Trying for a baby after 40, or with a low egg count: IUI or IVF?

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Many couples today start trying for a baby later in life, and many women first see a fertility doctor in their forties or after being told their egg count is low. In this video, Dr Mayur Pai discusses the treatment options for women over 40 with a low AMH, and how IVF and IUI are approached in this age group. The message running through it is simple: time matters, so decisions should be made early and honestly.

Why age matters so much after 40

A woman is born with all the eggs she will ever have. Their number falls steadily through life; the fall becomes noticeable from the mid-thirties and steeper after 40. Egg quality changes too: with age, more eggs carry errors in their chromosomes. Such eggs are less likely to become a healthy pregnancy, and more likely to end in a miscarriage.

This is why, after 40, the chance of pregnancy each month is lower than at a younger age, and why every month counts. It is not a reason to lose hope. It is a reason not to wait. For more on how age affects both partners, read fertility and age.

What the tests tell you

Two tests show roughly how many eggs are left: the AMH blood test, and a count of the small follicles on an ultrasound scan early in the cycle. Together they show quantity, not quality. At 40, AMH is expected to be lower than at 30; a very low result mainly tells us the ovaries will respond less to medicines. Age remains the better guide to egg quality. You can read more in low AMH explained.

The rest of the check-up matters just as much: whether the tubes are open, the husband's semen analysis, and general health, including blood pressure, blood sugar, thyroid and weight. A pregnancy after 40 asks more of the body, so it is worth preparing well.

When to see a doctor

At 40 or over, see a fertility specialist straight away rather than trying on your own for a year. Between 35 and 40, it is sensible to get checked after about six months of trying. At any age, come sooner if your periods are irregular or there is a known problem.

Is IUI worth trying after 40?

Sometimes, for a short while. IUI is gentler and simpler than IVF, and it can be reasonable when:

• the tubes are open
• the husband's semen report is good
• the ovaries still respond to ovulation medicines
• the egg reserve is reduced, but not very low

Even then, we plan only a small number of attempts before reviewing, because trying IUI for too long can use up the time that IVF needs. For more on this, read IUI when your AMH is low.

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In this second video, Dr Mayur Pai walks through how one IUI cycle was approached for a woman of advanced age with a low egg count, and what needs extra thought when the reserve is reduced. Every woman is different, so treat it as one example rather than a rule.

Why IVF is often the more direct route

In IVF, the ovaries are encouraged to grow several eggs in one cycle, the eggs are collected, and fertilisation happens in the laboratory, where it can be seen. The embryos are grown to the blastocyst stage, which helps the embryologist choose the strongest one for transfer, and good extra embryos can be frozen for later. If the husband's sperm are also weak, ICSI can be added. See how IVF works, step by step.

After 40, IVF has its own realities. With a low reserve, fewer eggs may grow, the medicines are adjusted to how your ovaries respond, and occasionally a cycle has to be stopped because the response is too small. Some couples go through more than one round of injections to collect and freeze embryos before a transfer. The doctor explains each of these choices as you go.

Honest expectations

We do not quote general figures, because they say little about you. What we can say honestly is that the chance of pregnancy per attempt falls with each year after 40, and that miscarriage is more common. After your tests, the doctor will give you a clear, realistic picture for your own situation.

It helps to decide together, early on, how many attempts you are prepared for, what budget you have and how much time you want to give. Planning this at the start is kinder than deciding it in the middle of a disappointment.

Preparing for a pregnancy after 40

A pregnancy after 40 carries higher chances of high blood pressure and diabetes in pregnancy. A check-up before you start, folic acid, a healthy weight, stopping smoking and alcohol, and reviewing any regular medicines all help. Once you are pregnant, careful antenatal care matters, and Pai Hospital provides pregnancy care as well.

Where treatment happens

This guide is by Dr Mayur Pai, MBBS, MS (Obstetrics & Gynaecology), a fertility and laparoscopy specialist. Pai Hospital in Goa has its own operating theatre and its own IVF laboratory, so the scans, the egg collection and the laboratory work happen in one place, under one team. Free patient transport is available from across Goa.

Getting started

If you are 40 or over, please do not wait. Send your AMH result, scan reports and your husband's semen analysis to us on WhatsApp at +91 95185 02773, with any questions you have. Consultations are by appointment, so please call our reception on +91 95459 20817 to book. Please come together as a couple. Our treatment packages are transparent and fixed, so just ask us about the cost. This article is for education only and is not personal medical advice; please consult your doctor about your own situation.

Your questions

Or call +91 95185 02773

This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.