Best fertility centers for women over 40

Many people who search for IVF clinics abroad are over 40 and they want to find the best IVF clinic which specialises in this age group.  Women who are over 40 are not usually entitled to NHS treatment and have to rely on self-funding. IVF clinics abroad in countries such as Greece, Spain, the Czech Republic and Cyprus for example offer much lower prices for fertility treatment.  But what should you look for in a clinic if you are over 40.
This technique involves removing a few cells of the developing embryo and these are screened for genetic abnormalities. I hope that this has provided a mini-checklist to help narrow down your choice of IVF clinic if you are over 40.
At age 40 and above women have reduced fertility potential as compared to that seen in younger women. When couples are trying on their own to get pregnant the fertility issue that reduces chances for success is related to the quality of the eggs.
Although these age and fertility statistics are specifically about IVF success, there is a similar loss in fertility potential with aging in the general "normal fertile" population.
The graphs below are from the 2012 ART Success Rates report published by the CDC, Centers for Disease Control and Prevention, a US government agency.
Another point shown here is that there not a substantial decline in success by age of the recipient woman with donor egg IVF. The national summary (as well as clinic specific results) of IVF success rates for cycles done in years 1995 through 2012 are posted on the CDC website. All clinics have some upper age limit after which they will not perform in vitro fertilization with the woman's own eggs. We want a test that shows how many eggs a woman has at a point in time - as well as telling us about the quality of the eggs.

Antral follicle counts by ultrasound are one of the best ovarian reserve tests that we currently have available. Antral follicle counts (along with female age) are by far the best tool that we currently have for estimating ovarian reserve, the expected response to ovarian stimulating drugs, and the chance for successful pregnancy with in vitro fertilization. Antral follicle counts are a good predictor of the number of mature follicles that we will be able to stimulate in the woman's ovaries when we give injectable FSH medications that are used for in vitro fertilization.
Higher risk for overstimulation and ovarian hyperstimulation syndrome if a Lupron trigger is not utilized. The level of response of the ovaries when the woman takes injectable FSH for stimulation is often predictive of the egg quantity and quality - and therefore, also the relative chances for success with infertility treatment. For example, eggs may demonstrate poor morphology, may have problems with maturation, or with fertilization, proper cleavage, or blastocyst formation, etc.
For women over 40 who are at risk of their embryo developing Downs syndrome or other genetic abnormalities, this technique can tell which embryos are free of the abnormality. Women over 35 years are at higher risk of developing diabetes and high blood pressure during pregnancy and so it is very important that the pregnancy is monitored closely. They also have substantially lower success rates with fertility treatments including in vitro fertilization (IVF). With IVF treatment we hope to get multiple embryos so we can choose the best ones from a group for transfer back to the uterus. However, when going through a fertility treatment such as IVF, the quantity of eggs remaining influences response to ovarian stimulating medications. This report was generated from national data from hundreds of clinics and well over 100,000 IVF cycles.

As women age, they have less eggs (primordial follicles) remaining and they have fewer antral follicles. This means that if we had several different trained ultrasonographers do an antral count on a woman, they would not all get exactly the same result. Some risk for ovarian overstimulation if a Lupron trigger is not used for final egg maturation injection. Preimplantation genetic screening (PGS) can be used to test embryos for chromosomally normalcy (euploidy) prior to transferring them to the uterus. For women over 40 who may have embryos which may have the potential to have genetic abnormalities than a younger woman, embryo monitoring can help the embryologist select the best embryos for transfer. Embryos that have normal chromosomal analysis after PGS have a very high potential for implantation and live birth. So if a clinic reports a high pregnancy rate for women over 40’s using their own eggs then it is prudent to query this data. It is non-invasive and if you only have a few embryos, you want to make sure that the best ones are transferred.
Mammograms are over in a few minutes and a degree of discomfort for a short time is nothing if it will save your life.

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