Fertility issues when IUI/IVF are not options: what are the odds?

January 22, 2023 3:34 PM

For Reasons that will be explained, IUI and IVF are not options. I am about to turn 40, and my last AMH from a year ago was .85. Assuming I can access a clinic that can improve my chances through medication, but not anyone else's, what are my rough odds at the moment I begin actively trying to get pregnant through sex? What about over the next few years? How can I improve them?

So, I'm separated and in the process of a very lengthy divorce. My healthcare is extremely retrograde: it will only offer assistance to married couples, so any future partner would at *best* not be able to access it for a few years until the divorce is through and I engage in a remarriage. It will however still likely help *me* as this divorce goes on.

I absolutely do not want my last very wanted child to be yet another casualty of the shit sandwich that is this divorce as my fertility slowly ebbs. I have the familial and social support to raise a child as a single mom, I have been a single mom before and did very well as a single mom. However, I don't have the cash-on-hand to freeze eggs because, well, divorce.

I don't know what to do and am kind of panicking right now; a lot of the online things I try to find are links from IVF sites that are designed to terrify me into using them. I want to know how many years - or months, or weeks - I have before I need to get ruthlessly serious about this, and what I need to start doing *now*. Research would be most helpful and appreciated, but I'll also take anecdata at this point.

posted by corb to Science & Nature (10 answers total)

You might find Queer Conception by Kristin L Kali helpful. I can’t vouch for any of the information personally, but it goes into a great deal of very concrete information about fertility, timelines, age, etc, in what I found to be a much more grounded and less alarmist tone than a lot of online info.
posted by elanid at 4:05 PM on January 22, 2023

Resolve is the National Infertility Association with education and advocacy links . My husband and I had success with IVF and have since donated to support their work, but I did not know of them when before/during our journey, so I can't speak to the content but I hope it's helpful. I relied on the acquired knowledge from friends and colleagues who also took this journey and wish you the best on yours.
posted by icaicaer at 4:15 PM on January 22, 2023

Have you met with a reproductive endocrinologist yet? When I saw mine she tild.me you gave ~x years before your fertility tanks (not sure what polite medical term she used and ~y years til you stop menstruating.

If I recall correctly the AMH isn't a direct measure of your fertility but a measure of your body will respond to ovulation-stimulating medication. I know someone with undetectable AMH who got pregnant twice in her 40s with unmedicated IUI. The AMH is more a tool for knowing how to approach your fertility treatment and less a measure of your fertility.

Strongly recommend you join single mom by choice groups either in person or on fb, including some local to you. I went through a clinic, which I know is not an option for you, but I know.lots of people in the US do home insemination or have a midwife do IUI which is cheaper than a clinic. If you join a group you can learn more about what others with similar medical stats have done (though obviously there's selection bias there so remember that when taking what you can from others' stories.)

I'm not sure I have more direct advice to offer as my medical options were different but feel free to memail me if there's anything more I can offer or if you want help hooking up with SMC groups.
posted by If only I had a penguin... at 4:27 PM on January 22, 2023 [3 favorites]

Oh...and as you are not divorced yet, talk to a family lawyer in your area about your legal situation should you decide to go the SMC route. In some places it may be the case that since you are legally married when your child is born, your spouse is the legal parent of that child regardless of the genetic connection (or lack therof). IANAL.
posted by If only I had a penguin... at 5:35 PM on January 22, 2023 [1 favorite]

Things you can start doing now:

Easy:
Take prenatal vitamins
Get a physical and bloodwork (esp. check iron and thyroid)
Supplement anything you're low on

Medium effort:
Sleep more
Eat more veggies
Drink more water
Go for walks in nature
Love on your body

Hard but crucial:
Legally extricate yourself from your ex
Do some emotional cleanup (therapy, journalling, etc) to help lower your stress and entanglement levels
Get your home life in order and restful
Start creating a healthy work-life balance

