What to Do after IVF Fails and You’re over 40yo

In vitro fertilization (IVF) is often the default medical treatment for women over 40 years old trying to conceive. The promise of IVF can give much needed hope after trying to get pregnant naturally without success for at least six months.  For many women though, IVF doesn't get the expected results.  

What do you do after IVF fails and you're over 40?  Consider an alternative approach - natural IVF.  Unlike the traditional IVFs you did, natural IVF lets you ovulate without medications - giving you valuable  time to improve egg quality.  

Although rarely offered as an option by fertility doctors, natural IVF can offer hope in women who have been told that getting pregnant is not possible because you and your eggs are "too old."

Success Rate of IVF

Before we get into what natural IVF is, let's understand why the success rate of traditional IVFs decline with age but more quickly after 40 years old.  

Consider the live birth rate for women using IVF according to age: (1)

  • <35 yo - 47.6%
  • 35-37 yo - 34.8%
  • 38-40 yo - 21.8%
  • 41-42 yo - 11.2%
  • >42 yo - 3.3%

Why are success rates for IVF so low for women in their 40s?

IVF's success depends on quantity.  The more eggs retrieved, the higher the chance that they will fertilize,  become embryos, and implant on the uterine lining.  It's based on numbers.

Unfortunately, as a woman gets older, less eggs are available to respond properly to the IVF medications.  This is usually evidenced by blood tests like AMH less than 1 or FSH higher than 10.  Low ovarian reserve can also be visualized with an ultrasound.

Even if a woman over 40 years gets pregnant with IVF,  a higher likelihood of miscarriage exists because DNA damage increases with age.

Compare the miscarriage rate by age group below.

  • <35yo - 11.8%
  • 35-37yo - 15.3%
  • 38-40yo - 21.6%
  • 41-42 - 27.1%
  • >42 - 41.5%

Why does the risk of miscarriage increase with age?  The longer you're on this planet, the more time your DNA has to become damaged.  From toxins in the air, environment, food, water.  Stress.  Poor quality sleep.

It's unavoidable...causing you and your eggs to age.

The DNA damage results in poor embryo quality that can't progress to a healthy full-term pregnancy.

But the exposure to toxins can be reduced and DNA repair stimulated so that egg quality improves enough for a health pregnancy.

And this is where a procedure called "Natural IVF" might be an option for you.

What is Natural IVF?

A traditional IVF uses medications to stimulate your ovaries to pump out a lot of eggs.

In contrast, natural IVF doesn't use these medications.  Instead, your fertility doctor tracks your cycle and retrieves the egg that you would naturally ovulate on your own.

No medications.

Less cost.

Sounds great so why don't you know about it?

Very few doctors offer it as a standard service.  Understandably so, because the success rate of it is so low compared to a medicated IVF cycle.

Using medications to stimulate the ovaries is a more effective strategy than natural IVF for most women.

However, knowing when natural IVF might be an option can offer hope when there seems to be none.  Especially when you've been given the donor eggs talk.  It gives you a "Plan B."

The advantage to natural IVF is that the focus is on quality, NOT quantity as in traditional IVF.

In a natural menstrual cycle, a pool of eggs start maturing in preparation for ovulation.  However, only one egg will become the dominant one and is collected in a natural IVF cycle.

Instead of forcing your ovaries to superovulate with medications as in a traditional IVF and split nutrient resources to many eggs, a natural IVF cycle allows your ovaries to do what they're designed to do naturally - grow one egg at a time and put all your resources to that one.

The perceived downside to natural IVF is the amount of time it will take.

A traditional, medicated IVF cycle can start and finish within 1 menstrual cycle with a fresh transfer.  Or 2 menstrual cycles, with a frozen embryo transfer.

In contrast, natural IVF will take several months to collect enough eggs to move forward with a transfer.

Although technically, you can have a transfer after the first retrieval, taking the time to do several retrievals creates a safety net of multiple embryos to choose from.

