Rewinding The Clock: Pregnancy After 50 Now An Option
When a California specialist started searching last year for women in their 50s who wished to become pregnant, he didn't have to wait very long.
Requests poured in from dozens of women willing to undergo the hormone-replacement therapy that would reverse menopause and, in effect, rewind their biological clocks.
And that doctor wasn't alone.
Another in New York was besieged with inquiries after a 53-year-old patient gave birth to a healthy boy in December.
Doctors stop short of calling pregnancy among 50-somethings a trend, but they say there is growing interest in a parenting option that until recently was scientifically impossible.
Why would someone trade her biological freedom for a return to menstrual cycles - and pregnancy, and the pain of labor and childbirth?
Doctors say that some of those women undergoing in-vitro fertilization were among the infertile legions who tried as long ago as the 1950s to get pregnant - the old-fashioned way. Others didn't marry for the first time until in their late 40s.
Then there was the woman who, having adopted a child just before turning 50, was told after reaching the half-century mark that she was too old to adopt another.
So she turned to high-technology medicine and got pregnant.
Dr. Frank Riggal, medical director of Sand Lake Hospital's Center for Advanced Reproductive Technologies in Orlando, Fla., said reversing menopause is the least difficult part of preparing
50-year-olds for pregnancy.
Women are given synthetic estrogen and progesterone, the two hormones that decline dramatically with menopause. The object: to re-establish the monthly menstrual cycle and prepare the uterus for pregnancy.
"The most negative effect of age on pregnancy is egg quality," he said. As women age, egg cells become less viable, even defective; by the time women are in their 50s, their ovaries have shut down and no longer expel them."
"By using a younger woman's eggs, you can bypass that problem altogether," Riggal said.
Only in recent years have doctors even considered in-vitro fertilization in older women, let alone using younger women's eggs. Dr. Mark Sauer of the University of Southern California was the first to try the technique in a scientifically controlled group of women in their 50s. His studies show that the uterus remains receptive to pregnancy long after menopause.
Some doctors credit his work with moving the concept of such pregnancies from theory to practice.
As part of Sauer's ongoing studies, USC doctors have found a pool of younger women willing to donate eggs, and a pool of older ones waiting to receive them.
Sauer describes the donors as "middle-class, working mothers." Each donor - usually in her 20s - receives $2,000 for every egg doctors retrieve.
Eggs are mated with sperm in the laboratory, then transferred to a recipient's uterus by way of a catheter. Up to four embryos are transferred at a time, with the hope that one will attach itself to the uterine wall and develop.
The procedure has allowed pregnant grannies to capture headlines.
An Orchard Park, N.Y., woman who delivered a boy in December is technically both the child's mother and his grandmother. The 53-year-old woman, Geraldine Wesolowski, underwent in-vitro fertilization at a Pennsylvania fertility clinic as a surrogate for her son and his wife.
Since the birth, Wesolowski's Buffalo obstetrician, Dr. Ida Campagna, has received dozens of calls from older women interested in donor eggs and pregnancy.
Another 53-year-old, Mary Shearing of Anaheim, Calif., delivered twin girls in November after undergoing in-vitro fertilization with donor eggs in Sauer's program.
Shearing is the mother of three adult children and two grandchildren. She and her second husband, Don, said they pursued in-vitro fertilization to set an example for older women and for couples experiencing trouble having children.
Four other pregnancies among women in their 50s are now in progress in Sauer's program.
The National Center for Health Statistics, which keeps figures on a range of health matters, doesn't even compile data on births to women beyond the age of 49. Menopause generally occurs around 50, ending a woman's reproductive life.
Critics of impregnating post-menopausal women label it technologically bizarre. They raise the specter of gray-haired grannies being exploited as baby machines by younger women willing to offer big bucks.
Of the critics, none has been more vocal than the American Fertility Society, the Alabama-based organization that represents 11,000 U.S. reproductive-medicine specialists.
Citing medical, familial and societal concerns, the organization's ethics committee has issued guidelines on the use of in-vitro fertilization, discouraging attempts to produce pregnancies beyond the ordinary childbearing age, which generally ranges from 15 to 44.
"We represent physicians, scientists and other professionals involved in reproductive medicine, and we have a lot of concerns on that issue," society spokeswoman Joyce Zeitz said.
Chief among them is "the potential strain of pregnancy" on women 50 and older, she said.
"Even given the life expectancy we have today," Zeitz added, "I am not sure that a 63-year-old woman would really want to deal with a 13-year-old."
Concerns have been brewing internationally since the mid-1980s, when Israeli scientists first broached the possibility of reversing menopause to permit pregnancy.
British doctors responding to the California studies wrote in a recent editorial in the medical journal The Lancet that physicians should proceed with caution: "A woman of 55 may be pleased to cope with a baby, but at 65 or more could well be too old to provide the emotional support for a teen-ager."
Sauer, who expects to screen 30 women in their 50s, and monitor about 12 births to them this year, say critics are missing the point.
"Many children have been raised by their grandparents in various cultures," Sauer said. "As the average life expectancy in our population increases, establishing pregnancy in individuals nearing 60 years of age becomes a more rational goal."
He estimates that fewer than 5 percent of the nation's fertility clinics are willing to perform in-vitro techniques on women over 50. Many, Sauer said, are reluctant to provide the service to women in their 40s.
While Riggal has not attempted the procedure in a woman in her 50s at Sand Lake Hospital's in-vitro program, he is not opposed to trying.
"We have never treated a patient over the age of 45," he said. "But I would be willing to consider it (for a woman in her 50s) under the right set of circumstances. That is, if the woman fully understood what she was getting into and had no medical contraindications for pregnancy."
In the California program, Sauer and his colleagues initially screened 18 women, choosing only the most fit. The mean age of the subjects was 52.2 years.
Before being chosen, all had to undergo blood work, treadmill tests, a mammogram to screen for breast cancer, a Pap smear and tests for insulin and thyroid function. The sperm quality of their partners also was examined.
After the screenings, pregnancies were established in nine women; one suffered a miscarriage. Three have delivered healthy infants, two by caesarean section. The remaining women are still pregnant.
Sauer believes that hormone replacement therapy and in-vitro fertilization are allowing older women a biological option that nature all along has permitted older men.
"Everybody assumes that because of their age, these women are going to die," Sauer said. "We're not doing this with our eyes closed, or with the intent of producing orphans.
"People wouldn't tell a man of 50 he's too old to father a child. We think the same should be true for women." --------------------------------
Number of babies born to women in different age groups:
AGE ANNUAL BIRTHS ----------------------- Under 15 11,657. 15-19 521,826. 20-24 1,093,730. 25-29 1,277,108. 30-34 886,063. 35-39 317,583. 40-44 48,607. 45-49 1,638.
Note: These figures are based on 1990 data, most recent year for which complete statistics were available. Source: National Center for Health Statistics
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