Modern lifestyles, demands for professional advancement, economic difficulties and insufficient social incentives to have children have pushed up the age at which couples start trying to have a child. It is a global social phenomenon, but in our country it is particularly intense.

In Greece, both the average age of women at first birth and the proportion of births to women aged over 40 (9.7% in 2021) are at levels significantly higher than the corresponding average levels in Europe, while steadily, Greece is the country with the highest proportion (about 50%) of IVF cycles in women over 40 years old.

Fertility declines with age in both sexes. In women, however, this reduction is more pronounced and accelerates rapidly after the age of 37. It is due to the progressive decrease in the quality and number of eggs, the hormonal deficiency of the ovaries and the progressive increase in the creation of embryos with chromosomal disorders that either do not implant or end up as first trimester miscarriages. In the 40s and as we approach menopause, more than 90% of embryos created either naturally or through IVF carry chromosomal abnormalities.

So what’s a woman to do as she watches the years go by?

1. He should as soon as possible adopt one healthy lifestyle: not to smoke (smoking delays conception, reduces the chances of IVF success, while accelerating menopause), to maintain her weight at satisfactory levels with a healthy diet, not to abuse (alcohol and caffeine) and to exercise. All of this will help her speed up her pregnancy when she starts trying.

2. He should think about it in time egg freezing: Advances in the field of cryopreservation are very important and now the probability of a child being born from a cryopreserved egg is considered the same as that of a ‘fresh’ egg in a standard IVF cycle. But since this possibility depends on the quality of the egg and therefore on the age, it is clearly preferable for women to do the procedure in time, preferably before 35 years. The younger the age, the smaller the number of eggs that must be cryopreserved so that there are high chances that they will later lead to the birth of a healthy child (or even more). Also, because the losses from the egg reserve of each woman accelerates as we mentioned above after 37, it would be good to make an estimate of the reserve between the ages of 30 and 35, by measuring the anti-Müllerian hormone (AMH) in the blood, so that if there is an indication to make faster decisions. The drugs that a woman takes in an egg freezing program are safe and pose no risk to her future health; all the major scientific companies have officially placed themselves on this. Egg freezing is considered prevention with multiple benefits for a woman’s fertility.

3. When you start trying to conceive you should not to delay in asking for help if the pregnancy does not come. For women aged 35 – 40 years, the period of natural attempts is placed at around 6 months, while for those over 40 years old, carrying out the basic infertility check is recommended even before the beginning of the attempts (so that precious time is not lost if some other problem).

4. If the couple is taken to an extracorporeal program they should to be treated properly with knowledge, honesty and seriousness. The goal should be to maximize the ovarian response to the protocols to obtain the highest possible number of oocytes. Some facts are that: there is a maximum dose limit of the available drugs beyond which it makes no sense to increase the dose, mild ovarian stimulation protocols often have the same or better results, natural cycles are the last resort eggs, while the ‘rejuvenation’ of the ovaries with PRP is on the one hand still considered experimental and on the other hand it can have some effect only when there are still some egg reserves (and not when they are almost exhausted, as in the cases usually applied until now).

5. He should know that with him preimplantation genetic testing of embryos after their biopsy can avoid the transfer of embryos that are doomed to fail or lead to miscarriages and pregnancies of embryos with chromosomal abnormalities. In this way, mental and physical strain from failures and scrapings is avoided, while at the same time the couple gains time so that if there are no healthy embryos, they can immediately proceed with a new attempt. Therefore, this strategy can be extremely beneficial, especially if we can get enough eggs in each ovarian stimulation.

6. Finally, h use of donor eggsis the last resort, which has excellent success rates even in women of very advanced age.