You also get two deep dives every month on a challenging aspect of the fertility industry. No more scanning Reddit forums at midnight. The previous Tuesday Briefing covered the donor sperm decision.

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Hey,

Several years ago, I had a chance encounter with a woman I knew as the ‘Viagra lady’. Over lunch, she explained the impact of her work.

She led the team at Pfizer who developed sildenafil - brand name Viagra. She changed the lives of so many, and she cried as she recounted the letters she had received from men thanking her for enabling their families.

I was struck by her humility. She retired in 2012 and yet she was still moved to tears about her work. She dedicated a chunk of her career to something she would never directly experience herself - helping other people build their families.

It wasn’t until later I learned her full name: Dr Gill Samuels, CBE. Throughout her career in pharmaceutical science, she supported many women into STEM roles. She understood what it meant to be a woman doing ground-breaking work in a field where women are typically the minority.

The system was built for couples

Pharmaceutical giant Pfizer invested hundreds of millions into developing and marketing Viagra so that men could have families. Gill was part of that - extraordinary science, extraordinary impact.

Now consider the world of assisted conception.

The first IVF baby was born in 1978. That’s nearly 50 years ago. And yet, solo women wanting to start their family are entering a system that wasn’t designed for them. The forms assume a partner. The language assumes a partner. The appointment times assume a partner will split the information-load.

The system was built for couples. Solo women are mostly invisible.

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Why the usual pathways don’t work for you

You walk into a clinic as one person. But the system is built for two. This isn’t oversight - it’s design.

A clinic that sees solo women would:

• Never assume a partner exists. Remove “partner’s name” from forms. Replace “you and your partner” language. Train staff to reflect this.

• Give solo patients longer consultation slots. You’re absorbing information alone that a couple would split.

• Assign a named point of contact for questions between appointments, so you don’t have to re-explain your situation each time.

• Provide a written summary after every consultation. You’re not relying on memory of a conversation you had alone, under pressure.

• Offer a staffed companion for high-stress moments - retrieval, transfer, results calls - when you have no one available.

These changes cost clinics nothing but attention. Yet the investment in solutions for men’s family-building (and pleasure) has been enormous.

Where’s that investment for solo women wanting to start a family?

What this means for me now

That lunch with Gill changed something in me.

She'd made an accidental discovery - sildenafil was meant for angina, not erectile dysfunction. But once that benefit emerged in clinical trials, it got what it needed to reach those who needed it. Attention, investment, resources, commercialisation. A problem the industry hadn't recognised suddenly became a priority.

But there’s another gap. One that’s been invisible for almost 50 years.

Solo women are navigating a system that wasn’t built for them. The fertility industry sees women, but it doesn’t see solo women - because it assumes they'll come anyway. Why invest in design for a population you're already making money from?

And no single clinic, or person, is filling that gap. Or designing for the invisible women.

So I am.

Gill saw what was missing for men and built a solution. I see what’s missing for solo women and I’m building a pathway through it.

I wish Gill were here to explore the Briefing Room. I’d love to know what she thinks. And I’m inviting you to take a look. Reply to this email and let me know?

You’re solo - but not alone.

Sarah

P.S. The Briefing Room reveals what no clinic will tell you: how to navigate a system that wasn’t built for you. Six weeks with me and four independent experts - an embryologist, fertility doctor, nutritionist, therapist. Together, we build your treatment strategy - before you spend five figures. Applications open for the Autumn cohort.

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I’m Sarah. I write about what happens when solo women over 40 enter the fertility system - the things they’re not told, the costly decisions they’re expected to navigate often without proper guidance, and what women really need to know before they spend five figures.

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By Sarah - For solo women over 40
Weekly essays for women who need a plan, not false optimism with a big price tag.

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It’s the Tuesday Briefing - a deeper dive for those making informed decisions about fertility treatment at 40+.

“Educated, dark features (like me) and ideally degree educated.”

I thought those were the most important characteristics for a potential donor. So I flicked through profiles on a big sperm bank website, trying to create a shortlist. I found a couple - their baby photos were so cute. Then I flicked to their present day photos.

OMG. A 21-year-old student?!

Suddenly, it all felt very weird. I shut down the website, unable to pinpoint my feelings about choosing - or using - a sperm donor.

Eventually, I preferred an anonymous donor. I was also clear on how I’d talk about it with my baby. I decided to use in-country banks, in Spain and then Greece, supplying sperm for around 500 euros per straw, rather than the big banks charging at least double that.

I’d heard about apps like Just a Baby and using them was a hard no. I didn’t want to end up in legal battles over access to my baby. Selecting sperm outside of a clinic is riskier.

The irony: my donor-conceived baby was the product of a chance encounter with someone who became the known donor. We created an agreement. But I knew it wasn’t legally binding.

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This isn’t actually one decision - it’s four

No one ever explained that selecting your donor is a mix of several personal considerations: a values decision, a legal decision, a relationship decision, and a futures decision.

These things take time to figure out - which might be tricky if you’re feeling under pressure to get things moving.

Most women don’t get frameworks for thinking through that complexity. They get clinic options. They get profiles to browse. They get told to choose quickly because the timeline is moving.

I didn’t realise I was making four decisions at once.

This isn’t a medical question. It’s an architecture question. And it requires clarity on things clinics don’t explicitly teach:

• What do you actually want your child to be able to know?

• What does a long-term arrangement with a known donor look like when circumstances change?

• What are the legal implications you’re not being told about?

• What is the strangeness you’re feeling actually about?

The women who navigate this best don't start by scrolling profiles. They answered the hard questions first.

Why the usual advice fails

“Choose the donor that feels right” assumes you know what “right” feels like.

It doesn’t account for the fact that the choice itself - using someone’s genetic material to become a mother - is strange for almost everyone at first. And that strangeness doesn’t predict anything about whether the decision is sound.

“Go with your gut” skips past the legal and relational complexity. If you’re considering a known donor, your gut feeling about him as a person is only one piece of the decision. The legal framework you’re both operating in, what happens if he wants more involvement than agreed, what you’ll tell your child - these need to be thought through deliberately, not felt through.

What changes when you have a framework

The decision moves from “which option feels less wrong” to “which option aligns with what I actually want for my child’s future and for my relationship to this process.”

You can sit with the strangeness without panic. You understand the regulatory landscape - what your child will legally be able to access, how that differs between countries. You’ve asked the hard relationship questions if you’re considering someone you know. You have language for the emotional complexity instead of just a feeling you can’t name.

Before you start scrolling

There are three things to work through before you open a profile.

1. Known or sperm bank?

Answer the relationship and values questions first. Does someone come to mind? What does 18+ years of connection look like? What do you want your child to be able to know? Decide which path before you decide which donor.

2. Understand the regulatory landscape.

Know what your child will legally be able to access depending on where you treat. Anonymous in Spain and Greece. Identifiable in the UK. This shapes everything downstream, so know it upfront.

3. Get clear on selection criteria before you start scrolling.

Know what actually matters (health history, genetic screening, CMV status, whether they’re proven) vs what won’t predict the right decision (photos, eye colour, personal statements). This keeps you grounded when the sea of profiles pull you sideways.

When you’ve worked through these three things, you may not feel less scared. But now you’re making the decision from solid ground, not spinning. You know what you’re choosing and why. The strangeness doesn’t disappear - but it starts feeling manageable.

I’ve built a full decision tool that walks you through each layer: the known donor vs sperm bank fork, the regulatory reality by country, what actually matters when choosing from a profile, the legal and relationship questions for known donor arrangements, what to tell your child, and the emotional reality that doesn’t fit anywhere else.

This tool was built from listening to women describe what they wished they’d understood before making this decision - the emotional reality, the legal complexity, the relational questions, and the regulatory landscape that shapes what your child will eventually be able to know.

Read the first three sections here.

For paid subscribers:

The full six section tool (sections 4-6 including the legal framework and emotional complexity) can be found here:

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Read more

On Thursday 27th August at 7pm BST, Victoria from All About Embryology will help us understand what’s actually happening to our eggs over 40, and what good lab support looks like.

Victoria will walk us through which treatments are important at this age, and which are unnecessary add-ons - so you can advocate for what you actually need with confidence.

Victoria is an independent embryologist with eighteen years in the lab and no clinic affiliation. When so much of the process can feel overwhelming, especially with all the acronyms, Victoria puts everything in plain terms, so you don’t have to become a medical researcher.

Paid subscribers can find the link to the call below.

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During my first IVF cycle at a Spanish clinic, I was sold a package that included PGT-A, a genetic test.

Nobody talked me through the pros and cons. It never occurred to me that I could question the doctor. I had absolutely no idea about embryology, or about the people who would fertilise (with donor sperm) the five eggs they collected, and then test the three embryos those eggs became.

If the fertility doctor is your egg collector, then what is the embryologist? And why should we care?

Some argue the embryologist is the real champion on our path to pregnancy because they do the delicate work that decides whether fertilisation happens at all.

Most of us never meet that person, and never really understand what they do. Once your eggs are collected, the embryologist takes over.

Retrieving a healthy egg is only half the story. That egg still has to become a viable embryo, and whether it does comes down to the conditions and the skill inside the lab.

Through both my IVF cycles, in Spain and Greece, the lab stayed a mystery to me. I deferred to the medical team on everything, including whether to use ICSI - the technique where a single sperm is injected directly into the egg. It was never put to me as a choice. It was simply done.

That is the gap Victoria Wigley works in.

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So what should you be scoping out before you hand over your money?

The frustrating part is that lab quality is genuinely hard to judge from the outside. Clinics rarely offer it up, and the numbers that matter are not on the glossy success-rate page.

So it falls to you to ask.

• How experienced are the embryologists who will handle my eggs, and how many of them are there?

• What are your freeze and thaw survival rates for blastocysts?

• How do you track and witness which eggs and sperm are mine at every step?

• And if I go ahead with PGT-A, who performs the biopsy, and how practised are they?

• Is this recommendation right for me, or is it what the clinic offers everyone?

Each of these has a reassuring answer and a worrying one. An independent embryologist with nothing to sell you is one of the few people who can help you tell the difference.

The lab might be a room you will never enter.

But asking the right questions upfront will help you understand how your eggs will be treated, discern the skill of the lab equipment, and the expertise of the embryologist handling the most precious parts of you.

Victoria will walk through all of this - what to ask, and how to read the answers you get. Paid subscribers can bring their own questions, or catch the replay.

A one-to-one consult with Victoria usually costs £100 for 60 minutes. This session comes included with your paid subscription. It won’t replace a private consult, and Victoria can’t give advice specific to your situation without the full context of your history. But she’ll share as much guidance as she can, so you leave knowing what to ask and what to listen for.

Link for the call

Read more

On Thursday 27th August at 7pm BST, Victoria from All About Embryology will help us understand what's actually happening to our eggs over 40, and what good lab support looks like. Victoria will walk us through which treatments are important at this age, and which are unnecessary add-ons - so you can advocate for what you actually need with confidence.

For 1:1 advice, an initial consultation with Victoria is £100 for 60 minutes.

This is for paid subscribers seeking deeper support. A link will be shared before the call.

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Hey,

Aged 43, I did IVF cycles in Spain, and then Greece. Both failed.

The second cycle was harder than the first. Not just the outcome. But the drugs, the recovery, and the feeling of having again put everything into something that didn’t work.

I went abroad twice, alone, for sedated operations. Both times, I used donated sperm from local banks that was chosen for me. All of it was a lot to process.

I flew to India for winter to recover. That’s when another path unexpectedly opened up.

I met a guy in my local café over breakfast. He eventually learned about my fertility treatments. He saw I was struggling. He saw the bald patches on my hairline. Then he offered to help.

The rest is history.

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The strangeness of it all

Before any of that - back when I was going through IVF - the idea of using donated sperm didn’t sit well with me. It was so far from what I’d imagined for having a baby and starting a family.

But I knew I couldn’t put myself through any more dating app encounters. So I’d reached a fork in the road. It was a binary decision: try for a baby via assisted conception, or give up on motherhood.

Fertility treatment became a decision by default, more than a choice.

Scanning donor bank websites was the first time I felt confronted with the enormity of the process. Shopping for the father of your child. But it wasn’t the father, just a donor, a kind man (I imagined) helping a woman to become a mother. Slowly, I pieced together my feelings. I wanted an anonymous donor.

