Register for Age alone should not exclude women in their 50s from attempting pregnancy
ObstetricsDecember 5, 2002
2002 DEC 5 - (NewsRx.com & NewsRx.net) -- There appears to be no definitive medical reason, based on age, why women in their 50s should not try to become pregnant by in vitro fertilization with donor eggs, according to a study by Richard J. Paulson, MD, and colleagues of the Keck School of Medicine of the University of Southern California, Women's and Children's Hospital, Los Angeles, who investigated pregnancy outcomes in women aged 50 years or older who conceived after in vitro fertilization with donor oocytes (eggs).
The findings were published in the November 13, 2002, issue of the Journal of the American Medical Association, a theme issue on aging, and presented at a JAMA media briefing on aging.
"In vitro fertilization (IVF) with donated oocytes has made pregnancy possible for many women whose infertility cannot be treated by any other means," the authors noted. "Oocyte donation was initially developed as a therapy for young women with premature ovarian failure, rather than as a means of overcoming the age-related decline in fertility." The researchers said that the therapy has been used successfully in younger women, as well as women in their 40s and 50s.
In this study researchers analyzed the cases of 77 postmenopausal women with no chronic medical conditions (including hypertension) who underwent 121 embryo transfer procedures (89 fresh and 32 frozen) from 1991-2001 at a U.S. university assisted reproduction program. The women ranged in age from 50-63 years, with the average age about 53. The women were given medical and psychological screenings. The donors were young women who were either relatives or friends of the women who wanted to attempt pregnancy or were anonymous and compensated for their eggs. The donors ranged in age from 22 to 33 years.
"There were 55 clinical pregnancies for a total pregnancy rate of 45.5%," the researchers reported. "Of the 77 women in the series, 42 (54.5%) had live births. Three women carried 2 consecutive pregnancies. A total of 42 donors provided oocytes for the 45 deliveries. In 26 cases (58%), the delivery was the mother's first." For the single births, the average gestation age at delivery was 38.4 weeks; the average birth weight was 3039 g.
The total live-birth rate was 37.2% (45 live births resulting from 121 fresh and frozen embryo transfers). Of the 45 live births, there were 31 single babies, 12 twins, and 2 triplets delivered. The multiple gestation rate was 31.1%. "Of singletons, 68% were delivered by cesarean, and all multiples were delivered by cesarean. Mild pre-eclampsia was noted in 25% of patients and severe pre-eclampsia in 10%. Gestational diabetes required diet modification in 17.5%, and 2.5% required insulin," the researchers stated in their findings.
There were no neonatal or maternal deaths. The authors noted that the complications of pre-eclampsia and gestational diabetes were markedly increased in women over 50 as compared with younger women, including those in their 40s. Furthermore, the incidence of complications appeared to increase among those older than 55 as compared with those aged 50 to 54 years.
In conclusion the authors wrote, "Appropriately screened women aged 50 years or older can successfully conceive via oocyte donation and experience similar pregnancy rates, multiple gestation rates, and spontaneous abortion [natural termination] rates as younger recipients. During pregnancy, they appear to be at increased risk of pre-eclampsia and gestational diabetes. A majority can expect to deliver via cesarean. However, there does not appear to be any definitive medical reason for excluding these women from attempting pregnancy on the basis of age alone."
The authors added that, "Favorable maternal and neonatal outcome may be expected with contemporary obstetric surveillance and management" (JAMA, 2002;288:2320-2323; jama.com.). This article was prepared by Women's Health Weekly editors from staff and other reports.
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