When I wrote
40 is the New 20 for Having Babies and
40 is the New 20 for Having Babies-II, people had concerns and raised questions. To dispel misinformation and to learn the facts not only about the safety of having a baby in your 40s, but also about how far assisted reproductive technology has come, I invited the authors of
A Baby at Last! The Couple's Complete Guide to Getting Pregnant--from Cutting-Edge Treatments to Commonsense Wisdom, Drs. Zev Rosenwaks and Marc Goldstein from Weill Cornell Medical Center in New York, to be guest bloggers. Here's what they have to tell us:
A Baby in Your 40s
We are able to help young couples in their 20s who are having a difficult time achieving a pregnancy, couples in their 30s who may already have one child but can't seem to have another one, and even women into their 40s and 50s who thought having a baby was beyond their reach.
Although age has a significant impact on pregnancy outcome and infertility, advancing age alone should not prevent you from trying to become pregnant. More than one-third of all pregnancies and births in the United States occur in women who are in their 30s or older. Good prenatal obstetrical care has made pregnancies in older women safer than they were 20 to 30 years ago.
If you're over 40 and trying to conceive, you're in good company. Technological advances, such as better in vitro fertilization (IVF) techniques, now make it possible for women in their 40s to have babies. With the extension of life expectancy for older women, the benefits of hormonal replacement therapy, and general improvement of the health and living conditions of older women, very late childbearing has become more socially acceptable.
Some women who seek to conceive after age 40 have no difficulty in achieving a pregnancy. For those who do have problems, prompt and thorough evaluation and aggressive treatments are crucial. The chance of becoming pregnant with one's own eggs is very difficult after the age of 42-43. Many women in this age group must turn to egg donation. While IVF success rates go down drastically after age 37, the success of donor eggs remains high.
One simple blood test - measuring the level of follicle stimulating hormone (FSH) in your blood on day 3 of your menstrual cycle - has become an important test to assess the ovarian reserve, a term used to describe the number of eggs remaining in a woman's ovary. The pituitary gland produces FSH, which is responsible for the development of the ovarian follicle and egg each month. When the ovaries have very few eggs remaining, the pituitary gland senses this and begins to produce and release higher and higher amounts of FSH in an effort to push the ovary. If your FSH levels are consistently elevated, you have an extremely low chance of conceiving and carrying to term; if your FSH levels are slightly above normal, this suggests that you have a lower chance of achieving a pregnancy.
In the last few years, we have added another ovarian marker to help us assess ovarian reserve. The hormone called anti-mullerian hormone (AMH) is produced by an early stage of the developing egg-containing ovarian follicles. Very low levels of AMH denote poor ovarian reserve, whereas high levels suggest that the woman has many eggs remaining in her ovary.
Unfortunately, there are no treatments available that can "turn back the clock" on a woman's ovaries. We prescribe fertility drugs to try to increase your chances of pregnancy. These powerful hormones can increase the number of eggs that develop in a given month, and enhance the chance that at least one of them might be able to be fertilized and develop into a pregnancy.
Another important approach to improve the success rate of assisted reproductive technology procedures, such as IVF, is to optimize the laboratory conditions for early embryos. Human embryos can survive in a simple medium (culture) for a few days in the laboratory, but a sub-optimal environment may compromise their viability. We have developed a method to co-culture embryos with certain helper cells to enhance the development of fertilized eggs and improve embryo quality.
Older eggs are more likely to have chromosomal abnormalities in their embryos, but preimplantation genetic diagnosis using IVF technology allows us to analyze the genetic makeup of embryos that are developing outside the body. We can now remove a single cell from the developing embryo without harm and analyze that embryo for specific genetic disorders (or flaws) that may exist in either or both parents. More than 200 genetic diseases have been successfully analyzed in pre-implantation embryos. Future developments in this area will allow us not only to diagnose genetic problems better but to treat genetically related disorders.
Technological advances such as these, along with ever-improving IVF techniques, make it possible for more older women than ever before to have a baby at last.
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