After 40, fertility declines mainly because egg quality and ovarian reserve decrease, leading to fewer chromosomally normal embryos and higher miscarriage risk. IVF is commonly the first treatment, often combined with ICSI, blastocyst transfer, and frequently PGT-A to focus transfers on euploid embryos. When own-egg IVF is no longer effective, egg donation becomes the most effective option, with success driven by donor egg quality rather than the recipient’s age.
IVF over 40 – Summary
- “Advanced maternal age” is typically 35+, with a sharper fertility drop after 40
- Age affects eggs and embryo genetics more than the uterus
- After 40, fewer embryos reach blastocyst, more are chromosomally abnormal, miscarriage rises
- IVF is a first-line option, usually with ICSI and blastocyst transfer
- About 50% of fertilized eggs reach blastocyst (average used for counseling)
- PGT-A helps select euploid embryos, improving implantation and lowering miscarriage risk
- If own-egg IVF isn’t working (low reserve/quality, repeated failures), egg donation is often recommended
- Donor-egg success is largely independent of recipient age, but pregnancy risks still rise with age
- Single embryo transfer is strongly recommended (risk is higher with multiples)
Who This Guide Is For
If you’re asking any of these, you’re in the right place:
- “Can IVF work after 40 with my own eggs?”
- “Do I need PGT-A after 40?”
- “When should I consider egg donation?”
- “Does AMH matter more than age?”
- “Should I transfer day 5 or day 6 embryos?”
- “Does stress or inflammation affect embryo quality?”
This guide is based only on an event led by Dr Esther Marbán, Gynaecologist and Fertility Specialist at Clínica Tambre (Madrid), focused on fertility options for women over 40 especially IVF strategy and egg donation.
What Counts as Advanced Maternal Age?
Dr Marbán explained that advanced maternal age is typically defined as pregnancy at 35 or older, with a more pronounced decline after 40.
As age increases, several changes happen at once:
- Egg quality declines
- Ovarian reserve decreases
- Antral follicle count and AMH fall
- FSH rises
These shifts reduce the chance of natural pregnancy and also affect fertility treatment outcomes.
The Core Issue After 40: Egg Quality
A key point emphasized is that age primarily affects egg quality, not the uterus.
As age increases:
- The proportion of eggs with chromosomal abnormalities rises
- Fewer embryos reach the blastocyst stage
- A higher proportion of embryos are chromosomally abnormal
- Miscarriage rates rise
- Live birth rates fall
This is why realistic counseling after 40 focuses heavily on embryo genetics and expected embryo viability.
Risks of Pregnancy After 40
Dr Marbán explained that age-related risks affect both the fetus and mother.
Fetal risks
- Increased risk of chromosomal conditions (including Down syndrome)
- Higher miscarriage and stillbirth rates
- Abnormal fetal growth
- Higher rates of pregnancy complications
Maternal risks
- High blood pressure
- Gestational diabetes
- Preterm birth
These risks rise further in multiple pregnancies, which is why single embryo transfer is strongly recommended in older patients.
IVF After 40: Why It’s Often First-Line
IVF is the most common treatment offered to women over 40.
IVF step-by-step
- Ovarian stimulation to produce as many follicles as possible
- Close monitoring using ultrasound
- Egg retrieval under sedation
- Fertilization in the laboratory with partner or donor sperm
- Embryo culture up to five days
- Transfer, usually at blastocyst stage
Why ICSI is now the norm in IVF
Dr Marbán noted that more than 90% of IVF cycles now use ICSI, where a single sperm is injected into each mature egg. This approach:
- Maximizes fertilization rates
- Gives better control when egg quality is reduced
Why Blastocyst Transfer Is Standard After 40
Embryos are monitored daily, and around 50% of fertilized eggs are expected to reach blastocyst (average used for counseling).
