Conceiving naturally

Many women come to us saying they have been told by their doctors that they’re too old for natural conception, that they should go for IVF — and go as soon as possible.

This is a curious phenomenon, as our decades of experience say otherwise.

IVF and age

The date shows that IVF success rate rapidly declines after 35. Beyond 46, the statistics show that IVF using one’s own eggs is certain to fail. Because of this, the regulator says that IVF clinics should not accept women over 46 using their own eggs — in order to stamp out unscrupulous clinics who offer IVF to older women, purely to take their money.

In short, IVF is highly sensitive to age, especially for women over 40, where the numbers tell us the success rate is low, very low or none at all.

Conceiving naturally and age

Technically, there is no cut-off point for natural conception, other than menopause. In practice, the older one is, the less likely one is able to conceive. The main reason is because a woman’s hormones get worse as she gets older. Since hormones directly impact egg quality, women’s egg quality gets poorer and poorer as she gets older. At menopause, it will be next to impossible for a woman to conceive. 

It is important to note that age is not the problem by itself: Age is not a disease. Rather, it is the hormonal changes that an older woman experiences that makes her less likely to conceive. What this means, then, is that if a woman’s hormones can be improved, natural conception will become more likely — more on this later.

The following are the key facts:

  1. A minority of women do manage to have successful natural pregnancies over the age of 46, but this is not possible with IVF
  2. Scientific literature says that after 43, the chances of IVF and natural pregnancy success are the same anyhow

We should also note that, a few generations ago, women routinely gave birth to a large number of children, where having 10 or 12 children were not uncommon. This means they have would have given birth to their last few children after they were 40 years old. Yet, the impression given is often that women in their 40s are too old to have natural pregnancy, and they should go for IVF.

IVF and miscarriages

A good number of patients we’ve seen have had miscarriages — of all ages. Some had as many as 8 miscarriages. Again, the common advice given by their doctors, again, is to do IVF.

IVF does have the advantage of making sure an egg meets a sperm. In ICSI, this is 100% guaranteed (ICSI is offered usually when there are male fertility issues).

However, women with miscarriages clearly have no problem of conceiving — of getting an egg and a sperm to meet. This is why it is difficult to see how IVF can help with miscarriages.

What should a thorough investigation for fertility (natural conception) look like?

Our patients often tell us that not much investigation have been done by themselves or their doctors before coming to see us at TCM Healthcare. Some are not even sure what has been done. Most are told they are fine, but nearly all are advised to do IVF.

A thorough investigation of the causes of failed natural conception should consist of the following steps as a minimum:

  1. Hormone tests
  2. Scan of ovaries and uterus to see if there are cysts, PCOS, fibroids, endometriosis, adenomyosis, etc.
  3. HyCoSy test to check fallopian tubes

We routinely have women come in who have not been offered all of the above, let alone have a proper interpretation of the results — which we think is just as important as doing them.

  1. The hormone tests offered should consist of at least 6 hormones. They are FSH, LH, prolactin, oestradiol, AMH and testosterone. The first 4 are associated with menopausal symptoms (not necessarily menopause itself, if one is under 40) and the last 2 are associated with PCOS. These hormones are vitally important because they directly impact egg quality.
  2. The scans are important because they may help identify PCOS (note that PCOS is not solely determined by a scan, see our blog on PCOS) or other physical issues that may impact fertility.
  3. The HyCoSy test is important because natural conception requires at least one fallopian tube to function properly.

Doctors may not offer all the above in one go. They may check if there are good reasons for do 2 or 3 first. For example, if one has recurring miscarriages at a late stage in a pregnancy, there may be no need to do a HyCoSy test as the fallopian tubes are likely to be working. 

Egg quality and hormones

In our over 20 years of practice, we found that the most important factor for female fertility is egg quality. Egg quality is highly dependent on hormones. When your hormones are at the right levels, and are balanced, your egg quality is likely to be good. When they are not, your egg quality is likely to be compromised. Difficulty in natural conception or IVF, and a high probability of miscarriages may be the result.

We believe hormone imbalance leads to poor egg quality. After the late 30s, hormonal imbalance usually gets worse, or its effect gets amplified.

Curiously, according to our patients, hormone tests and how to treat hormonal imbalance do not seem to feature high on the fertility agenda — by both our patients and their doctors. Many come to us without knowing which hormones should be tested. Some have never been told they need to do hormone tests. Some said they did some tests before but did not know what they were. Some said the results were not explained to them, nor their implications with regards to f ertility. Those who went for IVF often came with FSH and AMH test results only, while other important hormones such as oestradiol, prolactin and testosterone had not been tested. Many had little idea that hormones are directly related to their egg quality. The list goes on.

When it comes to treatment, patients with mild hormonal imbalance are often not given attention, while patients with severe hormonal imbalance are given hormones to regulate the periods or to induce ovulation. These treatments are a quick fix: They are not designed to improve the organ systems that generate the hormonal imbalances in the first place; the issue of poor egg quality remains. Many told us that, as soon as they stopped using hormones, their hormonal imbalance issues came right back.

At TCM Healthcare, we focus on improving egg quality to help women to achieve natural pregnancy or mitigate against miscarriages. We do this by using herbal medicine to improve hormones. For more details, you may wish to check our blog on egg quality.

To check your egg quality through checking your hormones, please click here.

Book an appointment!

A booking fee of £100 (refunded when you attend) will be processed at booking. 

Late cancellation fee £50
We appreciate that you might not be well or have urgent matters to attend. As a result you may have to postpone the appointment. We would like to have at least 24 hours’ advance notice. A late cancellation fee of £50 is payable if advance notice is not given.

Are there patients we cannot help?

Yes. No medical system is foolproof and medical practitioners, however good, are not omnipotent. As great as our success rates are, they are not 100%. There are times patients do not respond to our treatments despite our best efforts.

Delayed improvements are possible when patients rest a little. However, even with rest, patients may still not respond well. Fortunately, these cases are in the minority. We minimise the number of these cases by trying to understand our patients’ conditions as much as possible before taking them on. We minimise time and financial commitments from patients by insisting they have hormone or sperm test results prior to treatment, and to get retested after 3 months — following our evidence-based approach.

At TCM Healthcare, we will always have your best interests in mind and we will do our best.