I know A LOT of women who've had healthy babies at 40, 41, 42. You don't have time to mess around, but it's absolutely possible. So just keep your eyes on the prize and start drop-kicking sources of stress out of your life so your body can feel safe. Good luck!
posted by nouvelle-personne at 7:18 PM on January 22, 2023 [3 favorites]

Is switching jobs an option? Or advocating for more comprehensive health care at your current workplace? Better coverage might ease some of the stress here and give you better/more options.
posted by Threeve at 7:58 PM on January 22, 2023 [2 favorites]

You've already had kids so that's hopeful for your chance of becoming pregnant again in the future. My mom had her last kid at 45 and last pregnancy (miscarriage) at 47 without any medical interventions; I know of others in the same situation. Science also keeps expanding what's possible as the years go by so who knows what will be available in even five years?! I can understand how this situation is extra stressful when you're already stressed about the separation and divorce. There are no guarantees but there's a lot of hope for you!
posted by smorgasbord at 9:30 PM on January 22, 2023

The rough odds of a 40 year old woman naturally (ie by having unprotected sex 2 or 3 times a week) conceiving within a year are 40-50%. This is a source, but I've seen similar numbers in multiple places and it fits with a per cycle chance of slightly below 5%.

It looks as though once you are in your 40s your fertility declines rapidly, very few women get pregnant naturally at 45 and their rate of miscarriage is about 80%. Your best bet for any kind of conception with your own eggs is as soon as possible. The only option that offers a very good chance after age 45 is donor eggs and IVF (which is expensive).

All of which is to say very roughly, aged 40, 41, 42 definitely not impossible, at best even odds and declining. Aged 43, 44 still not impossible but much more likely to be unsuccessful than successful. Aged 45 and over, it does happen but not enough to pin any hopes on.
posted by plonkee at 1:47 AM on January 23, 2023

Btw, if I believe you are in the U.S., since you mentioned that you intend to/are open to doing this as a single mom, you should know that IVF/IUI and sex are not your only options. In fact if your intent is to be a single mom in many jurisdictions it is a terrible idea to get pregnant by having sex. You can also just buy sperm and do ICI (intra-cervical insemination - just shoot it in with a syringe) at home. This is a thing lots of people do. You can do it yourself or if you prefer you can have a midwife help which would raise the costs a little. Sperm is not expensive (I mean I know "expensive" means different things to different people, but it costs a lot less than a month of daycare).
posted by If only I had a penguin... at 8:22 AM on January 23, 2023 [2 favorites]

As a piece of anecdata, I'm 41 and just conceived "naturally" after two previous stillbirths at 36 and 38 years of age. We decided that given my history of not carrying to term (due to completely unrelated, lightning-strike reasons), we didn't want to go through all that is IVF.

nouvelle-personne has a great approach that you can take right now and it will improve your chances of conception when the time is right.

I've always been good about diet and exercise but in the last year I really dialed it in and worked with my primary care doctor to monitor my nutrition. Check your thyroid health, too, as that can play a big factor.

Lily Nichol's Real Food for Pregnancy has excellent, evidence-based advice on how to best prepare your body for conception and pregnancy.

In my case, I started supplementing with magnesium and vitamin D on top of a solid prenatal. After my first loss, I worked with a reproductive endocrinologist who advised me on improving my late 30s egg health with Ubiquinol (CoQ10) and myo-inositol. (He also advised magnesium.) I realized last summer that my regular pre-menstrual spotting likely pointed to a progesterone deficiency, so I cut out caffeine entirely and started sleeping in a very dark room (turned my alarm clock away from my bed, got blackout curtains). I also cut out nearly all alcohol. Within two months of this, my cycle was more "normal," and I conceived within a few months.

Talking to my OB and maternal-fetal medicine specialist early in my current pregnancy, they said they see women in their early-mid 40s deliver healthy babies all the time. You still have time and hope, and I wish you all the best!
posted by writermcwriterson at 9:21 AM on January 23, 2023 [1 favorite]