Age and Infertility: Using Donor Eggs to Overcome Reproductive Aging

Deciding when to start a family is a deeply personal choice, and many women today are choosing to grow their families later in life. One important consideration, especially as women enter their mid-30s and late 30s, is the natural, age-related decline in both the number and quality of eggs in the ovaries.

As fertility changes over time, you may begin to wonder whether fertility testing or fertility treatment could help. For those whose fertility has been affected by these age-related changes, donor eggs can offer a meaningful path toward achieving the goal of pregnancy.

The biology behind fertility and age

*Averages from large population studies and CDC/ASRM summaries.

Why does fertility decline with age?

Finite egg supply

Women are born with approximately one million eggs. That number drops to about 300,000 by puberty and fewer than 1,000 by menopause. Over the course of a woman’s reproductive lifespan, fewer than 500 eggs are actually ovulated; the vast majority are lost through a natural degenerative process called atresia.

This decline in egg count can be estimated using Anti-Müllerian Hormone (AMH), a key marker of ovarian reserve. AMH levels generally reflect the number of remaining eggs. Median AMH levels fall from approximately 4 ng/mL in women 25 and younger to about 0.5 ng/mL by the early 40s.

Declining egg quality

Human embryos require 23 chromosomes from the egg and 23 from the sperm. As women age, the cellular machinery responsible for proper DNA division becomes less reliable, increasing the risk of chromosomal errors (aneuploidy). These abnormalities can prevent implantation or lead to miscarriage.

Hormonal changes

Follicle-stimulating hormone (FSH) is produced by the brain and signals the ovaries to grow and ovulate an egg each month. As the number of eggs declines, the ovaries become less responsive, prompting the brain to produce higher levels of FSH to stimulate ovulation. An elevated FSH level (typically >10 mIU/mL) may indicate diminished ovarian reserve.

Together, these changes explain the well-documented relationship between advancing age, declining fertility, and lower chances of pregnancy using one’s own eggs.

Checking your current fertility

Understanding whether these natural, age-related changes in egg quantity and quality may impact your family planning timeline is an important first step. To evaluate how many eggs remain in the ovaries—and how the ovaries may respond to fertility treatment—fertility clinics use ovarian reserve testing. This typically includes:

• AMH blood test: reflects the pool of available eggs.
• FSH and estradiol (measured on cycle days 2–3): higher baseline FSH levels can suggest diminished ovarian reserve.
• Antral follicle count (AFC): an ultrasound measurement of the small resting follicles visible in the ovaries at the start of a cycle.

Together, these results help predict how the ovaries may respond to stimulation and guide individualized treatment decisions, whether that involves trying in vitro fertilization (IVF) with your own eggs, pursuing egg freezing, or considering donor eggs.

When are women most fertile?

Peak fertility occurs in the early to mid-20s, when most healthy couples have about a 25% chance of conception each cycle. Fertility begins to gradually decline around age 30 and more rapidly after age 35. By age 40, the chance of conception per cycle falls to the single digits, while the risk of miscarriage increases significantly. 

Egg donation: a powerful answer to age‑related infertility

For women whose egg quantity and quality have declined, the use of donor eggs can effectively “reset the clock,” as pregnancy success depends primarily on the age of the eggs rather than the uterus. 

How egg donation works

1. Donor screening

Ideal egg donors are typically women in their 20s with excellent ovarian reserve. Potential donors undergo comprehensive screening, including a detailed personal and family medical history, physical exam, blood testing, urine drug screening, and psychological evaluation.

2. Ovarian stimulation and egg retrieval

Similar to an IVF cycle, egg donors take injectable medications for approximately 10–12 days to stimulate the ovaries to produce multiple eggs. These eggs are then collected during a brief outpatient procedure called an egg retrieval.

3. Fertilization and embryo culture

Mature eggs are fertilized with sperm, either from a partner or a donor. The resulting embryos are cultured in the laboratory for 5–6 days until they reach the blastocyst stage.

4. Embryo transfer or freezing

High-quality embryos can be transferred into the recipient’s uterus for implantation and pregnancy. This may occur in a fresh cycle (without freezing) or a frozen cycle (after cryopreservation and later thawing). Any additional embryos can remain safely frozen for future use.

Chances of success

National data show live birth rates of about 50–60% per embryo transfer when using donor eggs. Importantly, success rates are driven more by the age of the egg than the age of the person carrying the pregnancy.

That said, pregnancy at advanced maternal age can come with higher medical risks, so some patients may benefit from meeting with a high-risk OB-GYN doctor ahead of time to talk through any individual concerns.

Who should consider donor eggs?

• Prior unsuccessful IVF cycles, particularly when related to low egg number or quality

• Diminished ovarian reserve, due to age, endometriosis, prior surgery, chemotherapy, or other factors

• Premature ovarian insufficiency (early menopause)

• Carrier of a genetic condition you wish to avoid passing on to your child 

Practical tips to optimize fertility at any age

• Don’t delay evaluation. If you’re under the age of 35 and have been trying to conceive for 12 months, or 35 or older and trying for 6 months, schedule a fertility consultation. Don't wait if you have known concerns regardless of age.

• Know your numbers. Ask about your AMH, FSH, and AFC results, and what they mean for your individual fertility.

• Prioritize your overall health. Focus on a healthy lifestyle, including avoiding smoking, limiting alcohol and caffeine, and managing any chronic medical conditions. 

FAQs about fertility and age

Does male fertility decline the same way as female fertility?

Not exactly. Women are born with a finite number of eggs that decline in both number and quality over time, leading to a clear age-related drop in fertility. Men continue to produce sperm throughout life, so sperm counts do not decline in the same steady way. That said, advancing paternal age (≥40) is linked to a small increase in the risk of miscarriage and certain genetic conditions. 

Does AMH tell me exactly when I’ll reach menopause?

No. AMH cannot precisely predict the timing of menopause. A lower-than-average AMH for your age may suggest that menopause could occur earlier, but it cannot determine exactly when that will happen. The rate at which egg supply declines varies significantly from person to person. 

Can supplements or lifestyle reverse egg aging?

Unfortunately, no. While we cannot reverse the natural decline in egg quantity or quality, healthy lifestyle choices can help support overall reproductive health and optimize fertility potential. Certain supplements, including the antioxidant CoQ10, are commonly used in fertility care and may help support egg quality.

Is pregnancy safe after 45 with donor eggs?

Many women have healthy pregnancies at advanced maternal ages. However, the risk of certain pregnancy complications (such as preeclampsia and gestational diabetes) is higher with increasing maternal age. For this reason, we recommend that women aged 45 and older, or those with underlying medical conditions at any age, meet with a high-risk obstetrician prior to pregnancy. A preconception consultation helps optimize health before pregnancy and ensures the best possible plan for care during pregnancy.

Should I consider freezing eggs instead?

If you are planning to have a family in the future but are not ready to start now, it may be worth considering egg freezing. We recommend meeting with one of our fertility specialists who can assess your current ovarian reserve and discuss whether egg freezing is a good option for you.