Pregnancy Bliss | Reproductive Health Answers
By Dr J Kabyemela, MD
In mid-May 2009, British news outlets were all full of a story of 66 year old Elizabeth Adeney née Munro who at 8 months pregnant was on the brink of becoming Britain’s oldest mother. She became a mother for the first time later that month. Of-course she was not the first 66 year old to have become a mother (see below) and was still 4 years short of the record of the known oldest mother in the world. That is held by India’s Omkari Panwar who had twin sons in July 2008 at the age of 70. Mrs Panwar was already a mother of two (daughters) and a grandmother of five.
In the UK, according to the Human Fertilisation and Embryology Authority, the proportion of women over 40 seeking fertility treatment rose from 10% in 1998 to 15.5% in 2006. In fact, over the past 15 years, the number of cycles of fertility treatment given to women aged between 40 and 45 has increased more than tenfold. Considering that the actual number of women seeking this treatment has not fallen, this is testimony of a clear trend of more and more older women attempting to start a family or even have more children at a later age. In some private clinics, the proportion of women over 40 is reported to approach 50%!
When a retired Romanian university lecturer Adriana Iliescu had her IVF baby at age 66 in January 2005, it created a sensation. A year later, Maria del Carmen Bousada de Lara of Spain had twin boys just a week short of her 67th birthday. Even among public figures, babies in the older mother are not a rarity. Elizabeth Edwards, the late wife of US presidential contender John Edwards had her son Jack in 2000 at age 51. A year later, Annie Leibovitz, the portrait photographer had a daughter at age 52.
So, babies born to mothers in later years aren’t that rare, but what are the factors that a woman has to consider before embarking on this quest? This is what we will try to address here rather than why women leave it that late. That is a subject that has been and continues to be exhaustively debated elsewhere.
There is no question that, for a woman, fertility in general starts declining once the 30’s get underway and this decline accelerates after the mid-30s. Many, probably most women who desire having children in their 40's or beyond are likely to embark on assisted conception. Even ignoring the financial outlay required, there are formidable obstacles in the way of such a woman.
At a very basic level, assisted conception may involve just stimulating ovulation to maximise the chances of spontaneous conception. In the early 40's, this might just do the trick. Drugs like Clomiphene (Clomid) are often successful in inducing the release of eggs allowing for successful natural conception. However, it is important to bear in mind that, response to this medication is not as good the older the woman is.
If an attempt to stimulate egg production is unsuccessful or the eggs are of poor quality then the next logical step is to use a donor egg. In the USA, there were 12,000 IVF cycles using donor eggs in 2003 with a take home baby rate of a shade under 50%. The success rate of this method is therefore comparatively quite good. However, it is quite expensive and only a few can afford. Donors get paid around $5000 per cycle. In the UK where regulations are a lot more stringent and eggs cannot be ‘sold’ this is not so and the waiting could be as long as 4 years.
Even when successful, the quality of the eggs released may not be as good. It is an established fact that the risk of chromosomal abnormalities such as Down’s syndrome or even the lethal ones such as Edward’s Syndrome increases as the woman gets older. At age 40, the risk of Down’s is about 1 in 70 but by age 44 it would have dramatically shot up to 1 in 20. This compared to a 1 in 1000 at 20 years of age. Likewise, with Edward’s syndrome, the risk shoots up close to 20-fold between age 20 and 40. (It is 1 in 200 at 40).
There is also the spectre of miscarriage. At 40, almost 40% of all pregnancies will end in miscarriage and the loss rate is 75% at 45.
In assisted conception (IVF), the success rate across all age groups is around 20%. So, if we were to ignore age, a woman embarking on IVF will have a 1 in 5 chance to taking a baby home at the end of it. However, the reality is rather grim for the older mother. The success rate is barely half that (12%) at 40 and less than 3% by the time she is 44. Considering that most women in this age group will pay for this treatment privately and that they will probably need several treatment cycles, the financial commitment is likely to be massive with a far from guaranteed successful outcome.
Most people will know somebody who has had a baby in their 40s. The occurence is by no means rare. It is therefore easy to fall in the trap of thinking pregnancy at this age is a routine affair. However, looking at the stark facts detailed above, it is clear that trying to conceive at a later age is a tough challenge that, for many women at least, will be fraught with trials and tribulations and may very well end in failure. Women in their 40’s may look evermore youthful today but the internal biological clock is an altogether different matter.
Last update: January 14, 2013
© Mark Large