The single most important parameter which decides the success of any couple undergoing IVF is the age of the woman. And when a woman is trying after the age of 40, it is definitely a big challenge. There are many problems associated here.

First of all, we have to understand that every woman is born with a stock of eggs which remain constant. They are utilised right starting from the puberty every month and this stock very often starts depleting after the age of 30. After the age of 35, it starts depleting even faster and very few times there would be very few women who would have a good stock of eggs after the age of 40.

Mostly the eggs would be all over and very few would be remaining. We very often do a blood test which is called anti-Mullerian hormone or AMH which helps us to understand what is the stock of eggs that is left in the ovaries. Very often we see that after the age of 40, the AMH levels are very low and unfortunately there is no way that we can replenish these eggs.

When we are doing IVF, we are trying to make embryos from the eggs by injecting a good sperm inside the egg. Now if the number of eggs is less, obviously the number of embryos formed would also be less. Because very few eggs will have the capacity to multiplicate and form embryos.

We grow the embryos till the stage of blastocyst i.e. day 5 of the life of the embryo. And very very few eggs can have the capacity to develop very well and become blastocysts. So the success rates of IVF in the age group 40 and above is very often only about 25-35%.

And there are some other medical illnesses that may have set in in older women. The effects of diabetes, the effects of high blood pressure and the incidence of fibroids and sometimes endometriosis can also be detrimental in the quality of the eggs that are produced. So it is very important nowadays that we are educating women that all those women who want to postpone their plans of pregnancy should think of having frozen, freezing their eggs.

Because when we are doing IVF for women in whose eggs are at the age of 40 and above, very often such embryos may land up having some aneuploidies i.e. chromosomal defects and that is the reason that the incidence of miscarriage is also much higher in these patients. But we do very often process called as embryo pooling in which we do IVF, the pickup of the eggs not once but maybe 2 or 3 times. We don't overstimulate such patients and we try to be as natural as possible and we go on accumulating eggs and making embryos and then finally selecting the best embryos and inseminating to good blastocysts which definitely gives us much better results.

And of course, the last option if nothing works out in such patients remains that of going for donor eggs. But overall IVF has been a great boon for all women who are trying pregnancy at the age of 40 or above.

In regard to how age has a great impact upon the outcome of IVF, as previously stated, staying informed of new methods of conception and decision-making strategies in fertility by physicians is also of great importance. Medline Academics is an intermediary between physicians and new evidence-based reproductive medicine since they provide organized, clinically useful training to help physicians better appreciate complex areas of fertility, such as how to assess ovarian reserve, embryo quality, and advanced assisted reproductive techniques (e.g., embryo pooling and individualized stimulation protocols). Medline Academics provides many opportunities for Fellowship in IVF in India and physicians to discuss real-life case scenarios along with evidence-based practices, so physicians can more confidently provide care for their patients facing fertility challenges related to their age. This becomes particularly important when providing patients with counselling regarding their treatment options, expected outcomes, and the feasibility of emerging options (e.g. egg donation, frozen egg donation, etc.) available to patients in an age-sensitive fertility practice. Enhanced physician knowledge and clinical skills achieved through these educational opportunities in Fellowship in Infertility, ultimately result in improved physician-patient outcomes as fertility becomes more age-sensitive.

In the context of how age significantly influences IVF outcomes, as discussed above, it becomes equally important for clinicians to stay updated with evolving fertility practices and decision-making strategies. Medline Academics plays a crucial role in bridging this gap by offering structured, clinically relevant training in reproductive medicine. Their programs are designed to help practitioners understand complex concepts like ovarian reserve assessment, embryo quality, and advanced IVF techniques such as embryo pooling and individualized stimulation protocols. With a strong focus on real-world case discussions and evidence-based learning, Medline Academics enables doctors to confidently manage age-related fertility challenges in their day-to-day practice. This becomes especially valuable when counselling patients about realistic expectations, treatment options, and emerging alternatives like egg freezing or donor programs. By enhancing both knowledge and clinical skills, such training ultimately contributes to better patient outcomes in an increasingly age-sensitive fertility landscape

You may have seen the headlines about celebrities having babies into their 50s and even 60s and wondering, how did they do that? Or you might have asked, is that really safe? And if you're trying to conceive and you're seeing this, you might ask, why not me? With different treatment options like egg donation or previously frozen eggs from a younger age, it is possible for people to get pregnant and have a baby even after menopause. But should we? In the latest 2025 American Society of Reproductive Medicine Practise Guidelines, they give some updates on how to counsel, navigate and think about getting pregnant at an advanced reproductive age. Let's break it down.

According to information online, Aramati Mangama delivered at age 74 after IVF with donor eggs in India. Now the oldest woman to do IVF with her own eggs and have success and deliver a baby, according to a case report from March 2025, the woman was 48 years old. So she did IVF at age 48, had eggs retrieved, created embryos, got pregnant with an embryo and had a baby, age 48.

And the record breaker for the oldest age a woman got pregnant without IVF. So, no donor eggs, no IVF with their own eggs, but just naturally pregnant and delivered a baby. According to the Guinness Book of World Records is Dawn Brooke, who delivered at age 59 in 1997.

what is the deal with age and fertility? So, we know that women are born with all the eggs they're gonna have their whole life. And as eggs age, it takes longer to get pregnant, miscarriage rate goes up and success with fertility treatment goes down.

