- The Washington Times - Saturday, March 26, 2005

Catherine McAlpine was 41 when her son, Nathaniel, was born. She was 42 when she and her husband, Rick Eig, started trying for another baby.

Two years and a series of unsuccessful fertility treatments later, Ms. McAlpine, now 44, has learned a lot. There still is no sibling for Nathaniel, though. The couple is looking into adoption.

“You hear all about [in-vitro fertilization] and medical advances,” says Ms. McAlpine, a social worker who lives in Rockville. “You see celebrities having babies in their 40s. Being a parent has been the best experience of my life, and I want to do it again.”

Indeed, more women then ever are becoming mothers at a later age. The Centers for Disease Control and Prevention estimates that nearly 25 percent of American mothers are older than 35 when their first child is born. Advances in fertility treatment have made it possible to push the upper limit of a woman’s fertility window.

In some highly publicized cases, the limit has been catapulted. Television host Joan Lunden, 52, recently became a mother of twins (via a surrogate) for the second time in two years. Actress Geena Davis had twins at 48. Elizabeth Edwards, wife of former vice presidential candidate John Edwards, had two children in her late 40s.

Aleta St. James, a New York woman who gave birth to twins in the fall shortly before her 57th birthday, told reporters soon after: “It is never too late. You are never too old. It is just in your mind.”

Stories like these irritate Cara Birrittieri, author of the book “What Every Woman Should Know About Fertility and Her Biological Clock.”

“I remember being 35 or 36 and seeing magazine covers with ‘Twins at 45!’” Ms. Birrittieri says. “I thought, ‘I’ve got time, and there is medicine.’”

Ms. Birrittieri, who lives near Boston, was 40 when she fairly easily conceived and gave birth to her son, A.J. Next up came a long road of treatments, miscarriage and insurance hassles. Ms. Birrittieri, now 45, and her husband, Jackson Smith, welcomed daughter Victoria last June. Victoria was conceived using a donor egg.

It’s likely most of those celebrity babies were, too. While those high-profile moms welcomed the publicity about their new arrivals, they have been more vague about whether they used donor eggs.

“All that publicity is hurting younger women who believe that medicine is performing miracles,” Ms. Birrittieri says. “A lot of women don’t understand what the medical reality is.”

Dr. Paul Gindoff, division director of George Washington University Medical Center’s Fertility & IVF Center in Northwest, agrees. He says the high-profile pregnancies, coupled with a basic lack of knowledge about how and why fertility declines, is leading to some confusion among hopeful older parents.

“Women who are having babies over age 46 are by and large using donor eggs,” he says. “Much of the population does not realize that.”

The biological clock

First, a little biology. The decline in fertility as a woman ages is primarily because of diminished egg quality, Dr. Gindoff says.

A woman is born with all the eggs she will ever have. At birth, she has about 2 million. By puberty, that number has dropped to about 400,000. During a woman’s reproductive years, the best eggs ovulate first, so by the time a woman is in her 40s, the quality of the remaining eggs is compromised.

Older eggs mean a lower chance of conceiving, a greater miscarriage risk and an increased risk of genetic abnormalities, says Dr. Robert Schenken, a reproductive endocrinologist in San Antonio and president of the American Society for Reproductive Medicine.

For example, a 30-year-old woman has about a 20 percent chance of conceiving in any given month. A 40-year-old’s chances are only about 5 percent, ASRM data show. Meanwhile, the risk of chromosomal abnormalities is about 1 in 385 at 30; at 40, it is about 1 in 66. Risk of miscarriage is about 12 percent for women 30 to 34; it is 34 percent for women 40 to 44.

Even with sophisticated treatment, there is more success with younger patients. In 2002, the most recent year for which ASRM statistics are available, there was a live birth rate of 25 percent for 30-year-olds who underwent assisted reproductive technology treatment such as in-vitro fertilization. At 40, the birth rate was 16 percent. By 42, the rate was down to 9 percent.

“The realistic odds are about a 5 percent chance per cycle of conceiving [with IVF] over age 43,” Dr. Gindoff says. “After 43, the chances decline fast. I know of no births for a woman undergoing IVF over age 46 and using her own eggs.”

Of course, there are cases in the Guinness Book of World Records of women in their 50s spontaneously conceiving and giving birth, but that possibility is more like 1 in a million.

“The word clearly isn’t out there that there is such a drop in fertility after age 40,” Dr. Gindoff says. “There is this illusion that IVF and technology is supposed to be so remarkable, and there is this concept that we can reverse the biological clock.”

Doctors may not be able to reverse the biological clock, but there are many things they can do to determine whether a woman 40 or older has a good chance of conceiving — with treatment or without.

Women near the upper end of their reproductive years should ask their doctors to test their follicle-stimulating hormone (FSH) levels on day three of their cycle, says Dr. Frank Chang, a reproductive endocrinologist at Shady Grove Fertility Center.