However, this longer period can actually be advantageous.  It automatically gives you more time to make the necessary lifestyle changes to improve egg quality before and during the retrievals.  That includes nutrition, supplements, and environmental modifications.

Unfortunately, as is the rule of thumb in life, quality often takes more time than quantity.  This is certainly the case with improving egg quality.

It will take at least 3 months for egg quality to improve significantly enough for a healthy pregnancy.

Why 3 months?

When you're born, your eggs go into stasis - they stop developing.  Awakened from that arrested state, it actually takes about 1 year for an egg to fully mature into a fertilizable egg.  However, the most active growth occurs in the last 3 months.

At any time, your ovaries contain follicles in many stages of development.  For your best chances of getting pregnant, you need enough time to improve the egg quality during those last 3 months of maturation.

Three months may seem too long to wait.

However, natural IVF in conjunction with lifestyle changes may actually extend your fertility window.

Who Should Consider Natural IVF?

Although not a strict guideline, women in these situations may consider natural IVF, if traditional IVF isn't an option...

  • If you can't afford traditional IVF after weighing the success rate for your age group.  The reality is that multiple IVF cycles are needed to achieve a pregnancy, if it's even successful.
  • You have had at least 2 canceled IVFs because no embryos survived for transfer.
  • You have had at least 3 failed IVFs with embryo transfers.
  • Your fertility doctor recommends donor eggs based on your AMH, FSH, or ultrasound but you still have a regular menstrual cycle.
  • You are concerned about the toxicity of the medications and want to go as natural as possible.  Although not 100% medication-free, much less is used since none are given to stimulate the ovaries.  One medication recommended to keep is a shot to time ovulation so it doesn't get missed accidentally.  This technically then makes it a "modified natural IVF."

What's Your Next Step?

  1.  Detox as instructed below.
  2. If natural IVF is an option you want to explore, contact me to discuss if it's appropriate for you.  In conjunction with your fertility doctor, you will need guidance from me to pace natural IVF properly for optimal results.

What to Do After a Failed IVF

After a failed IVF cycle, while you're figuring out your next move, it's beneficial to detox from any residual medications, especially the estrogen given during the cycle.

Taking the time to do so improves the results of future cycles - IVF or natural.

Detoxing is like a reset button for your ovaries and body.

Often, the liver is mistakenly viewed as a filter.  Like a coffee filter, the liver will strain out the toxins.  This isn't how the liver works.

Rather, detoxification occurs by changing the chemical structure of harmful substances so that it can be removed from the body.  It's a chemical process, not a physical net capturing toxins.

In order to detoxify properly, your cells need nutrients to provide the raw material to convert the compounds.

Estrogen is not only given in IVF medications but is abundantly found in our foods, water, and environment.

Two of the most well studied xenoestrogens (foreign estrogens) are BPA and Pthalates.

Bisphenol A (BPA), a synthetic chemical used to harden plastic, is an endocrine disruptor that mimics estrogen in the body by competitively binding to estrogen receptors.

BPA is found in many places in our environment (plastic bottles, linings of cans, thermal printed receipts) and most of us carry it in our bodies.

In fact, a study that just came out this year found that 90% of infants (in the study area in NY) were born with BPA in their blood, which show that it also is crossing the placental barrier, interfering with baby's development. (2)

Your BPA levels affect fertility: Studies have found that women dealing with infertility are likely to have higher serum BPA levels, and women undergoing IVF are also negatively impacted by BPA. Several studies have recently determined that BPA impairs the implantation of the embryo in the uterus. (3)

BPA is also a big problem for your male partners: BPA is not only a problem for women trying to conceive; it also affects male sperm quality. A recent study showed that as the  urinary concentration of BPA increased, the quality of sperm reduced through decreased motility, less mature sperm, and increased chromosomal abnormalities. One thing to note is that BPA was found in the urine samples of 98% of men in the study. (4)

Phthalates are another ubiquitous environmental toxin that interact with women’s hormones. Mainly used as plasticizers to make plastic flexible, phthalates are found in bendable plastics, vinyl, cosmetics, fragrances, and detergents.