Dr Marbán explained why blastocyst-stage transfers are preferred:
- Higher implantation potential than day-2 or day-3 embryos
- Better selection of viable embryos
- Enables genetic testing (when indicated)
Early-stage transfers (day 2 or day 3) were described as outdated practice in this context.
PGT-A After 40: What It’s For and What It Can’t Promise
PGT-A (genetic testing for aneuploidy) plays a key role for women over 40.
What PGT-A involves
- Biopsy of a small sample from the outer layer of the blastocyst
- Chromosome analysis
- Selection of euploid embryos for transfer
Why it’s used after 40
Because embryo chromosomal abnormalities are a major limiting factor at this age, PGT-A can:
- Increase implantation rates
- Reduce miscarriage risk
- Shorten time to pregnancy
- Reduce failed transfers by avoiding aneuploid transfers
Important boundary: PGT-A does not guarantee pregnancy, but it helps focus transfers on embryos with the highest potential.
IVF Success After 40: What “Realistic” Can Look Like
Dr Marbán’s data indicates:
- Implantation rates remain relatively high after 35
- Decline more sharply after 39
- For women over 39, pregnancy rates may be around 40–45% per transfer when using appropriate strategies
She also highlighted improved outcomes when IVF is combined with PGT-A, because embryo chromosomal status is a key limiting factor after 40.
When IVF With Your Own Eggs Is No Longer Effective
When IVF cycles fail repeatedly often due to low egg quality or low egg numbers, Dr Marbán explained that alternative options should be considered.
Egg donation is recommended in cases such as:
- Premature ovarian failure
- Repeated IVF failure related to egg quality
- Very low ovarian reserve
- Certain genetic conditions
- Ovarian damage from medical treatments or endometriosis
Egg Donation: How It Works
Egg donation involves two parallel processes:
- Donor stimulation (similar to IVF stimulation)
- Recipient uterine preparation (endometrium preparation for transfer)
How donor matching is performed
- Initial matching based on general physical traits (skin, hair, eye color)
- Advanced matching using facial biometry software to optimize similarity
Anonymity in Spain
In Spain, egg donation is strictly anonymous:
- Donors and recipients do not know each other’s identity
Why Donor-Egg Success Isn’t Driven by Recipient Age
One of the most reassuring points shared:
- Implantation and pregnancy rates with donor eggs are largely independent of the recipient’s age
- This is because donor eggs come from young, healthy women, keeping embryo quality high
However:
- Pregnancy risks still increase as the recipient gets older
- That’s why single embryo transfer remains especially important in donor-egg cycles for older patients
Cumulative Pregnancy Rates: Why Multiple Transfers Matter
Dr Marbán explained cumulative implantation rate:
- One transfer gives one chance
- Repeating transfers with frozen embryos increases overall success likelihood
In some cases, cumulative pregnancy rates can reach over 70% after multiple transfers, particularly in egg donation cycles.
Key Messages for Women Over 40
Dr Marbán’s take-home points:
- Age matters, but it’s not the only fertility factor
- Accurate diagnosis and tailored testing are essential
- Both male and female factors must be assessed
- IVF + PGT-A can improve outcomes and reduce miscarriage
- Egg donation offers the highest success when own eggs are no longer viable
- Single embryo transfer reduces pregnancy risks, especially in older patients
You can see the full webinar here
What would you suggest for a 41-year-old in her final IVF cycle with immune/clotting factors and thyroid antibodies?
Thyroid antibodies can matter, and TSH should be controlled. If TSH is fine, treatment isn’t automatically added. Depending on other factors, heparin or aspirin may be considered, but the main limiting factor remains age. If she can achieve at least one good-quality, healthy embryo, chances improve; without that, even perfect immune treatment won’t work.
Would you suggest IVF with AMH 0.5 at age 47?
Assuming AMH is in ng/ml, the chances of success with own eggs at 47 are described as almost zero. Egg donation should be discussed, and this situation is presented as an indication for it.