I used local donor banks in Spain and Greece. They were a fraction of the cost of the large ones, and the cost of the sperm alone across multiple cycles priced me out of the UK.

Anonymous meant I had minimal details about the appearance of the donors. The questions looped constantly: Who would the baby look like? Would I bond with it, knowing half of it came from a mystery man I’d never meet? What if it didn’t look like me? What if I’d prevented my child from knowing half its origins?

But seeing details brought other questions. What kind of person he was, why he was donating, why was he donating so young, would he regret it?

I didn’t say any of this out loud. I just went with it. Because it was this - or no baby.

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It was different with the known donor

I met the known donor through a chance encounter in my local cafe. He came to learn of my story. He saw the hair I’d lost from my temples. Then he offered to help.

This time, my approach was different.

It still felt strange because it was a situation I’d never imagined myself being in. But seeing the donor in the flesh, and getting to know him, brought comfort.

I was still grieving the absence of the partner I always assumed I’d be starting a family with. But the offer, out of the blue, felt like something I needed to explore.

We talked about everything: the arrangement, what involvement would look like, what we both wanted. We put it in writing. I had a witness. I knew it wasn’t legally binding, but it recorded our intentions upfront.

His sperm was tested.

And then, my gorgeous baby girl. She arrived in the depths of winter - my little light child became the new centre of my world.

The donor hasn’t been involved since I mentioned I was pregnant. That was the plan. And it has worked exactly as we intended.

Of course, I’ve heard other situations turn sour. Courtroom battles after donors decided they wanted to be involved, anxiety, expense. It’s why I never recommend using a known donor without getting proper legal advice first.

But this is my story.

(Last year, I ran a webinar with UK Family Law expert Anest Mathias at TV Edwards to discuss the legal implications of using a known donor.)

What I learned

You can grieve the partner you imagined while being driven by the absolute clarity that you want to be a mother. You can find the whole process strange and uncomfortable and still choose it. You can step outside the norm when no one around you is doing the same thing, knowing it will feel lonely and peculiar, but do it anyway.

And then, when it works, you realise that motherhood built this way - on your own terms, with your own agency - can be more meaningful than the conventional script ever was.

The strangeness isn’t a flaw in the process. It’s the price of doing this alone. But the reward is huge.

Flicking through donor profiles finding a donor this way feels like a strange process. I don’t think most solo heterosexual woman imagined baby-making this way.

At the same time, having that choice is incredible. Being able to access banks, to have options, to build a family in different ways - it’s an evolution.

I never set out to use a known donor. There were risks. But I’m hugely grateful it happened this way. I have a healthy, happy baby who has changed my life for the better.

Upcoming: The Tuesday Briefing - August 25th

I’ve built the decision framework I wish had existed when I was deciding about donor sperm.

It’s a deep dive including six sections covering every fork: known donor vs sperm bank, the regulatory picture, what actually matters when choosing from a bank, the legal questions, disclosure, and the feelings that don’t fit anywhere else.

If you’re not a paid subscriber yet, this is a good reason to become one. The paid tier also gives you two deep dives per month and a live Q&A with a fertility expert who works with women over 40.

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You’re solo - but not alone.

Sarah xo

PS. A preview of the Donor Sperm Decision Guide is on the website here.

I’m Sarah. I write about what happens when solo women over 40 enter the fertility system - the things they’re not told, the costly decisions they’re expected to navigate often without proper guidance, and what women really need to know before they spend five figures.

Subscribe to Solo Fertility 40s
By Sarah - For solo women over 40
Weekly essays for women who need a plan, not false optimism with a big price tag.

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Aged 42, I finally took family-building into my own hands. I’d almost waited myself out of motherhood, hoping the right guy would appear. I was done with waiting.

So I plunged straight into IVF, spending 11k euros on the first cycle alone, without doing any upfront research or preparation. I just headed directly to the same clinic as my friend - though a different branch and doctor. Bad idea.

The second IVF cycle when I was 43 also failed. I kept choosing the wrong doctors. But I didn’t know what the right ones looked like.

Both doctors told me IVF with my own eggs wouldn’t work - and that I should use a donor egg.

I built Solo Fertility 40s because of how much I had to work out for myself through the IVF cycles. By the time I selected my third IVF clinic, I had done 15 consultations across 6 countries, speaking with fertility doctors from the UK to India. I was exhausted.

Throughout all this, I felt so alone.

I joined solo women groups - but I was lumped in with women a decade younger. I was 42, listening to 32 year olds wondering about whether to freeze their eggs, or wait a little longer to meet a partner, or to go for IVF. I was well past that point. It was IVF or no baby, which I call a decision by default. So the “solo mothers by choice” framing didn’t fit.

Then I joined groups for over 40s - but women talked about their partners and improving sperm health. I also didn’t fit in here.

I felt like an anomaly. Surely there must be other solo women over 40 having fertility treatment?

After my first failed cycle of IVF, a traumatic experience at a Spanish clinic, I started writing on Substack. Then something unexpected happened - 40-something women from around the world started messaging me about their own difficult experiences. I realised I hadn’t got unlucky - I was part of a pattern. And I wasn’t on my own after all.

Speaking with them helped me realise there was a huge information gap for solo women over 40. I knew something needed to change. Solo Fertility 40s was born.

Two years into this now: almost 100 stories on Substack, read by women in around 35 countries. And none of it came from the outside looking in - I’ve been inside the system, having treatment in Europe, alone. I’ve walked the path I’m writing about, not just researched it.

And I’ve learned that nothing with fertility and conception is predictable. Just before heading into treatment at a third clinic, I conceived through a chance encounter with a man who became a known donor.

My daughter Bibi was born when I was 44.5 years old. I had no pregnancy complications and healed well after the emergency c-section.

This is written for you wherever you actually are, not where society says you’re supposed to be by now.

You don’t have to start at step one - come in wherever you actually are on this.

No hype

What you won’t find here is hype.

And what you don’t need right now are tactics using fear marketing to cloud your thinking.

What you do need is a strategy - a plan - so you go into the fertility system prepared. Whatever the outcome, it won’t be because you didn’t know what to ask.

If you only remember three things:

1. You don’t need to have it all figured out before you start. You need a plan, real questions to ask, and the willingness to ask them.

2. I did this without any real support in place - and it was horribly hard. This is the community I wish I'd had, so you don't have to do this completely alone.

3. Deciding to start is easier because you have the IVF Guide Clinics Won’t Give You. Do the groundwork first. The rest follows.

Welcome to Solo Fertility 40s. I’m glad you’re here.

Sarah

P.S. If you’re the type who reads everything before deciding - good instinct. Start with the IVF guide clinics won’t give you, or take the quiz if you’re not sure where you stand, and come back when you’re ready.

And if you already know you want a second opinion - book a Strategy Session. Let’s talk it through.

Subscribe to Solo Fertility 40s
By Sarah - For solo women over 40
Weekly essays for women who need a plan, not false optimism with a big price tag.

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On Thursday 27th August at 7pm BST, Victoria from All About Embryology will help us understand what's actually happening to your eggs over 40 and what good lab support looks like. Victoria will walks us through which treatments are important at this age, and which are unnecessary add-ons - so you can advocate for what you actually need with confidence.

This is for paid subscribers seeking deeper support. A link will be shared before the call.

Subscribe now

Hey,

I always imagined pregnancy to be a time filled with slowing down and sinking into the miracle of new life. But my pregnancy was very different.

Rather than putting my feet up, I found myself re-reading the emails I’d received from women around the world, sharing their difficult experiences. And talking to some for deeper conversations. What I heard was startling.

I thought I’d got unlucky with my own difficult experiences of fertility clinics. But talking to them helped me realise I was part of a pattern.

When I started writing here on Substack, I never expected women to reach out because they recognised themselves in my stories. But they did.

I listened to what happened to them. What surprised them. What they wish they’d known before they walked into their first clinic.

And that’s when the pattern became clear.

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The research

The women who wrote to me weren’t telling me about bad luck. They were describing a gap between what they expected and what they got. Between being treated like an informed decision-maker and being patted on the head and told to be optimistic.

One woman told me: “Full faith in the medical team, don’t question anything, because I just didn’t know any better.”

Another said: “When I went in for my first IVF… I would have liked to be told there are different protocols, different drugs, each does a slightly different thing.”

A third: “They wasted an entire year of my fertility with a rigid protocol that didn’t apply to me.”

These weren’t complaints, they were patterns, repeated across dozens of conversations, referencing different clinics and countries. Each time, it outlined a woman over 40, intelligent and capable, entering a commercial system unprepared because no one gave them the framework they needed.

What you need to know before you start

The women who navigated this best came with clarity. They knew what mattered. They weren’t relying on hope - they were relying on preparation. This is what going in well-informed looks like:

1. Start with the prep guide. Before you talk to any clinic, read the guide that teaches you what to prepare for. It’s the orientation clinics won’t give you. Five steps over five days to plan your treatment.

2. Don’t be fooled by a page 1 ranking and a shiny website. They indicate marketing budget, not medical quality. Reputation can obscure what actually matters - whether the clinic will communicate clearly with you, individualise your protocol and whether they will set expectations accurately.

3. Understand that clinics are a business with commercial objectives. Once you know that, you stop expecting them to protect you and start preparing to protect yourself.

Why I’m telling you this

Good things happen when women talk. When they share what actually happened. When they compare notes and realise the system isn’t built to protect them - it’s built to sell them treatment.

I discovered an informal network while I was researching. Women sharing tips, protocols, medicines, red flags. Recommendations for clinics. Warnings about doctors. Real information, peer to peer, filling the gap that clinics and websites leave empty.

Women wrote to me. Now I write to you.

The women who broke the pattern weren’t smarter or luckier. They just walked in knowing what to look for and what to say no to. Preparation isn’t something you’re born with - it’s something you choose. And you can choose it before you invest figure figures with a clinic.

You’re solo - but not alone.

Sarah

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P.S. Want to talk through your next steps? I’m offering free 30-minute Strategy Sessions this month. Limited slots available. Book here.

Plus: I’ve been writing here for almost two years - over 90 free stories on everything from my own cycles in Spain and Greece to navigating the fertility industry and becoming a solo mother at 44. It's time to provide more targeted support to those who need it.

The paid tier gives you access to two deep dives per month and a live QnA with a fertility expert who works with women over 40.

I’m Sarah. I write about what happens when solo women over 40 enter the fertility system - the things they’re not told, the costly decisions they’re expected to navigate often without proper guidance, and what women really need to know before they spend five figures.

It’s the Tuesday Briefing - a deeper dive for those making informed decisions about fertility treatment at 40+.

Is there a real answer to “am I too late”? What can you actually find out this week, instead of waiting for a doctor’s verdict? And what changes once you stop confusing “unprepared” with “impossible”?

These are expensive decisions. Nothing is taken lightly here. That’s why paid subscribers get twice-monthly deep dives from someone who’s lived this, plus monthly live Q&As with specialists skilled in treating women over 40.

This month, we’re talking with Victoria, from All About Embryology about what women over 40 should know about their eggs and what can be done in the lab to support more fragile eggs to fertilise.

Join us Thursday 27th August, 7pm BST. A link will be shared to paid subscribers before the call.

Upgrade to get answers, not reassurance.

Subscribe now

If you don’t know where to get started, the “Should I Start IVF at 40?” tool walks through it in about three minutes. And if you’re past the question and into deciding about treatment, that’s what the Briefing Room Programme is for.

Ten calls in total, including six to build your bespoke treatment strategy before you spend a penny on treatment, plus four independent expert sessions - an embryologist, a fertility doctor, a nutritionist, a therapist - selected for their expertise in treating women over 40.

Applications are now open for the Autumn cohort.

Built for solo women over 40 who don’t have time or money to waste.

The panic that keeps you up

You’re 40-something. And you’re scrolling clinic websites at midnight, reading Reddit threads, asking: am I too late?

Every woman I’ve spoken to has asked this exact question. It might arrive as a panic. It sits under every other decision: Can I afford this? Do I have time? Is this even worth trying?"

But here’s what I’ve learned from consulting doctors from the UK to India and doing two IVF cycles at European clinics: the question itself is the problem.

“Am I too late?” sounds like it has a yes or no answer. It doesn’t. What you actually need to know is completely different - and it’s entirely within your control.