Studies show that phthalate levels increase the risk of uterine fibroids (5), ovarian cysts (6), miscarriage risk (7), disrupts normal hormone levels (8), and increases premature ovarian insufficiency (9).

For couples using IVF, higher phthalate levels have been linked to decreased odds of implantation. (10)

Decode Your DNA to Know How Well Your Body Detoxifies

So how do you get rid of excess estrogen and estrogen-mimicking compounds?

It's a two-step process in the body. First, those chemicals are broken down by enzymes produced mainly in the liver, and then they go through a second phase to convert the compounds into a water-soluble form that can be excreted.

Your DNA will give you an indication of how efficiently you can detoxify.

There are several common genetic variants that impact how well your body gets rid of the estrogen-mimicking compounds that we are exposed to each day.

UGT1A1 is a gene that codes for an enzyme which breaks down estrogens.

Genetic variants of UGT1A1 change the speed at which your body processes estrogen so that excess estrogen can be removed.  Decreased UGT1A1 metabolism can cause foreign estrogen from medication and the environment to build up faster than it can be excreted through urine.

Sequencing your DNA is easy with a service like 23andMe or Ancestry.com that provides your raw DNA data file.

If you're Asian, in your raw genetic data file, search for “rs4148323” on Chromosome 2.

Because you get one copy of this gene from your mom and another from your dad, the gene you have is identified by a 2 letter combination.

If you have at least 1 copy of the A variant of rs4148323, your cells are less efficient at metabolizing estrogen into harmless substances.  You will need to be more aware of your exposure to foreign estrogens and support your body's ability to detoxify with the right foods, like cruciferous vegetables.

Three possible genetic combinations exist:

  • AA - 32% decreased activity compared to normal
  • AG - likely decreased activity compared to normal but not as much as AA
  • GG - normal

If you're Caucasian or Africanthere is also a common genetic variant in UGT1A1 that causes a significant decrease in the enzyme function. About 40% of Caucasians and Africans carry this variant.

Check your genetic data for rs34983651:

  • II: decreased clearance of BPA in liver and breast tissue (11)(12)
  • ID: somewhat decreased clearance of BPA
  • DD: normal

You will need to be more aware of your exposure to foreign estrogens and support your body's ability to detoxify with the right foods, like cruciferous vegetables.

Another gene in the UGT family, UGT2B15, is also involved in metabolizing estrogen-mimicking compounds like BPA.

UGT2B15 codes for an enzyme that is responsible for BPA metabolism at lower concentrations in the body. (13)

Again, if you have genetic data, you can check to see how well your UGT2B15 gene works.

Check your genetic data for rs1902023:

  • AA: decreased UGT2B15 activity, impairs BPA detoxification
  • AC: slight decrease in UGT2B15 activity
  • CC: normal UGT2B15 activity

For getting rid of phthalates, your body also uses the UGT enzymes along with enzymes coded for by the glutathione s-transferase genes.

There is a fairly common variant in GSTP1 gene that you can check for in your genetic data to see if you are likely to have a harder time detoxifying phthalates.

Check your genetic data for rs1695:

  • GG: increased phthalate levels (14)
  • AA: normal GSTP1

How to Detoxify from Too Much Estrogen

What can you do to rid your body of the extra estrogen-mimicking compounds we are bombarded with?

Adding in a lot more cruciferous vegetables, such as broccoli or bok choy, to the diet will help.  A compound in cruciferous veggies called I3C, which the body metabolizes into diindolylmethane (DIM), causes your body to create more UGT1A1 enzyme, thus increasing the rate at which your body will get rid of extra estrogens. (15)

DIM is also available as a supplement for those who don’t eat enough cruciferous veggies.  Take 100-200mg daily.

