OLDER MOMS
Doctors’ ethics committee OKs helping older women get pregnant
Healthy post- menopausal 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 post- menopausal women.”
The old statement 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, associate professor of obstetrics and gynecology at Oregon Health and Science University. “The risks are still increased compared to younger women,” she
The risks are still increased compared to younger women.
DR. PAULA AMATO ASSOCIATE PROFESSOR OF OBSTETRICS AND GYNECOLOGY
said. “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, pregnancyinduced 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.
“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.”