Fertility Treatment Over 40: IVF Options Abroad for Women 40+

Understanding Fertility After 40

The biological reality of fertility after 40 is challenging but not hopeless. Women are born with approximately 1-2 million eggs, and this number declines continuously throughout life. By age 40, the average woman has approximately 25,000 eggs remaining — fewer than 3% of her original supply. More importantly, the proportion of chromosomally normal (euploid) eggs decreases significantly with age. At 40, approximately 60-70% of eggs have chromosomal abnormalities; by 43, this rises to 80-90%; and by 45, over 95% of eggs are chromosomally abnormal.

These statistics can be discouraging, but they also highlight a critical point: even at 43, 10-20% of eggs are still chromosomally normal and capable of producing a healthy pregnancy. The challenge is identifying those good eggs. This is where modern IVF techniques — particularly PGT-A genetic testing and time-lapse embryo monitoring — become invaluable. By creating multiple embryos through IVF and testing each one for chromosomal normality, it is possible to select the embryo with the highest probability of success, significantly improving outcomes for older patients.

IVF Success Rates by Age

IVF Options for Women Over 40: Cost Comparison

Turkey prohibits egg donation. For donor egg IVF, Spain and Czech Republic are the leading destinations. PGT-A is strongly recommended for patients over 40 to maximize success by selecting chromosomally normal embryos.

The numbers tell a clear story: IVF success rates decline with age, but the decline is gradual until 42-43, after which it becomes steep. For women 40-42, live birth rates with own eggs are approximately 15-25% per transfer at the best clinics — meaning that 2-4 cycles may be needed to achieve pregnancy. For women 43-44, rates drop to 5-10%, and for women over 44, success with own eggs becomes rare (<5%). However, PGT-A testing can dramatically improve per-transfer success rates by ensuring only chromosomally normal embryos are transferred — though it requires banking enough embryos to find a normal one, which becomes increasingly difficult with age.

At Turkey's leading fertility clinics, including Bahçeci IVF Centre, patients over 40 receive individualized treatment protocols designed to optimize egg retrieval numbers and quality. These may include higher-dose stimulation regimens, dual trigger (combining hCG and GnRH agonist for maximum egg maturation), and sequential banking (accumulating embryos over 2-3 retrieval cycles before PGT-A testing and transfer). The Jinepol IVF Clinic also specializes in tailored protocols for older patients, using advanced monitoring techniques to time every step of the cycle precisely.

Own Egg IVF Options

For women over 40 who want to use their own eggs, several IVF strategies can optimize outcomes. Conventional high-stimulation IVF aims to retrieve as many eggs as possible (ideally 8-15) to maximize the chance of finding chromosomally normal embryos. For women with diminished ovarian reserve who respond poorly to stimulation, modified protocols — including mini-IVF and natural cycle IVF — may actually produce better-quality eggs, though in smaller numbers.

Sequential embryo banking is an increasingly popular strategy for older patients. Rather than stimulating and transferring in a single cycle, patients undergo 2-3 retrieval cycles over several months, freezing all embryos. Once a sufficient number of embryos have been banked (typically 5-10 for patients over 40), they are all tested with PGT-A simultaneously. The healthiest chromosomally normal embryo is then transferred in a subsequent frozen embryo transfer (FET) cycle. This approach maximizes the chance of finding a viable embryo while avoiding the emotional roller coaster of cycle-by-cycle failures.

Donor Egg IVF Abroad

For women over 42-43, or younger women with severely diminished ovarian reserve, donor egg IVF offers the highest probability of success. Because the egg comes from a young, healthy donor (typically aged 21-32), donor egg IVF bypasses age-related egg quality decline entirely. Live birth rates with donor eggs are approximately 55-65% per transfer — regardless of the recipient's age — making it one of the most successful treatments in reproductive medicine.

Spain and the Czech Republic are the leading destinations for donor egg IVF abroad. Spanish law guarantees donor anonymity and requires comprehensive donor screening, including genetic carrier testing for hundreds of conditions. Czech clinics offer some of the shortest donor wait times in Europe (1-3 months) and competitive pricing ($5,000-$8,000 for a complete donor egg IVF cycle). For patients who need both world-class IVF expertise and donor egg availability, combining initial consultation at a Turkish clinic like Adem & Havva Center — which can perform comprehensive fertility assessment and counseling — with a donor egg cycle in Spain or Czech Republic can provide the best of both worlds.

Natural & Mini-IVF

Natural cycle IVF and mini-IVF are increasingly popular alternatives for women over 40 who respond poorly to conventional stimulation or who prefer a gentler approach. Natural cycle IVF uses no stimulation medications, retrieving the single egg produced naturally each month. While the per-cycle success rate is low (5-10%), the cumulative success rate over multiple cycles can be reasonable — and the cost per cycle ($1,800-$3,000 abroad) makes repeated attempts financially feasible.

Mini-IVF (also called minimal stimulation IVF) uses lower doses of medications to produce 3-5 eggs rather than the 10-15+ aimed for in conventional IVF. Proponents argue that lower stimulation produces higher-quality eggs with fewer side effects and lower cost. For women over 40 with diminished ovarian reserve, mini-IVF may produce similar numbers of mature eggs as conventional stimulation — simply because their ovaries cannot produce more regardless of medication dosage. At Memorial Şişli Hospital, fertility specialists offer both natural and mini-IVF protocols for patients over 40, tailoring the approach to each patient's ovarian reserve and response history.

Optimizing Success Over 40

• PGT-A Genetic Testing: Essential for patients over 40. By testing embryos before transfer, you avoid transferring chromosomally abnormal embryos — which account for 60-90% of embryos at this age — saving time, money, and emotional distress.
• CoQ10 Supplementation: 600mg daily for 2-3 months before IVF. Evidence suggests CoQ10 improves mitochondrial function in eggs, potentially improving egg quality.
• DHEA Supplementation: 75mg daily for diminished ovarian reserve. Some studies show improved response to stimulation and higher egg counts.
• Growth Hormone Adjuvant: Some clinics add growth hormone to the stimulation protocol for poor responders, potentially improving egg quality and yield.
• Dual Trigger: Combining hCG and GnRH agonist for maximum egg maturation, especially important when every egg counts.
• Time-Lapse Embryo Monitoring: EmbryoScope technology allows continuous monitoring without disturbing embryos, helping embryologists select the best embryo for transfer based on development kinetics.

At 42, I was told by my local fertility clinic that my chances were 'very slim.' I refused to give up and found an experienced fertility specialist in Istanbul who designed a personalized protocol with PGT-A testing. After two retrieval cycles and one transfer, I am now 34 weeks pregnant with a healthy baby girl. Don't let anyone tell you it's impossible.

Catherine B., treated in Turkey