So there is a slight drop-off at age 35 for most women, a higher drop-off at age 40. And after the age of 42, it is really rare to conceive with your own eggs or to have IVF be successful with your own eggs after the age of 42. That is just statistics and reporting.

And of course, people can get pregnant naturally after the age of 42, it's just statistically it starts to get lower and lower chances. Now why is this? When we are born, eggs are frozen in a genetic state where they have two copies of each chromosome. It's meiosis one, it's a stage in biology if you want to pull out your biology text.

Eggs are sitting in this genetic state until they ovulate. When we ovulate, whether we're age 25 or age 45, the eggs have to turn back on and go through the genetic changes to finish meiosis and get rid of half of the copies of the chromosomes in order to be ready to fertilise with sperm. Sperm comes along and gives half of the copies its chromosomes; egg gives its half.

And if those chromosomes are aligned and in the embryo, that embryo has the best chance of dividing into cells, implanting and turning into a beautiful baby about nine months later. Now as eggs age, statistically fewer and fewer of them are able to do this genetic work correctly. And when you have an imbalance of chromosomes and mistakes in the genetic code, it can take longer to get pregnant and miscarriage rates go up and success with fertility treatments go down.

Now there is an age impact of sperm. Not everyone is Mick Jagger and having babies into 70s. And there's definitely this misconception that guys don't have any age factor, but it does take longer to conceive as men age.

Sperm counts drop, motility drops and fertility does change. Miscarriage rates go up when men are over the age of 50, depending on which study that you look at. So, there is an age factor for men.

What's different is men make sperm every single day. So, the sperm isn't sitting in your body, kind of being exposed to things and just age, whereas the eggs are. So, guys make sperm every single day and when they make sperm, it is ready to go.

It has got half of the genetic equation in order to fertilise with the egg. And guys make millions of sperm every single day and the egg does a really good job of selecting typically the best ones to try and fertilise with. So eggs and sperm just biologically are different and so men in general do have a longer fertility potential than women and their own eggs.

So it's not just about the ability to get pregnant. It's about having a safe pregnancy and a healthy delivery and mom and baby both doing okay through the pregnancy and the delivery. After the age of 45, statistically the risks of some complications with pregnancy start to go up.

IVF clinic in Bangalore suggest that complications can include hypertension in pregnancy, gestational diabetes, preterm birth, and stillbirth. Those risks are even greater at age 50 and beyond. In one study, for example, in pregnancy, pregnancy-induced hypertension is much more common as the person who's pregnant is advanced reproductive age.

Pregnancy-induced hypertension is 16% chance if the mom is age 45 to 49, and that risk is doubled to 33% risk if the mom is 50 or above. Gestational diabetes risk also doubled in these age groups. So many pregnancies do well when the mom is age 45 or 50 or above, but everyone should be informed that it is a higher risk pregnancy and precautions should be taken.

That's one of the reasons ASRM has their guidelines and suggests being very careful about weighing risks and benefits at advanced maternal reproductive age and someone who's planning to get pregnant. Topic number four, what about paternal age? We talk so much about age of eggs and age of the person getting pregnant, but what about age of the sperm? As men age, sperm parameters decline. Count, motility, morphology, and DNA fragmentation increases.

Older paternal or father age has been associated with an increased risk of several diseases, including autism spectrum disorders, schizophrenia, miscarriage, and certain single gene disorders, for example, achondroplasia, which is a type of dwarfism. To be clear, most children born from men over the age of 50 are healthy and doing great, but it is important that people are aware that sperm from advanced paternal age also can carry some risk. Topic number five, what about the child's perspective? What about ethically having a baby when both parents especially are over the age of 50 or over the age of 60? So there are pros and cons.

Some people will argue that having a baby at an advanced age allows for more financial stability, but children who are born to older parents have a higher chance of experiencing parental illness and death when they're still minors. Statistically, if a mother has a baby at age 50, there's a 16% chance that she will die before the child turns 18. If the father is age 50 when the baby is born, that chance increases to 22%, and at age 60, the risk increases to 40%.

That is compared to statistically a 3.5% chance that a parent will die before a child turns 18. These numbers aren't to make you scared or fearful or avoid having a baby at advanced paternal age. It is just important to think about and discuss.

Dr. Kamini Rao Hospitals encourages patients who are having a baby at advanced paternal age to have systems in place and a care plan. Topic number six, what are the 2025 ASRM recommendations for clinics? Number one, the recommendation is clinics should have transparent and clear age policies. Number two, clinics should offer medical clearance and screening when women are planning to get pregnant age 45 or later.

Guideline number three, clinics should collaborate with a maternal foetal medicine doctor or an obstetrician that is willing and prepared to care for a pregnant person over the age of 45. Number four, the clinic should provide informed consent and counselling about risks of getting pregnant at advanced paternal age, both for the pregnancy and for advanced paternal age. Number five, ASRM recommends gender-neutral policies that both age of the mother and the father or both partners should be taken into account when counselling.

ASRM also reminds us that just because we can proceed with a treatment, that clinicians are not obligated to proceed with a treatment if they feel that the risks outweigh the benefits. These decisions must be based on medical decisions, not bias, and these decisions need to be made without discrimination or bias. ASRM recommends that clinics offer certain options to patients or at least discuss these options with patients.