Pregnancy in older women

By Dr. Beth Taylor MD, FRCSC
Reproductive Endocrinology & Infertility

 

The word on the internet is that Janet Jackson is pregnant at 50. This is wonderful news - I am always happy to hear about new life, new light, being brought into the world. There is something that makes me deeply happy when people grow their families.  It is why I do the work I do. It is why I have children. It is why I tear up at every birth announcement and thank you note I receive from patients.

While I don't know Janet Jackson's case, I can give an educated guess that her pregnancy was conceived using donated eggs. With the use of donated eggs we could get any women with a healthy uterus pregnant. We could get a 95 year old pregnant. We don't though, because of the medical risk to the mother of being pregnant at older ages. These risks have been quantified in many studies. A large UK study from the 1990s looked at pregnancy complications of 385,120 women at different ages:

 

Reference: Jolly M, Sebire N, Harris J, Robinson S, Regan L. The risks associated with pregnancy in women aged 35 years or older. Hum Reprod. 2000 Nov;15(11):2433-7.

You can see from this table that disease in pregnancy is more common as women age and this can put the health of the mother and child at risk. As a result we do not treat women to help them conceive after a certain age. There is no law or regulation that tells us what the age cut off should be. Instead we following guidelines. The American Society for Reproductive Medicine (ASRM) guideline states that because of the maternal and fetal risks "as well as concerns related to longevity and the need for adequate psychosocial supports for raising a child to adulthood, providing donor oocytes or embryos to women over 55 years of age, even when they have no underlying medical problems, should be discouraged."

In Canada most centres have a lower age cut off to treat of the 51st birthday. I believe this is a reasonable age as the pregnancy risks increase dramatically after the age of 50. We will not treat at any age if the risks of pregnancy are too great to the mother or baby. Defining "too great" can be hard - that's the ethical and moral challenge of what we do. In such instances we encourage couples to consider surrogacy, or adoption. No matter what, in medicine, we must first do not harm.

On the positive side of a story like Janet Jackson's, donated eggs are generally from young, healthy women. Such young eggs mean the child is more likely to be healthy chromosomally. We know chromosome diseases like Down Syndrome increase as the egg age increases. Your risk of having a child with Down Syndrome based on egg age is:

 

Good luck to all mothers, of any age.  You too, "Miss Jackson, if you're nasty."

 

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