I’m 45 with regular periods and had embryos before, but one early miscarriage—can I still try?
It’s possible to try, but realistic expectations matter. Embryo testing is strongly suggested before moving forward, because the chance of healthy embryos after 45 is quite reduced and chromosomal abnormalities are a common reason for miscarriage.
What donor information can be shared in Spain?
Before treatment, selection information isn’t allowed. During treatment or pregnancy, medically relevant information like donor age and blood type can be shared. General traits like skin, eye, and hair color may be shared if requested, but nothing that could identify the donor (donation is anonymous).
Does stress influence fertility?
Stress may affect fertility (quantity, quality, implantation), but its impact is difficult to measure, hard to study in a standardized way, and the depth of effect cannot be stated precisely.
I transferred 2–3 embryos and still didn’t get pregnant—does that mean implantation failure?
Not necessarily. The number of embryos transferred alone doesn’t prove implantation failure. Embryo quality, blastocyst stage, and whether embryos were tested all matter. The full case details are needed to assess.
If I’m 42 with AMH 0.5, does that mean early menopause? Do I still have a chance?
Early menopause refers to people under 35 who no longer have periods. At 42, AMH 0.5 can be considered normal for age if periods are regular. IVF can give good results, but expectations should be realistic. If embryos are tested, a typical expectation mentioned is around 12–14% healthy embryos due to age, not AMH.
Can chronic tonsillitis affect embryo quality? Should I do retrieval and PGT anyway?
If tonsillitis is treated (e.g., antibiotics) and there are no other problems, stimulation and retrieval can proceed. Surgery can be done afterward when recovered. It shouldn’t affect embryo quality in this context, and PGT can still be performed.
Are supplements helpful for fertility over 40?
No supplement is presented as scientifically proven to produce clear changes in egg quality. Supplements like CoQ10 and inositol are sometimes used and may help, but the effect is not clearly proven and is not expected to be large.
Can IVF work with donor eggs if I’m in menopause and have uterine scar tissue?
Own-egg IVF wouldn’t be possible in menopause because ovaries are not working. Donor eggs may be a better option, but uterine scar tissue (e.g., Asherman syndrome) can be challenging; outcomes depend on severity, and uterine assessment is crucial.
If a woman is in her 50s and in menopause, can she do IVF with donor eggs?
It depends on age and country. The discussion notes that in Spain, treatment is not done over age 50 due to pregnancy risks and potential complications, even if results could be possible elsewhere.
Do you transfer aneuploid embryos or discard them?
Aneuploid embryos cannot be transferred under Spanish law and are excluded. Poorly graded embryos depend on the case; embryos graded CC, DD, or CD are normally discarded. Very low-grade embryos like 5CC are generally not expected to implant, but rare exceptions may be considered if it’s the only embryo and the patient insists.
Can stem cells restore ovarian quality? What about PRP?
Stem cells are not used due to limited experience. PRP is used in a specific group: younger patients with very low ovarian reserve (typically below 35). These are experimental techniques; some patients respond better, others show no difference. Reversing age impact in older patients is described as almost impossible.
Should you transfer Day-6 embryos if they weren’t ready on Day 5?
Yes, if the Day-6 embryo has expanded and is good quality, transfer can be recommended. Day-5 is preferred if comparable quality, but Day-6 transfers can still have good success rates.
IVF over 40 – Guide
| Situation | What matters most | Typical direction discussed |
| Over 40 with repeated miscarriages/failures | Embryo chromosomal status | Consider IVF + PGT-A |
| Low ovarian reserve / repeated IVF failure due to egg quality | Egg quantity + egg quality | Discuss egg donation |
| Using donor eggs at older ages | Pregnancy risk management | Single embryo transfer strongly recommended |
| Day-5 not ready but Day-6 expands well | Embryo stage + quality | Day-6 transfer can be a good chance |
| Menopause + desire to carry | Uterine condition | Donor eggs possible, uterus must be assessed |
