What Happens When You Go Through Perimenopause & Fertility Treatments at the Same Time?

One day, when I was around 10 years old, my mother sat me down to tell me she would not be able to have any more children. Not being well-versed in menopause, I assumed that meant the government gave women a deadline for having kids, and for her, that day had passed. But as I later learned, reproductive timelines aren’t that neat. In fact, in some cases, it’s possible to go through fertility treatments and perimenopause at the same time.

Flow Space spoke with experts to find out more.

At What Age Does Perimenopause Start?

Perimenopause can begin at a wide range of ages. Some people enter menopause as early as their mid-30s or early 40s, while others don’t start until their mid-to-late 50s, says Dr. Janet M. Choi, a reproductive endocrinologist, OB-GYN, Menopause Society Certified Practitioner (MSCP) and the chief medical officer for fertility benefits company Progyny. And perimenopause starts several years before menopause. 

There is no test for perimenopause, and according to Choi, the signs of perimenopause can be “tricky and subtle.” Some experience small shifts in their menstrual cycle—like going from a 28-day cycle to one that’s 25 or 26 days, she explains. For others, the first signs are increased moodiness or brain fog while they still get their period.

“While some women are done with family building during perimenopause, others who are struggling to conceive might find it even more difficult to plan for pregnancy based on their irregular cycles,” says Dr. Erika Munch, a reproductive endocrinologist at Texas Fertility Center.

Is There a Cutoff Age for Fertility Treatments?

Like the beginning of perimenopause, the upper age limit for fertility treatment varies, Choi says. “Typically, the chances of somebody getting pregnant with their own eggs starts to hit closer and closer to zero once you get into your early-to-mid 40s,” she explains. 

After that, fertility clinics may have age cutoffs for those who want to use their own eggs because, realistically, the chances getting pregnant are so small, there’re not feasible, Choi says. “There are also some health conditions that increase risk based on the age of the person carrying [a pregnancy], and that’s the reason why some fertility centers will have age ceilings,” she notes. 

Doing in vitro fertilization (IVF) using donor eggs, or their own eggs that were frozen earlier in life is another story.

“Sometimes people will come and say, ‘I don’t understand: how come this celebrity who is clearly 50 is happily pregnant and just delivered a healthy baby?,’” Choi says. “In that case, that person either went through fertility preservation when they were younger—because those eggs and embryos can stay frozen now for years—or they used donor eggs.” According to Choi, if a woman is otherwise healthy, they may be able to carry a pregnancy to term—even postmenopause. 

“Postmenopausally, if the uterus is intact and deemed to be healthy… whether it’s from their own frozen eggs years ago or donor-eggs—then, they create an embryo, either with donor sperm or partner sperm,” Choi explains. “[Women] could be undergoing embryo transfer in their early 50s.”

How Do You Know If Someone Who Comes in for Fertility Treatments Is Going Through Perimenopause?

Because there’s no test to diagnose perimenopause, it’s based on medical history, clinical history and gynecological cycle, Choi says. (This is why keeping a period journal can be helpful.)

“You also want to make sure that you’ve ruled out other medical issues, like thyroid irregularities and other hormonal issues that could sometimes masquerade as menopause,” she explains. “But if you have someone who’s reporting symptoms associated with a perimenopause, and if they’re like, ‘I’m 43—am I really perimenopausal?’ If they have suspicions, likely, the answer is yes.” 

While this is not a way to confirm that somebody is going to hit menopause at a certain age, it is possible to do an ovarian reserve test on the second or third day of a period to get a sense of a woman’s remaining egg supply, Choi says. “When you’re not on any kind of hormone therapy, you can measure hormones like estrogen and FSH [follicle-stimulating hormone],” she explains. “A high FSH and a low estrogen on that day, or conversely, a high estrogen, low FSH, can be a sign of ovarian aging.” 

Similarly, you can do a random blood test for a hormone called AMH, or anti-Mullerian hormone. “Fertility doctors will use it a lot—not to guesstimate prognosis for that person, but just to get a sense of what’s going on for egg supply,” Choi says. “If their AMH comes back very, very low, that can also suggest that maybe this person is experiencing all these symptoms associated with perimenopause, because their egg supply is dwindling.”

