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Fertility options at age 45
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Questions in the Fertility/Infertility forum are answered by medical professionals. Topics covered include fertility or infertility issues, egg quality, fertility drugs and side effects, fertility tests, genetic testing, in-vitro fertilization (IVF), pregnancy reduction post IVF, ovulation, relationship issues, risk factors, sperm count/quality, and surgery.

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Fertility options at age 45

I am 45 and 1/2 and have been married a year. Before we married, we decided we would see if we could have a baby naturally (without donor eggs), but also pursue adoption. My desire to have a biological child was stronger than I expected, so we recently ended up at a Reproductive Endocrinologist, hoping they would try drug therapy on me. (A recent 3rd-day FSH test came back as high normal/10; my periods are still very regular.) The RE strongly discouraged drug options--saying at my age, there was virtually no chance of my conceiving with my own eggs--and urged me to enter the donor egg program. He did say, though, that if I wanted to try drugs, he would offer me drug treatment until I was 46, but I should only try drugs so that I could feel I tried everything, not so I would have a baby. (The doctor also discouraged adoption, saying with donor eggs I could control the pregnancy, but I wouldn't know what I was getting if I adopted.  He also said terrible things about the other big RE clinic in the area, basically suggesting they used women off the street as donors.) My husband is opposed to donor eggs, doesn't think I should try drug therapy if there's no chance it will work, and wants us to adopt. I still wasn't sure if I wanted to try drug therapy, so the RE clinic offered us the name of a social worker who would help us think through our options. Instead, however, it was an appointment in which she bombarded us with information on the donor egg program. We were also contacted four more times by the doctor's office on insurance coverage for donor eggs, next steps, etc., even though we said we weren't ready to pursue that option and were proceding with adoption. My q. for you: we ended up feeling that the donor egg program must be a huge money maker for the clinic, and we were being railroaded into an option we weren't ready for. Since we're not confident in the clinic's ethics, we are not sure we got good advice on drug therapy. Is there any hope drugs might help me conceive? Is there any point in visiting another RE clinic?
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Here is what I can tell you. There have been studies on IVF success rates in women with very advanced reproductive age. Two studies, one from England and one from Israel, found that not a single person trying IVF at age 44 or older got pregnant. A third study, from Cornell, found a 3.1% delivery rate in 45 year old women undergoing IVF as long as their FSH was normal, but this was after close to 1/3 of all cycles were cancelled due to poor response. Overall pregancy rate was higher, but unfortunately 85% of those who conceived miscarried. So....trying on your own using fertility drugs is not hopeless, but realistically it is at best 1%-2% if you put all of the studies together. Regarding donor egg, if you are considering this, an alternative would be to look at donors from egg donor agencies that have signed an agreement with the Society for Assisted Reproductive Technology agreeing to abide by ASRM Ethics Committee guidelines regarding payment of donors. This list is available at http://www.asrm.org/Patients/eggdonor_agencies.pdf. When you go with a donor from an agency, you pay the agency for agency fees and donor compensation. Finally, there is absolutely nothing wrong with adoption as an option! Of course, you also need to factor in cost - is it worthwhile paying for a fertility drug cycle with almost no chance, or using that money to assist you with donor egg or adoption? Remember that even under the best circumstances donor egg has a 50% chance of working each time, so that is not a guarantee. Good luck with your decision!
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A related discussion, IUI/IVF move on to donor's eggs was started.
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