“Older couples trying to get pregnant run a high risk of failure, so my main concern is that they get through the process whole,” says Machelle Seibel of the Fertility Center of New England. His success stories include, clockwise from bottom left: Beth Strubeck, 47; Douglas and Adam Strubeck, 47 and 4; Charles Volz, 48; Eileen and C.J. Volz, 50 and 2; Paul Craffey, 45; Kathleen and Mary Katherine Vignolo, 46 and 2 month; John and Bryan Sabbag, 49 and 3; Carol and Lauren Sabbag, 49 and 3.
To become a father at 52 is unusual. To become a mother at 52 is to defy nature. Alan and Deirdre, both 52, don't want to let many of their friends and colleagues in on their secret yet, in case something goes wrong. But they are doing everything in their power to have a baby. They have the money, and they have the will. Deirdre, a trim, athletic researcher at a medical school in Connecticut, has three adult children from a previous marriage; Alan, a college English professor, has never had kids. "I always wanted children," he says. "Three years ago, when I found this woman I loved who was my own age, I thought, 'Well, that's one dream I'll have to relinquish.'"
Deirdre had already gone through menopause. By supplying the correct amounts of estrogen and progesterone via hormone therapy, it is relatively easy to make the uterus of a postmenopausal woman hospitable to a fetus. But even then, the chance of a woman Deirdre’s age getting pregnant with her own eggs is nonexistent. So doctors suggested the couple consider implanting a donor egg fertilized with Alan’s sperm. Egg donation is no longer considered cutting-edge medicine, but using the procedure to impregnate a woman over 50 is. Still, Alan and Deirdre were overjoyed. “I thought, ‘Isn’t science great?’ ” Alan says.
In a few weeks, Machelle Seibel, a reproductive endocrinologist at the Fertility Center of New England, will mix the eggs of a much younger woman with Alan’s sperm and introduce the resulting embryos to Deirdre’s uterus. Her chances of giving birth will then rocket from less than 1 percent to 50 percent. “I would have considered doing this even if I hadn’t remarried,” Deirdre says with a lopsided grin. “The idea of having another child at this stage is compelling.”
Not that Deirdre and Alan are unaware of the problems of being older parents. They worry about how they’ll function with little sleep—“although I needed a lot of sleep even when I was in college,” Alan says—and they are concerned that they might not be around to see their child come of age. If Deirdre gets pregnant, they plan to move to the Midwest to be near Alan’s four brothers and sisters. “As a hedge against possible early death, we want our child to be surrounded by as much family as possible,” Alan says.
Deirdre’s three children, all in their twenties, are trying to be supportive. But they’re skeptical. “Independently they came to me and said they thought it would be weird to be their age and have parents in their late seventies,” Deirdre says. “But I look at it like this: Our definition of ‘family’ has expanded. Now there are gay and adoptive and single-parent families who’ve used assisted technology. So although an ‘older-parent family’ is what we’ll be, it’s only one of several variations.”
Twenty-two years after the world’s first test-tube baby was conceived through in vitro fertilization, science is giving men and women—at least those who can afford the steep medical fees—increasing flexibility to alter the seasons of their lives. Infertility treatments once considered revolutionary are now commonplace: If a man has a low sperm count, sperm cells can be retrieved from a testicle for direct injection into an egg’s cytoplasm. If the shell of an egg has hardened because of age, doctors can hatch it in the lab and then implant it on the uterine wall. If a woman has stopped producing eggs, she can avail herself of drugs to induce ovulation, as well as donor eggs or donor embryos. These days, the science of assisted reproductive technology is advancing at such a rapid rate that laboratory researchers say it will soon be medically possible for even a centenarian to give birth. But such tinkering with the biological clock begs a commonsense question: How old is too old to have a baby? And this seemingly straightforward question trickles into a cascade of other questions: How old is too old for parents? For children? For society?
Machelle Seibel, a fertility specialist, views lab advances as both a blessing and a curse for older couples. “Some people go from one technology to another and find it very hard to stop,” he says.
When it comes to treating women for infertility, the American Society for Reproductive Medicine would like to draw its line in the sand at menopause. “Around 50, that’s when reproductive processes have physiologically stopped, and therefore the intervention and treatment by physicians should also stop,” says Robert Stillman, a former member of the society’s board of directors. “Infertility is a medical disorder, affected by the reproductive life span. Just as we wouldn’t consider inducing a prepubescent individual to conceive—although we could—we shouldn’t induce pregnancy in someone who’s gone through menopause.”
In recent years, an increasing number of women have chosen to spend more time building a career, or looking for the right mate, before having children. Some have been shocked to belatedly discover there is no denying a fact of nature. Without any scientific intervention, childbearing is out of the question for most women by the time they reach their early forties. Between the ages of 35 and 40, fertility tapers off, and after 43 it pretty much plummets off the cliff. That is because something about the aging process upsets the process of meiosis, the nuclear division of the ovum or sperm in which chromosomes are reduced to half their original number. Sex cells do not divide properly, and there are too many or too few chromosomes in the egg or sperm.
For women in their mid-forties, there is a dramatic increase in the risk that their eggs will have the wrong number of chromosomes after ovulation. Hence the difficulty in getting, and staying, pregnant. And unlike a man, whose sperm supply is constantly renewing itself, a woman is born with all the eggs she’ll ever have. In fact, ovaries start aging before a woman’s birth. A 20-week-old fetus has about 7 million eggs. Eighteen weeks later, at birth, that number has been decimated to less than 2 million. Even though the eggs remain unused throughout childhood, by puberty the egg supply has dropped to 400,000—less than 6 percent of what the child started with. By menopause, the egg larder is close to empty.
Even when an older mother manages to get pregnant, she and her baby face additional medical hurdles. With mothers over 35, there is a greater risk of hypertension and diabetes for themselves, and likely a greater risk of juvenile diabetes for the children. A 1995 Swedish study found that women born to mothers age 45 or older had a slightly higher chance of developing breast cancer than women born to younger mothers. Most well known is the increased risk of certain chromosomal abnormalities such as Down’s syndrome, in which there is an extra set of genes in each cell.
Studies suggest that being the child of an older father also carries risk. Because older sperm tend to have more chromosomal mutations—ranging in seriousness from harmless to lethal—there is among older fathers a higher rate of kids born with certain rare tumors, neural-tube defects, congenital cataracts, and upper limb defects. Curiously, there’s also a higher rate of homosexual children born to older dads.
For more information about different kinds of infertility and treatment options, see the resolve national infertility organization's Web site: www.resolve.org.
For updates and a searchable library on advances in reproductive technology, see the home page of the American Society for Reproductive Medicine at www.asrm.org.
Find the Centers for Disease Control's report on the efficacy of various reproductive technologies, alongside a wealth of information on reproductive health: www.cdc.gov/nccdphp/drh/index.htm.