FOR MORE MAGAZINE, SEPTEMBER 2012
Laura Reid feared she’d lost the baby.
In 2009, she’d started spotting only two weeks into her pregnancy — surely a bad sign, she thought. Sitting in the Hamilton, Ont., fertility clinic where she’d received in vitro fertilization (IVF) only weeks earlier, Reid peered at the monitor, her untrained eyes desperately searching the foggy ultrasound for any sign of life. “Do you see a baby in there?” Reid whispered, fearing the answer.
“As a matter of fact,” replied the clinician, “I see two.”
The words hit her like a freight train. At 38, Reid would give birth to two children, and raise them as a single mom. It was true she had fully intended to become a parent — she’d used donor sperm to do so — but she’d never planned on twins. The doctor had made the likelihood of a multiple birth seem tiny.
Her thoughts turned to the health of the babies — would they be okay? She knew having kids at her age carried certain risks, and that a multiple pregnancy only compounded those risks. Would she be up to the challenge of raising two potentially disabled children in her forties and fifties? Reid burst into tears and didn’t stop crying for 24 hours.
Today, almost one in every five live births in Canada is to a woman 35 to 49; of those women, more than one in four is a first-time mom. In 1991, only 23 per cent of first-time moms were 30 to 49; by 2009, that number was 37 per cent.
Data reveal a litany of medical risks for both mother and child that increase with advanced maternal age. And yet a lack of public education about fertility, coupled with media images of happy older celebrity moms, has led Canadi- an women to believe they can delay childbirth into their late thirties, forties and even fifties with relative ease and safety.
Recent studies show that while women in this country believe they know the limits of their reproductive longevity, they are actually quite poorly informed on the subject.
“Canadians are not getting the information they need to understand the lifespan of their fertility, and many are paying a big price,” says Judith Daniluk, a professor of counselling psychology at the University of British Columbia who specializes in women’s sexuality and reproductive health. “I cannot tell you the number of women in their forties who’ve told me they’re ready to have a child and are devastated to find out it’s too late.”
Daniluk recently authored a major study on childless women’s knowledge of fertility and advanced reproductive technology. Only about half of the more than 3,000 Canadian women surveyed knew a woman’s eggs are as old as she is, and more than half erroneously believed that health and fitness are better indicators of fertility than age. “There’s this sense that, if I look good, I can do it until menopause,” says Daniluk, “and it’s simply not true.”
By the time a woman reaches age 30, the quality of her eggs will have begun to diminish. She may ovulate less frequently and not release as many eggs each month, and the eggs that are released can be more difficult to fertilize. This slow decline steepens around 35 and then nosedives at 40. For example, a 20-year-old has about a 25 per cent chance of getting pregnant after a month of regular unprotected sex, a 30-year-old about 20 per cent and a 40-year-old about five per cent.
“In conjunction with that decrease in fertility comes an increase in the chance of miscarriage,” continues Daniluk. Older eggs are more likely to carry chromosomal defects than younger ones, and the body will often spontaneously abort these fetuses. So around the time fertility drops, the miscarriage rate goes up.
How is it that women don’t know these things?
Daniluk thinks the media shoulder much of the blame. “We hear about celebrities such as Céline Dion having
twins in their forties,” she points out. “What we don’t always hear about is how many rounds of IVF were required, and we never hear when donor eggs are used.”
According to national statistics from the Canadian Fertility and Andrology Society, the live birth rate using IVF was 40 per cent for women under 35 years old, 29 per cent for women 35 to 39, and just 12 per cent for women over 40. And although IVF provides many women with the solution to their infertility, the procedure is driving a rise in another risk factor: multiples.
“There are couples out there who, after being unable to conceive and go- ing through IVF, might see twins or triplets as a blessing,” says Jon Barrett. As the head of the maternal-fetal medicine program at Toronto’s Sunnybrook
Health Sciences Centre, he specializes in high-risk births, particularly multiples. “But having multiples carries with it far greater risks than having a baby at a later age.” Barrett sees the boom in multiple births — the number swelled by 45 per cent to 12,000 between 1991 and 2008 — as an epidemic fuelled by the fertility industry.
The proliferation of multiples is partly natural — women are delaying motherhood more than ever before and the likelihood of a multiple birth in- creases with age. But it’s also because fertility doctors often insert two or more embryos in a single cycle in the hopes that at least one embryo will develop successfully.
