TUESDAY, Nov. 12, 2002 (HealthDayNews) -- Are you 50 or older and want to have a baby? Go ahead, says a new study.
The research, appearing in tomorrow's issue of the Journal of the American Medical Association, concludes there is no medical reason why women over the age of 50 should not try to become pregnant if they use in vitro fertilization and donated eggs.
Although the women in the study had an increased risk of preeclampsia (pregnancy-induced hypertension) and gestational diabetes, their pregnancy rates, multiple gestation rates and miscarriage rates were similar to those of younger women undergoing the same procedures. The majority of women delivered their babies by Caesarean section.
"What is interesting and not unexpected is that when you use donated eggs, the pregnancy outcomes, for all intents and purposes, are just as good," says Dr. William M. Gilbert, a professor of obstetrics and gynecology at the University of California at Davis. "It's the egg that drives things."
Egg donation took hold in the United States in the mid-1980s as a way for younger women who had had premature ovarian failure to have babies. "What we didn't realize at the time is how much it would open the whole area of older women being able to get pregnant," says Dr. Richard J. Paulson, lead author of the study and director of the fertility program at the University of Southern California's Keck School of Medicine.
Paulson had been working with women under the age of 40, some of whom crossed that age threshold while they were still in the program. When in vitro fertilization was performed in this older bracket of women, Paulson was still able to get extremely high success rates. That's when he had his "ah-ha moment."
"Women over 40 were getting pregnant at the same rate as women under 40," Paulson says. "We realized that women had not one biological clock but two. The biological clock for the egg gets very weak at 40. The uterus and the rest of the reproductive tract seems to do just fine."
Here, Paulson and his colleagues looked at 77 postmenopausal women aged 50 or older (the range was 50 to 63, with an average age of almost 53) who conceived via IVF with donor eggs. After conceiving, the women were given a supplementation of estrogen and progesterone until the 12th week, at which time the placenta took over making all the hormones they needed.
All of the women were screened for medical conditions and, as a result, were in exceptionally good health.
The total pregnancy rate was 45.5 percent. Of the 77 women, 54.5 percent had live births. Of the 45 live births, there were 31 single babies, 12 twins and two sets of triplets. Three women became pregnant twice. This was the first delivery for 58 percent of the mothers and, for those first babies, the average gestation age at delivery was 38.4 weeks and the average birth weight 6.64 pounds.
Some 25 percent of patients had mild preeclampsia, while 10 percent had severe preeclampsia. Gestational diabetes requiring diet modification occurred in 17.5 percent; 2.5 percent required insulin. There were no neonatal or maternal deaths.
"They do have complications; we know that. Now we have an idea of what the complications are going to be," Paulson says.
Preeclampsia and gestational diabetes are nothing to scoff at. "Severe preeclampsia can be a condition that puts the mother's life and limb at risk. The vast majority end up doing fine, but we don't have a lot of experience with women in their 50s having severe preeclampsia," Gilbert says. "This is not something without risk and we shouldn't enter it lightly."
Complications seemed to become substantially worse in women over the age of 55. That is the cut-off age that Paulson is working with, at least for now.
"Fifty-year-olds are running marathons and doing all kinds of other things. Being 50 years old in 2002 is very different from being 50 years old 50 years ago," Paulson says. "Even when I was growing up, someone who was 50 was old or middle-aged. That's changed, and things may change even more in another 10 or 20 years because we're so much more aware of how we take care of ourselves. We're starting healthy lifestyles earlier in life."
The study did not address any issues that might a rise after the baby is born, such as how easy it will be for an older woman to take care of a newborn.
And older women wanting to get pregnant still need to remember one thing. "The big issue is the donated eggs, and women have to be willing to accept that once you're beyond 42 or 45, the chances of being successful with your own egg are dramatically decreased," Gilbert says. "I think it's important to remind women who think they can have babies through their 50s that it will not be their own eggs. It's no different from adopting a kid."
What To Do
For more on IVF and egg donation, visit the American Society for Reproductive Medicine or the InterNational Council on Infertility Information Dissemination.
