Scientists: women reach a "critical point" of fertility at approximately 49 years old

For a long time in reproductive medicine, it was believed that the main reason for age-related decline in fertility was the aging of egg cells. Therefore, the use of donor eggs from young women was considered a way to some extent to circumvent the biological clock.

However, new research by Italian specialists, the results of which were presented at the annual congress of the European Society of Human Reproduction and Embryology (ESHRE), indicates that everything is much more complex. It shows that with age, not only the quality of egg cells deteriorates, but also the condition of the uterus itself, which must accept and ensure the development of the embryo.

What the study showed

Scientists analyzed the treatment outcomes of 1774 women who underwent in vitro fertilization (IVF) using donor eggs.

Among women aged 35-40 years, pregnancy after such a procedure occurred in 54% of cases. In women aged 49 years and older, this indicator decreased to approximately 43%.

Even more noticeable was the difference in the number of cases resulting in the birth of a live child. If in the 35-40 year old group this occurred in 46% of procedures, then in women aged 49 years and older — in 32%.

Simultaneously, the risk of pregnancy loss increased. In women over 49, miscarriages occurred in 38% of cases, compared to 24% in the 35-40 year old group.

At the same time, when considering the transfer of all obtained embryos, the probability of a live birth was about 80% for women aged 35-40 and 62.5% for women aged 49 and older.

It's not just about egg cells

The authors of the study believe that the reason lies in age-related changes in the endometrium — the uterine lining where the embryo implants and pregnancy develops.

The thickness of the endometrium in women of different age groups hardly differed, but its functional state deteriorated with age. This, according to the researchers, may explain why even the use of young donor eggs does not fully overcome the effects of aging of the reproductive system.

The authors of the study emphasize that these results should not deter women from seeking donor egg treatment. The effectiveness of such treatment remains quite high even at an older age. However, patients should understand that this method cannot fully compensate for age-related changes in the reproductive system, especially after 49 years of age.

Why this is important

Researchers hope that in the future it will be possible to develop methods that will allow predicting, preventing, or reducing the consequences of uterine aging. This could make infertility treatment more effective.

Independent experts urge not to perceive 49 years as an absolute limit. They emphasize that the condition of the uterus and ovaries can vary significantly among women of the same age, so each case requires individual assessment.

One patient, British woman Sharon Marshall, told the BBC that she gave birth to her daughter at 46 after six years of unsuccessful IVF attempts. Prior to this, she had two miscarriages and was only able to conceive on her seventh attempt.

According to her, stories of celebrities giving birth after 45 or even 50 years create the impression that it is relatively simple. In reality, many women go through years of treatment, unsuccessful attempts, and difficult psychological experiences.

"Let's be honest with women about the difficulties they may face and how challenging it can be to get pregnant at an older age. We deserve to know about this," she said.

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