Advanced maternal age and IUI

[BG-MN]

I am almost 46 and 4 months ago became pregnant without fertility treatments after a few months of trying to conceive. (We married late in life, and neither of us has children or has tried to conceive before.) My initial HCG levels were strong, and we saw a heartbeat at the 6-week ultrasound. My progesterone, however, went from 21 to 24 to 17 to 15 despite progesterone suppositories. At the 9 1/2 week ultrasound, the heartbeat was no longer there, and I had a D&C. Prior to my getting pregnant naturally, the RE said my only real option was donor eggs. At the time of the missed miscarriage, he said he would be willing to try fertility treatments once I had had 2 normal cycles. The RE said he would NOT do IVF on a woman my age using my own eggs, so I guess we are talking about drugs/IUI (we see him this week to find out). Friends are telling me that IUI does not work as well as IVF, so they are not sure why the RE would think non-IVF routes would have a better chance of success. (My husband and I have lots of money tied up in an international adoption, so donor eggs aren't really an option for us financially this year; I have full insurance coverage on other fertility treatments, so that's a major factor in trying the fertility treatments right now.) Could drugs/IUI actually work on a woman my age given my recent pregnancy?

[Forum-M.D.-SP]

It is highly unlikely that either IVF or IUI will work at age 46. Regarding IVF, I am aware of three studies looking at IVF in women of advanced reproductive age. One, from Cornell, showed a 3.1% live born rate in 45 year olds with IVF, and 3/4 of all positive beta-HCGs end in miscarriage. There were no pregnancies beyond age 45. Two other studies, one from the UK and one from Israel, showed even more discouraging results - 0% pregnancy rates in women aged 44 and older. Even if you are fortunate enough to get pregnant at age 46, 75%-80% of the time the pregnancy ends in miscarriage. It is likely that, even though you saw a heart beat with your miscarriage, that the pregnancy was genetically abnormal - probably a trisomy.  Thus, I would not recommend IVF. IUI is, I believe, equally futile - just cheaper. Sorry to be so pessimistic - I would not recommend IVF with your own eggs or IUI. By far your best bets for a family are adoption or donor egg.

[BG-MN]

I forgot to say that based on home ovulation tests, I appear to ovulate monthly, and a day-3 FSH test done three months before the pregnancy was high-normal (10).  I also forgot to say thank you for considering my question!

[Beemar]

I have the same issues. I am 47. I conceived spontaneously this past July. Ultrasound at 6 weeks saw a yolk sac, at 7 weeks showed inadequate growth (only 3mm embryo) and no cardiac activity and fetal demise was diagnosed. I am now waiting for the miscarriage to take place.  I conceived very quickly after treatment for a pituitary tumor which was keeping me from ovulating correctly. I do not see why IVF with pre-implantation genetic checking is not available for older women.  That maybe is something to research.

[BG-MN]

Thanks for responding.  I am very sorry for your loss.  It turns out my RE is willing to do IVF on me (partly because we have insurance coverage for IVF without donor eggs), but only if I understand the odds of success are very, very low.  He said they would put all of the embryos in me no matter what quality, in the hope that one would work out.  Personally, I would prefer using donor eggs, but we probably can't afford that option for at least a year.  (I don't feel a strong need to have a biological child, and I just want a pregnancy that works out.)  By the way, I had a D and C rather than continue to wait to miscarry, and I thought it was much easier emotionally just to have it over with; a week later we left on a vacation, which also helped.  I know you didn't ask my advice on that topic, but I just thought I'd share my experience in case it's helpful.

[AZ Angie]

I am sorry for your pain, as I feel it --  I am 44 and was recently pleasantly surprised to find I was pregnant (IUD was removed for medical reasons, and I was not expecting that I could get pregnant as I had infertility treatment for my other children at age 30, 33, and 36)  I had only 2 weeks to enjoy the dream, when I had a miscarriage on August 15th.  I went into the city to see an OB 2 days before the miscarriage, and apparently my HCG was already dropping, because the urine test was negative.   From that point, I was treated like I was nuts, an old woman starting menopause.  By the end of that day, I knew the pregnancy was not viable, as the serum HCG was too low, and the ultrasound showed nothing.   Talk about adding insult to injury!

To my wonderment, I had a positive pregnancy test again this weekend (this time we WERE trying), only 32 days after the miscarriage -- along with all the returning signs/symptoms.  Coincidentally, I already had a gyn appt today, and as I related my circumstances to the Dr., she looked at me like I was crazy!   The urine test was only lightly positive.    She spent the whole appt telling me that something was wrong -- I could have a tubal pregnancy, or residual tissue that was related to the last miscarriage, I could have some kind of cancer, and that I was jumping to conclusions thinking I was pregnant again.

My feeling (after much encouragement from my DH) is that I have to think positive!    I have to hope and be confident, and to want it real bad!  I will need to seek out a Dr. that will support me, at the same time think about the realities.  If you are not totally confident and comfortable with your Dr., try another -- there are so many different ideas -- mindsets -- knowledge levels out there.  I would encourage you to be confident in your body, and keep trying.  I will do the same.  Keep us posted

[beb5733]

I can feel your pain, i too am 44 and trying to conceive. what ever happened to the stories you hear about women hoepful of the menopause yet finding out they were pregnant. Menopause doesn't happen till late 40"s.  Why can't we be in that group. Maybe we are trying to hard.  I am going to try and let this out of my mind for now and just keep trying on our own. The injections, hormones and particularly the money is very depressing given the outcome.