What your age actually means

The UK regulator the Human Fertilisation and Embryology Authority (HFEA) publishes live birth rates by age. For women aged 43-44 using their own eggs, the birth rate per embryo transferred is 8% in 2024. For women aged 18-34, it’s 38%.

Those numbers look like answers. They’re not - they’re population averages.

Your doctor cannot tell you where you sit in that average. Your egg quality, your health, your response to stimulation - these are individual. Your doctor can estimate based on markers. They cannot predict your outcome.

When a doctor says “at your age, we should try donor eggs,” they’re not reading your biology. They’re reading a national chart.

And Reddit makes this worse. Women ask: “Is IVF worth it at 43?” Someone replies: “The success rate is only 8% so don’t waste your money.” That’s not wisdom. That’s misreading data without context.

Context matters. Your situation is specific. Anti-Müllerian Hormone (AMH) tells you about egg quantity, not quality. A 29-year-old with low AMH can still do well, while a 42-year-old with normal AMH may still face quality limits due to age - but that’s different from saying 42-year-olds can’t succeed.

What doctors can actually measure

Before you panic about age, understand what your doctor can know about your individual case.

Ask your doctor for three numbers:

• Your AMH level (marker of ovarian reserve — how many eggs you have left)

• Your antral follicle count (the follicles visible on ultrasound this month)

• Your FSH level (how hard your pituitary is working to stimulate your ovaries)

These numbers matter because they help your doctor estimate how many cycles it might take with your own eggs, given your specific biology. AMH predicts how you might respond to stimulation more than it predicts your chance of live birth per embryo transferred.

But there’s something else your doctor won’t tell you: most women over 40 need multiple cycles. Not one. Multiple.

The Reddit threads are full of this: “I thought one would work,” “I wasn’t prepared for a second cycle,” “I’ve already spent £18,000 and I’m not sure I can do another.”

That’s not a failure. That’s realistic planning.

The invisible window: 90 days

Here’s what might change things: the 90-day egg maturation cycle.

Although women are born with all their eggs, their maturation occurs over approximately 90 days before ovulation. During the final stages of this process, the egg builds its nutrient stores and develops its mitochondrial network - the energy systems that determine whether an egg can fertilise and divide.

This is important because it means you have a window. Not to change your age. But to change how your eggs are prepared when they’re retrieved.

The practical window for egg quality improvement is about 2 to 4 months before ovulation, which lines up with the roughly 90-day maturation cycle of developing follicles. Once a follicle is on its way toward ovulation, you can’t rewrite its history - but you can influence the environment it’s developing in.

Most fertility clinics don’t teach this. Most doctors don’t mention it. But a growing number of fertility nutritionists and supportive doctors use it as a framework.

(Try this free fertility checklist from Root and Leaf Nutrition. Solo Fertility 40s does not have any commercial arrangements with any service providers.)

The next section shows you exactly what to do during those 90 days, how to talk to your doctor about egg quality (not just age), and what the real decision points actually are - not the ones the internet tells you to panic about.

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Hey,

Did you ever question the conventional two-parent structure?

This week, I suddenly realised I didn’t. I just accepted it.

The heterosexual two-parent family is found in the fairy tales. In the films. In the stories we tell ourselves about what life is supposed to look like. And we absorb it without ever questioning whether it actually works, or whether it’s right for us.

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The narrative we inherited

Divorce rates alone suggest this structure isn’t quite as fool proof as we were promised. Yet we stay glued to the idea of the glitzy wedding with a house purchase, and then the kids. We’ve bought into it without ever really interrogating why - or whether there are other ways.

When you’re a single woman over 40 who wants to be a mother, this narrative becomes a weight. Because somewhere in your programming, you still believe the two-parent household is better. Safer. More stable. The right way.

So you question yourself first, instead of questioning the narrative.

What the research shows

Professor Susan Golombok’s extensive research on single-parent families shows something different: what matters isn’t the shape of the family. It’s the health of the structure. The quality of the relationships. The stability of the home. Whether the child is wanted and well-cared for.

Children in single-parent households thrive when the parent is emotionally available, financially stable, and supported. Not because of the presence or absence of a second adult, but because of the quality of what’s actually there.

Solo mothers aren’t a departure from the ideal. They’re just a different shape of something that works when the foundations are solid.

Create your own storybook version

You might want a partner; but do you actually need one?

What you need is clarity about whether you genuinely want this. You need financial stability - or at least a realistic plan. You need a support network that holds you up. (This is Step 5 in the IVF guide clinics won’t give you.)

And it’s permission to stop comparing your family structure to the fairy tale you were sold. Start building the one that actually works for you instead.

There are solo women over 40 doing this right now. They moved through the doubt, the fear, the guilt about doing it alone. Their children are healthy, thriving and well-balanced. Living in happy homes that don’t look like the storybook version - but feel like home.

Knowing that exists - that it’s actually possible - changes something.

Is life exactly how you imagined it?

The partner might not arrive on schedule. The career might take some detours. The fertility struggle wasn’t in the script.

By the time I got to considering solo motherhood, I’d already let go of half the fairy tale. And I’m relieved I did. The real version is far more exciting.

Travelling around Mexico, I saw this graffiti: “Don’t let your life be the product of a lack of imagination.” It stayed with me. Because solo motherhood is exactly that - choosing to imagine something different.

I didn’t plan this path. But I opted in anyway because being a mother was more important to me than not. And I was right to follow that - because my baby girl is probably the best thing that’s ever happened to me.

Will you mourn the fairy tale, or build something real instead?

You’re solo - but not alone.

Sarah

P.S. The Briefing Room is where we do the groundwork for solo motherhood together. Six weeks, four independent experts - an embryologist, a fertility doctor, a nutritionist, a therapist. Ten calls in total, to build your treatment strategy, so you’re well informed before you spend five figures. Applications are open for the Autumn cohort.

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Hey,

This is the second of the Saturday Letters that free subscribers receive most Saturdays. It’s a note to you, whether you’re wondering what fertility over 40 is about, you’re considering treatment, you’re in the thick of it, or coming out the other side.

Upgrading gets you deeper support. A monthly live Q&A with a hand-picked expert sharing essential insights for women over 40 to guide your fertility journey. Plus access to Substack Chat where you can find other solo women over 40 in a similar position.

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Here’s what happened in my first IVF cycle, at a clinic in Spain.

I was told to test my embryos using PGT-A (a genetic test). The package was chosen for me. There wasn’t any conversation about whether I wanted to. Or explanation of what it meant, what it would cost, or what the legal implications were in Spain.

It was only after the cycle that I learned it’s illegal there to transfer an aneuploid embryo. So when all three embryos came back aneuploid, it felt the decision had already been made for me.

The same doctor then advised I should use a donor egg as casually as if commenting on the weather. It wasn’t a conversation. It was a redirect, offered in the same breath as the bad news.

I was devastated by the IVF outcome. But harder still was the realisation that I’d been processed as a customer, not cared for as a human. All the way along, decisions had been made for me while I nodded along.

The decisions that weren’t yours to make

This happens to a lot of us.

It hits hardest when you’re a solo woman over 40, alone in the consult with no backup. You might be used to managing complexity everywhere else - especially if your job involves considerable responsibility. But in the world of assisted fertility, it's easy to become an obedient bystander, without realising until it's too late, in one of the most important decisions of your life.

This isn’t about becoming a medical expert, or thinking you know better than the doctor. It’s about giving yourself space and agency from the outset, as both the customer and the patient. It’s your money, and your body, and your decisions.

Why “trust your doctor” isn’t enough

“Trust your doctor” sounds sensible until you’re three cycles in, wondering why you trusted them on something they never explained.

I've heard it time and again from women. “I assumed the doctor would tell me.”

Online research tells you about success rates. It doesn’t tell you what’s actually optional, what the clinic’s incentives look like, or that language like “your stats are above average” might be a sales tactic to get you into treatment (and spending). It’s more enticing to invest in a doctor being optimistic, than one giving you the harder reality check.

And nobody tells you you’re allowed to ask. You're allowed to take an active role in your treatment. You're allowed to demand answers before you commit thousands of pounds and months of your life.

The rules are different in assisted conception, and nobody explains them to you.

Preparation is protection

You can’t control the biology. You can’t control the outcome. That’s the grief, and it’s real.

But you can control whether you walk in blind. Knowing what to ask, what’s actually optional, whose interests the clinic serves, is what protects you from the second trauma of feeling exploited or misled, on top of the grief.

Infertility-related trauma is more common than previously recognised, and it’s often compounded by feeling unheard or blindsided. Preparation doesn’t change whether the cycle works. It changes whether you walk away knowing you did everything you could to protect yourself, and whether you knew how to identify the best doctor for you.

This isn’t about the doctor being a miracle worker. It’s about being able to trust they’re doing everything they can, because you can see the decisions being made with you, not for you.

What to ask, before you say yes

Before the cycle starts, ask these and get the answers in writing. “Let’s be optimistic” is not a treatment plan.

One. Ask whether procedures like PGT-A are optional. What are the pros and cons? What’s the legal framework in [insert country]? What does it cost, and what happens if you decline?

Two. Ask for outcomes with your own eggs versus donor eggs, for your specific age and diagnosis, before the cycle starts rather than after it fails. Ask when and why donor eggs would be suggested, and have that conversation upfront, not as a redirect after bad news. As a woman over 40, donor eggs inevitably become a part of the conversation. Preempt it before it’s dropped on you.

Three. Ask what happens if this cycle fails. Ask whether that answer changes if retrieval is cancelled, if no embryos fertilise, or if transfer is postponed.

One more, optional but revealing: ask what the clinic’s most commonly recommended add-ons are, why they recommend them, and who benefits financially.

The control you do have

By my third cycle, I finally understood what had been missing. I went into consultations knowing what to ask, what to prioritise, and what to steer clear of.

And I stopped assuming the doctor would offer the information I didn’t know to request.

The difference wasn’t entirely the clinic. It was that I wasn’t a bystander anymore. I was in the driving seat. I selected my third IVF clinic as a well informed 43-year old woman. I felt certain about investing the rest of my finances with them.

And when I found myself able to try naturally with a known donor, that clinic was supportive of the opportunity.

You can’t guarantee an outcome. But you can guarantee you walked in with your eyes open.

And if the cycle doesn’t work, at least it won’t be because you didn’t know what to ask.

Sarah

P.S. Every other Tuesday, The Tuesday Briefing gives you deeper stories on one element of treatment or the industry: the questions to ask and the one thing you need to know before you commit. Plus a monthly live Q&A with hand-picked experts who specialise in treating women over 40.

One private consultation costs around £250 and gives you one doctor’s time. A year of the Tuesday Briefing costs the same, and gives you twelve expert Q&As plus the frameworks to walk into that consultation ready.

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P.S.S. The outcome of my time with that clinic was quite the plot twist. I paid the deposit; and then conceived a healthy baby via natural conception aged almost 44, with the known donor. (Here’s a timeline of everything I did in the months leading up to pregnancy.)

What actually goes into that number? Why does a standout success rate deserve more scrutiny, not less? And what should you be asking your clinic instead, before you hand over a deposit?

This is a free preview of a Tuesday Briefing, one part of the industry or your treatment plan, unpacked properly, every week for women seeking deeper support.

Upgrade to get the two monthly issues delivered to your inbox (along with other opportunities to get the support you need).

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Find more insights for your fertility journey on the Solo Fertility 40s YouTube and Instagram.

I’ll start with a confession.

I never interrogated my clinic’s success rate. I looked at one clinic in Spain, not several, and the number played almost no part in my decision, because I didn’t know what it meant, and comparing felt impossible.

I was also panicking about my low AMH, worried I’d waited myself out of motherhood hoping Mr Right would appear.

€11,000 later, I understand what I should have asked. If you’ve found yourself hesitating on the headline numbers during your clinic research, or if you’ve wondered if you’re right to trust a shiny website for a clinic found on page 1 of a Google search, you’re right to be cautious.

Here’s why comparing clinics feels so difficult, and why some women eventually stop trying.

Clinics don’t all advertise the same metric. Some quote per embryo transfer; others quote per cycle started. Some report pregnancy rates; others report live birth rates. Time periods differ. Patient populations differ. Nobody flags this when you start looking.

