If you have a friend who is making test tubes, there are many such cases

. She is 38 years old and has an AMH value of only 0.6-which means that the ovarian reserve is running low. There were three promotions and three transplants, each time was full of hope and each time failed. In the families we contact, too many people have traveled the same path: entering the cycle with hope, waiting for the lottery, crashing down, waiting for a few months to muster up courage, and being disappointed again. But "failing" does not mean "not getting through." The real question is not "Do you want to try again", but: The last failure, was it seriously reviewed?

In today's article, we give less comfort and more framework.

1. Spread out the data first: How difficult is it to advance towards advanced age?

According to the assisted reproductive technology monitoring data released by the National Health Commission and the industry report of the Reproductive Medicine Branch of the Chinese Medical Association

, this is the most favorable range:

35 - 37 years old: about 40%-45%,

and 38 - 40 years old: about 25%-30%, embryonic chromosomal abnormalities become the core variable

41 - 42 years old: about 15%-20%, every step is racing against time.

Over 43 years old: less than 10%

, look at European data. The 2024 report of the European Society of Human Reproduction and Embryology (ESHRE) shows that the proportion of women over the age of 40 in IVF cycles across Europe has reached 23%, an increase of 7 percentage points from five years ago. Over 43 years old dropped to below 5%.

Translation into plain Chinese: 35 years old is a watershed, 40 years old is a hurdle, and the fault tolerance rate over 43 years old is extremely small. But "difficult" does not mean "impossible"-the key is whether you have found the reason for your failure and whether you are going in the right direction next.

2. Why are "advanced age" and "repeated failure" always tied together?

1) Egg quality: Experts from the Reproductive Center of Peking Union Medical College Hospital, the most fundamental and difficult variable

, said very bluntly at the 2024 academic conference: "After women are 35 years old, the rate of chromosomal abnormalities in eggs increases significantly. By the age of 40, about 60%-70% of eggs have abnormal chromosome numbers; over the age of 42, this proportion exceeds 80%. This is not something that can be reversed by any hospital's technology, but a basic law of biology. "

For example: eggs are like seeds. When you are young, most of the 100 seeds are good; by the age of 40, only 20 - 30 of the 100 seeds may be useful. You plant seeds in the soil. If there is a problem with the seeds themselves, no matter how good the soil is, they will not grow.

That's why doctors talk about PGT-A (pre-implantation chromosome screening)-screening out embryos with chromosomal abnormalities before transplantation, leaving limited opportunities for the "right embryos." But note: This is not necessary for every cycle and depends on age, number of embryos, and previous failures.

2) Uterine environment: Repeated failure in planting "soil" that has been ignored by many people

(2 - 3 consecutive high-quality embryo transfers without implantation or early abortion) has been identified as a multi-factor issue in the 2023 China expert consensus. In addition to seeds, soil should also be checked

. The detection rate in people with repeated failures of chronic endometriosis is as high as 30%-57%(2023 review data of the Chinese Journal of Obstetrics and Gynecology). It may sound scary, but standardized antibacterial treatment after diagnosis can solve

intrauterine adhesions/thin endometrium that may be caused by previous curettage and a history of abortion. Hysteroscopy is needed to see clearly

immune and coagulation problems, antiphospholipid syndrome, abnormal NK cell activity, etc. When indicated

, the proportion of elderly women with adenomyosis is not low, which will significantly affect implantation. Experts from the

Reproductive Center of the First Affiliated Hospital of Sun Yat-sen University shared a view at the 2023 academic conference: "About 40% of patients with repeated implant failure have at least one uterine or immune factor that can be intervened. A hysteroscopy + endometrial biopsy + targeted immune screening can often find the real reason for the 'failure'. "

3) Whether the plan has

the most unfortunate type of repeated failures of" hit the target "is not that medicine really has no way to do, but that after each failure, it has

not been reviewed again to review AMH, AFC (basic follicle number), and the last follicular reaction

." Did you ask "Where did the embryo develop last time? Did you do chromosome evaluation?"

No endocarditis, no immunocoagulation, and no review of the man's sperm DNA fragmentation rate

? Next time, it will be the same dose, the same rhythm, and the same sentence."Spit again"

review is the most important thing to do at this step.

3. If you consider taking another step, you should complete this "failure review list" first

. We often advise families to spread out the previous materials and answer these questions with their doctors before starting a new cycle.

This list does not allow you to make your own diagnosis, but helps you ask the right questions before you see your doctor.

4. When should we seriously talk about "changing ideas"? When the path of one's own eggs is repeatedly blocked, there are still several directions that are being discussed in medicine? The cumulative strategy for women with reduced ovarian function does not gamble on a single egg harvest. Instead, use multiple relatively mild cycles to accumulate evaluable embryos-this is a reconstruction of the plan, not a "try again" repetition. The volunteer path involves complex ethics, laws and alternative realities.

Domestic volunteer resources are in short supply and waiting times are long; the volunteer resource matching process in some overseas destinations is relatively mature, but it must be operated within the formal medical and legal framework. ◆ Overseas compliance medical treatment connects some families due to indications, local legal routes, and verifiable laboratory resources, consider going to Thailand, Malaysia, the United States or parts of Central Asia/Caucasus for evaluation.

However, it must fall on the local licensee + clear contract entity + verifiable qualifications. Changing ideas does not mean admitting defeat if you want to go wherever it is cheaper.

To replace a solution that is getting more and more difficult in biology with a solution that matches the evidence is responsible for yourself.

5. What can Le Laiwa do on this road to reach the stage of advanced age + repeated failure? Second, no one even explains "Where did I lose last time?"

Le Laiwa's positioning is "the connection between overseas assisted reproductive consultation and medical treatment"-we do not replace doctors 'diagnosis and do not promise pregnancy results. What we do is to clarify complex information and put compliance resources on the table.

Specifically, review the offer first, and then match it, the consultant will open the previous report with you first (AMH, hormones, cycle records, hysteroscopic clues), and then a dockable reproductive doctor conducts an individualized pre-assessment, and then talks about where to go, whom to see, and what path to take-not using a package to reverse the person. Cooperative hospitals can verify that our cooperative institutions are based on the premise that the local health department can check the qualifications, and do not use vague posters as evidence. Costs and responsibilities to clearly write the medical contract. Consulting service contracts are separately discussed; Who is responsible for which link, literally. The whole process is connected from report translation, remote consultation appointment, cycle follow-up, interpretation of embryo reports, to filing and communication suggestions after returning home-making the middle line, and medical decisions are still made jointly by locally qualified doctors and patients. We don't play digital magic, we don't package" a certain rate at a certain year" as your personal guarantee; All the success rate citations, back to the open literature context of age stratification and indications, we would rather be the person who can spread out the reports in the drawer one by one after you cry and tell you," Check this one first, put that one first, and the next one will ask this question."

6. At the end, if you are stuck in these cases, you are over 35 years old, have done a test tube more than once and failed, and you are over 40 years old, and you are blocked by the sentence "volunteer directly", but you want to first find out the path of your own eggs. Repeated transplants have failed. For more than 2 - 3 times, no one has given you a complete review of low AMH and low eggs, but you always feel that "there seems to be something wrong last time," please don't rush to put yourself in "no chance."

Advanced age is really difficult; but the correct action corresponding to "difficulty" is a more refined assessment, a more honest review, and a more compliant resource, rather than a louder guarantee.