Age almost no barrier to pregnancy

Rick Weiss

Women in their sixth or even seventh decade of life can get pregnant with relative ease using eggs from younger women and can expect to have reasonably normal pregnancies and healthy outcomes, according to a study published Wednesday. The new study, the largest of its kind, confirms previous evidence that it is older women’s eggs, not their wombs, that go into decline at menopause, leading to age-related fertility problems.

"On the basis of these data, there does not appear to be any definitive medical reason for excluding these women from attempting pregnancy on the basis of age alone," wrote Richard Paulson and colleagues at the University of Southern California in the Wednesday issue of the Journal of the American Medical Association. Paulson’s group acknowledges that there are medical, psychological and social impacts of late motherhood that deserve careful consideration. But for women who want to go down that path, they conclude, the odds of success are remarkably good when they use donor eggs from women in their 20s and 30s.

Paulson and his colleagues tracked the fates of all 77 postmenopausal women, ages 50 to 63, who underwent in vitro fertilization with donor eggs at the university from 1991 to 2001. Each had to pass a thorough medical exam, including a cardiac stress test and a uterine lining biopsy to ensure that the womb could still respond to the hormones that would be given to support the pregnancy. The women had, on average, three to four embryos transferred to their wombs. All told, 42 of the 77 women had live births - including three who each had two consecutive - for a total of 45 births, producing 61 babies (31 single children, 12 sets of twins and two of triplets), all of them healthy. More than half of those women had never had children before. Most of the babies - and all of the twins and triplets - were delivered by Caesarean section, a higher rate than normal even for mothers who have in vitro fertilization.

For a variety of medical and other reasons, in vitro pregnancies have twice the C-section rate of other pregnancies. Paulson suspects that older uteruses are less able to produce the contractions needed for vaginal delivery. The incidence of gestational diabetes in the pregnant women was also elevated, with about 20 percent of the women affected - compared with the usual 5 percent or so for women in their teens and 20s and about 14 percent for women over 30. The biggest complication was pre-eclampsia, a form of high blood pressure that can harm the developing fetus, which affected about a third of the women. That is a tenfold higher rate than is typically seen in young women and about three times the rate for women older than 40. The practice of helping women become pregnant in their 50s and 60s has been controversial since the first cases were documented more than a decade ago. The American Society of Reproductive Medicine concluded six years ago that the practice is not unethical but should be discouraged. Others echoed that view Tuesday, warning against wide promotion of the practice. "Just because you can do something doesn’t mean you should," said Robert Stillman, medical director of the Shady Grove Fertility Reproductive Science Center in Rockville, Maryland.

(International Herald Tribune)

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