Good news for woman getting Pregnant after 50

Pregnancy after 50: Using egg, embryo donations

This is my third blog on Pregnancy. In first blog we saw why Smoking during Pregnancy is reducing reading score. In the second blog we saw Why C-section Babies More Likely to Develop Allergies.

This is very good news for woman who want to become pregnant after 50 and older. This study will encourage them to have baby even after 50.

What are Pregnancy Risks after 50?

More women than ever are giving birth after age 50, thanks to the increasing use of infertility treatments.  Just how risky are these late-life pregnancies for both mother and baby? Riskier than giving birth even a few years earlier, according to findings from one of the first studies to address the issue.

Women in the Israeli study who gave birth in their sixth decade and beyond had a much higher risk of pregnancy- and delivery-related complications than women who gave birth in their mid- to late 40s.The older women in the study were hospitalized during pregnancy almost three times as often as the 45- to 49-year-old women, and twice as many delivered low-birth-weight babies. Researchers from Israel's Sheba Medical Center characterized the findings among women 50 and older as "disturbing," but they also found reason for optimism. “It was encouraging to see that the pregnancy outcome in our (45-plus) population was generally good," they wrote.

Childbirth after Menopause

Giving birth after age 50 is not common. Of the roughly 12 million births in the U.S. between 1997 and 1999, only about 500 involved women who were 50 or older. The vast majority of these births involved donor eggs from younger women, a practice that has made childbirth among menopausal women possible. Twenty-four women who gave birth between the ages of 50 and 64 were included in the new study. All the women conceived via in vitro fertilization using donor eggs, and all delivered at the Sheba Medical Center between January 1999 and June 2004. Their pregnancy outcomes were compared with those of 99 women between the ages of 45 and 49, who also gave birth at the center during the same period. Well over half of the age 50-plus mothers-to-be (63%) were hospitalized during pregnancy, compared with 22% of the women who were younger than 50.

And 61% of the age 50-plus women delivered low-birth-weight babies, compared with 32% of women between the ages of 45 and 49. The average gestational age at birth for single babies born to the older mothers was 36.9 weeks, compared with 38.4 weeks among the younger women.

The incidence of pregnancy-related diabetes and hypertension was high overall -- 21% and 28% respectively. But the complications occurred with the same frequency in both age groups.

The study is published in the November issue of the journal Obstetrics and Gynecology.

 

How Babies Fared after 50

The good news from the study was that despite a high rate of pregnancy complications, birth outcomes were generally good. No severe birth defects related to premature delivery occurred among the babies born to the women in the study, even though the premature birth rate was high. Russell Kirby, PhD, of the University of Alabama at Birmingham, was a researcher on one of the few other published studies to examine birth outcomes among women 50 and older. Kirby and colleagues' review of birth records among babies in the U.S. born between 1997 and 1999 also indicated that the risk to both the mother and baby increases as the age of the mother increased. "Women who contemplate a pregnancy in their 50s need to be made aware that they face increased risk and so do their babies," Kirby tells WebMD. "But that doesn't mean that [late-life] pregnancies should not be attempted. I would be a strong advocate of patient choice in this matter, but women have to know the risks."

New Research-Pregnancy after 50: Using egg, embryo donations to extend a woman’s reproductive life

Healthy postmenopausal women shouldn’t be discouraged from pursuing pregnancy using donor eggs or embryos, one of the world’s largest organizations of reproductive medicine says. In a shift in its official stance on whether women of “advanced age” should be discouraged from achieving pregnancy, the ethics committee of the American Society for Reproductive Medicine now says that some women over 50 who are healthy and “well prepared” for child rearing are candidates to receive donated eggs.

The society sees it as a natural extension of what science can do. But not everyone agrees with the idea of artificially extending fertility past 50. The group’s guidelines strongly influence practice in Canada. While infertility may be a natural consequence of menopause, the committee says that allowing women to conceive through egg donation “is not such a significant departure from other currently accepted fertility treatments as to be considered ethically inappropriate in postmenopausal women. The old statement, published in 2004, said that, given the physical and psychological risks involved, “postmenopausal pregnancy should be discouraged.”