So you try to compare two clinics’ numbers and something feels wrong, but you can’t name what. Eventually, most women abandon the comparison entirely.

What fills the gap?

Perhaps a recommendation from another woman in a fertility forum or a WhatsApp group, a woman who may have an entirely different diagnosis, or different circumstances to yours.

Or a doctor who sounded confident in the consultation, which doubles as a sales pitch, not a clinical assessment. (Profit-making clinics want your business.)

How about a website that looks clean and professional. A clinic within reasonable travelling distance.

You end up making one of the most significant decisions of your life on variables that felt more manageable than the numbers, because the numbers were unmanageable.

At 41, the cost of getting this wrong is higher than it would be at 31. A wrong clinic choice (made on a recommendation that doesn’t apply to you, or a number you couldn’t interrogate) doesn’t just cost money. It costs months.

And months are not a neutral variable when you’re working with your own eggs. A failed cycle at the wrong clinic doesn’t just set you back financially: it delays a timeline that’s already tight.

You don’t have the time or the money to waste on a decision made by default.

Understanding these numbers before you choose isn’t perfectionism. It’s the most efficient thing you can do.

Part 1: The denominator problem

A success rate is a fraction, and everything depends on what goes underneath it.

A rate quoted per embryo transfer counts only the women who got as far as a transfer. Every cancelled cycle, every cycle that produced no usable embryo, disappears from the maths, and past 40, those cycles are common. A rate quoted per cycle started includes them, which is why it’s always the smaller, more honest number.

Same clinic, same year, same patients: two very different percentages, depending on which one marketing preferred.

If a clinic tells you their over-40 success rate is 70%, the only useful response is to ask what they’re actually talking about. What exactly is the denominator?

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Part 2: Whose eggs are in that number?

This is the one that matters most for us, and the one a woman coming in fresh has no reason to suspect: an “over 40” success figure can blend own-egg and donor-egg outcomes.

Donor eggs come from young women, and their results are dramatically better, so a clinic treating plenty of donor-egg patients over 40 can publish an over-40 figure that has very little to do with your chances with your own eggs. This isn’t a fringe practice; some specialists openly acknowledge that headline numbers benefit from it.

The gap is not subtle. In the 2024 HFEA Fertility Trends report, women aged 43–44 using their own eggs had a birth rate of around 8% per embryo transferred, compared with 38% for patients aged 18–34.

With donor eggs, age matters far less, because the embryo's chromosomes reflect the donor's age, not the recipient's. Blend an own-egg population with a donor-egg population into a single "over-40" number, and the figure describes nobody.

What should happen instead? Every clinic should be able to provide patient-specific data: in your age group, their success rate with genetically normal embryos, and separately, their success rate with untested embryos.

If the breakdown exists, you’re allowed to see it. If it doesn’t exist, that tells you something too.

Part 3: Why a standout number is a warning sign

Here’s the perspective shift that would have changed how I read every clinic website.

Reputable clinics mostly perform within a similar band. You’ll see roughly the same success rates everywhere you go, but a huge difference in the quality of the care that’s delivered.

Which means a number that dramatically stands out from the cluster is not a reason to get excited. It’s a reason to ask questions. A standout figure usually reflects how the number was constructed or which patients the clinic accepts: clinics can protect a rate by declining the harder cases, and a woman over 40 with her own eggs is exactly who gets declined.

One prominent London clinic has claimed the UK’s highest success rates for three decades, and to its credit, its headline specifies the stricter measure, per treatment cycle started. But the claim sits beside miracle testimonials with no age-band or own-egg breakdown in sight.

It may be entirely defensible. You just can’t test it from the marketing, only from the clinic’s page on the HFEA register.

Also, the number tells you almost nothing about the thing that will actually vary: what the care is like when your cycle doesn’t go to plan.

What to ask

Here are four questions that cut through the marketing.

Ask for answers in writing, and pay attention to how each clinic responds. A clinic that answers precisely is showing you what the care will be like when things don’t go to plan. A clinic that deflects, generalises, or gets defensive has answered a different question, and answered it clearly.

“What is your live birth rate per cycle started, not per transfer, for women my age, using their own eggs?”

A clear answer gives you a specific figure and explains exactly what it covers. An evasive answer talks about success rates in general terms, or pivots to overall clinic figures without breaking them down by age or egg type.

“Does that figure include donor-egg outcomes?”

A clear answer separates own-egg and donor-egg results without prompting. An evasive answer conflates them, or suggests the question isn’t relevant. It is, especially past 40, where donor-egg outcomes are significantly better and can inflate a headline figure substantially.

“How many women my age did you treat last year with their own eggs, and what was the average number of eggs collected?”

A strong percentage built on a very small patient volume is statistically unreliable: it tells you very little. If the answer is vague, or the volume is low, note it. Clinics with genuine experience treating women your age will be able to answer this directly.

“Who do you decline to treat (with their own eggs), and why?”

This is the question clinics don’t expect. A clinic that protects its success rate by declining harder cases (older women, lower AMH, previous failed cycles) will publish strong numbers that may have nothing to do with your situation. A clinic that answers this question directly is showing you something important about how it actually operates.

In the UK, verify published figures against the clinic’s page on the HFEA website rather than relying on the clinic’s own marketing. In other countries, ask who audits or verifies the numbers: in some jurisdictions, the honest answer is nobody.

Outside the UK, the picture varies considerably. In some countries, clinics report their own figures to professional bodies, with no independent verification. If you’re considering treatment abroad, it’s worth asking not just what the number is, but who collected it.

Who the number is really for

The success rate was never information about you. It’s marketing about them. The information about you comes from the questions they’re hoping you won’t ask. Part of the industry’s advantage is that patients don’t know what to ask.

After this briefing, you do.

Sarah

P.S. If you want this level of preparation behind every decision, not just this one, The Briefing Room Programme opens this Autumn: six weeks to build your bespoke treatment strategy before you spend a penny on treatment, with four independent expert sessions - an embryologist, a fertility doctor, a nutritionist, a therapist - all focused on women over 40. Applications are now open. Built for solo women over 40 who don’t have time or money to waste.

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Hey,

Things are changing a little around here. This is the first of the Saturday Letters which is what free subscribers receive most Saturdays. It’s a note to you, whether you’re wondering what fertility over 40 is about, you’re considering treatment, you’re in the thick of it, or coming out the other side.

Upgrading gets you deeper support. A monthly live Q&A with a hand-picked expert sharing essential insights for women over 40 to guide your fertility journey. Plus access to Substack Chat where you can find other solo women over 40 and quickly crowdsource the information you need.

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Today is World IVF Day - 48 years since the birth of Louise Brown, the first IVF baby. Last year I marked it by imagining the industry of 2072, where a woman over 40 is offered a guide to map out her strategy for treatment, not a sales funnel looking to get you through the doors as quickly as possible.

Today, the industry will be celebrating how far it’s come. Here’s how far it hasn’t.

Three weeks ago, at an awards gala in a London gallery, the European Fertility Society handed out its annual Fertility Care Awards during the congress of the European Society of Human Reproduction and Embryology, the industry’s biggest gathering. Best fertility doctor - awarded. Best embryologist - awarded. Best holistic clinic, best podcast, best social media channel - all awarded.

And in three categories, the jury gave no award at all. One of them: Best Patient Care & Support, for clinics.

In the year of AI embryo selection, time-lapse incubators and genetic screening that would have sounded like science fiction when Louise Brown was born, the industry’s own judges looked at the entries and couldn’t find one clinic whose patient care met the bar.

I’ll give the jury credit for withholding it rather than pretending. But if you’ve been through treatment and felt the care gap first-hand, you didn’t need a gala to tell you. The science is extraordinary. The care is where it falls apart - and I say that as someone who changed clinics twice looking for it.

For women like us - solo and over 40 - this has three consequences.

One: we’re still invisible - but I’m changing that. The system was designed for heterosexual couples in their thirties. Everyone else has been a gradual inclusion as the industry notes where there are profits to be found. Although my first clinic claims an expertise for handling “complex” cases, with a reputation built on decades of experience - they didn’t know how to handle a solo 43-year-old with no known fertility issues who had simply never tried before. I wasn’t complex. I was just older. Their solution? “Use donor eggs.”

There isn’t even a name for this cohort, so I’ve started using one: the SM40s. Solo mothers over 40 - and the women on their way to becoming them.

Two: the support has to come from you, arranged before you start. If clinics were winning awards for patient care and support, you could lean on them for the hard days. They aren’t. So your support system - the friend who knows your appointment dates, the women ahead of you on the road, the professional in your corner - has to be built before the first scan, not improvised after the first bad news when you’re in shock. It’s why creating your support network - a constellation of care - is step 5 of the Roadmap, not an afterthought.

Three: you have to learn the system you’re about to invest in. Not because you should have to - but because it’s unlikely anyone in the industry is going to show you the ropes. How clinics make their money, how success rates get presented, what a good answer to a hard question sounds like. Understanding the industry before you hand it thousands is step 1 of the Roadmap for a reason: every decision after it gets easier.

None of this is fair. And I’d love to tell you the system will change - but this is an industry churning out billions, and asking it to reform itself is a long shot you’d be betting your forties on. Far better to know exactly what you’re walking into, and to put in place the foundations you’ll need to hold yourself up. Past 40, when you’re solo, there’s no time to wait for an industry that has little incentive to change.

But good clinics, doctors who care, do exist. I hear about them from the women reading this across 37 countries, as much as I hear about the heart-breaking experiences. It’s just that finding the right one is a needle in a haystack affair. And that’s work most solo women over 40 don’t have time to absorb in addition to jobs that likely demand significant responsibility.

Happy World IVF Day. Here's to the science - and to closing the gap it left behind.

Sarah

P.S. The Tuesday Briefing exists because the care gap is real. Every other Tuesday, you get a deep dive on one element of navigating the fertility industry or planning your treatment - guidance for your exact case as an SM40 - plus a live Q&A every month with an expert skilled at working with women our age.

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Hey readers,

You’ve probably seen Anne Hathaway in a gorgeous flowing blue dress at ‘The Odyssey’ London Premiere, blooming during her third pregnancy, now aged 43. It was something I had to write about.

What do you think about all these celebs in the headlines lately for forty-something pregnancies?

Find more insights for your fertility journey on the Solo Fertility 40s YouTube and Instagram.

Anne Hathaway announced her pregnancy in June aged 43. And Anne has done something rare for a celebrity in her position: she has been honest. She told US chat show host Seth Meyers they were shocked it worked - that they knew what they were doing but didn’t really expect it to happen. She deserves credit for her honesty.

The wider cultural moment around her announcement is real too. Forties motherhood is being talked about more openly than it ever has been. Celebrities are announcing pregnancies later. Women are writing about it without apology. Something has genuinely shifted in the tone of the conversation — having a baby in your forties is no longer treated as something to explain or justify.

That shift is good. But if you are a solo woman in your forties, watching it from the outside, the distance between that celebration and where you actually are can feel challenging to absorb.

What the headlines are not telling you

Anne Hathaway has two sons. She is in a long marriage. The shock she described — we were shocked it worked — was a happy one, absorbed in a life that already had two children and a partner in it.

That is not the same situation as a solo woman at 43 who has never been pregnant, has no partner to try naturally with, may never have tried before so her fertility is unknown, and is looking at IVF as her primary route in. And the data makes that difference stark.

Natural conception at 43 carries roughly a 2% chance of pregnancy per cycle. ((Source: American Society for Reproductive Medicine — asrm.org). That figure already accounts for why some women in their forties conceive with a partner and are genuinely surprised — the odds per cycle are low, but across months of trying, some will get there.

A solo woman does not have that option. She cannot try naturally month after month with a partner. Her route, if she is using her own eggs, is almost certainly IVF — and IVF at 43 and 44, according to the HFEA, carries a 8% pregnancy rate per embryo transferred. (Source) That means for every 100 embryo transfers at this age, 8 result in a baby being born. Miscarriage rates rise sharply with age, and chromosomal abnormalities become more common. The headline number a clinic quotes is rarely the one that matters most.

Those are not the same odds as natural conception across twelve months of trying. They are the odds per cycle of stimulation, retrieval, and transfer — a process that costs thousands of pounds and takes a significant physical and emotional toll each time.

