While it’s true that egg quality declines with age, it’s also true that the “cliff of 40” has shifted a bit as technology around fertility treatments has evolved. Whether you’re pursuing your career, waiting to meet the right partner, or have decided to delay parenthood to feel more financially and emotionally ready—don’t panic! There are many paths to parenthood if you’re over 40.

First things first

For both men and women, it’s essential to have your fertility tested, because the results will help your doctor decide the best option(s) for you. Fertility specialists, who are OB/GYNs who have completed their fellowship training in reproductive endocrinology, have access to advanced testing options. Women will complete a series of blood tests, ultrasounds and a uterine evaluation to help get a good understanding of their fertility health. If there’s a male partner involved, they should do a semen analysis to be sure there is adequate healthy sperm for fertilization, in addition to a few simple blood tests. All of this information can help a fertility specialist make a recommendation about the best path forward. 

Intrauterine insemination (IUI)‍

IUI is a procedure in which semen is inserted into the uterus through a small catheter. It can be done when a few things check out: fallopian tubes are open, ovulation can be induced (or happens naturally!) and the semen analysis meets the criteria. Your doctor may only recommend you do this for 1-3 cycles before moving on to treatments that may work better for you.

Pros of IUI: It’s minimally invasive, requires little or no medication, and is a lower-cost option. 

Cons of IUI: Fertilization is up to chance, and the embryo created can’t be screened for genetic disorders before implantation and pregnancy. 

In vitro fertilization (IVF)‍

IVF is a procedure in which the ovaries are stimulated with medications, and eggs are surgically retrieved and fertilized in a lab to create an embryo. The highly trained embryologist will look under a microscope to select the best quality sperm to inject into the egg and hope for fertilization. It’s not a guarantee, but it can increase the chance of fertilization. 

Based on your history and age, your doctor might recommend screening the embryo(s) you create for genetic disorders prior to implantation. This process is called pre-implantation genetic testing (PGT), and is helpful in reducing the risk of miscarriage. Some embryos don’t grow quickly enough in the lab, and others might have structural problems that won’t allow them to develop normally, which won’t be suitable to freeze or transfer. 

If your doctor doesn’t recommend carrying a pregnancy, using your own eggs, or using a partner’s sperm, there are other options:

IVF with donor eggs

‍You and your doctor might decide that egg donation is the best path to parenthood for you, based on your age, egg quality, and fertility treatment history. Some women decide to use egg donors for personal reasons, like if they have inheritable health conditions. Egg donors are typically young women who are deemed good candidates after going through a fertility test and psychological evaluation. The donor can either be anonymous (from an egg bank) or known (like a friend or family member). If you choose an anonymous donation, it can sometimes take upwards of 6-12 months to be matched, unless you can find a good match from an egg bank.  There are many donor egg agencies and banks, and it’s best to ask your doctor for recommendations.

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IVF with donor sperm

Similar to donor eggs, sperm donors can either be known or anonymous. Donor sperm can be used to fertilize your own eggs or a donor’s eggs. There are many sperm banks, so it’s best to ask your doctor for recommendations.

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Surrogacy

Surrogacy is the process in which a gestational carrier becomes pregnant, carries, and gives birth to your child. The surrogate becomes pregnant through an embryo transfer, after you have undergone IVF to create embryos (either using your own eggs or donor eggs). There are many laws protecting the intended parents as the parents of the unborn baby, but you’ll hire a lawyer to help construct a contract between you and the gestational carrier. Each state also has its own requirements around surrogacy, so a lawyer will be able to help you navigate your local laws. Note: Surrogacy isn’t currently covered in a Gaia Plan.

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Adoption

Adoption is the process of becoming the legal parent of a child, whether they’re genetically related to you or not. For good reason, it’s a complicated and expensive journey that can take months, or even years, to finalize. Many people find it incredibly rewarding to become parents through adoption. Note: Adoption isn’t currently covered in a Gaia Plan.

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The bottom line

There are many ways to build the family you desire. Consult with your physician sooner rather than later to help you navigate your options.

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