After 3 years of marriage without children, Minh was advised to consider donor eggs for IVF. Tests at the Center for Reproductive Support, Tam Anh General Hospital, Hanoi (IVF Tam Anh) revealed that she was entering menopause, with an ovarian reserve (AMH) of just 0.01 ng/mL, eliminating the possibility of natural conception.
Five egg retrieval cycles yielded only one mature egg. Intracytoplasmic sperm injection, followed by embryo culture in a modern incubator system, resulted in a positive pregnancy test. However, a subsequent ultrasound showed a blighted ovum, indicating no embryonic development.
"Age is the primary cause of chromosomal abnormalities in eggs and decreased sperm quality," Dr. Nguyen Le Thuy explains, adding that earlier intervention would have significantly improved Minh's chances.
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Dr. Nguyen Le Thuy counseling an older female patient on infertility treatment. Photo illustration: Tam Anh General Hospital |
The General Statistics Office of Vietnam reports a rise in the average marriage age from 25.2 in 2019 to 27.2 in 2025, reflecting a trend toward later parenthood. The national birth rate has fallen below replacement levels. The total fertility rate in 2023 was 1.96 children per woman, the lowest ever recorded, and is projected to decline further.
The World Health Organization (WHO) warns of a growing infertility trend in developing countries, attributed to age, lifestyle, pollution, and conditions such as polycystic ovary syndrome and endometriosis. Many older women seek fertility assistance when their chances of conception are diminished.
Ly, in her early 40s, with an AMH of 0.5 ng/ml and endometriosis, faced additional challenges with her husband's low sperm count. Compared to Minh, Ly produced 5 eggs after 4 stimulation cycles, resulting in 3 average-quality day-3 embryos, but her chances of successful IVF remained low.
"Female fertility declines after 35, with pregnancy rates dropping sharply after 40. By 50, most women enter perimenopause or menopause, and ovarian function ceases without medical intervention," says Dr. Thuy. A study by the National Institutes of Health (NIH) shows that women aged 45 have only a 2.9% chance of conceiving with their own eggs, while using donor eggs increases the success rate to 30-40%, provided uterine health and overall well-being are suitable.
IVF Tam Anh annually receives hundreds of cases involving couples seeking parenthood later in life, many between 45 and 52. Not everyone is healthy enough for pregnancy due to risks like preeclampsia, gestational diabetes, and premature birth. Many patients present with multiple conditions, complicating treatment. Doctors often resort to multiple egg or embryo retrieval cycles, genetic screening for healthy embryos, and advanced uterine interventions to facilitate embryo implantation.
Two additional egg retrieval cycles for Minh yielded one more egg and a single average-quality day-3 embryo. After meticulous preparation, this embryo was transferred, resulting in a successful pregnancy. However, Minh's pregnancy was fraught with complications, including threatened miscarriage, gestational diabetes, and placenta previa. She ultimately persevered, giving birth at 50.
Due to the limited number of embryos and Ly's health concerns, doctors opted against embryo screening, focusing on optimizing endometrial receptivity. "It's a race against time because if it fails, there's little chance for another attempt," explains Dr. Thuy.
The WHO recommends childbearing between 25 and 35 for optimal success and safety. Women over 35 who haven't conceived after 6 months of unprotected intercourse should seek fertility evaluations. For women over 40, this waiting period shouldn't exceed 3 months.
At IVF Tam Anh, doctors encourage premarital checkups and early ovarian reserve assessments, even for those not yet married. Younger women are advised to consider egg freezing between 28 and 35 if they aren't ready for parenthood. "As long as it's not too late, modern medicine can make the dream of parenthood a reality," says Dr. Thuy.
Thanh Ba