This is the statistical gap inside the cultural moment. The women conceiving naturally in their forties with a partner are not in the same biological story as the solo woman doing IVF on her own income, in a clinic she researched herself, flying to appointments alone. Both are having babies in their forties. The experience, the odds, and the cost are clearly entirely different.

But the cultural moment does point to something real — women's bodies are capable of more in their forties than medicine once assume. That is worth keeping in mind, even as you go in with a clear picture of what you're actually facing.

The version that’s true for solo women

The women I hear from most are not extending families. They are trying to start one — from scratch, alone, often after years of hoping the right person would appear and realising, gradually then all at once, that waiting was no longer an option.

Some women have come out of relationships that ended too late. Some have frozen eggs they are now trying to work out how to afford to use. Some have spent years dating — open to it, trying, genuinely hopeful — and been let down repeatedly, not by any lack of desire for partnership but by the consistent failure of the men they met to be ready for either fatherhood or a real relationship. Time ran out on a life they had not chosen to live alone.

For these women, the cultural celebration of forties motherhood can feel like noise from a party they were not quite invited to.

I was one of them. IVF failed me twice at 43. I was advised to consider donor eggs on the basis of my age alone — with no other conversation about what that recommendation was actually based on. The confusion and lack of information is why Solo Fertility 40s exists.

What the system does not make easy

A 2026 study published in Human Reproduction, drawing on 590 fertility patients across the UK and Ireland, found that 41% met clinical criteria for PTSD or Complex PTSD by the time treatment was over. Sixty-one percent said the care they received made their distress worse. (Source: Human Reproduction, Oxford Academic, March 2026)

For solo women, who may not have someone at home to help them process the stress of it all, those numbers are particularly devastating. Every piece of difficult news, every failed cycle, every appointment all falls on one person to manage.

The cultural moment will keep moving. More announcements will come. More women will write, with full justification, about the joy of later motherhood. Some of that will be useful and true and worth reading. But inside all of it, there are women for whom this is not yet a moment of celebration. Many of them are in the Solo Fertility 40s community - where you are solo, but not alone.

If you want more than information — Solo Fertility 40s gives you access to fertility experts skilled at treating women over 40, in monthly live Q&As, plus a community of women who understand exactly where you are, and guidance built specifically for solo women over 40.

The packages are designed to be as affordable as possible. The idea is simple: get the guidance you need from the right experts for women your age, so that when you do pay for a private consultation, it’s because you really need to.

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Hey readers,

This time two years ago, I was coming out the other side of my first IVF cycle at a clinic in Spain. Alone, and wondering what had just happened. That’s what I’m writing about today.

Find more insights for your fertility journey on the Solo Fertility 40s YouTube and Instagram.

It was July 2024

The call was scheduled for 11am. By 12.15pm the phone still hadn’t rung. I had to email and phone the clinic. When the call finally came, I was shaking.

“All three of your embryos are aneuploid. Not compatible with life, according to PGT-A. The best option for you is donor eggs.”

The doctor explained, briefly, why they couldn’t lead to a successful pregnancy. My mind was whirring and I felt sick. I managed to ask whether diet or supplements might improve egg quality for another round with my own eggs. I don’t remember his exact words. It just seemed that he had already moved on.

That cycle cost me €11,000. I was processed like a number by a clinic I thought I’d chosen carefully.

The question I’d asked weeks earlier

Weeks before, I’d asked my doctor what seemed to me a reasonable question. “What’s Plan B? Can we make a treatment plan?”

His answer: “Let’s be optimistic.”

Let’s be optimistic is not a treatment plan. It felt like being patted on the head — and I accepted it. That was the moment I should have paid attention to.

Optimism can be a way of not answering

Here is the position you’re in when you do this solo, past 40: the doctor holds all the information, and you hold all the risk. How much information they choose to share with you is another matter. You’re left trying to work through appointments, decisions and invoices - alone - while assuming that your doctor is always working in your best interests.

When you’re scared and uncertain, optimism from a doctor feels like kindness. Sometimes it is kindness. It can also be a way of not answering the question.

What the research can’t tell you

I did what most women in my position do. I researched the clinic — success rates, patient reviews, years of experience, a polished website. None of it reveals how a doctor answers a direct question.

Clinics get vetted. Doctors rarely are. One woman’s glowing experience tells you very little, because every doctor within a clinic is different, and IVF is closer to an art than a science — the same woman could be offered two entirely different approaches by two doctors in the same building.

There were red flags from the outset — that answer was one of them. But I didn’t know what a red flag looked like. I just thought he was being positive.

What I’d ask now

Asking the question is half of it. Waiting for a sensible answer is the other half.

• Can we make a written plan, including what happens if this cycle fails?

• Who calls me with results, and when?

• Donor eggs are not an option for me. Is my position on that understood and respected here?

The test isn’t whether the doctor tolerates your questions. It’s whether they answer them. A doctor who deflects a planning question at the outset is showing you exactly how he’ll handle bad news.

After the call

I came off that phone devastated by the news and numb from what came with it: the suggestion that my own eggs were unusable, and my best option for a baby was another woman’s egg.

I was alone. Nobody in my life knew what I was going through that day. So I turned to the fertility socials — a few women I’d connected with and never met.

Nine months after that first suggestion to use a donor egg — the next doctor recommended it too — I became pregnant with my own egg. Naturally conceived, with a known donor.

You’re solo — but not alone.

Sarah

PS. The 5-Step Roadmap exists so your first cycle doesn’t cost you €11,000 and the anguish mine did. Steps 3 and 4 cover choosing the clinic and managing the consultation.

Solo Fertility 40s is independent guidance for solo women over 40 navigating fertility treatment — built from lived experience, not sales targets.

Happy Friday.

After my second failed IVF cycle in 2024, I was again told to use a donor egg. My 43-year old eggs weren’t proving a success. Plus with a negligible AMH, the numbers were not on my side. At 43, the birth rate for women aged 43–44 using their own eggs is 5% per embryo transferred.(HFEA)

So I went to Goa, my winter home, to slowly piece myself back together — rebuilding my health, and, more than that, rebuilding my relationship with my own body after it felt as though two doctors had written it off. Part of that came from reading about the egg’s role in conception, and discovering how far it is from the passive bystander we’ve been told to believe. Four months later, against the odds I’d been given, I became pregnant (via a known donor).

I don’t know why that pregnancy happened and I won’t pretend that reading about egg biology caused it. We never know what specific factors spark conception. What the insights changed was how I saw myself — it gave me back a sense of my body as capable.

Which brings me to today’s piece: an extract from Milli Hill’s fifth book, The Body Myth, out July 16th. It exposes the stories we’ve been told about the female body — declared defective, pathologised, controlled — and replaces them with a different narrative: that women are powerful and whole exactly as we are. The section below, on the egg, is what changed my thinking.

You can pre-order the book with a 40% discount.

Over to Milli.

‘She shall be called Woman, because she was taken out of Man.’ Genesis 2: 23

One way of sending out little pew-pew-pews is by simply writing a narrative in which the most powerful type of person is male and then making sure that narrative is spread far and wide. There’s a meme that does the rounds on social media of a woman holding a placard at a feminist protest that reads: ‘I didn’t come from your rib, you came from my vagina.’ It’s funny because it’s a reversal of the biggest lie ever told: the two largest world religions, Christianity and Islam, both teach that Eve was made by a male God out of Adam’s rib. The idea that the first woman was born from a man’s body is obviously the complete opposite of what we all know to be reality, but it’s certainly an effective way of setting out the stall of patriarchy and positioning men as the ones with the most important power of all – the power to create.

Even when Eve does give birth to her first child later in the book of Genesis, the Bible tells us she says, ‘With the help of the Lord I have brought forth a man.’ This Eve – to blame for temptation, sin and the Fall from paradise, and condemned to be ‘ruled over’ by her husband and experience painful childbirth – has definitely got things off to a terrible start for the Sisterhood. And her story, still told to little boys and girls around the world today, reinforces the idea of ‘Woman’ as weak, secondary, powerless and culpable. How many little girls who hear it must feel that, given the choice, they would rather be Adam?

The idea that the power of creation belongs to men is by no means confined to religion. Another story you may well have learned in school is that of the heroic sperm’s epic journey or ‘race’ to fertilise the egg. In fact, if you go on to Google right now and do an image search for ‘cartoon sperm and egg’, you will find illustrations of this, perhaps reminiscent of your teenage biology lessons: the egg is depicted wearing lipstick, perhaps with a flower in her hair, batting long eyelashes and gazing coyly at the sperm, who is shown flexing his biceps, wearing cowboy hats or superhero capes, and looking cool in sunglasses. The sperm is ‘active’ – he will get the prize of the egg if he is the strongest and fittest and wins the race, while the egg is passive, and simply waits for her hero to arrive. Just like Eve, the egg is a character that ‘things happen to’; she is a supporting actor in the story. Creation is not her business.

This story – of action-hero sperm and passive egg – illustrates brilliantly how the patriarchal desire to claim the territory of creation is written into our understanding of our very biology. In fact, anthropologist Emily Martin was the first to recognise how, linguistically at least, our conception story betrays our social assumptions about gender roles, in her 1991 essay The Egg and the Sperm: How Science Has Constructed a Romance Based on Stereotypical Male-Female Roles.

Now, thanks to recent advances in understanding, science has caught up with Martin’s critique: the egg is not passive at all. She has her own journey – and if we want to create a narrative of winners and losers (which, arguably, is also quite patriarchal), then she is also a winner. The female ovaries contain little sacs, called follicles, where there are always eggs in different stages of development. Each month, around ten of these follicles start to get bigger and stronger, and if you wanted to frame the story this way, you could think of this as a competition – which follicle will become dominant and release the winning egg?

Imagine them all, wearing sunglasses and vest tops and pumping barbells in their little training follicles, and then, suddenly, one of them triumphs, and with one last flex of her biceps, pops out of her follicle and is taken up by the fallopian tube. The fallopian tube, by the way, is another part of female reproductive anatomy that ‘does stuff’ – rather than just being a highway from the ovary to the uterus, the fallopian tube has ‘fimbriae’, finger-like projections that catch the egg as it is released.How do they do this? They are lined with hair-like structures called cilia and, at ovulation, they move in closer to the ovary and beat the cilia in rapid motion, sweeping up the egg into your fallopian tubes. Which, as you might recall, are named after a man – sixteenth century Italian anatomist Gabriele Falloppio.

The egg could be thought of, then, a bit like the sperm, as active and strong, as a winner. OK, OK, I hear you say, but once she’s in the fallopian tube, she waits for her hero, right? Not so. Without the egg, the sperm would, quite literally, be lost – because it’s progesterone, released by ovarian cells, that stimulates the sperm and attracts them towards the egg. This chemical signal from the egg causes sperm to be ‘hypermotile’ – stronger and wrigglier and, basically, better swimmers. Without this, sperm would lack the strength to reach and fertilise the egg.

And there’s more: scientists are now beginning to understand that the egg may actually play an active role in choosing which sperm to attract. In a process known as ‘cryptic female choice’, the egg’s follicular fluid gives off chemical signals that can influence which sperm are selected and therefore able to reach them. In a study on mice, it was shown that the eggs showed a preference for sperm from less-related males. In humans, studies have shown that different eggs will have different preferences, with some eggs being better at attracting sperm from one male, while a different egg from a different female was better at attracting sperm from a different male. All of these relatively recent discoveries about the role of the egg have surprised scientists. Professor Daniel Bryson, the senior author of the 2020 study that showed this microscopic selection process, said, ‘The idea that eggs are choosing sperm is really novel in human fertility.’

This novelty may at least in part be down to the male-centred narrative that humans have for so long superimposed: even at a cellular level, we have assumed the male is more active, dynamic and powerful. And it’s not just the egg that plays a part in conception – the female body works in a variety of ways to ensure that only one sperm cell with intact DNA makes it to the egg. The vaginal fluids, which if you’re female you may have observed are more slippery and stretchy around ovulation time, become thinner, less acidic, and also greatly increase in volume – you’ll produce around ten times as much fluid on fertile days as on other days of your cycle – all allowing sperm to move better and live longer in the vagina. But your vaginal fluid can be hostile to sperm, too – in a similar way to the egg’s follicular fluid, it will also filter out sperm that have a closer genetic profile to your own. Your cervix may then play a role in selecting the fittest sperm: it contains tiny grooves which the sperm swim up, and those with abnormal shapes don’t travel through the grooves as easily, getting flushed back out by the vaginal fluid.

