Why older women have lower IVF success rates

The reason older women have lower success rates when they do IVF is because their eggs take a tanking as they age.
Both the quantity of their follicles ( as measured by their AMH level and their antral follicle count) as well as the quality of their eggs declines - and this can be quite dramatic after the age of 35.
As they get older, they start running out of eggs, because the ovary cannot produce any new eggs after birth.
This poor egg quality comprises of two components .
Firstly, these eggs accumulate genetic defects over time. Many of these older eggs have abnormal genes, which are transmitted to the embryo, as a result of which it may arrest in the lab, or fail to implant . The problem is that we can't test for these lethal genetic defects because there are over 30000 genes in the human egg.
Equally importantly, as the eggs get older, their mitochondria - the powerhouses which drive cell division - don't work properly anymore. As a result of this, even if the egg fertilizes , it doesn't continue to divide. Because it runs out of energy , the embryo arrests in the lab and there is no top quality blastocyst to transfer.
Sadly, these biological changes are irreversible, and while doctors have tried all kinds of interventions to "treat " these - including stem cell therapy - sadly, these "treatments" don't work !

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Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.