Menopause is often described in such a sad and final way – as ‘marking the end of a woman’s reproductive years’, but what happens if you are going through menopause in your late forties or early 50s and you want to start a family?

What if you have focused on your career this whole time, or you have only just met the right partner and you feel as though now is the right time to start a family? Can you have a family? Is it too late? Can you get pregnant whilst going through the menopause?

Over the course of the following weeks, we want to really get to the bottom of this topic with the help of the experts at Embryolab fertility clinic, and explore everything there is to know about menopause and conception, and what you can do if you want to have a child. 

To start us off, we turned to Dr. Dimitrios Michalakis, MD, MSc, IVF Gyneacologist from Embryolab and asked him to help us gain a better understanding about what it means if you are menopausal.

IVFB: What happens to a woman’s reproductive health when she starts the menopause?

Dr M: Menopause is an inherent physiological phenomenon characterised by a gradual decline in the production of hormones, specifically estrogen and progesterone, by a woman’s ovaries. This normal biological process is expected in the life cycle of all women, usually occurring in the late forties or early fifties. This decline ultimately leads to the cessation of menstrual periods; in fact, menopause is defined by the discontinuation of menstrual cycles for a duration of 12 consecutive months.

The inadequate production of hormones, especially estrogens, is the main reason for the distressing symptoms that may bother many menopausal women. These symptoms, commonly known as menopausal symptoms, can include hot flashes, night sweats, mood swings, vaginal dryness, and difficulty sleeping. Decreased estrogen levels can also lead to bone loss and an increased risk of osteoporosis. However, it is important to emphasize that early medical visits prior to and during menopause are essential for correct diagnosis, symptom treatment, preventative care, and emotional support. Regular checkups enable women to maintain their general health and well-being throughout this significant life transition and facilitate a stress-free menopausal transition.

IVFB: Does this mean that a woman can’t have a child with her own eggs if she is menopausal?

Dr M: The natural process of menopause may be highly stressful for many women, especially when it comes to the question of whether or not they will be able to have a child using their own eggs. Although at Embryolab we constantly keep in mind our point of view, which is to evaluate each woman on a unique basis, we should also keep in mind the time for pregnancy. Our goal is to assist women in achieving pregnancy and experiencing the precious gift of motherhood as soon as possible, given that menopause is associated with an increased risk of health issues compared to younger women.

IVFB: What would you advise a woman to do if she is menopausal but wants to start a family? 

Dr M: If a woman who has reached menopause wishes to establish a family, we recommend that she consult a fertility specialist. A fertility specialist can evaluate her reproductive health thoroughly and discuss the available options, such as assisted reproductive technologies (ART) like IVF or egg donation. It is crucial that she undergoes all necessary testing and consultations to comprehend the potential difficulties and risks involved, as well as investigate alternative routes to motherhood that may be suitable for her condition. A comprehensive evaluation is essential so that she can gain a deeper understanding of her fertility potential and the most effective course of action to accomplish her desired outcome. The specialist will be able to evaluate her ovarian reserve, hormone levels, and overall reproductive health, enabling them to design an individualized treatment plan for her. In addition, they can provide advice on lifestyle modifications, medications, and other interventions that may increase her odds of conceiving with the aid of assisted reproductive technologies. This action will enable her to make well-informed decisions about her fertility journey and improve her prospects of becoming a mother.

IVFB: Is IVF an option for a menopausal woman?

Dr M: The efficacy of in vitro fertilization in menopausal women is heavily dependent on the quantity and quality of their oocytes. Menopausal women typically have diminished egg reserves, making it more difficult to retrieve viable eggs for fertilization. It is essential for menopausal women to consult with a fertility specialist who can evaluate their unique circumstances and recommend the best course of action. The specialist will evaluate a woman’s general health, the quality of her eggs, and her likelihood of carrying a pregnancy to term. If the woman’s own eggs are no longer viable, they may recommend egg donation. Additionally, hormone replacement therapy may be required to prepare the woman’s body for the IVF procedure. Ultimately, the decision to pursue IVF should be made in consultation with medical professionals, taking into account the associated risks, benefits, and success rates. Before commencing any type of fertility treatment, we all, as fertility specialists at Embryolab, strongly believe that women should be apprised of all aspects and expected success rates of each treatment approach.

IVFB: Would the woman definitely need to use a donor egg?

Dr M: The necessity for a donor egg in IVF is not a black-and-white answer; it varies based on the woman’s individual circumstances, such as age, ovarian reserve, and overall reproductive health. Although the majority of menopausal women may require a donor egg due to factors such as advanced maternal age and diminished ovarian reserve, the decision to use a donor egg is usually made after thorough evaluations and discussions with fertility specialists and clinical embryologists, who will assess the woman’s individual fertility factors and provide personalised recommendations in order to create the most suitable treatment plan for her. At Embryolab, we believe that every woman deserves the best chance of achieving a successful pregnancy; therefore, we offer consultations with fertility specialists and clinical embryologists in order to provide the best care and treatment for menopausal women who are going to enter a fertility treatment program. In addition, considering the great effort and stress of these women, we have a range of advanced technologies, procedures, and psychotherapy support to increase the chances of a successful outcome.