And, if and when a sperm does make it past the mighty egg’s rigorous selection process, then she has a few finishing tricks – including initiating a reaction in the head of the sperm to allow it to fuse with her outer matrix, known as the ‘zona pellucida’, which it does by gently ‘spooning’ with her, according to developmental biologist Scott Gilbert – a process of ‘melting together’, rather than the violent penetration that is often described. Once this has happened, the egg then quickly pulls up the drawbridge, so to speak, by changing the structure of the zona pellucida so that no further sperm can gain access.

Every story you are told about the female body, even if it’s presented as ‘science’, bears further scrutiny. Even as I’ve researched the last few paragraphs, I’ve had to search extensively to discover more about the female role in conception, with so many articles and pieces of research written with the sperm always playing the protagonist and the egg barely getting any of the lines.

Further reading:

• The Body Myth Tour

• The Royal Society Publishing - Chemical signals from eggs facilitate cryptic female choice in humans (June 2020)

The annual fertility jamboree - the European Society of Human Reproduction and Embryology (ESHRE) - has kicked off in London. As I type, the world's fertility bigwigs are strutting their science stuff and greasing the wheels of a fertility industry valued at roughly the size of the Swiss watch export market.

I couldn’t be at ESHRE so I’ve browsed the programme and cast my non-medical eye over the bits relevant to women over 40.

Looking to get started with treatment but have no idea what to do? You’ll want this Roadmap created specifically for solo women over 40.

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If you're 40-something and looking to grow your family, here’s what is likely keeping you awake at night: gauging your egg quality, a low anti-müllerian hormone (AMH) result, whether your uterine lining is thick enough to hold a pregnancy even if fertilisation works, how many of your eggs will actually reach blastocyst, and the maths of how many cycles you can afford to try before the money or the time runs out.

It’s these challenges that the world’s fertility scientists will be discussing over the next few days at ESHRE. If it feels like too much detail - I get it. But I also know many women have to become medical researchers on their path to solo motherhood.

It’s not only scientists in the building. Rooms will also be humming with sales and marketing teams. This is a genuinely enormous industry — the global IVF market is valued at roughly $31 billion in 2026, in the same range as Swiss watch exports, which reached CHF 25.9 billion in 2024. An industry that size determines the hopes of millions of people trying to have a family.

I wasn’t planning to write about a conference I’m not attending. But the deeper I went into the programme, the clearer it became that the innovations actually relevant to women like us are thin on the ground.

Here are this year’s ESHRE sessions worth knowing about.

Low ovarian response.

This session covers what happens clinically when stimulation produces very few eggs, which is disproportionately something older patients face rather than a rare exception. It’s relevant now because it concerns most of us. It matters longer-term because the protocols being tested here will inform future protocols that better treat older women starting treatment with a smaller reserve.

Reproductive ageing,

This is a rare session where age is the entire subject rather than a footnote buried inside someone else’s data. What gets discussed here shapes how ageing itself gets modelled and explained to patients, which has a direct line to how a woman ten years from now will be told what her own numbers mean.

AMH testing: pathway to empowerment or cause for confusion.

This session asks directly whether a test handed to nearly every woman entering treatment actually helps her, or just causes confusion. As a reminder, it was getting my low AMH that caused me to panic, invest in the wrong clinic and then allow myself to be rushed into treatment.

Some doctors are helping to educate on the real meaning of a low AMH. Here’s Dr Victor of Victory Reproductive Care bringing clarity to the confusion. Check my Youtube for more insightful videos for women over 40.

Nicotinamide mononucleotide and poor-prognosis eggs.

A Spanish team gave this NAD+ precursor to immature eggs from women aged 37 to 45 and saw better maturation rates, though not better chromosomal health. It’s early lab work, nothing offered in any clinic yet.

It’s encouraging to see an older woman’s eggs being scrutinised. Findings like this are usually the first step before anything built from them reaches a clinic.

The effort in fertility innovation splits into two directions, and both speak to the problem sitting underneath a low AMH.

There’s everything upstream, before an egg is even retrieved, where the ageing and low-response research above lives, alongside in-vitro maturation, the approach Gameto is building around: growing eggs to readiness outside the body instead of putting a woman through weeks of stimulation injections. It isn’t proven yet for our age group specifically. But the possibility that the injections themselves might one day be optional rather than mandatory is worth watching closely, given how much of a physical burden this can feel for some women. (Like me, with a needle phobia.)

Then there’s everything downstream, once eggs are retrieved and an embryo exists, the work of actually reading an embryo’s health and identifying the one most likely to hold. This is where AI has made real, measurable progress: tools reading egg quality from a single image, others assessing embryo development without a biopsy, taking some of the guesswork out of a process that used to rest entirely on one embryologist’s trained eye.

For a woman with a healthy reserve and eggs to spare, better egg and embryo assessment is a helpful refinement, but she has enough eggs that a less accurate call can still be absorbed by trying again. For a woman with only a handful of eggs to work with, there's no room for that kind of error. Every embryo matters, and getting the assessment right the first time can be the difference between succeeding on this cycle and needing three or four more. That's exactly the group a low AMH result points to — women with fewer eggs, who have the least margin for the system to get it wrong.

That distinction carries even more weight when you’re doing this alone. There’s no shared cost, no partner’s income absorbing a failed cycle and no emotional support for what can become a long gruelling process. Every increment of precision, every tool that improves the odds a single retrieval succeeds, isn’t a luxury. It’s the difference between one cycle you can afford and the three or four you can’t, now and for the woman starting this in 2036 with a body of research that we’re only watching take shape.

Improving outcomes for older women

I’ve been watching these two fertility companies and the potential of their solutions to boost success rates for older women. They’re both at ESHRE.

Gameto is working on the possibility that in-vitro maturation could one day mean fewer injections and less physical toll for an older body already carrying enough.

Future Fertility is the company behind VIOLET, an AI tool reading egg quality from a single image rather than another invasive test, alongside a second tool assessing maturation the same way.

Aside from named companies, the research itself is moving somewhere worth watching too. A review published last year looked at whether the fluid an embryo has been sitting in, rather than the embryo itself, can reveal whether its chromosomes are healthy, without a biopsy needed at all. It’s still early, and not something offered in clinics yet. But it points at the same instinct running through everything here: get more information from what a woman already has, rather than asking her body, or her embryo, for more than either can give.

The 5-Step Get Started Roadmap

None of this changes the fact that whatever the science eventually delivers, you're the one living through the waiting, the injections, the appointments squeezed around work, largely on your own.

A clinic can hand you excellent medicine and still leave you without anyone to call after a difficult scan. That gap is exactly why building a support system - your constellation of care - has it’s own step in the 5-Step Roadmap, rather than an afterthought tacked onto the medical planning.

Who you tell, who you lean on, who shows up when a cycle doesn't work deserves the same deliberate planning as choosing a clinic or budgeting for a second round. If you haven't mapped that part out yet, the Roadmap walks through how.

Get your Roadmap

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Find more insights for your fertility journey on the Solo Fertility 40s YouTube and Instagram.

She’s well-educated, in a long-term relationship, and she wants children one day. She’s just not ready yet. She has almost no savings.

I didn’t want to alarm my cousin. But I also didn’t want to stay quiet, because I know what it costs — financially, physically, emotionally — to postpone family-building until later than you needed to.

Some of the data in the recently launched 2024 HFEA Trends Report red flagged what I wanted to say to her. If you know a woman in the cohort behind ours - a decade or so younger - share this story with them.

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The women getting the message — but possibly not the full picture

According to the HFEA’s 2024 Trends Report, the number of women freezing their eggs has increased from around 700 in 2014 to 5,580 in 2024. Women in their 30s are clearly getting the message not to delay. That is genuinely good.

What I’m less sure about is whether they’re getting the full picture.

Egg freezing is sold — and it is sold, by private clinics whose business model depends on it — as a way of “preserving your fertility”. This is the most widely used phrase. It implies you're locking something in place. But more accurately, you cannot preserve fertility. What you can do is freeze eggs at the quality they are today, store them, and hope that if you need them in the future, enough of them survive the thaw, fertilise, and result in a viable embryo. That is a very different thing from a guarantee.

The number of eggs you need to freeze to have a reasonable chance of a live birth is typically higher than most women are told upfront. It may require multiple cycles. And the success rate depends heavily on the age at which you froze — which is why doing it at 30 is meaningfully different from doing it at 37. Clinics are not always forthcoming about this because their incentive is to get you through the door, not to give you a number that might put you off coming back.

None of this means egg freezing is the wrong decision. For many women it is exactly the right one. It means going in with eyes open — asking how many eggs you’re likely to retrieve per cycle, how many cycles you may need, and what the realistic success rates are at your age and with your ovarian reserve. Clinic add-ons, medications, and storage fees add up fast. If you don’t have savings, that conversation needs to happen before you commit to anything.

Women in their late 40s distorting biological reality

My cousin probably doesn’t know about the use of donor eggs to grow her family. So this was a big flag.

There are women — some of them well-known — who have announced pregnancies in their late 40s without commenting on how those pregnancies were achieved. Whether that’s a private decision or a deliberate omission, the effect is the same: younger women see it and conclude that getting pregnant with their own eggs, at 47 or 48, is a realistic possibility.

I’ve written about this before, and I won’t repeat all of it here. But the data is worth stating plainly. According to the HFEA, the birth rate per embryo transferred for women aged 43–44 using their own eggs was 8% in 2024. For women aged 40–42, it was 18%. These are not numbers that support leaving it until your late 40s and hoping for the best.

Donor eggs change that picture significantly. But that is a different treatment, a different cost, and a different decision — one that involves using another woman’s eggs to conceive. It is not the same as getting pregnant naturally at 47. When that’s not explained, it means younger women are misinformed about how much time they have left to use their own eggs.

I am not saying every late pregnancy involves donor eggs. I am saying that when it goes unacknowledged, younger women are left to draw their own conclusions from incomplete information.

Even if you’re with a partner, your fertility is still only yours

This one is for my cousin specifically, but it applies more broadly than she might expect.

Fertility starts declining from around 35 in the shape of a ski hill, according to Canadian fertility physician Dr Victory. Getting pregnant at almost 44, as I did, is possible but I wouldn’t hold it up as a reason to wait. I conceived on the first ovulation cycle I attempted, with a known donor, after IVF had failed, twice — but I had also been told twice by doctors that I should use a donor egg. My anti-müllerian hormone (AMH) was 2.2 pmol/L when it was measured in April 2024. That’s very low. A year later, I became pregnant.

I shared this because I wanted to remind her that a number (the AMH) is not a verdict. What I would not do is use my story as a reason to leave things to chance.

Being in a relationship doesn’t protect you from any of this. Relationships change. People change. The fertility you have at 30 is yours — not yours and your partner’s. And whatever happens over the next ten years, the eggs you have today are the youngest they will ever be.

That is not a reason to panic. It is a reason to get informed, to understand what your options actually are right now, and to make a decision based on what you know — not on what you’ve assumed, or on what you’ve seen someone else announce on Instagram.

Not medical advice. For clinical questions, speak to your doctor or a specialist.

Solo Fertility 40s is independent guidance for solo women over 40 considering or embarking on solo motherhood. It doesn’t have any clinic affiliations or commercial ties.

This newsletter takes hours to research, write, and publish. Here are ways to support my work:

1. Leave a comment on the story

2. Subscribe

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The next virtual gathering is coming up on the first Wednesday of the month.

Wednesday 1st July at 7pm BST is an hour to be together and share as much or little about where you are in the process - thinking about it, in treatment, coming out the other side…You’re all welcome. We have cameras on for safety and inclusivity.

Reserve your place

Hi from a sweltering UK which as you can probably guess, has inspired today’s subject line! We celebrated my daughter’s 6 months this week. I am feeling a bit proud of myself that we have made it this far and that we are thriving.

My initial fears about solo mothering were valid. I know why they existed. But you manage because you just have to. And you’re rewarded for it by being their world. Now I see that this is the way it was meant to be for me.