They do this because IVF is both ex- pensive and gruelling. Each cycle costs $5,000 to $15,000. Combine that with the fact that IVF requires regular hormone injections and the physical extraction and reinsertion of eggs, and you can understand why both doctors and potential parents feel the pressure to make each cycle count.
The trouble is, it’s not unusual for more than one transferred egg to result in a child, as the numbers make clear: The likelihood of having multiples naturally is less that two per cent, yet women who undergo IVF have a 27 to 30 per cent chance.
Barrett lists some of the potential problems with multiples: Twins are four times more likely to die in utero, face an increased risk of preterm birth and low birth weight, will probably spend extended time in intensive care, and have four times the risk of cerebral palsy. For triplets, all of these complications multiply. Compound these numbers with the amplified consequences that come with being an older mother, and it becomes clear why Barrett describes the IVF industry as spawning a “legacy of sick babies.”
Even if you were to take IVF and the increased incidence of multiples out of the equation, there are still risks.
“We can’t predict anyone’s reproductive lifespan ahead of time,” points out fertility researcher Wendy Robinson. A scientist at the Child & Family Research Institute in Vancouver, Robinson studies the genet- ics of infertility and placental complications of pregnancy. She slides a printout of a PowerPoint presentation across her desk with the foreboding ti- tle: “Reproductive Aging: Are the Last Ones the Rotten Eggs?”
“After years of researching this topic, it’s hard to find anything medically relevant, except age,” says Robinson. She explains the fertilization of eggs over age 35 — housed in a body increasingly less adept at regulating the hormones that make healthy babies possible — means an increase in all kinds of risks.
We go over some of them: Women age 35 and older are twice as likely to develop gestational diabetes as their younger counterparts. For those 40 and over, the risk triples. There’s a greater risk of gestational hypertension as well as pre-eclampsia, a serious condition that causes high blood pressure and protein in the urine.
Older moms are also more likely to have difficult or dangerous births: Cesarean births are more probable in mothers 35 and over, forceps and vacuum extraction are more common, and the risk of placenta previa — premature separation of the placenta from the uterus — is greater.
What inevitably concerns potential parents most, though, is the health of their baby-to-be. For moms 35 and over, newborns are more likely to be preterm and smaller for their gestational age — both factors that impact how successfully the child will develop.
Robinson does point out, while the risk of developing these conditions relative to a younger woman is much higher, for the majority, the absolute risk — or actual chance — of developing them is still quite low.
The same cannot be said about the chance of chromosomal abnormalities, including trisomy-21 (Down’s syndrome). The odds of having a child with the condition increase from one in 1,300 at age 25, to one in 365 at 35, to one in 30 at 45. “It’s something that can be tested for in the fetus,” says Robinson, “but terminating a pregnancy for that reason is not an easy decision.”
Ultimately, concludes Robinson, maternal age overwhelms every other risk factor she examines: “The numbers are clear — bearing children at a younger age is safer.” However, for many women who end up delaying childbirth un- til their late thirties or older, the timing is not necessarily a conscious choice.
Laura Reid certainly hadn’t planned to wait so long. “As the years went by, it became harder to accept that it wasn’t just going to happen naturally,” she says. At home in Paris, Ont., with her healthy ginger-haired twins, Jacob and Abigail, now toddlers, she explains how she came to the realization that if she wanted kids, she’d have to do it on her own.
A manager for an international medical manufacturer, Reid was focused on her career, but motherhood had also always been part of the plan. Yet a marriage in her mid-twenties didn’t last, and the ensuing years of dating did not lead to a partnership into which she wanted to bring a child.
As her mid-thirties approached, Reid finally had the courage to ask herself a difficult question: “Will I be happy if I don’t have a child?” When she realized the answer was no, she began the process of IVF with donor sperm. With the help of her mother and sister, Reid felt she would have enough support to raise a child without a partner.
“I just didn’t think it would happen,” says Reid.
But it did, and ultimately, she was lucky. Her pregnancy was relatively uncomplicated, and although Abigail was underweight at birth and had a one-week stay in hospital, today she is developing normally.
“No one wants to be a single parent and outnumbered right off the bat, especially at this age,” says Reid, now 42. “But I’m so grateful and happy to have them in my life. I realize how lucky I am that they’re healthy — and that I was able to have them at all.”