Mothers at 35 plus:
What medicine and society still need to learn about them
My grandmother delivered my dad after she turned 40.
My dad was her tenth and last child (seven of ten survived to adulthood). Since my grandma’s oldest daughter was already married, everyone in the small village in the Balkan mountains considered it shameful for my grandma to give birth to a baby at a time when she was supposed to help raise her grandchildren.
So my grandmother let her last baby be raised by her daughter’s young family and everyone seemed perfectly fine with that. Even my father, who is now almost 70, saw nothing wrong with that arrangement.
In the US, women over 40 now represent the proportionally fastest growing age group having children. Amazing, right? Therefore, it makes sense that national US data from the previous fifteen years demonstrate that IVF clinics are also treating increasingly older women.
The issue of infertility in women in the developed world reaching the far edge of reproductive age has potentially far-reaching medical and societal consequences that have been hardly addressed in the medical literature.
In spite of the IVF industry exploding in revenues and numbers of delivered babies, we have no answers to some of the most pressing questions and issues affecting this population of mothers of 35 plus who conceive with the aid of fertility treatments. In the true sense of the word, we are learning by doing and hope to not make too many wrong steps along the way.
The “graying” of infertility services can be expected to further accelerate, and women in their 50s who get pregnant with donor eggs will be more frequent patients in maternity wards.
Many fertility clinics are experiencing an increase in patient age. In those fertility clinics, which are regarded as “centers of last resort” due to their expertise in dealing with women with previously failed IVF and history of infertility, the median age at admission is about to reach 41 years.
Only five years ago, this center’s patient pool’s median AMH values were around 0.80 ng/mL (already below favorable for women with low ovarian reserves). From 2010 on, these pre-treatment levels progressively decreased to below 0.40 ng/mL for women who entered the IVF program at this particular clinic.
As a quick reminder, let me say that an AMH level of 0.40ng/mL is seriously low and much like driving on a highway with the fuel gauge on empty. How long and how far can you drive a car like that? (In this post, you will find the basics concerning ovarian reserve).
This phenomenon of women getting pregnant late in life has found a lot of attention in celebrity magazines (where stars often create an impression that getting pregnant naturally at 35 plus and even above the age of 40 is the most natural thing possible).
Unfortunately, the same phenomenon has received little attention in the medical literature, even though both studies and life experiences offer convincing evidence for the importance of age as a predictor of achieving live birth. In the next years, both medicine and society will need to adapt to this new development and provide a more realistic picture of what is possible for women who are becoming mothers at 40 and above.
But where is IVF destined to go over the next two decades?
No one knows.
The only reliable source of information right now comes from data collected in the clinics that treat women at an advanced reproductive age (35 plus). These data are often hard to find and understand and it is no wonder that an average woman becomes easily influenced by celebrity magazines. In addition to being easy to read and understand, magazines paint a picture that we wish to believe in.