How Old Is Too Old?

WHEN A HEALTHY WOMAN walked into Dr. Richard Paulson's Los Angeles infertility clinic four years ago, he saw no reason to reject her as a patient. Her medical records indicated that she was 50 years old--five years younger than Paulson's upper limit for in-vitro candidates--and she passed rigorous physical tests, including a treadmill jog. By the time Paulson found out she was actually a decade older than she claimed (she had been lying to her previous doctors), the woman was already pregnant with an embryo created from her husband's sperm and an anonymous donor's egg. Late last year, at 63, she delivered a normal baby girl--and went into the record books as the world's oldest first-time mom.

That distinction may not last long as advances in reproductive technology enable postmenopausal women to bear children. The numbers are still small: worldwide, fewer than 100 pregnancies have been reported in women over 50. But the mere possibility--that someone could become a mother at a time when most women are dreaming of grandchildren--raises difficult questions about the long-term emotional and physical effects on both mother and child. Doctors have had to wrestle with the delicate problem of how to set and enforce age limits. Paulson's patient (who does not want to be identified) ultimately disclosed her real age herself; infertility specialists concede that there's no way of knowing how many other patients may have lied in order to have one last chance at conception.

At Paulson's clinic at the University of Southern California, the average age of patients is a relatively young 43. "Women appear to have not one but two biological clocks," says Paulson, who reported his record-breaking case in the May issue of the journal Fertility and Sterility. Though the ovaries shut down at menopause, "the rest of the reproductive system is still ticking," he says, and his patient proves that with hormonal therapy an aging uterus still works.

Many feminists argue that the extra help merely levels the playing field. "Until we are ready to severely castigate the so-called start-over dads, I think we can't be too judgmental and moralistic about women who avail themselves of technology that exists," says writer Katha Pollitt. Others contend that fiddling with nature's clock is a perversion of reproductive medicine and perpetuates sexist views of women as baby-making machines. "The bad news is that some women could feel obligated to do this," says George Annas, head of the Health Law Department at Boston University. "Do guys have the right to expect that their 60-year-old wives can go to a clinic and have babies? That's horrific."

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Other critics worry about the mother's health. Paulson's patient became pregnant on her third attempt at egg donation. Doctors gave her supplemental doses of the female hormones progesterone and estrogen. Along the way, she developed gestational diabetes and high blood pressure. Both were successfully treated, but no doctor will deny that pregnancy puts strenuous demands on an older woman's body. "I've seen a huge number of complications," says Dr. Mark Sauer, who pioneered postmenopausal pregnancies in the early 1990s at USC and is now chief of reproductive endocrinology at Columbia University. "It's not an easy pregnancy."

And what about the kids? Child rearing is hard enough for parents in their 30s and early 40s. Should a mother be battling arthritis and adolescence at the same time? Older mothers counter that they're committed and focused. "I'm more prepared than young mothers," says Judith Bershak, 50, of Los Angeles, who gave birth six months ago to her first child, Sarah. Bershak, a teacher, and her husband have already set up a college fund for Sarah; she plans to retire in five years and concentrate on motherhood. Preliminary follow-up studies on patients over 47 indicate that most are raising their kids in stable, healthy families, says Sauer. But he and others worry about the future. "I think the problems will begin 10 to 15 years from now," says Larry Stone, president of the American Academy of Child and Adolescent Psychiatry. Older parents may be unable to keep up with the demands of teenagers. And the burden on the kids can be equally great; they may worry that their parents may die at any moment. "It's selfish to bring a child up under those conditions," says Philadelphia bioethicist Evelyne Shuster.

Given the potential problems, it is unlikely that many senior citizens will be storming infertility clinics. And in the absence of legal age limits--which most fertility specialists oppose--doctors will probably continue to decide whether to accept or reject patients on a case-by-case basis. Meanwhile, Paulson's patient has successfully finished breast-feeding and is caring for her baby in happy anonymity--with the help of her 60-year-old husband and her still vigorous octogenarian mother.

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