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Archive for the ‘too old to conceive’ tag

Infertility Podcast Series: Journey to the Crib: Chapter 31: When Are You Too Old to be a Mother?

By David Kreiner MD

November 24th, 2013 at 9:44 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty-One: When Are You Too Old to be a Mother? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=143

When Are You Too Old to be a Mother?

 

Over the years, there have been reports of women as old as in their 70′s having babies as a result of In Vitro Fertilization (IVF) performed using donated eggs from a young fertile donor.  Immediately after these reports appear, I am bombarded with questions and criticisms about how wrong it is that we (somehow I am included as part of the responsible party as an IVF practitioner) allow women to have children beyond that which is not just natural but also reasonable. Those of us in IVF have had many experiences with making the news as this medical technology pushes to the edges of what society views as acceptable.

 

We are often put in the position of making decisions with our patients that have even larger implications to society than the individual patient.  I do my best to look at each patient and each situation as unique and treat them accordingly.  Regarding the age of a prospective egg recipient however we are dependent on the patient’s honestly reporting such to us.  Unfortunately, there are circumstances where patients have misled their doctors and in the case of one 70 year old mother, she had reported to the clinic that she was in fact 53.

 

Even so, it is the responsibility of the IVF provider to ensure that a woman is healthy and capable of bearing the pregnancy, giving birth and being a mother.  There is not an absolute age cutoff at which point a woman is universally unfit to undergo IVF and become pregnant.

 

My personal oldest woman I helped achieve a pregnancy was a 53 year old who delivered at age 54.  She had a normal stress test, EKG and was cleared by an internist, perinatologist and psychologist.

 

Some point out that beyond a certain age, it is unnatural to become a mother and that it puts the family at risk that she may not be around to help raise the child or that perhaps the woman lacks the energy and stamina to raise the child properly.  I personally struggle to separate my own feelings about the proper age to have a child which may be inappropriate for others who have a different perspective.  My responsibility as the physician is to the health of my patients, the well-being of the child and for the good of society.

 

Many women in their 50′s have the health and energy to carry a pregnancy and bear a child with no more risk than many women 10-20 years younger.  That being said, what about the risk that the mother may not be around to raise the child to maturity?   There is no question that a young healthy couple with sufficient financial support and emotional maturity is ideal to raise a family.  But, happy, successful families can take on many different faces.  Single parent families exist, survive and often thrive.  One can never be certain that the condition of the couple at the time of conception will continue through the child’s birth or for that matter until the child has reached maturity.  In addition, at least 50% of couples in the U.S. become divorced.  One can argue that couples at risk of divorce should not get pregnant.

 

I apologize that I cannot offer an answer to this question, when are you too old to be a mother.  For me personally, it is more a question of health …for the mother and baby… which needs to be evaluated individually for each case utilizing testing and experts to make the best assessment.  Otherwise, I feel it is an individual’s right to choose as long as society is unaffected or supports the individual in those cases where the pregnancy has a significant impact beyond the immediate family.

 

 

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Was this helpful in answering your questions about what fertility doctors might consider when questioning if an older woman may be able to conceive and carry a pregnancy?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

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Is Your Biological Clock Running Out?

By Tracey Minella and David Kreiner MD

May 19th, 2011 at 9:02 am

I’ve always hated this term.

It used to nag at me in the back of my mind as I pursued my education and got settled in my career…especially since I married young. And when it wasn’t in the back of my mind, it was being shoved smack in my face by the rude comments of nosy jerks, collectively known as the "masses of asses".

If you’re wondering whether your biological clock is really running out, this post by Dr. David Kreiner of East Coast Fertility may be enlightening:

Tears start to course down the cheeks of my patient, her immediate response to the message I just conveyed to her. Minutes before, with great angst anticipating the depressing effect my words will have on her, I proceeded to explain how her FSH was slightly elevated and her antral follicle count was a disappointing 3-6 follicles. I was careful to say that though this is a screen that correlates with a woman’s fertility, sometimes a woman may be more fertile than suspected based on the hormone tests and ovarian ultrasound. I also said that even when the tests accurately show diminishing ovarian reserve (follicle number), we are often successful in achieving a pregnancy and obtaining a baby through in vitro fertilization especially when age is not a significant factor.

These encounters I have with patients are more frequent than they should be. Unfortunately, many women delay seeking help in their efforts to conceive until their age has become significant both because they have fewer healthy genetically normal eggs and because their ability to respond to fertility drugs with numerous mature eggs is depressed. Women often do not realize that fertility drops as they age starting in their 20s but at an increasing rate in their 30s and to a point that may often be barely treatable in their 40s.

A common reason women delay seeking help is the trend in society to have children at an older age. In the 1960’s it was much less common that women would go to college and seek a career as is typical of women today. The delayed childbearing increases the exposure of women to more sexual partners and a consequent increased risk of developing pelvic inflammatory disease with resulting fallopian tube adhesions. When patients have endometriosis, delaying pregnancy allows the endometriosis to develop further and cause damage to a woman’s ovaries and fallopian tubes. They are more likely to develop diminished ovarian reserve at a younger age due to the destruction of normal ovarian tissue by the endometriosis. Even more important is that aging results in natural depletion of the number of follicles and eggs with an increase in the percentage of these residual eggs that are unhealthy and/or genetically abnormal.

Diminished ovarian reserve is associated with decreased inhibin levels which decreases the negative feedback on the pituitary gland. FSH produced by the pituitary is elevated in response to the diminished ovarian reserve and inhibin levels unless a woman has a cyst producing high estradiol levels which also lowers FSH. This is why we assess estradiol levels at the same time as FSH. Anti-Mullerian Hormone (AMH) can be tested throughout a woman’s menstrual cycle and levels correlate with ovarian reserve. Early follicular ultrasound can be performed to evaluate a woman’s antral follicle count. The antral follicle count also correlates with ovarian reserve.

By screening women annually with hormone tests and ultrasounds a physician may assess whether a woman is at high risk of developing diminished ovarian reserve in the subsequent year. Alerting a woman to her individual fertility status would allow women to adjust their family planning to fit their individual needs.

Aggressive fertility therapy may be the best option when it appears that one is running out of time. Ovulation induction with intrauterine insemination, MicroIVF and IVF are all considerations that speed up the process and allow a patient to take advantage of her residual fertility.

With fertility screening of day 3 estradiol and FSH, AMH and early follicular ultrasound antral follicle counts, the biological clock may still be ticking but at least one may keep an eye on it and know what time it is and act accordingly.

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