Fertility specialist explains what women in their 40 need to know about IVF, egg quality and their treatment options

For women reaching their 40s who are considering starting or growing their family, fertility can feel increasingly time-sensitive. However, age alone doesn’t tell the whole story. Dr Victoria Sephton, Chief Medical Officer at Care Fertility, explains that understanding ovarian reserve, egg quality and individual circumstances can help women make informed decisions about their fertility options at this stage of life.

It’s something Becki Fishwick experienced first-hand. After spending much of her 20s and 30s travelling and pursuing her career, she found herself approaching 40, single and still knowing that she wanted to become a mum.

“I was getting towards 40 and I just knew that I always wanted to be a mum, and it just hadn’t happened naturally,” she says. “I’d spent a lot of my 20s and 30s travelling and chasing my career dreams, so I started to think, ‘How am I going to do this?’”

Rather than immediately committing to treatment, her first step was simply finding out what might be possible. She booked an initial consultation at Care Fertility Manchester and attended alone, without initially telling her family or friends.

“My initial appointment with the doctor at Care Fertility was the first time I understood what I could do,” she says. “It gave me something to think about, helped me understand my options and understand what was happening in my own body. I’d got to nearly 40 and didn’t know if I even could have children, never mind whether it would work.”

Regular periods don’t mean fertility is assured

“One of the most common misconceptions we see is that having regular periods means fertility is broadly the same as it was a few years earlier,” says Dr Sephton. “Unfortunately, that isn’t necessarily the case. A woman can have regular cycles while the number and quality of her eggs are changing with age.

“For women over 40, the important thing is not to make assumptions about what is or isn’t possible based on age alone. Fertility testing can give us a clearer picture of ovarian reserve and how the ovaries may respond to treatment, while a consultation allows us to consider the wider picture, including medical history and sperm quality where relevant.

“We also need to be honest about the impact of age on egg quality. As egg quality declines, there can be fewer eggs that fertilise normally, fewer embryos that continue developing and a greater likelihood of chromosomal differences. This is one of the reasons why IVF outcomes can change significantly with age.

“That doesn’t mean there is one pathway for everyone. Some women over 40 may be suitable for IVF using their own eggs, while for others, donor eggs may be an option worth discussing. The important thing is having those conversations early enough with your fertility consultant to understand the options available to you.”

Why does fertility change in your 40s?

Fertility decline is driven largely by changes in both egg quantity and egg quality, although the two affect IVF treatment differently.

“Ovarian reserve refers to the number of eggs remaining in the ovaries,” adds Dr Sephton. “Tests such as Anti-Müllerian Hormone (AMH) and antral follicle count (AFC) can help fertility specialists understand how the ovaries may respond to stimulation during IVF. However, AMH cannot tell a woman everything about the quality of her eggs.

“Egg quality is closely linked to age. As egg quality declines, fewer eggs may fertilise normally, fewer embryos may continue developing to day five, and there is a greater likelihood of chromosomal differences in embryos. This can affect the chances of implantation and pregnancy. This is why two women with similar AMH levels can have very different IVF outcomes.”

IVF success rates decline with age

The latest figures from the Human Fertilisation and Embryology Authority (HFEA) show that IVF outcomes vary significantly by age. However, as Dr Sephton explains, national statistics are averages and cannot predict an individual’s chance of success.

“Statistics are useful for understanding the bigger picture, but they can also feel frightening when you’re looking at them as an individual,” says Dr Sephton. “A national average can’t tell you what will happen in your particular fertility journey.

“That’s why we start by understanding the individual. Looking at your test results, your medical history and the likely response to treatment can help us have a much more meaningful conversation about what your options are.”

For Becki, that individual journey led her to begin IVF in early 2023, the same week she turned 40.

“People assumed that because I was single, nearly 40 and didn’t have a child, I didn’t want children,” she says. “It wasn’t that at all - it just hadn’t happened for me.”

Following egg collection, six eggs were retrieved, which resulted in three embryos. Her first embryo transfer resulted in a pregnancy and her daughter, Betsy, was born in October 2023.

“I know people often talk about how many eggs they get, but I didn’t want to compare myself to anyone else’s story,” she says. “The six eggs became three embryos and the first embryo that was transferred was a positive pregnancy. I was so fortunate that it worked first time.”

What are the options for women in their 40s?

There is no single treatment pathway for women aged 40 and over. Depending on fertility test results and individual circumstances, women may be suitable for IVF using their own eggs, IVF with ICSI, or treatment using donor eggs or sperm.

For some patients, additional techniques may also be considered. Technologies such as Caremaps AI use time-lapse embryo monitoring and artificial intelligence to support Care Fertility embryologists in embryo assessment.

Dr Sephton explains: “For women whose egg quality is significantly affecting their chances of success, donor eggs can be another option to discuss. Because outcomes with donor eggs are more closely linked to the age and quality of the donor eggs, rather than solely to the age of the person receiving treatment, success rates can be higher for some women over 40.”

For Becki, becoming a solo mother also meant learning to accept support from the people around her. Although she had chosen to pursue motherhood independently, she says the experience taught her that she didn’t have to navigate the journey entirely alone.

“I may have chosen to become a mum on my own, but I didn’t need to go through the process on my own,” she says. “I did have to let my walls down and let people in.”

Don’t wait until you’re ready to start treatment

For women in their 40 who are thinking about having a baby, Dr Sephton says understanding their fertility sooner rather than later can be valuable, even if they are not planning to begin IVF immediately.

Reflecting on becoming a mother at 40, Becki says women shouldn’t feel defined by assumptions about when they are “supposed” to have children.

“There’s a lot of pressure you can put on yourself, and the media and social media maybe don’t help when they talk about women’s ages as negative, as if they’re a bit too old to be having a baby,” she says. “At the end of the day, it’s my life and my choices. You’ve just got to do what’s right for you.”

Dr Sephton concludes, “There can be a lot of pressure around the idea that women over 40 have to make an immediate decision about IVF. I would frame it differently: the earlier you understand your fertility, the more information you have to make that decision.

“For some women, that may mean proceeding with treatment. For others, it may mean exploring other options, considering donor treatment, or deciding that IVF isn’t right for them. Our role as clinicians is to give people the information they need to make that decision with the full picture.”

ENDS

For any questions, imagery or interview requests, please contact: carefertility@itsmaven.com

About Care Fertility

Care Fertility is the UK's most trusted fertility specialist, with over 25 years of experience in delivering world-class treatments. Care Fertility’s teams deliver personalised treatment plans that support patients every step of the way. Care Fertility isn’t just a clinic, it’s a community of compassionate experts committed to helping individuals and couples on their fertility journeys.

Care Fertility offers the widest range of fertility services, in the largest number of locations across the UK. Including, intrauterine insemination (IUI), intracytoplasmic sperm injection (ICSI), in vitro fertilisation (IVF), egg freezing, donor egg and sperm programs, and surrogacy.

Care Fertility’s mission is to make family possible for everyone; through compassion, collaboration, and expertise.

For more information, please visit Care Fertility’s website: www.carefertility.com