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Older Mothers, the Economy and the Fertility Class Divide
With a photoshopped cover of a 63-year-old model striking a Demi Moore pose, New York Magazine’s "Parents of a Certain Age" article raised important points and set off a national debate over when is a woman too old to have children.
Unfortunately, in today’s economic and social climate, when many women are ready to be mothers, their bodies are not as young and fertile anymore. U.S. births fell from 4.37 million in 2007 to 4.01 million in 2010, and from 2007 to 2010, the U.S. total fertility rate fell 10 percent — to below two births per woman. However, Americans still believe that two or more children is ideal, according to a new study, “The Sustainable Demographic Dividend: What Do Marriage & Fertility Have To Do With the Economy?"
The study found that among developed countries, over the next two decades, the United States will be one of the only countries to maintain fertility levels close to the replacement level of 2.1 — but only if the U.S. economy does not stagnate or fall back into recession. “Even though couples and women are having fewer children today because of the fallout associated with the recession, most Americans of childbearing age think that having two or more children is ideal,” said Dr. Sam Sturgeon, director of research for Demographic Intelligence, LLC, a provider of U.S. birth forecasts and U.S. fertility analytics for companies.
Age and Fertility
According to the American Society for Reproductive Medicine, age is a significant factor in a woman’s ability to conceive, and social trends have led to deferred childbearing and an increasing number of women with age-related infertility and pregnancy loss. The ASRM recommends that any woman older than 35 years (which seems young compared to the women discussed in the New York Magazine article) should receive "expedited evaluation and treatment after six months of failed attempts to conceive."
Fertility significantly declines at age 37 — with the number of eggs declining from 1 to 2 million at birth to approximately 25,000. The average age of menopause is 51, with the number of eggs declining to approximately 1,000.
But how old is too old to get pregnant — even via assisted reproductive technology such as in vitro fertilization (IVF)?
What Older Women Should Know about Fertility, Eggs and Embryos
Norbert Gleicher, M.D., FACOG, FACS a reproductive endocrinologist and founder of the Center for Human Reproduction (CHR) in New York City, says when an older woman is interested in assisted reproductive technology, every situation is unique. “CHR does not have artificial age limits,” he explains. “As long as the patient is physically, mentally and socially fit to go through pregnancy and motherhood, we will try to help. We, of course, objectively determine all of these criteria first.”
Before in vitro fertilization (IVF) at CHR, a patient will receive a physical evaluation that includes a chest x-ray, a mammogram, a blood chemistry screen, a cardiac exercise stress test and general medical clearance from an internist or specialist if the patient has any medical problems. In addition, patients receive a single psychological evaluation with psychological testing and a psychological clearance letter for pregnancy. Also, “we evaluate her social situation carefully,” Dr. Gleicher says.
“Once a patient qualifies for pregnancy, the question arises whether she still can do it with own eggs or will need donor eggs,” Dr. Gleicher continues. “We do NOT see it as our responsibility to tell women when to give up on their own eggs and go into egg donation. We, however, DO see it as our responsibility to be brutally honest about their chances with own eggs vs. donor eggs. Then it is up to them to decide!”
According to Society for Assisted Reproductive Technology (SART) reports, in 2009 there were 5,916 IVF cycles with fresh embryos from non-donor eggs for women over age 42, with 4.2 percent resulting in live births. There were 961 IVF cycles with thawed embryos from non-donor eggs, with 13.9 percent resulting in live births,
For women of all ages, donor eggs help with success rates. With fresh embryos created from donor eggs, the percentage of transfers resulting in live births is 55.1 percent for women of all ages; for thawed embryos from donor eggs, the percentage of transfers resulting in live births is 33.8.
CHR’s oldest successful IVF pregnancy with a woman using her own eggs was 46 years and 10 months at time of conception. The fertility center’s oldest pregnancy with donor eggs was at age 54. “Pregnancy chances with donor eggs are very high, almost independent of recipient age — 60+ percent with transfer of two embryos,” he says.
Dr. Gleicher says that success rates, especially above age 42, no longer depend that much on the woman's age, but they do depend on the number of embryos a woman can create. “Pregnancy rates ‘til age 42 are still quite good — around 20 percent average,” he explains. “Above age 42, it all comes down to number of eggs and embryos. Even a 45-year-old will still have a good pregnancy chance around 20 percent with four to five good embryos. The same woman with one poor embryo will have a very poor chance.”
Will the Trend of Older Motherhood Continue?
Even though the United States will probably be producing children at the same 2.1 replacement level, a recent Slate article points out an increasing Fertility Class Divide — the contrasting reproductive profiles of rich and poor women. A Guttmacher Institute study found that the rates of unplanned pregnancies and births had increased dramatically among poor women while it had decreased substantially among higher income women. Another study from the Center for Work-Life Policy found that the rates of childlessness among corporate professional women are higher than those experienced in some European countries that are having fertility crises.
The fact is that in our society today, the more affluent, educated women are waiting longer to have children — whether it is because they have fears about the economy, they haven’t found the right partner or they are simply waiting until they feel “ready.” The good news is that as research advances, and technology procedures such as egg freezing and preimplantation genetic diagnosis improve, many of these women can have successful pregnancies and healthy babies — even if they choose to do so at an older age.