In vitro fertilization (IVF) is a fertility treatment option for women navigating perimenopause, a transitional phase before menopause. While it is possible to pursue IVF during this time, important considerations regarding individual fertility, success rates, and potential challenges need to be understood. Perimenopause involves biological changes that influence a woman’s reproductive capacity, making a tailored approach to IVF treatment essential.
Perimenopause and Fertility Decline
Perimenopause marks the natural transition a woman’s body undergoes before reaching menopause. This stage is characterized by fluctuating hormone levels, primarily estrogen and progesterone, which affect menstrual cycle regularity. As ovarian function gradually declines, ovulation becomes less predictable, and menstrual periods may become irregular, more frequent, or sometimes skipped.
These hormonal shifts lead to a decline in a woman’s natural fertility. The most significant change is diminishing ovarian reserve, meaning both the quantity and quality of remaining eggs decrease. Eggs produced during perimenopause are more likely to have chromosomal abnormalities, which can reduce successful fertilization and increase the risk of miscarriage.
IVF Suitability During Perimenopause
Undergoing IVF during perimenopause is feasible, though success rates are generally lower compared to younger women. This reduced success is linked to age-related changes in ovarian function. Diminished ovarian reserve means fewer eggs are available for retrieval, and those retrieved often exhibit lower quality due to increased chromosomal abnormalities.
For women under 35, IVF success rates can be around 40-50% per cycle. These rates decline significantly with age: approximately 22.1% for women aged 38 to 40, and about 7.2% for those over 40. The presence of chromosomal abnormalities in eggs from perimenopausal individuals contributes to lower implantation rates and a higher risk of miscarriage.
Key Aspects of IVF for Perimenopausal Women
Before initiating IVF, perimenopausal women undergo diagnostic testing to assess their ovarian reserve and hormonal status. These tests include Anti-Müllerian Hormone (AMH) levels, which indicate egg supply, and Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), and estradiol (E2) levels, which provide insights into ovarian function. Elevated FSH levels often indicate diminished ovarian reserve, suggesting fewer eggs are available and may not respond optimally to stimulation.
Ovarian stimulation protocols are tailored for perimenopausal women, often requiring higher doses of medication to encourage multiple egg development. Despite stimulation, lower egg yields are common due to reduced ovarian responsiveness. Given the increased risk of chromosomal abnormalities in eggs, preimplantation genetic testing for aneuploidy (PGT-A) may be recommended to identify chromosomally normal embryos before transfer, potentially reducing miscarriage rates and improving pregnancy chances.
Pregnancy at an older age, even through IVF, carries increased risks. These include:
Gestational diabetes
Preeclampsia (high blood pressure during pregnancy)
Preterm delivery
Higher likelihood of cesarean section
Comprehensive monitoring throughout the pregnancy helps manage these potential complications.
Considering Donor Eggs
For perimenopausal women with low ovarian reserve or compromised egg quality, using donor eggs often presents a more successful alternative. Donor eggs typically come from younger, healthy women, increasing the likelihood of a successful pregnancy. This option bypasses the age-related decline in egg quality, as the success rate largely depends on the age of the egg donor, not the recipient.
The process of IVF with donor eggs involves synchronizing the donor’s and recipient’s menstrual cycles using medication. The donor undergoes ovarian stimulation and egg retrieval. Eggs are then fertilized with sperm from the recipient’s partner or a sperm donor. The resulting embryos are transferred into the recipient’s uterus, prepared with hormonal therapy to support implantation. Success rates for IVF with donor eggs can range from 50% to 70% or higher per cycle.