High levels of FSH — the hormone that signals follicles to develop into mature eggs — indicate that the ovarian reserve is low, Dr. Chang says. Every doctor has a different gauge for how to proceed with treatment. However, a level less than 10 is considered optimal.

Ms. Birrittieri says knowing one’s FSH levels could save time, money and disappointment.

“When I had my first baby at age 40, my doctor should have told me to get an FSH test,” she says. “I could have just been lucky when I conceived him.”

When Ms. Birrittieri began trying for her second baby (at age 42), her FSH level was high.

“It was a shock to me, to have had a baby and then a year later be infertile,” she says.

Doctors look at the FSH levels, along with other factors such as sperm quality and structural abnormalities, when determining whether a woman would be a good candidate for assisted reproductive technology.

Dr. Gindoff says a high FSH level won’t necessarily restrict a woman from treatment. The numbers just give her an indication of her odds for success.

In fact, fertility specialists are treating more women over 40 than ever. A decade ago, many clinics had age limits, Dr. Gindoff says. With advances in care, many clinics have expanded their range.

One reason: the advent of procedures using donor eggs. Women older than 43 seeking fertility treatment have a very slim chance of getting pregnant with their own eggs. Those same women, however, have pregnancy rates practically the same as younger women using assisted reproductive technology when they use an egg donated by a younger women, ASRM statistics show.

The average cost of a donor egg cycle is $15,000 to $30,000, Dr. Schenken says.

Moving on

For Ms. Birrittieri, the decision to use donor eggs was not easy.

“I joke that my son was my last good egg,” she says. “Making the decision to use donor eggs was pretty traumatic. It is hard to let go of genetics. But after a while, you have three choices: donor eggs, adoption or skip it all together.”

Ms. Birrittieri, who had insurance coverage for her donor cycle, eventually found “a fantastic donor” — a 24-year-old graduate student.

“It’s a very strange process,” Ms. Birrittieri says. “Every time I look at both my kids, I know they are miracles.”

Ms. McAlpine and her husband ultimately decided against using donor eggs. Her husband has an adopted child from his first marriage, so the couple was open to building their family through adoption.

“Donor eggs were going to cost $20,000 per cycle, and there still was no guarantee of a baby,” Ms. McAlpine says. “I am tired of being a professional patient. At least with adoption, you are guaranteed to get a child.”

Ms. McAlpine says she has found great support by joining Resolve, a national fertility support group, and talking to other women and couples who are in pursuit of a family. At the same time, she has sought out families pursuing adoption. She says being proactive will help any woman in the same situation.

“Moving on was a gradual process,” she says. “My husband and I wanted to do everything we reasonably could to have a biological child. Having Nathaniel is a gift from God. He fulfills my dream, but not of a whole family. My husband and I are each from families with four children. This is my dream. We are doing everything we can to make it come true.”

More info:

Books —

• “What Every Woman Should Know About Fertility and Her Biological Clock,” by Cara Birrittieri, New Page Books, 2005. This book, by a woman who had two children after turning 40, combines personal stories with research and experts’ advice.

• “Rewinding Your Biological Clock: Motherhood Late in Life,” by Richard J. Paulson, W.H. Freeman and Co., 1998. This book focuses on options for older mothers, including using donor eggs.

Associations —

• American Society for Reproductive Medicine, 1209 Montgomery Highway, Birmingham, AL 35216-2809. Phone: 205/978-5000. Web site: www.asrm.org. This professional association has information for the general public regarding conditions that cause infertility, treatment success rates and research.

Online —

• Resolve: The National Infertility Association, has information about conditions, treatments and support groups on its Web site (www.resolve.org).

• The International Council on Infertility Information Dissemination (www.inciid.org), a nonprofit organization, has research and treatment information, forums and message boards on its Web site.

• Mothers Over 40 (www.mothersover40.com), a site run by a British woman who had children in her 40s, has many personal stories by midlife parents.

More info:

Books —

• “What Every Woman Should Know About Fertility and Her Biological Clock,” by Cara Birrittieri, New Page Books, 2005. This book, by a woman who had two children after turning 40, combines personal stories with research and experts’ advice.

• “Rewinding Your Biological Clock: Motherhood Late in Life,” by Richard J. Paulson, W.H. Freeman and Co., 1998. This book focuses on options for older mothers, including using donor eggs.

Associations —

• American Society for Reproductive Medicine, 1209 Montgomery Highway, Birmingham, AL 35216-2809. Phone: 205/978-5000. Web site: www.asrm.org. This professional association has information for the general public regarding conditions that cause infertility, treatment success rates and research.

Online —

• Resolve: The National Infertility Association, has information about conditions, treatments and support groups on its Web site (www.resolve.org).

• The International Council on Infertility Information Dissemination (www.inciid.org), a nonprofit organization, has research and treatment information, forums and message boards on its Web site.

• Mothers Over 40 (www.mothersover40.com), a site run by a British woman who had children in her 40s, has many personal stories by midlife parents.

LOAD COMMENTS ()

 

Click to Read More

Click to Hide