It’s also two years ago that I was gearing up for my first IVF cycle in Spain. I was feeling very alone, totally overwhelmed and panicking because of my low Anti-Müllerian hormone (AMH) result. The memories of it are still so vivid. I’m reflecting on this today.

Find more insights for your fertility journey on the Solo Fertility 40s YouTube and Instagram.

At the very beginning.

I knew the alarmingly low stats for women aged 43-44, using their own eggs: 5% chance of a live birth. (HFEA)

But I secretly hoped I was an outlier. I had a regular cycle and a healthy BMI. I just didn’t know how to gauge my fertility because as a solo woman, I’d never tried to get pregnant. As for being treated abroad - I’m a confident solo traveller, surely I’d be fine flying alone for treatment?

The overwhelm and confusion started early in the process.

I got the most expensive parcel in the post I’d ever handled: it was my IVF medication. There was so much of it. What was it for? My clinic wasn’t going to explain. A lifelong needle phobia made the injections extremely challenging. I had to lie down and look the other way. Instagram influencers sponsored by clinics would like you to believe it’s no big deal. Well, it was for me.

Arriving at the clinic for the first meeting and scan with the doctor, I was pumped up on hormones and frayed with poor sleep. More clinic disorganisation and mismanagement worsened my stress levels.

This was far from ‘popping to Europe for a holiday’ that clinic marketing encourages you to buy into. I didn’t care about the plane food or what the weather would be like. I was too busy worrying about my eggs growing and whether I’d ever hold a heartbeat in my arms.

And I felt totally and utterly alone.

I thought the problems I was encountering were partly bad luck, partly mine to solve. Then I realised: the majority of the problems were actually structural.

The industry has had decades to build a starting point for you. It hasn’t.

Getting started with IVF looks, from the outside, like it should be manageable. You assume it will get clearer once you start doing the research. Actually it all gets more confusing.

We are talking about a global industry worth tens of billions of dollars. The industry has existed for decades and it has not — at any point — created a proper guide for the women entering it for the first time.

There is no reliable, independent starting point. That is not an accident. It is a business model.

The fertility industry’s incentive is to get you into treatment. Not to help you prepare for it or to help you choose the right clinic. Clinics on page 1 of a Google search are not a representation of excellence - they’re a reflection of a clinic’s marketing budget.

A clinic has no incentive to make sure you understand your test results. If you’re over 40, expect some clinics to use your low AMH to create urgency. Getting you through the door and into a cycle is where the revenue is. Any guide they produce is, at some level, a sales document. Which is exactly why information that comes from inside the commercial system should be handled with care.

Navigating a system without essential medical information, and changing clinics.

I know this because I was 43 and panicking about being late to all of it.

So I went straight to the first clinic a friend recommended in Spain without doing any real due diligence. Unsurprisingly, they were happy to take my money. What they weren’t interested in doing was educating me — including on the fact that my AMH of 0.31 ng/mL could also be read as 2.2 pmol/L in a different unit of measurement. That’s not a minor detail. It changes the picture entirely. I didn’t know and nobody told me. When the cycle failed, the doctor recommended donor eggs due to my age.

The next clinic came via another recommendation — an independent doctor in Greece. He didn’t personalise my treatment, ignored my complaints that I felt unwell, and recommended I use donor eggs, due to my age.

So I changed clinics a third time. Exhausting.

The third time, I found EmbryoLab in Greece. It felt more rigorous and professional. By now, £15k down, I had a clearer idea of what questions to ask. I was even more anxious about time and money. I was frustrated with myself for not being more thorough upfront. But the process is disorientating and you’re typically navigating it alone. Uncertainty at every turn when you’re gambling thousands and your dreams of motherhood is perhaps the most crushing sensation I have ever experienced.

The panic is real. Clinics know how to use it.

Low AMH is the number that tends to send women spiralling. You get your results, the number is lower than you hoped, and suddenly a clinic is telling you that you need to move quickly. Start now. There’s no time to wait!

And so you do. The urgency feels real and there is no one standing next to you telling you to slow down and think. Some of that urgency is legitimate. Time does matter at this age. But it’s worth asking who benefits most from your panic: a clinic that needs you to commit before you’ve had time to do proper due diligence, or you?

What gets skipped in that rush is often the preparation that happens before the clinic ever gets involved. Nutritional optimisation is one example — a specialism that most fertility doctors simply aren’t trained in, because it sits outside standard fertility care.

So when a cycle doesn’t work and the explanation offered is simply your age, it can be genuinely difficult to know whether that’s the full story. It might be but it might not be. A clinic with a vested interest in your next cycle is not always the most disinterested person to ask.

You’re doing the work of a full research team. Alone.

If you’re solo and over 40, you are almost certainly carrying all of this by yourself. Both emotionally and the actual labour.

You’re building spreadsheets of clinic prices across multiple countries, reading research papers at midnight, trying to understand what your numbers mean for someone your age specifically — not for the average participant in a study that probably didn’t include you. All of this while holding down a career that likely involves significant responsibility.

There is nobody to share the cognitive load with. Nobody to split the research, sanity-check a decision, sit in a waiting room, or just say: I know. This is a lot.

Most communities that exist for this are either US-centric, focused on younger women, or start mid-treatment — at the point where you’re already in it, rather than the point where you’re trying to figure out whether and how to begin. The early stages — that overwhelming period of researching, not knowing what you don’t know, trying to work out who to trust — are almost completely unaddressed.

This is not a story about one woman's bad experience. It is a description of what solo fertility treatment over forty actually looks like from the inside. *A 2026 study found that 61% of fertility patients said the care they received made their distress worse. This isn't surprising in a system that has yet to acknowledge that women are more than a pair of ovaries and a uterus. Clinics able to design their treatment around caring for the whole woman are the ones that deserve your money.

*Published March 2026, co-produced with Fertility Network UK, 590 participants across the UK and Ireland.

This is the gap SF40s exists to fill.

In June 2024, I needed this space to exist and it didn’t. My difficult experiences with clinics, and those relayed by other women, are what SF40s is built on.

If you’re at the beginning of this and you want a structured way through it, the Briefing Room Programme is for you.

The Briefing Room Programme

It’s for solo women over 40 who want to go into treatment prepared rather than panicked. It covers clinic selection, understanding your results, financial planning, and the emotional reality of doing this alone. It is supported by insights from four experts skilled at working with women over 40. As a cohort-based programme, this is the most cost effective way to get vital insights for your treatment, without paying for individual consultations.

If that sounds like what you need, you can apply here.

What are you doing on Wednesday 1st July?! The first Wednesday of the month is the SF40s monthly virtual gathering. I’d wanted to create this space for solo women over 40 for a long time because we are so invisible in the fertility landscape.

It’s a space to share anything on your mind. You might be considering treatment, having treatment or coming out the other side. It’s cameras on to encourage participation and create a safe vibe. No details will be shared from the discussion.

Join July 1st @7pm BST

Find more insights for your fertility journey on the Solo Fertility 40s YouTube and Instagram.

If you’re a solo woman over 40: the numbers you’ll want to know about

The HFEA’s annual fertility report is out. For solo women over 40, here’s what it actually tells us — and what it doesn’t. I’ve read it so you don’t have to.

If you’re a solo woman over 40 - let’s examine the data.

• Single IVF patients have more than tripled in a decade — from 1,100 in 2014 to 3,700 in 2024. Solo women now represent around 7% of all IVF patients, up from approximately 3% in 2014.

• Birth rates decline significantly with age — this is not new, and this report confirms it. Women aged 43–44 had the lowest birth rate per embryo transferred at 8% in 2024, against an overall average of 30% and 38% for those aged 18–34. Note: the HFEA flags that 2024 birth outcome data is preliminary, unvalidated, and uses a new methodology combining fresh and frozen transfers for the first time — making it not directly comparable to previous years.

• Solo women aged 18–37 had a 39% birth rate per embryo transferred — higher than women in opposite-sex couples at 35%.

• Solo women start IVF later on average — at 35.4, compared to 34.8 for those in opposite-sex couples.

• NHS-funded IVF has fallen from 35% of all cycles in 2019 to 28% in 2024. In England it sits at 25%. For solo women over 40, NHS funding was already largely out of reach.

• Despite being more invasive and expensive per cycle, solo women are increasingly choosing IVF over Donor Insemination (DI) as a first treatment. The report attributes this to higher birth rates per cycle, shorter time to pregnancy, lower overall donor sperm cost due to fewer cycles needed, and the possibility of storing embryos for future use.

What the report doesn’t examine

There is no combined data category for solo women over 40. Age and family type are reported separately throughout, which means this cohort — solo, over 40, often self-funding, often facing a decision about donor eggs — is invisible in the figures. You cannot track our outcomes. You cannot measure our growth as a group. You cannot see where we leave the system, or why.

There is no data on how many over-40 solo women move to donor eggs, or at what point. That decision — which is often the central one for women in this bracket — goes entirely unrecorded.

There is nothing on attrition. How many women start the process and stop? What makes them stop — cost, outcome, emotional weight, a combination? The system doesn’t ask.

And there is no data on treatment sought abroad. The HFEA only covers licensed UK clinics. That entire population of women, and their treatment outcomes, sits completely outside its frame. As you may have read previously, both my IVF cycles were in European clinics.

The women coming up behind us

There is a cohort in their 30s who appear to be watching what’s happening and trying to get ahead of it. The data shows they’re taking action.

Egg freezing among 30–34 year olds surged 67% between 2022 and 2023. Among 35–37 year olds, 53%. Across all age groups, egg freezing more than doubled between 2019 and 2023 — though the 2024 report records a plateau for the first time since 2020.

The average age of IVF patients has fallen slightly — from 35.1 in 2021 to 34.8 in 2024. Women are entering treatment a little earlier than the previous cohort did. The number of single IVF patients has tripled in ten years — growth that reflects something broader about how women are living, and what they’re no longer willing to wait for.

They are also increasingly choosing IVF over DI as a first treatment — a shift the report identifies clearly among solo women and female same-sex couples, for the reasons set out above.

What I think happens next

The low birth rate for women using their own eggs at 43–44 is not a new finding. It has always been the case that age affects outcomes — and at 8% per embryo transferred, against an average of 30%, the gap is stark. Nothing in this report suggests that is changing.

What the report does confirm is that solo women are entering IVF treatment in growing numbers. Single patients have tripled in a decade. And yet as a combined group — solo and over 40 — we remain uncounted in any meaningful way. No dedicated outcomes data, no analysis of where we go next, or any recognition that this cohort has specific and distinct needs.

My prediction is that solo women reading these figures will be further motivated to look beyond the UK as a rational first step. The standard of care at European clinics is, from what women consistently report anecdotally, often better than what many encounter in the UK. Greece in particular offers something the UK cannot match on cost: the possibility of multiple cycles for roughly what one cycle costs here. That changes the calculation entirely for women who know they may need more than one attempt.

There is also the question of donor sperm. The large private international sperm banks have become increasingly expensive — a big cost for a solo woman funding treatment alone. In Greece, access to local donor banks brings that cost down significantly. For many women I hear from, it is the detail that makes treatment possible at all.

The HFEA data cannot see any of this. It cannot see the women already in clinics in Athens or Thessaloniki or Barcelona, who will come home with — or without — a pregnancy, and whose outcomes will never appear in a UK annual report. That invisibility means the picture we have of how solo women over 40 are faring is incomplete.

This platform exists, in part, to fill that gap — with the experiences of women who have actually been through it, including my own.

Not medical advice. For clinical questions, speak to your doctor or a specialist.

If you’re a solo woman over 40 and the data in this report has raised more questions than it’s answered — that’s because the system wasn’t designed for you.

I put together a 5-Step Get Started Roadmap for women not yet sure where to start, feeling overwhelmed by a process that wasn't built with you in mind. It won't tell you what decision to make about your clinic or treatment. But it will guide you in how to get started. No late night Googling trying to figure it all out.

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Solo Fertility 40s is independent guidance for solo women over 40 considering or embarking on solo motherhood. No clinic affiliations or commercial ties.

A few milestones already this month! So I turned 45, with a 5 month old. I celebrated by walking round a lake with my dad and stuffing my face with pasta at an Italian restaurant.

Then SF40s welcomed some new people into the community on our first monthly virtual gathering. I’d wanted to create this space for solo women over 40 for a long time because we are so invisible in the fertility landscape. I’ve got lots more to say about that too.

