For many people, the path to parenthood isn’t always straightforward, and questions about age, hormones, and fertility often come into play. One of the most common concerns is how perimenopause — the natural transition before menopause — affects fertility and fertility treatment.
Understanding what perimenopause means, how it influences your reproductive health, and what options are available through fertility care can help you feel more prepared and empowered on your journey.
What is perimenopause?
Perimenopause is the stage leading up to menopause, when the ovaries gradually produce less oestrogen and ovulation becomes irregular. It usually begins in the mid to late 40s, but for some, changes can start earlier. Symptoms vary but may include:
- Irregular or missed periods
- Hot flushes or night sweats
- Mood changes or brain fog
It’s important to note that perimenopause does not mean fertility has ended — but it does mean that fertility is declining.
How does perimenopause affect fertility?
As you move through perimenopause, both the quantity and quality of eggs decline. This can make it harder to conceive naturally and can increase the risk of miscarriage. Some key points:
- Egg reserve (AMH and AFC): Tests such as Anti-Müllerian Hormone (AMH) and antral follicle count (AFC) can give an indication of ovarian reserve.
- Egg quality: With age, eggs are more likely to have chromosomal abnormalities, which can affect fertilisation, embryo development, and pregnancy outcomes.
- Hormone changes: Fluctuating hormone levels can impact cycle regularity and ovulation, making it harder to time conception.
Can fertility treatment help during perimenopause?
Yes, fertility treatment may still be possible during perimenopause, although the approach depends on your individual circumstances.
Options may include:
- IVF with own eggs: Some people in early perimenopause may still be able to attempt IVF using their own eggs, though success rates are lower with increasing age.
- IVF with donor eggs: Using donor eggs can significantly improve success rates, since egg quality is the main limiting factor during perimenopause.
- Fertility preservation (if earlier in the journey): Freezing eggs or embryos before egg quality declines further can sometimes be an option, though this is most effective before perimenopause begins.
Other considerations during treatment
- Health and safety: Fertility specialists will also review your general health, as pregnancy later in life carries higher risks such as high blood pressure, gestational diabetes, and preterm birth.
- Emotional wellbeing: The transition through perimenopause, combined with the stress of fertility treatment, can feel overwhelming. Support through counselling or peer groups can be invaluable.
- Partner or support system: If you are pursuing treatment, whether alone or with a partner, it’s important to build a support network around you.
Key facts to remember
- Perimenopause marks the natural decline of fertility, but it does not mean pregnancy is impossible.
- Egg quality and egg reserve are the main challenges during this time.
- IVF is sometimes possible with your own eggs, but many turn to donor eggs for higher success rates.
- Your overall health and wellbeing are central to...