IVFB: IVF has similar emotional side effects to the menopause such as mood swings, anxiety, depression. Would a menopausal woman struggle even more emotionally?

Dr M: Emotional status is extremely important for any woman or couple trying to achieve pregnancy. It is important for women and couples to prioritise their emotional well-being during the IVF process. Seeking support from a therapist or joining a support group can be beneficial for managing any emotional challenges that may arise. Having a strong support system in place and communicating openly with their healthcare provider about their emotional well-being throughout the process can add a significant benefit to our fertility goal. We strongly recommend that these women be open and honest about their feelings and concerns, as this can contribute to a more successful and positive fertility journey. Regarding the increase in emotional stress in this group of women due to the addition of estrogen and progesterone, we don’t anticipate a rise in these distressful symptoms during fertility treatment. At Embryolab, we devote time to the emotional well-being of our patients and provide comprehensive support throughout their fertility journey.

IVFB: Does a woman continue taking her HRT if she is taking IVF medication?

Dr M: A considerable number of menopausal women may have initiated hormone replacement therapy (HRT) in order to alleviate any menopausal symptoms that may impact their overall daily well-being. The determination of whether to proceed with hormone replacement therapy (HRT) during in vitro fertilisation (IVF) will be based on a range of considerations, including the individual’s unique medical background and the guidance provided by their fertility expert. It is imperative for women to seek guidance from their healthcare provider in order to ascertain the optimal course of action for their specific circumstances. At Embryolab, we prioritise personalised care and work closely with our patients to create a tailored treatment plan that takes into account their unique needs and circumstances.

IVFB: The endometrium plays such an important role in IVF. As a woman reaches menopause, does the endometrium change? Might a menopausal woman struggle to reach the optimum thickness?

Dr M: The morphology, function, and thickness of the endometrium are highly associated with the implantation, ongoing, and live birth rates in women undergoing IVF. The prevalence of a thin endometrial lining is increased in menopausal women compared to younger women, and occasionally we may notice some changes in the endometrium in women entering menopause, especially when it has been many years since their last menstrual cycle. But even though some studies have linked a thin endometrium to a lower chance of success, more recent studies in which only embryos with normal chromosomes were placed in the uterus have found that success rates may be more related to the morphology of the endometrium than to its thickness. Having all these in mind and considering that there are various strategies and treatments available to help improve endometrial thickness in menopausal women undergoing IVF, it is important for menopausal women to consult with their fertility specialist to explore these options.

IVFB: Is it important that a menopausal woman goes through the uterine rejuvenation process to prepare a womb for the embryo?

Dr M: The desire to boost the success rates in women of advanced reproductive age has led to the development of several tests and therapies that claim to create the optimum environment for embryo implantation. While uterine rejuvenation techniques such as intrauterine injection of Platelet-Rich Plasma (PRP), endometrial scratching, and hysteroscopy have been proposed as effective ways to increase endometrial receptivity and thickness in menopausal women, their efficacy remains unknown. Some studies have produced promising results, showing that these therapies might boost endometrial development and increase the likelihood of successful embryo implantation. More studies, however, are required to determine the exact advantages and possible hazards of uterine rejuvenation in menopausal women undergoing IVF. As a result, it is important for menopausal women to examine these alternatives with their fertility specialists and make informed decisions based on their unique circumstances and medical history. Furthermore, given the potential expenses and invasiveness of these operations, it is critical for women to assess the potential advantages against the potential hazards before going with uterine rejuvenation with IVF therapy.

IVFB: Is the IVF process more or less the same for a menopausal woman in her 50s as it would be for a woman in her 30s?

Dr M: Obviously, age is one of the most essential criteria to consider when estimating the success rate of fertility therapy using a woman’s own eggs; however, other aspects to consider include the individual’s general health, any underlying medical disorders, and the quality of the eggs. Furthermore, a woman’s lifestyle choices, such as obesity, smoking, or excessive alcohol use, might have an effect on the success rate of fertility therapy. All of these parameters must be considered by the fertility expert in order to deliver the most successful and customized therapy for a woman, regardless of her age. Individualized treatment protocols are our main goal for women trying to start a family and achieve pregnancy; therefore, fertility treatment can be efficient even for menopausal women when there is open and honest communication with our clinical embryologist or fertility specialist during the fertility consultation.

IVFB: What are the chances of a woman in her early 50s and going through the menopause of conceiving via IVF?

Dr M: The likelihood of IVF being successful for a woman in her early 50s varies widely based on a number of variables. However, it is essential to keep in mind that a woman’s chances of having a child via in vitro fertilisation (IVF) fall significantly as she grows older, particularly beyond the age of 45. This is because the amount and quality of eggs diminish as women get older. As a result, we strongly urge that women who have reached an advanced reproductive age have an in-depth consultation on their fertility dynamics. Despite this, every person is one of a kind, and the success rate of in vitro fertilisation (IVF) might vary from patient to patient based on a number of variables, including general health, lifestyle choices, and the particular fertility treatment plan. In some circumstances, it may also be suggested to investigate alternate possibilities, including the use of donor eggs or embryos, in order to enhance the likelihood of achieving a healthy and successful pregnancy.

If you would like to discuss anything you have read with one of the medical experts at Embryolab, drop us a line and we will connect you – info@ivfbabble.com