The Use of In Vitro Fertilization with Donated Eggs in Women Over 50
In vitro fertilization with donated eggs has made pregnancy possible for many infertile women. Studies have documented the success of the treatment not only in younger women, but also increasingly in women over 40. Because few data on the outcomes of this treatment in even older women exist, researchers studied outcomes of this treatment in women over 50. The results are published in the Journal of the American Medical Association ( JAMA ).
About the Study
Researchers from the University of Southern California (USC) studied medical records of women who received in vitro fertilization with donated eggs at the Assisted Reproductive Technologies Program at USC during the period of 1991–2001. They used chart review and follow-up phone calls to determine pregnancy outcomes.
They identified 77 cases of women aged 50 and older (age range 50–63) who received the treatment. All of the women receiving treatment had been pre-screened and found to be generally healthy and free from conditions such as heart disease, cancer, hypertension, and diabetes.
The outcomes the researchers studied included pregnancy rate, live birth rate, length of pregnancy, type of delivery (vaginal vs. cesarean), and occurrence of complications, including preeclampsia (a condition characterized by high blood pressure and other disorders during pregnancy), gestational diabetes, and maternal or neonatal death.
For the 77 women treated, 121 embryo transfers were made (89 fresh, 32 frozen), resulting in 55 pregnancies (45.5% pregnancy rate) and 45 live births (37.2% live birth rate). Of the live births, 31 were single babies, 12 were twins, and 2 were triplets. The average length of pregnancies was 38.4 weeks for single babies, 35.8 weeks for twins, and 32.2 weeks for triplets.
Average Apgar scores (a measure used to evaluate an infant’s condition, with 10 being a perfect score) at 1 and 5 minutes after birth were 8.2 and 9.1, respectively.
All of the multiple births and 68% of single babies were delivered via cesarean section. The authors refer to this as an “unusually high rate of operative delivery” in this group. These women (particularly those older than 55) also appeared to be at increased risk for preeclampsia and gestational diabetes—25% of the women had mild preeclampsia and 10% had severe; 17.5% had gestational diabetes, with 2.5% requiring insulin to treat it. There were no maternal or neonatal deaths.
The authors state that these results show no “definitive medical reason for excluding [women over 50] from attempting pregnancy on the basis of age alone.” However, this study has some limitations. First, it had a relatively small sample size, which may have been why the observed increased risk of complications such as preeclampsia and gestational diabetes did not reach “statistical significance.” In addition, this study didn’t compare the outcomes of older women directly with those of younger women receiving the same treatment from the same facility during the same time period.
How Does This Affect You?
Advances in reproductive technology have made pregnancy and parenthood possible for thousands of infertile women and men. This small study shows that even post-menopausal women over the age of 50, are able to successfully conceive and deliver through in vitro fertilization with donated eggs, albeit with potentially greater risks. However, while this study is intriguing, these results alone are not likely to influence the widespread use of this technique in this age group.
If other studies confirm these findings, many women who would otherwise have not pursued childbirth late in life may reconsider, now that the medical restrictions have been lifted. This will bring into sharper focus the many social and ethical implications of having children well beyond traditional childbearing years.
American Society for Reproductive Medicine
The American College of Obstetricians and Gynecologists
Paulson RJ, Boostanfar R, Peyman S, et al. Pregnancy in the sixth decade of life: obstetric outcomes in women of advanced reproductive age. JAMA . 2002;288:2320-2323.
Last reviewed Nov 15, 2002 by ]]>Richard Glickman-Simon, MD]]>
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