Long Life, Medical Ethics and Older Motherhood
Even more disconcerting, say experts, is that many couples - and in particular single older mothers –may fail to recognize the simple realities of raising children in your 60’s and 70’s. Indeed, at an age when most of their peers will be selling off their homes and business and retiring to Leisure City, most older parents will be knee deep in soccer games, PTA meetings and making cupcakes for the class bake sale.
An even more sobering thought: How many will actually live long enough to do any of these things with their kids – and if they don’t, how will that impact their children’s lives?
“Ultimately you can do all the testing and assess people’s health and make a judgment, but you cannot predict longevity,” says Lockwood. While the egg donation procedure – and even the pregnancy itself - may succeed, Lockwood tells us that none of that means much if the couple is not prepared to deal effectively with life after giving birth.
“If you have a family history of relatively short lives for example, you need to think about that – just as you need to think about financial and emotional resources to support this child, particularly if there is a handicap involved, when you are not around,” says Lockwood.
Indeed, even comic David Letterman – who became a dad at the age of 56 – frequently jokes about teaching his toddler how to push a wheel chair as he wonders aloud if he’ll even be around to see baby Harry become a man.
Admittedly, however, experts do concede there are many positive aspects to raising a child in your 50’s. As Brodman points out the value of life wisdom and what you can pass on to a child as an older parent is priceless.
Additionally he says that most women who go through the rigors of getting pregnant over 40 are generally so highly motivated, they make excellent parents.
But both ethicists and medical experts alike say the point no one can ignore is how little we know, not only about the immediate health implications of late age pregnancy, but how it will impact family structure, as well as the mother's future health.
To this end some studies have already shown that the risk of breast cancer increases the older a woman is when she has her first child and her last child. Lockwood says his files are brimming with anecdotal stories of women who got pregnant in their late 40's with the help of what he calls "unscrupulous medical care" - and are now severely disabled with advanced lupus.
Pisarska too expresses concern: “We already know by the increased risk of complications that the body is telling us to some degree that it is not comfortable sustaining a pregnancy at a later age –but in reality it will likely be ten or even fifteen years or more before we have the kind of data that tells us what this really means – and what the true risk picture really looks like for late stage motherhood.”
For Brodman, the bottom line is this: “ At the end of the day, all things being equal, it’s better to have kids at 25 than 45 – it’s better to have one kid at a time than three times at a time – it’s better to use your own egg than egg donation . But it’s also safer to walk than drive – and in the end much of what makes life worthwhile involves taking risks.”
The older women who are doing that now, he says, are the ones who will ultimately tell us whether or not we are pushing the envelop too far, and if so, when we should stop.
While some fertility centers already refuse patients older than 49, others have more open policies, choosing to make decisions on a case-by-case basis.
However, the experts we talked to say that any woman seeking to get pregnant after 40 should seek the guidance of a reputable fertility center, as well as getting a clean bill of health supported by reliable medical testing, including a Pap smear, mammogram, cardiogram, blood screening and an extensive family and personal health history. In most instances, doctors say a psychological profile and at least one meeting with a reproductive psychiatrist or therapist can help a couple further determine if advanced age parenting is really right for them.
If you are over 40 and trying to get pregnant, do all you can to enhance your fertility, but do talk to your doctor about egg donation, and other fertility treatments that can help.
Sources: Frederick Licciardi, MD, Associate Director of the NYU Program for IVF, Reproductive Surgery and Fertility in New York City; Michael Brodman, MD, Chairman, Obstetrics, Gynecology and Reproductive Science at the mount Sinai school of Medicine in New York City; Margareta D. Pisarska, M.D., Co-Director, Center for Reproductive Medicine Div. of REI, Dept. of Ob/Gyn, Cedars-Sinai Medical Center, Los Angeles; Charles J. Lockwood, MD, Chair, Department of Obstetrics and Gynecology, Yale School of Medicine; Centers for Disease Control ; CDC, Births, Preliminary Data for 2003; Obstetrics and Gynecology, 2004 104: 727-733; Pregnancy in the Sixth Decade of Life: Obstetric Outcomes in Women of Advanced Reproductive Age , JAMA, Nov 2002; 288: 2320 - 2323.
Getting Pregnant Over 40: Egg Donation: fertility: older mothers
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