.jpg)
A newborn cries.AP Photo/Mahesh Kumar A.
Seems like a terrible and heartless thing to ever say, right? The death of the oldest woman to give birth from in vitro fertilization (IVF) was announced this week; she was 69 years old and is survived by her twin sons. This naturally brings up a lot of questions I hear from women on a regular basis concerning IVF and assisted reproduction technologies (ART).
Women are waiting longer on average to begin having children in the last 20-30 years due to careers, education and other opportunities not traditionally available to women. As a result, more women are finding that natural conception has become increasingly difficult. On the opposite side of this coin is the “Octomom” fiasco in which a woman with no medical need for IVF was given a rather radical treatment resulting in the birth of 8 children.
Why the difficulty?
It is common knowledge that women over the age of 30 begin to experience marked declines in potential fertility. The primary reason for this decrease in fertility is the age of the eggs which her body is supporting to maturation.
At birth, women have all of the eggs (egg reserve) that she will ever have the ability to mature and ovulate. In the mid 30’s, the viability of eggs begins to degrade as hormones and other physiological changes occur as perimenopause begins. Accordingly, the number of women and couples seeking ART for child birth increases. The CDC posts:
Among American women in their 20s to mid-30s, over 35% give birth per ART cycle using their own eggs. As women age, the live ART birth rate gradually drops:1
To about 20% per IVF cycle by age 39.
To 2% or less per cycle in women over age 43. Many women over age 40 choose to use donor eggs, which greatly improves their chances of giving birth to a healthy child.
The outcomes are much better for women who use donor eggs, rather than their own, as a fertility alternative.
From the CDC 2005 data on national IVF success rates for women over the age of 40. The live birth rate begins at 16% per cycle of IVF at age 40, declining steadily to just under 3% by age 44. Based on this information, most clinics set an upper limit for women they will allow to begin IVF to 50-55.
Risks Associated with IVF
Failure of treatment
Emotional and Psychological Stress
Multiple Birth Potential
Ovarian Hyperstimulation Syndrome
Ovarian Cancer (controversial)
The most sever medical risks occur from multiple births. Multiple birth pregnancies are automatically high risk, and the greater the number of fetuses, the greater the risk to both mother and child. Society of Assisted Reproductive Technologies (SART) statistics indicate that 32% of IVF births are twins and 7% are triplets or more.
Maternal Risks include:
Miscarriage
Hemorrhage
Pregnancy induced high blood pressure
Pre-eclampsia (three to five times more frequent in multiple births)
Polyhydramnios (excessive amounts of amniotic fluid)
Caesarean delivery is often needed in twin pregnancy (almost always required for more than twins)
Prolonged hospitalization resulting in higher cost of medical care
Increased chances of postpartum depression
Fetal risks include:
Preterm Delivery
Low Birth Weight
Increased stillbirth rate
Increased infant death
Increased risk for moderate to severe handicap due to early delivery
Cerebral Palsy risk is greatly increased
The most important thing a woman of any age can do to ensure the best chances of a healthy pregnancy is to have a good doctor who shares your philosophy on reproduction and delivery. The only way to make this happen is to do your homework, don’t feel like you have to be seen by the first doctor you visit. If it doesn’t feel right, keep looking.Be completely open and honest with your doctor. If you smoke, quit. If there is a reason other than fertility you want IVF, genetic screening for example, be upfront about it with your doctor. The following is a list of doctors with good reputations in the valley as well as a link to the SART statistics for the practice. If your clinic is not listed, don’t worry, most reputable practices include information on their website and certainly in the office concerning their success rates and the number of procedures of each type performed.
Arizona Reproductive Medicine Specialists
Southwest Fertility Center
Arizona Center for Fertility Studies
Arizona Associates for Reproductive Health
Comments