Can I get pregnant again at 46?

Hi Doctor,

I recently visited a reproductive endocrinologist because I was having issues with my period (heavy clotty periods).  They did an sonohysterogram and found a 2 cm uterine polyp.  I am due to have that removed in May.  However, they also did blood work to determine how far away from menopause I am.  I had an FSH test done actually 3 years ago and it was a 7.6 .  The current FSH level they did was an 8 and my estradiol was 94.  Doc says I’m pretty far from menopause. She also says that the polyp was acting like an IUD so once it’s removed, I should be careful. I am 46 years old.  I have two children already and wouldn’t mind a 3rd.  Should I even try at this age? Or would donor eggs make more sense? I will discuss these issues as well with my doctor once my surgery is over.

Thank you. K. from Pennsylvania

Answer:

Hello K. from the U.S. (Pennsylvania),

Thank you for seeking a second opinion from me.  I feel honored and hope you’ll be satisfied with my response.  First, keep in mind that FSH is a measure of ovarian function, which means that your ovaries probably would be able to be stimulated by fertility medications.  This, however, does not indicate that the eggs within are still good quality.  This is the problem with age.  It is not ovarian function, it is egg quality.  As you know, women are born with all the eggs that they have for their lifetime.  Like all the cells in our bodies, eggs deteriorate with age and so they are less fertile.  As such, the statistics are not in your favor.  Your natural chance of pregnancy is less than 1% per year of trying (very rare).  Even with IVF, there are almost no reported pregnancies after the age of 44.  So, based on your chances of pregnancy using your own eggs, IVF with donor eggs would be more effective.  That is not to say that you can’t be the exception to the rule, but if you think so, you will have to put your money in and take the chance.  If you don’t want to risk wasting your money, then donor eggs give better odds.  In terms of your doctor’s comment about being careful once the polyp is removed, I don’t think you need to worry about that especially if you want to be pregnant.

But, there is another consideration as well.  Should you become pregnant, you have a 1 in 30 chance of having a child with Down’s syndrome, and that risk is cited only because it is such a common disorder.  There are plenty of other disorders as well.  Are you willing to have a genetically abnormal child?  If the answer is “yes” then you could try with your own eggs.  If it is “No” then you should consider donor eggs.  The risk would be much less.

I hope this helps in your decision making.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG

Monterey Bay IVF