How old is too old?

How old are your eggs?

On hearing the term elderly primigravida, you’d be forgiven for thinking this was a very ripe, pungent cheese. In fact, it’s the medical term to describe any expectant mother who is 35 or older at the time of her first baby’s birth. In 1958, the Council of the International Federation of Gynaecology and Obstetrics accepted the age of 35 as the international standard.

Today, even in purely gynaecological terms, it seems ridiculous to think of a 35-year-old woman as “elderly”. But then you have to remember that a few hundred years ago the average age for childbirth was 13. A woman is born with her lifetime supply of eggs so, while a 35-year-old may not feel old, her eggs are as old as she is.

It is mostly the age-related deterioration in the quality of eggs that makes age so relevant in fertility.

But just how old is too old to have a baby? Increasingly women are first-time mothers in their 40s, even 50s, as careers and other imperatives or opportunities take precedence over raising families.

Delaying childbirth for a chance at a successful career

Naomi Wolfe, author of Misconceptions: Truth, Lies and the Unexpected on the Journey to Motherhood (Chatto & Windus), suggests there is a coercive force at work – that women are forced to delay childbirth because they – unlike men – have a social contract that does not allow them to “have it all”.

In a world where there is limited maternity leave, few work crèches and even less understanding of the intense rigours of childbirth and motherhood, women have no choice but to defer these until their careers are established.

Neuroscientist Louanne Brizandine, whose book, The Female Brain, takes a biochemical (read: hormonal) journey through the lives of women from birth to post-menopause, also sees our current social contract as severely limiting.

“The workplace should realise that women are wired to take care of children, and they want that time and need that time [to do so].” Women, both authors would argue, should not be compelled to defer pregnancy and childbirth.

Yet what sounds fabulously sane in theory is rarely the case in practise. For better or worse, through societal pressure or simply through choice, women are delaying childbirth. How often have you heard a woman say, “I want a baby, I’m just not ready for it yet. There’s so much I still have to do.”

What the statistics say

Birth statistics during the last few decades reflect this trend dramatically. In 1998, 44% of births were to women over 30. The biggest increase in the birth rate over the last decade is in women aged 35 to 39 – up by 60%. The number of births to women aged between 40 and 44 has doubled over the past decade, and this trend is set to grow.

Dr Jenny Rosendorff, a cytogeneticist at Lancet Laboratories in Johannesburg, is seeing the results of this in her lab.

“Broadly speaking, we’re seeing more women in the 40+ age group. Many of these women elect to have their pregnancies monitored by genetic amniocentesis, even though there is a small risk of miscarriage, while others rely on non-invasive screening tests,” she says. “But certainly, just from my own observations, I’ve noticed an increase in professional, often single women having children in their 40s.”

Advances in technology

Of course, the phenomenon of older mothers is not only due to social pressure but is, in large part, the result of the fact that it’s possible, which it wasn’t one generation ago.

Advances in reproductive technology have enabled and supported women to have babies at later stages in life – in some cases with eggs donated by other women.

Adriana Iliescu

It’s these advances that have led to the more extreme and ethically controversial cases of elderly motherhood. The most notable story was in 2005, when Adriana Iliescu, a Romanian academic, became the world’s oldest mother at the age of 66. The birth of her child opened up a Pandora’s box of ethical, clinical and social questions.

Writer Deborah Orr, tracking the story at the time for The Independent newspaper in London, wrote scathingly that “advances in medical science are moving at a faster pace than human ethics”.

Iliescu’s pregnancy, Orr argued, after 9 years of fertility treatment designed to reverse the menopause, and using donor eggs and sperm, “is nothing but an elaborate, expensive and grotesque form of adoption, carried out to persuade an obsessed old woman, quite erroneously, that she’s somehow, miraculously, reproduced herself”.

Quite simply, Orr blames the medical establishment. Instead of advising her to seek psychiatric help, it pandered to her demands in this highly unethical, “rather piecemeal creation of a child”. More worryingly, wrote Orr, extreme cases like Iliescu’s “misleadingly foster a belief among the general public that childbirth is something that women can achieve at increasingly advanced ages”.

Frieda Birnbaum

Earlier this year, psychologist Frieda Birnbaum, 60, became the oldest woman in the US to deliver twins. She and her lawyer husband Ken, 63, have been married for 38 years and have 2 older children, Jason, 33, and Alana, 29. They also have a son, Ari, who is 7. But not everyone in the Birnbaum family is beaming about the birth.

“My mother is too old, for health reasons and for lifestyle,” daughter Alana has said. “I don’t think she’s thinking about the future – being 80 or 90 and having a kid.”