The virtual gathering is a space to share anything on your mind about either getting started, having fertility treatment, coming out the other side. The floor is open! Sign up here.

Join July 1st @7pm BST

Find more insights for your fertility journey on the Solo Fertility 40s YouTube and Instagram.

This recent story in the Telegraph caught my eye.

It asserts celebrity culture is lying to women about their fertility. The writer references Sienna Miller, Natalia Vodianova, Rachel Weisz, Natalie Portman — all pregnant or recently delivered in their forties — and comments how their pregnancies have created the impression that biology is negotiable and that modern medicine has dismantled the ticking reproductive clock.

The author, , wants us to stop pretending otherwise. She’s writing specifically for younger women, and her argument about reproductive biology is clear-eyed and worth reading.

But there are aspects of the celebrity pregnancy conversation she doesn’t quite reach — aspects that matter enormously for young women seeking their own family one day, and for women who are already in their forties, already navigating treatment, and trying to make sense of a very distorted information landscape.

I want to add that layer.

Nobody is saying this is easy

Look again at what these women are actually saying.

Sienna Miller has spoken about the particular joy of motherhood in her forties — her own experience, at this point in her life. That’s not the same as claiming biology is negotiable or that the forties are a better time to start.

There’s a difference between a woman sharing what is true for her and a cultural message that promises the same for everyone. Prendergast conflates the two.

They’re continuing families, not starting them

There’s a detail missing from Prendergast’s analysis that a reproductive clinician would notice immediately.

Sienna Miller already had two children. Natalia Vodianova is pregnant with her sixth child. Natalie Portman has two. These women are not starting their families in their forties - they are extending them. And that is not a trivial distinction.

A woman who has previously carried a pregnancy to term has, in medical terms, proven fertility. It is widely understood in reproductive medicine that multiparous women over 40 - those who have already given birth - tend to have better outcomes than women of the same age who are pregnant for the first time, with the body thought to benefit from having already adapted to carrying a pregnancy. The body that has done this before is not the same biological proposition as the body that hasn’t.

For a solo woman over 40, starting from scratch, that difference is important.

The question nobody asks

Here is what Prendergast’s piece doesn’t address, and what the media rarely asks: were these pregnancies conceived with the woman’s own eggs, or via donor?

It is not a trivial question. According to the Human Fertilisation and Embryology Authority, for women over 42 using their own eggs, the chance of a live birth from a single IVF cycle is less than five per cent. For women over 42 using donor eggs, that figure rises to over 25 per cent - broadly in line with the average for IVF as a whole. The biology Prendergast is rightly defending applies specifically to a woman’s own eggs. Donor egg IVF is a different path with a substantially different set of odds.

None of the women named in the Telegraph piece has publicly confirmed whether they used donor eggs. Rachel Weisz, who gave birth at 48, has been publicly described by Dr Zaher Merhi, Director of IVF Research and Development at New Hope Fertility Center, as having “probably” used a donor egg — “the reality is that pregnancy rates at that age are rare,” he said. She has never confirmed or denied this, which is entirely her right. But that silence is important when it shapes what women reading about her pregnancy understand to be possible for them.

The media largely doesn’t ask, and that restraint is understandable - how a woman conceives is her own business. But there is a different kind of silence worth calling out: a woman actively pursuing column inches around a late pregnancy, speaking at length about the experience of older motherhood, building a public profile on it, while the one detail that would reframe everything for younger female readers goes unmentioned.

Many of those women will have no idea that donor egg IVF exists, let alone that it may be what made the pregnancy possible. Professor Adam Balen, lead clinician at Leeds Fertility, has observed that celebrity pregnancies at advanced ages routinely cause an increase in women arriving at clinics with unrealistic expectations of what is possible with their own eggs.

So the information gap is not abstract - it shows up in consulting rooms. It means women getting a shock about what’s really possible for them and potentially never becoming mothers.

The layer Prendergast’s story can’t yet reach

Prendergast froze her eggs at 31. She writes honestly about the numbers - what five eggs at her age actually means in terms of odds, how steeply those odds fall across the forties. It is useful information, and I applaud her for writing it.

But there is a whole layer of this conversation she can’t access because she isn’t there yet.

I had two failed own-egg IVF cycles at 43. After both, I was advised that donor eggs were my likely path forward. I was a healthy women with a regular cycle, who had never tried to get pregnant. My age was used as a diagnosis for donor eggs.

What nobody tells you, when you’re absorbing that information, is that donor egg IVF is an entirely different conversation - one most women outside the fertility world have never even heard of. You are not using your own genetic material. You are carrying a pregnancy with another woman’s egg.

For many women, that realisation arrives late, in a moment of crisis, with no time to process it properly. It’s even more painful if your doctor recommends it as casually as if commenting on the weather - as mine did.

Donor eggs are undoubtedly a beautiful way to create your family. I’m fortunate to know two happy well-balanced children and their mums who gave them life, born from donor egg and sperm.

At the time, I wasn’t quite ready to use a donor egg. Nine months after the first recommendation, I conceived with my own eggs, via a known donor. I share this not as a hopeful story but because it is true. It sits in the gap that neither the celebrity narrative nor Prendergast’s piece quite reaches: the picture is stranger and less predictable than either side wants to admit.

A woman who has used donor eggs and chooses not to discuss it publicly - perhaps because she wants her child to know before the world does - is making a legitimate parenting decision. That privacy is hers to keep.

However things get muddy when it’s a women using a pregnancy as content to build her brand, while leaving out the detail that would make it honest. This has consequences for other women who have never heard about the use of donor eggs.

The fertility internet doesn’t make any of this easier. When you’re searching for information about what’s possible at your age, you’re not getting a representative picture — you’re getting the stories compelling enough to be shared. These typically occupy extremes of good and bad outcomes. The women in the middle ground, whose experience most closely reflects statistical reality, are less likely to post about it. So the information landscape is distorted before you’ve even started, and women just getting going may not be so aware of this.

That is the more precise problem. Not that women are being lied to by celebrities. But that the information environment around fertility in your forties is so distorted - by PR, by the silence around egg origin, by the polarised experiences shared about - that making a well-informed decision is genuinely difficult, even when you are trying.

Prendergast is right to want younger women to understand their biology clearly. But the women I’m thinking of are past that point. They’re already in it, or standing at the edge of it. What they need isn’t a reminder that the odds are hard. They already know. What they need is the complete picture — including the question that never quite makes it into the glossy celebrity interview.

If you’re at the beginning of the journey and don’t know where to start, I’ve created the IVF guide clinics won’t give you. It outlines in 5 steps everything how to get started with fertility treatment. It’s worth a read even if you’re not ready to start.

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Solo Fertility 40s is independent, non-commercial guidance for solo women over 40 navigating fertility treatment — built from lived experience, not sales targets.

Starting on the first Wednesday of each month, I’m opening up a call for Solo Fertility 40s readers.

It’s a space to come together and talk about anything related to solo motherhood - whether you’re wondering if this path could work for you, you’re in the middle of treatment, or you’re already out the other side, with or without a baby. All of it belongs here. It’s not therapy and it’s not coaching - simply an opportunity for solo women over 40 to be together and bring however you’re feeling that day.

The next two months are free to join. After that, Solo Fertility 40s will be having an upgrade. More on that soon.

To join - reply to this email and I’ll send you the link.

You can find more insights for your fertility journey on the Solo Fertility 40s YouTube, Instagram and website.

Deviating from the conventional script

Solo motherhood was never my Plan A.

There’s a tidier, more palatable version where I say I chose this path, that it was always what I wanted, that I opted in with clarity and conviction from the start. But that wouldn’t be true.

Plan A was meeting someone. It wasn’t spending thousands on fertility treatment and the incredible stress involved. But Plan A didn’t happen. So I did what I’ve always done in life when something isn’t quite working out as I hoped: I pivoted.

Pivoting isn't giving up. It's accepting what's in front of you, holding your destination firmly in mind, and finding a different route to get there.

Enter Plan B

I was 42. I’d had a string of traumatic dating app encounters that I needed therapy to recover from. It was time for Plan B: IVF.

Two IVF cycles, thousands of pounds, operations abroad, totally alone. It didn’t work (no euploid embryo). They were tough experiences, for different reasons.

So I headed to India for winter to recover.

Enter Plan C

While in my local cafe in Goa, an extraordinary situation opened up. It was a chance encounter with the man who would become my daughter Bibi’s known donor. Suddenly I was pivoting again, taking a path I hadn’t even seen until it appeared in front of me.

I weighed up the risks, we talked, he did some fertility tests. We also created an agreement which I knew wasn’t legally binding. But it was a record of our intentions. A friend was my witness. Much to my surprise, I became pregnant on that ovulation cycle.

That chance encounter was probably one of the most pivotal sliding doors moments of my life.

(You can download the timeline to the pregnancy here which details everything I was doing. Warning: my journey doesn’t include any magic pills.)

Plan D - and beyond

Had I needed to pivot again, Plan D would have been donor eggs.

I know two gorgeous children conceived from donor egg and sperm. This path would have allowed me to step into motherhood and do so without any of the health issues that can affect eggs from older women. This was a big concern during my pregnancy even when a NIPT test confirmed the embryo was low risk.

What I’ve come to understand - and what I want Bibi to understand one day - is that none of those plans were consolation prizes. I also want her to know that each one cost something. The grief of Plan A not working is real. So is the grief of two failed IVF cycles - the physical toll, the financial hit, walking the tightrope of ‘hope for the best, expect the worst’. You’re allowed to mourn the life you thought you were going to have, even as you’re busy building a different one.

Each pivot required me to look honestly at what was in front of me - the facts, the resources, the options that actually existed rather than the ones I wished existed - and make a call. Making those decisions, hard and painful and expensive as they were, is its own kind of courage.

Solo mother by default

I’ve written before about why the phrase “solo mother by choice” never quite fit me.

It felt like it was asking me to retroactively want something I had arrived at through a series of decisions made with the information I had at each particular moment. Solo motherhood was, in the beginning, by default. And then it became a set of deliberate choices, driven by the fact that I wanted to be a mother more than I wanted any specific version of how that happened.

This is the story I don’t see told very often. The one where you didn’t set out for this, where you grieve the plan you had, and where you find - somewhere in the middle of all that grief and adaptation - that you have more courage than you knew. You keep going not because the path is clear but because the destination still matters so much.

Unpredictability creates space for something you couldn’t have imagined, because you were too busy imagining something else. In one sense, Bibi was my Plan C. But that's not quite right either. The plans were the attempts — the IVF, the known donor, the path I hadn't seen coming.

But Bibi isn't a plan. She is what happened when I stayed open long enough for life to surprise me. She is five months old today. And I can already tell her, with complete honesty, that I tried everything. That each time something didn’t work, I found a way to try again. That I grieved, and regrouped, and kept going because wanting her was stronger than the fear. That’s how she’ll know how much she was wanted. And it’s a story I can’t wait to tell her, when she’s old enough to hear it.

If you’re somewhere in the middle of your own pivot

If you’re reading this feeling anxious, grieving a version of your life that didn’t materialise, not quite sure which direction to take - that’s exactly where I was. You’re allowed to wish it had been different, and still opt into solo motherhood anyway. And you’re far from alone in making that decision.

• In 2022, 4,800 single women received IVF or donor insemination treatments in the UK — up from 1,400 in 2012, a 243% increase in a decade. (HFEA) We might guess a considerable portion of this involved women over 40.

• In Spain, almost 11% of all births are now to women aged 40 or over. We can guess a significant portion are solo women.

• In Australia, the number of single women opting for IVF rose by 42.7% between 2020 and 2024.

More solo women are choosing ‘baby first, romance later’. And what many of them discover - as I have - is that a life built around a love you fought this hard for has a way of exceeding everything you thought you wanted.

One day I’ll tell Bibi that when life doesn’t go to plan, you find another way. And that the other way might be better than anything you imagined.

If you're at the beginning of the journey and don't know where to start, I've created the 5-Step Get Started Roadmap — everything I wish I'd had before I spent the time, money and energy finding it out for myself, and making expensive mistakes.

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This newsletter takes hours to research, write, and publish. Here are ways to support my work:

1. Leave a comment on the story

2. Subscribe

3. Gift me a smoothie