Motherhood At Mid-Life — A Medical and Ethical Dilema
St. Louis Times, July 1997
Much of the world was shocked this past May when news reports out of California unraveled the details of a 63-year-old woman, Arceli Keh, who gave birth to a healthy baby. She is believed to be the world’s oldest new mom. Using fertility treatments and donated eggs, Keh reportedly delivered her healthy daughter last November. While Keh’s story has raised eyebrows and ethical issues about how old is too old to be having a baby, donor egg programs are becoming more and more popular and women between the ages of 40 and 55 are having babies in record numbers.
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Sherman Silber, M.D., Infertility Center of St. Louis at St. Luke’s Hospital, and author of “How To Get Pregnant With The New Technology”.
Here in the St. Louis area, there are three medical facilities (Barnes-Jewish, Missouri Baptist Hospital and St.Luke’s) that are offering donor egg programs that allow women who have already gone through menopause to become pregnant.
“It has become more common over the past decade but I don’t think the trend has significantly changed since 1990,” said Randy Odem, M.D., who is an associate professor of OB/GYN and the director of the division of Reproductive Endocrinology at Washington University.
Dr. Odem, who helps run the donor egg program at Washington University, says a woman can only have a baby after menopause if she is getting an embryo from a fertilized egg. A donor egg is used because once someone goes through menopause they no longer have any eggs of their own. Hormone therapy initially is also required.
“Is any age too old? It depends on whom you ask. We will do up to age 50 with donor egg. Some people will allow it to be age 55,” said Dr. Odem. He says probably about 2,500 to 3,000 women are entering donor egg programs every year in the United States.
“We have the biggest and best donor egg programs right here,” said Sherman Silber, M.D., who runs the Infertility Center of St. Louis at St. Luke’s Hospital. He says in these cases fertility is strictly related to the age of the egg, and how well the pregnancy goes does not have anything to do with the age of the uterus. As a result, there is really no barrier to women even older than 63 having a baby.
“We haven’t had an age cut-off yet. We haven’t had any requests for women over the age of 55 yet,” said Dr. Silber, who is the author of the recent book, How To Get Pregnant With The New Technology, published by Warner Books.
Dr. Silber has treated several thousand infertile couples over the past 20 years. Many travel to St. Louis daily from all over the world. He has patients come from Europe, South America, the Middle East, Asia and Africa. Many of his patients are very well off financially as well as highly educated.
“You have to look at both parents. They have to be in love and one of them at least has to have a decent life expectancy,” said Dr. Silber. He says his center will have about 50 or more women over the age of 40 getting pregnant with egg donation every year.
|Dr. Odem says donor egg programs have been growing in popularity for the last 10 years, but he says women are not entering these programs simply because they are something new in the fertility treatment arena, but because they are more of a last resort.”The reason this is becoming more popular is because it is a possibility that wasn’t out there in the past,” said Dr. Odem. “If you look at who is doing donor egg and these kind of therapies, it is people who have wanted to get pregnant for a long time and now they have an option and so they are taking advantage of it.”|
While almost all the experts agree that 63 is too old to be having a baby, most say up to age 55 is fine. Because people are living longer and women now make up a much greater proportion of the U.S. work force, delaying childbirth until after a career is established is becoming commonplace.
“It is not just that we are living longer, we are living better. A generation ago, it was expected that a man in his mid-40s would have a heart attack and die,” says Tricia Dusseault, 41, who just had her first baby May 31, 1997.
Dusseault says today people expect both men and women to live active and healthy lives well into their 7th decade of life, and so starting a family between the age of 40 and 55 is not that out of line with American lifestyles as we enter the new century.
“I have become a role model for some of my friends,” said Dusseault, who is a registered dietician. “I was amazed at the positive support I got. I got very little negative feedback.”
She says many of her friends who are over age 35 panic and think it’s too late for them to have a baby. However, she says once they saw she was able to become pregnant without any fertility treatments or any medical intervention and have a perfectly normal son, they too felt they could do the same.
|Dusseault says she was amazed at how many women she knew who were thinking about getting pregnant without having a permanent partner. She believes you really need a loving family and at least two parents to raise a child.
One of the reasons Dusseault and many others believe it’s a good idea for women to have babies after age 35 is because they can make better parents in many respects. Often times, older moms are much more emotionally and financially stable.
“I have so many resources now that I didn’t have when I was 25. I have money in the bank, emotional resources, I have better problem-solving skills, I am a better consumer and I have much more patience,” said Dusseault.
Dr. Silber says older moms not only tend to be more nurturing and better able to handle a child, they actually have children that are more confident and brighter. “By and large, the children are more intelligent,” said Dr. Silber. He theorizes that these children are better cared for during the first 24 months of life and that single factor greatly influences a child’s personality and intellectual ability.
Dusseault believes that older moms want their babies so badly that their child becomes an incredible gift and so they are able to become more patient, nurturing, and loving with a child in a way that younger moms can’t. Dusseault says for this very reason society as a whole has drastically changed its view on older moms.
