Ahmed Gibreel: IVF After 45 – What Does The Evidence Actually Tell Us?
Ahmed Gibreel, Senior Consultant in Reproductive Medicine at Dr. Samir Abbas Medical Centers, shared on LinkedIn:
”IVF After 45: What Does The Evidence Actually Tell Us?
1. Natural conception after 45
US national birth statistics recorded approximately 1.1 births per 1,000 women aged 45–49 annually in 2024 and 2025 (0.11%).
2. Miscarriage after 45
A large Danish national registry study reported a miscarriage risk of approximately 74.7% pregnant women 45 or older.
3. Autologous IVF: what are the actual chances?
A large US national database study (SART CORS, 2014–2020), including 24,650 women older than 42, reported the following cumulative live-birth rates using their own oocytes: (5% CLBR at age of 45, 3.5% at age 46, 2.5% at age 47). It is not a per cycle.
4. How many mature oocytes are needed?
A 2025 multicentre study found that women ≥40 required average 45 mature (MII) oocytes to obtain three euploid blastocysts.
An AI-based probabilistic model estimated that women older than 40 might require at least 49 MII oocytes to achieve a ≥90% probability of obtaining three euploid blastocysts.
5. How many blastocysts are needed to obtain one euploid embryo?
woman aged 45 would need approximately 29 blastocysts to have a 90% probability of obtaining at least one euploid blastocyst.
6. How many euploid blastocysts are needed for a live birth?
Three euploid blastocysts have been associated with an estimated 93% chance.
7. Trisomy 21 (Down syndrome) and maternal age
At maternal age 45, risk is 1 in 30. This is the risk at birth, not the total risk of embryonic aneuploidy.
8. Can CoQ10, PRP, Stem cell therapy, and antioxidants reduce aneuploidy?
Current evidence does not establish that CoQ10, PRP, stem cell therapy or other antioxidants prevent age-related embryonic aneuploidy. Improvements in AMH, AFC or ovarian response do not prove restoration of oocyte competence or reversal of aneuploidy.
9. Cytoplasmic and mitochondrial transfer
Cytoplasmic transfer and mitochondrial approaches have been proposed. However, they are not established treatments for age-related infertility.
10. PGT-A, Non-medical sex selection and PGT-M
PGT-A identifies or classifies aberrant chromosomal findings; it does not correct aneuploidy. Mosaicism and sampling limitations also need consideration. Gender selection or PGT-M for a specific genetic condition may further reduce the number of embryos available for transfer.
11. Can artificial intelligence change the picture?
AI may improve assessment and decision support; it cannot reverse biological oocyte ageing or correct chromosomal abnormalities.
12. Oocyte donation
Oocyte donation remains an established clinical approach. However, ethical, religious, legitimate and personal perception terms differ across regions universally.”
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