Work up a sweat.  Studies show that phthalates can be eliminated through sweat. In fact, the concentration of phthalate metabolites can be almost twice as high in sweat as in the urine. (16)

Lycopene, a plant-based antioxidant that is abundant in cooked tomatoes, has been shown to increase GSTP1 levels, which may help in detoxifying phthalates. (17)

Avoiding BPA and phthalates:

While it is difficult to completely avoid these two substances, you can cut down your exposure through a couple of easy steps.

Read the ingredients labels on your cosmetics and skin care product for phthalates.  Switching to more natural skin care products can reduce your body’s burden for detoxifying foreign estrogens.

Avoid storing warm foods or heating foods in plastic containers. Yes, we have all heard the warnings on this, but for people who don’t detoxify BPA and phthalates as well, this is an important step.  So invest in some good glass storage containers and use them.

Avoid foods that come in cans with BPA linings or in plastic packaging. While it isn’t practical to avoid all foods that are packaged, choosing fresh veggies and fruits is a good way to avoid a lot of plastic.

Phthalates are found in many fragrances, from air fresheners to fabric softeners. So opting for more natural laundry products (look for ‘Free and Clear” on the label) and avoiding artificial fragrances can help decrease your phthalate exposure.

Get into the practice of reading labels.

Related Questions

Can I get pregnant if my doctor says it's too late for me?

As long as you have a period and are ovulating, you can still get pregnant - no matter what your doctor says.  Your success  depends on your overall health and lifestyle choices more than your chronological age.  Trying naturally or with natural IVF may be your best options if you want to use your own eggs.

Why didn't my IVFs work even though I had embryos for transfer?

It's really difficult to say.  So many factors are out of your and your doctor's control that pregnancy cannot be guaranteed.  Often as you get into your late 30s and 40s, the egg quality isn't good enough for a pregnancy.  Taking the time to improve egg quality is critical to future success.

Bone Broth

A bone broth fast after a failed IVF is an easy way to remove excess hormones more quickly.

Short fasts allow your digestive system to rest.  Converting solid food into microscopic molecules requires a lot of energy and nutrients.  Resources that would otherwise have gone into digesting food are shunted to other systems, like detoxification, during a fast - giving you a much needed reset.

The nutrients in bone broth help the detoxification process while providing the essential building blocks for your ovaries and eggs.

Pre-made bone broth is available but nothing beats the real thing that you make at home.  It's easy to make.  The hardest part is sourcing high quality bones.

Drink nothing but bone broth for at least 1 day.  The total volume consumed should equal half your weight in ounces of broth.  Fasting can continue for up to 3 days.

Soy Ginger Salmon for Vitamin D when Trying to Get PregnantIngredients:

  • Grass-fed beef bones, about 1.5 pounds
  • Filtered water

Directions:

    1. Cover the bottom of the slow cooker insert with a layer of bones.
    2. Optional: add herbs and veggies for additional flavor.  You’re not getting many nutrients from the veggies because they’re cooked for so long.
    3. Cover with filtered water to the top of container.
    4. Let cook at the lowest setting overnight.
    5. Optional: In the morning, place stoneware in refrigerator until fat solidifies and can be skimmed off.  Keep fat for cooking.
    6. Serve as needed.  Salt to taste.
    7. Add more water to slow cooker as you take out what you need.
    8. Keep slow cooker on lowest setting.   The longer it cooks, the more it release the collagen, minerals, and other nutrients.  Important! Make sure the broth continues to simmer to prevent bacterial growth.
    9. Use bones until bone broth loses flavor.  One batch of bones can last several days, depending on how much you drink.

    Tips:

    • Save vegetables scraps in the freezer to add to your bone broth.  Stuff like, ends of carrots, onion peels, chunks of tomato, celery leaves and ends.  
    • Add dried organic seaweed, kelp, kombu, or wakame.  Sea vegetables are an excellent source of iodine, needed for healthy thyroid function.