She said her brother is worried they will end up taking care of the babies. “He’s against it even more than I am.” The Birnbaums were turned away from US clinics and flew out to South Africa for fertility treatment, where they struck it lucky. Birnbaum plans to write a book about her experiences.

A question of ethics?

While there are older mothers who are choosing to have children with the most natural and best motives in mind, the fertility industry does not always operate with the same honourable intentions. Profit-making imperatives in the industry often override the welfare of the older woman and her baby.

Osagie Obasogie of Biopolitical Times posted a blog voicing these concerns, “The impact fertility drugs and multiple-birth pregnancies have on women’s and children’s health suggest that we are approaching the fine line between treating infertility and experimenting on humans. And, in a growing number of cases, that line is behind us.”

Questions of ethics aside, the reality is that our bodies have not changed alongside the advances in technology. Only a few hundred years ago, child-bearing began very early with the onset of menstruation, at around the age of 12, and most women died before eaching menopause. What has changed is the average life expectancy and, with it, when in life we do things, including the age at which we have a baby.

In terms of our overall sense of wellbeing, self-esteem and self-perception, 40 may well be the new 30, but our bodies and our eggs are still 40. Dr Merwyn Jacobson, a fertility expert at Vitalab Fertility Clinic in Johannesburg, says the statistics are pretty stark.

“Until the age of 35, the average pregnancy rate is about 80%. At 38, we see a dramatic shift. It’s the pinnacle before the decline. By 40, the rate drops dramatically to about 40% and, by 45, your chances of conceiving are around 15%.” He also cautions that the miscarriage rate also increases with age.

What is the correct cut-off point for pregnancy?

So what age, in his view, is the correct cut-off point for pregnancy? Realistically, he believes it to be 45 to 50. “Physiologically, the womb just doesn’t do as well after this, as general health begins to change.”

But he argues that it is not only physiological issues that face the older woman. It’s essential to consider the impact of late parenthood on the child. “The first ethic of parenthood is about the welfare of the child. You have to ask yourself these hard questions: at an advanced age, how good a parent will you be, and how long will you be around to take care of that child?”

He believes that facilitating a pregnancy in a 60-year-old, while technologically possible, is highly unethical. “This is such an emotional issue and unscrupulous fertility experts could well manipulate the situation. But it is one’s professional responsibility to draw the line and not allow a patient to delude themselves indefinitely in pursuit of an elusive goal.”

He also, critically, makes the point that one has to look out for the babies that are being born through technologically-assisted pregnancies.

“Premature babies are on the increase because of multiple births resulting from assisted pregnancies. These premature babies, more often than not, will experience physical difficulties,” he says. “We may well be facing a generation of physically compromised children.”

It’s been argued that the compromises children of much older parents face are not just physical. Many psychologists and social workers believe that the generation gap is just too wide, that older parents lack the vitality and patience to keep up with their children’s needs and demands, and that they are unlikely to be around to take on the supportive role of grandparents, when their own children give birth.

Studies show...

• Studies have shown that mature women have more positive perceptions of their bodies and that they are more ready to tolerate the symptoms of pregnancy. Also, an older mom has more confidence to know what she wants, and the people skills to get it.
• Despite the real, perceived or potential risks, all studies agree that the actual outcome for the baby of an older mother is every bit as good as that for younger mothers, as shown by the Apgar Scores, which assess a baby’s wellbeing immediately after birth, and on-going checks through childhood.
• Unfortunately, it is true that simply by being older, a woman is at increased risk of developing medical conditions such as diabetes, hypertensive disorders or fibroids, which can affect pregnancy and birth. The incidence of pre-existing conditions rises from 5,5% in the under-29 age group to 11,8% in the over 35s.
• Studies on the effect of age on childbirth report an increase in the frequency of pregnancy complications such as high blood pressure, pregnancy-induced diabetes, bleeding in the third trimester and low-lying placenta. The incidence of pregnancy complications rises from 10,43% for women aged 20 to 29 to 19,29% for women aged between 35 and 39 years.
• “Fertility tourism”, in which a patient can get a holiday and full IVF treatment in one package, is on the rise. Romania is fast becoming known as a “paradise for late-life birth and egg donation”.
• In Israel, women are undergoing up to 35 IVF treatments in an effort to bear children, according to reports. Married and single women in Israel are allowed virtually unlimited attempts up to the age of 45. From the ages of 45 to 51, women are allowed to continue treatments with donated eggs. Nearly 5%of babies born in Israel are test-tube babies.