Forty and Fertile by Corey Senn Having children later in life carries risks, but IVF can help print article      send to a friend

Women of today are having children well into their 30s and even into their early 40s. Of course, bearing children at 41 is not without its risks.  Fortunately, infertility clinics are using modern in vitro fertilization (IVF) techniques to help older women harvest the fruits of family.

One of the most important reasons for women to hold off on having children is the simple fact that we're living longer. Many women are now building careers for a decade or longer before turning their attention and energy towards starting a family. Donna Chevalier (not her real name) underwent IVF at age 41. "I think I was in better shape when I was 40. I had been working when we first got married but after a few years I stopped and I started exercising. [The infertility clinic] told me that the eggs they got looked as good as any 25 year old's," she explains. 

Another important factor, which is certainly tied into living longer, is our change in lifestyle. The old model of women graduating from school, marrying, and raising a family is essentially a dead letter.  "I think society has imposed a standard on women that they are supposed to be career oriented and go to school and work, etc.," comments Dr. Amos Madanes, director of the Midwest Fertility Center.  Inherent in this statement is the notion that we are placing higher expectations on women-higher levels of stress can often be counterproductive to women's reproductive success.

Finally, women now have access to a wide spectrum of reliable contraception. Of course, it isn't as if this is a recent development-the pill (the most popular form of contraception in the U.S.) just celebrated its 40^th birthday. Nonetheless, the responsible use of birth control now allows couples to decide when and how to start their family on their own terms.

When a woman hits 35 years of age, the actual definition of infertility changes-from a couple trying unsuccessfully to conceive a child for a full year to a couple trying without success for six months. One of the reasons is that a woman's embryos become increasingly vulnerable, causing a steady decrease in levels of fertility. (Men seem to be spared this decrease in fertility until they hit the half-century mark.) Add to this the fact that older women in their first pregnancy run a higher risk of obstetrical complications. And finally, pregnancy for a woman at or beyond 35 years old carries with it two essential risk factors: first, a heightened incidence of miscarriage, tubal pregnancy, and stillborn births; and second, the risk of some, but certainly not all, birth defects.

That's the bad news. Now for the good news.  Infertility clinics have developed a whole host of sophisticated techniques that are helping counterbalance the difficulties and dangers of becoming pregnant later in life

The IVF Route

For women who have had their tubes tied, the question is whether to have a reversal procedure or undergo in vitro fertilization. For most couples, the choice is a financial one. If their insurance covers one procedure but not the other, patients will most often choose the covered procedure. Yet, as Dr. Madanes points out, "If both procedures are covered [by insurance], we usually recommend IVF because it does not require major surgery, and the women still maintains her method of contraception." (Using IVF, the eggs are taken from the ovaries, meaning that the fallopian tubes are completely bypassed.)

What can IVF programs do for women? For Donna, it wasn't until she and her husband visited the fertility clinic that they discovered that one tube was blocked and an ovary was stuck to the side of her uterus. IVF begins when the woman is prescribed fertility drugs in order to boost the number of eggs she will produce. For older women, there will typically be a higher amount of fertility drugs given because, as a woman ages, her body responds less effectively-ovarian response decreases and fewer eggs are produced. The key is making sure that the body responds well and produces a good number of eggs. The eggs are taken out of the ovaries, fertilized by the sperm in the laboratory, and reinserted into the woman's uterus. An IVF cycle will typically cost between five and eight thousand dollars. 

For a healthy pregnancy, a woman needs to follow all the usual health guidelines: taking vitamins, maintaining proper nutrition, as well as avoiding smoking, alcohol, and/or drugs. Most infertility clinics recommend to all woman over the age of 35 that they undergo amniocentesis, which checks the health of the baby and for certain congenital diseases such as Down's syndrome or spina bifida.

Doctor's Advice

Infertility clinics may allow a woman's clock to tick longer, but certainly not forever. "The biggest problem I see is when the woman is now 40 and the couple has spent three years trying to get pregnant," comments Dr. Madanes.  "If they'd have come to me when the woman was 37, the chances of getting pregnant would have been probably 80-90%. Now, after they've waited three years, the chances are closer to 40-50%. And in another three years, it will be 20%," he continues. For women at or beyond 35 years old who are trying to conceive children, these numbers may be the best argument for making an infertility clinic your first stop.

So how old can a woman be and still have children? For women, egg donor programs mean a healthy embryo could be implanted into a 50 year old woman. However, this scenario not only presents health concerns for the mother, but involves moral and ethical questions as well.

To be sure, having children at an older age carries with it certain risks and concerns. But it may also lend itself to certain advantages. Studies have indicated that children of older parents often fare better in school. As well, older parents have already seen friends and family go through the trial and error of raising children. This added experience and knowledge often comes in handy when it comes to raising their own family. And finally, couples are usually in a better economic situation when they have children later in life. All of these can translate to real advantages for the true purpose of all this--raising the All American kid.