When Are You Too Oldfor Pregnancy?

35-45 Not Too Late If You're Healthy (and Lucky)

By Daniel DeNoon, WebMD Medical News
Reviewed By Brunilda Nazario, MD
on Wednesday, November 03, 2004

Nov. 3, 2004 -- Late pregnancy is an option, but after age 40, you'll
need both health and luck. And after 45, you'll need wealth, too.

Since women can't count on luck or wealth, those wanting to become
pregnant should do so before age 45, argues Linda J. Heffner, MD, PhD,
in the Nov. 4 issue of The New England Journal of Medicine.

Faced with career advancement or the dreaded "mommy track," more and
more women are delaying pregnancy. First births to women aged 40 to 44
jumped 70% between 1991 and 2001, notes Heffner, professor and
chairwoman of obstetrics and gynecology at Boston University.

"The great news is that if you are in the 35-45 age group and have not
been in a position to have children - if you do get pregnant and stay
pregnant past the first trimester - you have every reason to expect a
good outcome," Heffner tells WebMD. "But the issue is that by your
late 30s and early 40s, your ability to become pregnant is diminishing
and your miscarriage risks are increasing."

Late Pregnancy: Modern Medicine vs Age-Old Biology

When it comes to pregnancy, what does "late" mean? Women obviously are
physically ready to have children in their teens. But in today's
world, that's not always the best time for the woman or the child.
There's a trade-off between when a woman's at her physical peak, and
when it's the best social and psychological time for her to raise
children.

"From a medical perspective, the safest time to have children is in
the earlier part of your reproductive life," Heffner says. "And when
education is an issue -- whether you intend to have a career or to
provide that kind of environment for the children you will raise --
looking to your early to mid-20s is very reasonable. And for those
with careers, that period between 25 and 35 is really ideal, all
things considered."

Readers of celebrity magazines may be inspired by stories of movie
stars in their late 40s having children. But the American Society for
Reproductive Medicine recently issued a warning that most women can't
expect to remain fertile that long.

Some women still don't understand that advice, says Richard J.
Paulson, MD. Paulson is professor of obstetrics and gynecology and
chief of the division of reproductive endocrinology and infertility at
the University of Southern California Keck School of Medicine, Los
Angeles. He's the author of Rewinding Your Biological Clock:
Motherhood Late in Life: Options, Issues, and Emotions.

"Now I will still see a patient at age 45 who says, "You know, doctor,
I am thinking of getting pregnant," Paulson tells WebMD."She has no
idea that the idea of a pregnancy with her own eggs is quite remote,
even with in vitro techniques. Most of these women are menstruating,
but nearly all are quite infertile. That is a relatively common
misconception, that regular periods mean you are still fertile."

Next: How Late Is Too Late?

Even Heffner's good news for women age 35-45 should be qualified, says
Alan H. DeCherney, MD, professor of obstetrics and gynecology and
chief of the division of reproductive endocrinology and infertility at
UCLA's David Geffen School of Medicine. DeCherney's 1982 NEJM
editorial, "Female Fecundity and Age," foreshadows many of Heffner's
current arguments.

"A woman's chance of becoming pregnant at age 35 to 40 is better than
it is at age 40 to 45," DeCherney tells WebMD. "For young women, the
longer they wait, there is a steady decline in fertility. But there is
more to life than just getting pregnant. If a woman has a career and
wants to delay pregnancy, she has an 85% chance everything is going to
be great."

Late Pregnancy: How Late Is Too Late?

Heffner, Paulson, and DeCherney agree that by age 45, most women are
no longer fertile.

"Past age 45, successful pregnancy requires health and wealth,"
Heffner says. "Of course there are some individuals who, at this age
and older, retain their ability to become pregnant. But a lot of women
don't. The great news is the biology is no longer totally limiting.
But you have to keep in mind, if you are counting on that, that there
still is an element of health -- and unfortunately, wealth. If you do,
indeed, end up in a donor-egg program, it has to be paid for."

Health in this case means no heart disease, no diabetes, and no high
blood pressure. Wealth means being able to pay for expensive
procedures because few insurance programs cover the costs of egg
donation. And Heffner notes that even among healthy women aged 45 and
older, there is a high rate of pregnancy complications.

And there are, of course, psychological issues. Heffner warns in her
editorial that couples who choose to have a baby in their late 40s
must be prepared to face the issues surrounding their child's
adolescence at the same time they face issues of their own retirement.

Paulson, however, says he's not too worried about the ability of older
couples to understand what they're getting into.

"We've found this idea of raising children during a couple's older
years to be not much of an issue," he says. "In many societies,
grandparents do much of the child raising. And people who choose to
become parents at 50 are smart and can make decisions for themselves.
We trust 50-year-olds to be presidents and run the world. We can trust
them to make decisions about their own future and how to spend the
next 20 years. Yes, they know what it is like to raise children --
probably more than most 20-year-olds."

SOURCES: Heffner, L.J. The New England Journal of Medicine,
Nov. 4, 2004; vol 351: pp 1927-1929. DeCherney, A.H. and Berkowitz,
G.S. The New England Journal of Medicine, Feb. 18, 1982; vol
306: pp 424-426. Linda J. Heffner, MD, PhD, professor and chairwoman,
obstetrics and gynecology, Boston University. Richard J. Paulson,
professor, obstetrics and gynecology; chief, division of reproductive
endocrinology and infertility, University of Southern California Keck
School of Medicine, Los Angeles; author, Rewinding Your Biological
Clock: Motherhood Late in Life: Options, Issues, and Emotions,
W.H. Freeman & Co., 1998. Alan H. DeCherney, MD, professor, obstetrics
and gynecology; chief, division of reproductive endocrinology and
infertility, David Geffen School of Medicine, University of
California, Los Angeles. American Society for Reproductive Medicine.