“If you look back 30 or 40 years ago, the thought of a woman having her first baby at age 40 was absolutely incomprehensible and now it is not at all like that. Now it is thought of as cool,” said Dusseault.
But while having a first child at age 40 may be “cool” to some, having one beyond menopause and over the age of 50 is far from cool for many people.
“This is ridiculous,” said Jane Ettelson, who is a clinical social worker and for more than 20 years has been working with children. “It is fine for infancy and childhood, but when you have someone in their 70s raising a teenager, it is not fair to anyone.”
Ettelson works with grandparents who end up having to raise small children and teenagers, and she says there are a whole set of problems they face, simply because of the grandparents’ age. In some cases, Ettelson says, you will have a man in his 60s or even 70s trying to raise a grade-school-aged child on his own. Many times she says the situation becomes impossible and these children must be placed in a new home.
Ettelson, who is 45, says anyone having a baby after age 55 should think about what the child’s needs will be when they are teenagers and whether the parents will be equipped to handle those needs. “I would have concern that people will not be in good enough health. Kids need more than 15 years. These parents will be at an age where they need to be cared for,” says Ettelson.
Amy Gill, who is 33 years old and the mother of two small boys, agrees with Ettelson. Gill did not want to give his name, but she has a relative who is 75 years old, and he and his 36-year-old wife have two small boys. Gill says her relative suffered a heart attack while standing at a school bus stop with his 4-year-old son.
“The 4-year-old was saying, ‘Daddy, Daddy, wake up,’ when the bus finally showed up and saw him collapsed and the child standing there,” said Gill. The two were at the bus stop waiting to pick up the man’s other small child.
Since that incident, the father has had triple bypass surgery and Gill believes this type of situation is unfair to the child. She says having a baby after menopause is naive in a certain way because it doesn’t take into account what it means to be around to care for a child when they are in their teens and twenties. “It devalues parenting,” said Gill.
But neither Gill nor Ettelson believe that laws should be passed to stop women from having babies after age 55 and no one is yet calling for the courts or state or federal governments to step in and pass laws limiting the age of women in donor egg programs.
“I don’t think it is an area where state legislature or the courts should step in and establish a law in what is strictly an ethical matter,” said Tom Hooyman, Ph.D., who is a medical ethicist.
Hooyman says if the technology is available and women give their consent, it has always been the practice in the United States that a woman can do whatever she wants with her own body.
“It would be schizophrenic to allow legalized abortion, but then on the other hand to have a law to prevent you from becoming pregnant based on your age,” said Hooyman.
He says the natural law argument is that you are going against the natural cycle of life, and that there is something inherit in that the body ceases to produce in the natural fashion after a certain age.
Hooyman says there is also the political social justice issue. The technology and treatments required for programs such as donor egg are not covered by insurance, and so poor people don’t have access to the technology.
“It shows the imbalance in how we have structured the health care delivery system. If you have the money, you can buy it,” said Hooyman.
Dr. Odem says he always looks at a couple individually and even though a mom may be a healthy, young looking 50, she may not have the stamina to handle what’s involved in having a child at that age.
The concern is general health, the ability to endure pregnancy, labor, and sticking around to take care of the child. If you are 63, you have a pretty good chance of not being around to raise that child and that is not fair to the child, and you have to ask is it fair to society,” said Dr. Odem.
Dr. Silber says every case is different, and there is no one law that could be applied. He says there are scores of women in their 60s who are still running marathons and many may have younger husbands who are in their 40s, and so having a baby for them is not inappropriate.
“If you legislate it, you will have trouble. If you put the cut-off at age 50 and someone is 51, you will have a gigantic battle over it by that woman. It is an undeniable right to have a baby,” said Dr. Silber, who was one of four physicians elected to be on the U.S. Congress Office of Technology Assessment study assembled by Senator Al Gore in 1988 to help infertile couples in the U.S.
The issue that worries people the most is what will happen to the children. Ronald Munson is a medical ethicist and a professor of the philosophy of science and medicine at the University of Missouri-St. Louis. He says the rights and interest of the child should override the interest of the woman, however he doesn’t believe it is a question for legislators.
“I think individuals should be free to decide. All children enter life with some sort of burden to bear,” said Munson. “There are many more ways of responding to social issues than legislation. There needs to be free and open discussion and public discussion will help shape policies.”
Munson says a donor egg program for post-menopausal women is tinkering with nature, but he says in medicine that happens constantly and so society is not that concerned about this entire issue. Munson says until there are thousands of women having children after menopause and then dying prematurely, leaving the state to raise the children, will there probably be government intervention.
Dr. Silber says there is already a growing demand for donor egg programs as well as programs that allow women to freeze their own eggs so they can be fertilized later. He believes that over the next 20 years, the numbers of women over 40 having children will rise dramatically.
“There will be a huge number of women in their 40s and 50s having children in the future. They will freeze their eggs early and then have them fertilized in vitro later,” said Dr. Silber. He believes this will happen partly because it allows women to have the same career objectives as men.