Counselling in older women who want children

The desire for a child in women above 40 years of age needs a special way of counselling. This must include the special background of assisted reproduction and special age-related risks of pregnancy and birth. Regarding assisted reproductive technologies it seems to be justified to favorize more invasive technologies like in vitro fertilisation (IVF). Here, the chances are higher as compared to techniques like intrauterine insemination. The chosen diagnostic and therapeutic possibilities, however, will be influenced by the age of the woman. The counselling must include that the chance of a 40 year old woman to have a child following several attempts of treatment will not exceed 10%. This can only be guaranteed by optimal conditions - which are not present under the regulations of the Embryo Protection Law (Embryonenschutzgesetz).The pregnancies have a high risk of spontaneous abortions, which is in the range of 50% in the 42 year old woman. Furthermore, the risk to develop preeclampsia or gestational diabetes mellitus is increased. More often as compared to pregnancies with a comparable risk a vaginal operative delivery or cesarean section is performed.