I am 41. I began infertility treatment with one IUI (due to low sperm count and slow motility) then had IVF twice. I had eight to 10 eggs retrieved, with five to six fertilized. I'm told the quality is not great. My next cycle will be a microflare IVF cycle, and my doctor suggested it may be my last because of very low success rates in women over 40 after three attempts! I feel I should be able to at least try this microflare once more time before I have to go to donor eggs. Am I being unreasonable? Are my chances greatly improved with the microflare cycles? Would "cytoplasm transfer" be another option?

Gina

Age-related fertility issues are the most frustrating for couples who see their friends or peers having children and wonder why they can't succeed. With two very important factors working against you -- age and sperm problems -- IVF with ICSI would seem to offer the only real chance for success. Yet, using your own eggs at age 41, your odds are quite low. Data from the finest programs in the country report a cumulative live birth rate of under 25 percent after five cycles with women age 40 and above.

At your age, the odds of success with a single cycle are so low that failure to conceive does not really provide much information. As your physicians have recommended a different approach -- the microdose flare -- they were obviously unsatisfied with the results using a more standard egg stimulation procedure.

The microdose flare approach involves using lower doses of the GnRH-agonist Lupron beginning at the start of the treatment cycle rather than a more standard dose started two weeks before IVF treatment. The microdose flare is usually chosen as a last-ditch option when other stimulation protocols have lead to poor results. I don't have enough information about your past IVF cycle to determine whether your desire to continue is "reasonable" or likely to lead to successful pregnancy. However, in our program, most women age 40 or above are strongly advised to consider egg donation to achieve a viable pregnancy. Only with eggs from a younger women can "reasonable" odds for success be predicted. Yet, "reasonable" is a subjective term. For some women a 5-8 percent chance of success would be quite reasonable, while for others, predicted pregnancy rates above 25 percent would be required to call the odds reasonable.

Cytoplasm transfer is a research technique that has been proposed as a means to rescue the eggs from the adverse effects of aging. The safety and efficacy issues have not yet been established, and as such, this technique has little clinical application outside of a very few research institutions.