in vitro fertilization (IVF).

The IVF is a treatment of choice in cases of infertility after 40, as it results in the maximum extent of available oocytes, allows controlled fertilization, and singles suitable embryos for transfer increasing the success rate and reducing the risk of miscarriage. The technique is now very simple to apply, safe for the drugs, but above all - effectiveness. The state participates in supporting the free supply of medications for IVF treatments from pension funds and, in many cases, returns part of the total cost.

Donor’s Eggs

Unfortunately, pregnancy is not a privilege of all, as there are women who want to have children, but fail because of:

• premature ovarian failure in women under the age of 35
• qualitative disturbance of eggs
• old age (women over 45)
• genetic (chromosomal) lesions and hereditary diseases that can be passed to the fetus
• low ovarian productivity due to chemotherapy, radiation, and surgery or endometriosis treatments at an earlier age

The solution for these cases is a donor’s egg. It is a popular process that is legally regulated, anonymous and has a great success rate, more than 60%, in our country. Mandatory thorough checks are carried out on donors in order to make the process extremely safe. The process is based on two pillars:

• The donor receives an injection treatment for the egg production
• The recipient takes estrogen and progesterone to prepare the uterus for embryos created from the donor’s eggs and the sperm of recipient’s partner

The embryo transfer procedure is simple and is carried out with the help of ultrasound. The results in our country are excellent and can be compared to those of other big units abroad. The waiting time is small due to the availability of sufficient donors’ eggs.