Thanks to a handful of publicity-seeking Hollywood stars along with our own ex-Olympian Lisa Curry, the middle-aged pregnancy phenomenon has been hitting the headlines recently amid much fuss and fanfare, but the skewed media frenzy is not to everybody’s liking.
Reports of older women from their mid 40s to their early 50s seemingly effortlessly falling pregnant thanks to advances in vitro fertilisation (IVF) are cause for real concern, according to two Australian fertility experts.
Dr Antony Lighten, fertility specialist at Genea Northwest (formerly Sydney IVF) believes that older women are being given false hope by misleading articles that depict late age pregnancies as now par for the course.
“The reality is a lot more sobering,” he says, explaining that even as early as 43, IVF “really doesn’t work”.
“Once you get to this age your chances of conceiving with IVF aren’t much better than trying naturally.”
So, how are all these older women managing to have viable pregnancies?
Certainly not with their own eggs, according to Lighten, who explains that it’s thanks to donor eggs that pregnancy at this age is made possible.
Why is 45 is the cut-off?
“I strongly advise patients 44 or over not to even try with their own eggs although occasionally I’ll treat a woman who is 44 or 45 if she’s never had a child before but really, you’re setting them up for a big fall because by then their chances of a live birth are less than 1%,” he says.
Dr Denyse Asher, IVF scientist and co-director of IVF clinic, Fertility East in Sydney agrees, pointing out that at 51 Lisa Curry “probably has zero chance” of falling pregnant without a donor, despite a different story doing the rounds in women’s magazines.
“IVF is just a technique – it’s there to help things along the way but cannot change the chromosomes of your eggs which are what become damaged as you age,” she says. “There are women who are trying in the 40-44 age range and you get the occasional pregnancy but you get a lot of disappointment too.”
Yet, it’s not fertilisation and implantation of the egg that’s the problem for these women, it’s getting through the first trimester that’s the challenge, according to Asher.
“Even if a 45 year-old woman has eggs in her ovaries, the miscarriage rate is really high not due to the fact that she can’t carry a pregnancy but due to the quality of her eggs,” she says, explaining that a woman’s eggs usually start deteriorating a decade before she actually reaches menopause.
The main issue, as Asher sees it, is that there is no way of predicting how long a woman will remain fertile. While testing for ovarian function and ovarian reserve is doable, she says it’s impossible to determine the quality of those eggs and when the ovaries are going to “switch off”.
Is freezing young eggs the answer?
For those women who want to delay having a family, there is the option of freezing their eggs but Lighten strongly advises getting in well before the age of 37.
“We use a new rapid freezing technique which has allowed us to get good pregnancy rates but it’s important to point out that egg freezing is still relatively experimental,” he says. “Our experience is that you probably should be freezing 10-20 eggs to give you a reasonable chance because when you freeze-thaw you tend to lose a lot of them.”
At around $11,000 for this type of treatment it’s a big outlay for most women, considering there is no guarantee it will work by the time they’re ready to start a family.
As Lighten says, better to put babies on the radar when you’re young than put too much faith into IVF and egg freezing.
Opting for donor eggs
Those over 45 do have the option of using donor eggs and the success rate is high, according to Asher, but this process usually requires a trip overseas to places like Greece or South Africa to access their egg banks.
“In Australia you can’t put your name down anywhere and expect a call to say we’ve got the eggs for you because there are no viable egg banks,” she says, attributing this situation to restrictive legislation that deters donors.
“Our job is to help people find a donor and for about $7000 that includes donor testing, donor monitoring, drugs for the donors, theatre costs and laboratory procedures.”
Significantly, both Greek and South African law allows donors to remain anonymous, which is not the case in Australia.
“This is the reason we don’t have any donors here because donors don’t want to be contacted 18 years later” says Asher. “It’s totally altruistic on their part … to help infertile people. I would consider doing it myself if I were young.”
And “young” being the operative word here. According to both Asher and Lighten, the younger the donor the better the egg quality and the greater the chance of a successful pregnancy and live birth.
As Lighten explains, “If you have an egg from a 20 year-old your miscarriage rate will be the same as the donor”.
Yet, even young eggs can’t fix old bodies. “In menopausal women we prepare them with oestrogen and progesterone but it’s not conceiving that’s the problem,” says Lighten. “These women are much more likely to have pregnancy complications because of their age. Their cardio system isn’t as healthy so they are more prone to have a growth restricted baby, preeclampsia and gestational diabetes. All of these things could result in a premature baby. And they almost always end up with a caesarean section because the uterus is no longer fit for labour.”
When 50 year-old Amanda Sheard gave birth to a baby boy in January this year she and husband Jan Skov, 55, were thrilled beyond words.
“We’d been trying to fall pregnant for a number of years and a few times we thought we’d give up,” says Amanda, who explains that the process of IVF was a hard slog that took its toll on her body and emotions.
Yet the couple persevered and little Odin, who was born by caesarean section six weeks premature, is the long-awaited child that completes their family unit.
Amanda, who already has two adult children from a previous marriage, says this pregnancy was similar to her others in that she felt fit and well throughout although this time she was advised to slow down and take it easier than she would normally.
“Doctors consider somebody at my age as being a high-risk pregnancy so I couldn’t exercise as much as I would have liked and I had to take it easy at work,” she says, with the latter being easier said than done due to her demanding role as a partner in a city management consultancy business.
Amanda’s pregnancy-induced high blood pressure meant that Odin needed to be delivered earlier than ideal but even then she was optimistic all would be well.
Today Odin is a thriving five-month old reaching all his milestones and keeping his parents on their toes, as is his want. As Amanda explains, “The constant breastfeeding and the lack of sleep are tiring but every new parent would say the same thing. Otherwise everything about having this baby has been sensational – he is such a joy to have in our lives”.
As for the reaction from family and friends, she says it’s all positive now although she concedes that announcing the pregnancy drew a mixed response initially.
“I had a number of adverse reactions from friends and family some of whom felt I was too old to have a baby and many of them made their opinions pretty clear from the outset. Although this was difficult at the time, now that he is born, nearly everyone is besotted with him which I hoped would be the case. I do sometimes wonder though what some people think when I am out with my 22 year-old and 18 year-old and my newborn baby!
“One lady recently asked me if he was my grandchild and of course I could be the grandmother so if anything it’s a reminder to keep healthy and fit. But I am really motivated to do that.”
Would she recommend trying for a baby so late in the piece?
“It’s like a dream come true now but I would say to others in a similar situation, that while there is hope it’s [IVF] not easy and maybe you do have to consider some alternatives.”