It’s also important to note that the results of hormone tests wouldn’t necessarily make someone ineligible for fertility treatments, she says.

What Type of Fertility Treatments Do Perimenopausal Women Typically Seek Out?

Women going through perimenopause and are trying to conceive usually seek out fertility treatments to help with egg development and access to good sperm, Munch says. “Most treatments involve augmenting egg production through oral or injection medications,” she explains. “Egg numbers and quality both decline rapidly in our 40s, so it’s important to try several eggs before the supply and quality runs out.”

As far as procedures, IVF with egg retrieval is probably the most common, says Dr. Rachel Pope, a gynecologist with an appointment in the department of reproductive biology at University Hospitals Cleveland Medical Center. Intrauterine insemination (IUI) is less expensive but has lower success rates, she explains, adding that some women will need a donor egg at this age. “These treatments are decided using a comprehensive look including Fallopian tube function and sperm counts,” Munch says.

If You Go Through Perimenopause and Fertility Treatments at the Same Time, Do You Do Anything Differently?

Women undergoing fertility treatments often use medications called “gonadotropins” that mimic brain signaling, in the hopes of helping with ovarian egg development, Munch says. The ovary usually produces estrogen when eggs are being developed.

“So when your doctor is trying to figure out if the ovaries have responded to the medication, taking extra estrogen may make the results difficult to interpret,” she explains. “Some fertility treatments, like doing IVF with embryo transfer, require taking hormones, like estrogen and progesterone, to create the uterine environment necessary to support a pregnancy.”

Many women in perimenopause choose the birth control pill or something similar to help with symptoms, especially irregular bleeding, Pope says. “This would be counteractive to fertility treatment because it shuts down the menstrual cycle, most importantly shutting down ovulation,” she explains. “Other women might choose menopausal hormone therapy or non-hormonal medications. None of these would be recommended during fertility treatment.”

Additionally, if a patient is going through egg freezing or IVF, their doctor might adjust the usual dose of the hormone injections if they’re going through perimenopause, Choi says.

When younger people go through these procedures, hyper-stimulation of their ovaries is a concern, but that’s not the case with older fertility patients. “Oftentimes, the doctors might, if the patient has never tried medications before, try to give them a higher dose to see if they can try to wake up a few extra eggs,” she explains.

Is It Generally Considered Safe to Undergo Fertility Treatments While Going Through Perimenopause?

In short, yes.

“If used appropriately in the right population—after you make sure that any other background medical issues have been stabilized, and your doctor has conferred with your specialist—fertility drugs are generally considered pretty safe,” Choi says. Fertility drugs do have side effects, like hyper-stimulation or impacting someone’s mood, but no more so than usual if someone is going through perimenopause, she explains.

“Besides those typical risks, it’s not like being perimenopausal puts you at higher risk of having complications from fertility drugs,” Choi notes. 

While that may be the case, Munch points out that pregnancy in your 40s can be a high-risk or a more complicated pregnancy. “It’s very important that you meet with your OB-GYN and your primary care doctor to talk about your risks for diseases that many people get in their 40s, such as diabetes, high blood pressure or cardiovascular disease, and how to minimize that risk during pregnancy,” she explains.

What Are Success Rates for People Who Go Through Fertility Treatments While Also Going Through Perimenopause?

The success rates of fertility treatments are much lower, because if a woman is beginning to experience the symptoms of perimenopause, that means that her ovarian reserve is dwindling, Pope says.

“The egg count will be lower, the quality of the eggs will be lower and they are overall producing less estrogen—hence the perimenopausal symptoms—and are less likely to respond to fertility treatment,” she explains. “It doesn’t mean [getting pregnant] is impossible, but it would be a challenge.”

According to Munch, it’s important to have a candid conversation with your reproductive endocrinologist about the chances of success and your family-building goals.

“Some patients who are unable or unsuccessful at achieving pregnancy using their own eggs are likely to have a very high chance of pregnancy using donated eggs,” she says. “The uterus is quite capable of carrying a pregnancy well into perimenopause, so it’s a matter of finding the right egg and sperm combination that can make it happen.”