While the data on the risks to older women and their fetuses is still scant, it’s more reassuring than what was available in 2004, particularly in women aged 50 to 54, says committee chair Dr. Paula Amato, a Toronto native and associate professor of obstetrics and gynecology at Oregon Health and Science University. “The risks are still increased compared to younger women,” she said in an interview with Postmedia News. “But we’re not discouraging it.”For women over 55, “substantial caution should be exercised” when considering egg or embryo donation, the committee says. The risks of gestational diabetes, pregnancy-induced high blood pressure and other complications increase the older the woman gets, and are particularly high after 55.“We’re saying we have more data in the 50 to 54 age group, but we’re still discouraging it after age 55,” Amato says.

Egg donations have made it possible for virtually any woman with a functioning uterus, regardless of how old she is, to have a baby, the committee says. A woman’s own egg supply and quality shrinks over time; at menopause she stops releasing eggs altogether. But she can conceive using the eggs of a younger woman. As a result, more women in their 50s are seeking fertility treatments. Some have re-married, or married for the first time; others want to use frozen embryos left over from an earlier IVF cycle. Meanwhile, younger women are putting their eggs in cold storage, freezing them until they’re ready to try to have a baby. Nearly half the nation’s fertility clinics are offering “social egg freezing.”  Some have also created and stored embryos for young couples. As a result, more people will be looking to have their freeze banked eggs or embryos thawed when they’re older and ready to be parents.

But, how old is too old?

In at least one case, doctors in Canada have transferred an embryo created by in vitro fertilization and conceived with donor eggs into a 57-year-old woman. The average age of menopause in Canada is about 52. Experts say egg or embryo donation to women of an advanced reproductive age raises sticky social questions, notably, is it in the best interests of the child to have a mother old enough to be a grandmother? Just because we can do something, should we?

“When age creates a situation where you could have orphans, or someone who doesn’t have the health or the energy to parent — where your child is entering high school and you’re entering a nursing home — that’s not the ideal situation or what the child needs,” says bioethicist Arthur Caplan, director of the division of medical ethics at New York University Langone Medical Centre. “The focus isn’t so much on trying to say older parents couldn’t be good parents. They have the resources, they have the wisdom,” he said. “But the reality is that nobody, in spite of a lot of ideology, beats father time,” he said. “Health and energy begins to wane, and disease and disability starts to escalate in your 60s and 70s. “I know we all want to believe that 50 is the new 30,” Caplan said. “But that’s more in the magazines than it is in anybody’s actuarial chart,” he said. “Most people faced with the prospect of becoming a parent at 60 would rather visit a psychiatrist than a fertility specialist. “More seriously, he worries that too little is known about the risks. Dr. Matt Gysler, president of the Canadian Fertility and Andrology Society, says that, in addition to an increased risk of uterine growth restriction and hypertensive disorders, pregnancy in older age places a significant stress on a woman’s cardiovascular system because of increased blood volume and increased blood flow. Other studies have shown an increased risk of maternal death.

Menopause isn’t the defining issue, he says. “It’s really an issue of trying to assess at which time the physiologic or health status of the mother no longer gives you a low, predictable risk.”“Is a fit California woman who has exercised and not smoked for 30 years; is in good physical shape and goes through all the appropriate assessments the same as someone who is overweight and has all kinds of medical problems?” (The ASRM ethics committee says egg and embryo donation should be “strongly discouraged” in women with underlying medical problems that could make pregnancy even more risky.) “We don’t have the hard data on pregnancies in older women for the simple fact they didn’t occur before ART (assisted reproductive technologies),” Gysler said. Some say it is sexist to suggest age limits should be imposed on a woman’s right to bear children when no one imposes a biological deadline on men. “Certainly nobody would tell a man that he couldn’t reproduce after a certain age,” Amato said.

Those opposed to egg donation in older women argue that menopause happens for a reason, she said, and that it’s “unnatural” to extend the limits of reproduction. “But a lot of things we do in assisted reproduction counteracts what might be considered natural, so I don’t know that that’s valid.”

The main argument in favour of egg donation to older women is patient autonomy, Amato said, “and in this country, and in Canada as well, that sort of takes precedence over everything. “People have the right to choose, to make their own reproductive choices. And that’s highly respected.”

(Source- American Society for Reproductive Medicine)