Various medically assisted reproductive techniques (MAP) help infertile couples. However, the chances of success depend on a number of factors, including the age of the woman. And technological progress leaves little hope in the short term.
“We can’t do much after 40.” Herman Tournaye, Head of Department at Brussels IVF, the Center for Human Reproduction at UZ Brussels, cannot repeat it often enough: Age, age, age. “Nowadays women in their 30s or even beyond are thinking about having children. Couples think as long as the woman is menstruating, everything is fine and doctors can work miracles, but that’s not true,” he insists. “Women wrongly believe that with PMA we solve all problems. However, if the egg quality is poor, we are stuck,” says Marine Guisset, gynecologist and fertility specialist at the Clinique Saint-Jean in Brussels.
This also emerges from the report on the causes of infertility presented to the French government last February. “The ignorance of many couples to the reality of their declining fertility with age combined with overconfidence in the performance of assisted reproductive technologiesresult in a demand for ever-delayed medical support, thereby limiting the success rate.”
Professor Tournaye railed against the stories of elderly and pregnant celebrities circulating in the press. “Often it’s thanks to a younger woman’s egg, but not everyone realizes that.”
In Belgium, The age limit for treatments with your own eggs is set at 45 years. After the age of 43, patients are no longer entitled to reimbursement from the health insurance company. Women with frozen eggs or embryos can be fertilized up to the age of 47. In addition, the only way to benefit from an assisted reproductive technology is to go to Spain, where the limit is set at 50 years.
Technologies of the (distant) future
Unfortunately, no miracle technology on the horizon. “The 21st century was supposed to be the century of stem cells, from which sperm and egg cells develop. But the technology is not keeping up. It has yet to work in animals, which isn’t the case yet. If a technology is reliable for mice, it will be another 10 or 20 years before it’s available for humans,” notes Professor Tournaye.
“Some scientific studies in mice show encouraging results, but we are only at the end beginning, confirms Marine Guisset. However, There is hope that we will one day Improve oocyte quality. But beware: We are talking about genetic manipulation. Which may not happen in the next fifty years.
the rejuvenation of the ovaries is another increasingly popular technology. But Annick Delvigne, gynecologist and head of the PMA center at Clinique MontLégia (Liège), frets: “This practice will never work on a 40-year-old woman, but rather on 20-year-old women with ovarian failure – early menopause – and in which there are still small amounts of follicles in the ovaries. The most important current research is try to reactivate these residual follicles in young women. In the older woman, we would reactivate old eggs, which isn’t particularly interesting.
Another track: Egg freezing before age 35. To? Too late! “We started with that Social Freeze in 2009. But to be honest, it’s unlikely that a woman who freezes her eggs at 40 will ever have a child.” Then it shouldn’t be cryopreservation – useful if the woman has not yet found the right partner – becomes “a prevention policy for couples who put careers ahead of parenthood, warns Christine Wyns, head of the gynecology department at the Cliniques Saint-Luc in Brussels. On the one hand, because pregnancy at an advanced age harbors risks, on the other hand, because success is not guaranteed.
Guaranteed, success is never guaranteed anyway, no matter what technique. In 2019, the success rate (at the first embryo transfer) in patients under 36 years old was 31%. And then it decreases with age. “There are very few areas of medicine where people accept treatment with such a low success rate,” notes Annick Delvigne.
According to the hospital, the chances could still dwindle. While anyone can use these techniques, not everyone has the same level of expertise. In 2015, the government began reimbursement for egg freezing for cancer patients. “Back then, the success rate per thawing cycle was 30-35% in the Brussel IP, but less than 8% in the rest of Belgium,” says Herman Tournaye.
However, consistent top expertise would not completely counteract the vagaries of the human body. In the house of micethese lucky ones IVF is 100% successful…
The three most popular techniques
Injecting sperm into the uterus (or cervix) to bring them as close as possible to the egg at the time of ovulation.
In vitro fertilization (IVF)
Fertilization of two reproductive cells, male and female, in the laboratory. Then, if successful, replacement of the embryos in the uterus.
Frozen Embryo Transfer
Freezing embryos obtained through IVF to create a reserve that doctors can use later for a new transfer.