We have all heard the stories, seen the headlines, and talked about it over the water cooler on Monday morning: “66-year-old woman delivers twins,” “65-year-old woman delivers quadruplets,” and most recently, “72-year-old woman delivers baby” (that last one really made us stop in our tracks)! It gets us talking and gets us thinking: How old is too old for a woman to have a baby? Is pregnancy in your 60s really healthy? Is it fair for a child to be born to parents who are 60?
The questions are endless. And although we are not advocating for Congress to raise the age for Social Security or cut Medicare benefits, we do believe (as does the American Society of Reproductive Medicine) that at some point we all must throw in our reproductive towel. Here’s why.
Let’s start by shedding light on how we women in our 50s and beyond (as well as most women in their late 40s) conceive. In nearly all cases, the pregnancies have been achieved with donated eggs. By the time we hit our mid-40s, our egg supply has pretty much gone kaput. And the ones that are still hanging around often lack the ability to make a healthy embryo.
But while the ovaries have waved goodbye to most things fertility, the uterus is still hanging on. It is like that friend you had growing up who could be dared to do anything (you know the kind we’re talking about… “Dare you to eat a worm…”). The uterus is sort of a pushover for anything with estrogen and progesterone. However, like your middle school friend, just because it will do it doesn’t mean it should do it.
There are guidelines released by the American Society of Reproductive Medicine (they’re sort of like the fertility FBI) suggesting at what age people should and should not be pregnant (no matter how willing their uterus is!). This is what they have to say:
“Physicians should obtain a complete medical evaluation before deciding to attempt transfer of embryos to any woman over age 50. Embryo transfer should be strongly discouraged or denied to any woman over age 50 with underlying issues that could increase or further obstetrical risks and discouraged in women over age 55 without any issues.” (ASRM Ethics Committee)
Let us translate. What they are really saying is that it’s okay to attempt pregnancy in women over the age of 50 as long as they have really, really clean bills of health. It is not okay to transfer embryos, no matter how clean their bill of health, if they are over the age of 55. And while they don’t have your phones wired and your Internet tapped, even if you as the doctor or the patient don’t get “caught” doing this, if you violate the rules, you could get hurt.
Pregnancy complications increase markedly as women age. It can be a pretty dangerous nine months for both mother and baby. In medicine, when the risks start to approach the benefits, you have to seriously stop and consider what you are doing. Donor egg pregnancies in women who are above the age of 55 are one of those times. There is an increased risk of pre-eclampsia (pregnancy-induced high blood pressure), gestational diabetes, low fetal birth weight and, in some studies, fetal mortality. Additionally, nearly three quarters of the babies born to woman above the age of 50 are delivered via C-Section—and while we all think of a C-Section as nothing, it is a major surgical procedure.
Pregnancy is somewhat of a conundrum for us doctors. It is the first time and the only time that you have two patients AT ONCE (in the same body!). It is not only difficult medically but also ethically. Donor egg pregnancies in women who are older than 50 bring up the “fair-to-child” debate. This topic is more controversial than who you voted for this election season.
Let’s just say it’s a good thing there are curtains at the polling places and in doctor’s offices—privacy is key! And while medical ethicists could debate this topic for hours (similar to MSNBC and Fox re: presidential candidates) citing studies and data points on both ends, the bottom line is that no one really knows the answer.
There are those who say that it is not uncommon for grandparents to raise grandchildren, to provide economic support to the family/children, and to serve as the parents in a family unit, so what’s the big deal with women getting pregnant in their 50s? Is it sexist to limit a woman’s ability to have a child while allowing older men to keep on keeping on, no matter how old they are? Shouldn’t women be given the same opportunity as men?
On the flip side, there are those who argue that older parents can’t meet the physical and emotional demands of raising a child. And furthermore, there is a fairly good chance that the child will lose one or both parents at a young age—how can losing a parent or parent (s) before adulthood be fair to a child?
It’s a pretty intense debate. And while all the speaking points may get muddled in your head and you don’t really know whose side you are on, what is important to remember is the following: our jobs as MDs is to keep you informed and healthy. If we think something could hurt you, no matter how badly you want a baby, we must hold up a big flashing STOP sign. While we want to make you a parent and help you build a family, our primary duty is to keep you healthy.
When we say no, it is not because we are being ageists, it’s because we are being “aware-ists.” We are aware of what could go wrong and don’t want to see this happen to you. We won’t play truth or dare with your health. Trust us, no dare is worth it.