In her best selling novel, State of Wonder, author Ann Patchett draws us into the science-fiction world of an indigenous people in Manaus, Brazil known as the Lakashi tribe. Deep in the rainforest tribal women nibble bark from the martin tree -- a veritable reproductive fountain of youth that offsets the normal conditions of menopause and enables women to bear children into old age. The character Dr. Annick Swenson, a senior pharmaceutical company scientist living among the native people, is so intent on exploring the wonders of the trees' powers that she becomes pregnant at the age of 70. Midway through the pregnancy, though, she experiences life-threatening medical complications, and the fetus dies.
A look behind the headlines reveals a 35-year landscape of assisted reproductive technologies that continue to fail far more often than is reported, particularly in older women.
Recently the ethics committee of the American Society for Reproductive Medicine (ASRM) issued a statement to its member clinics suggesting that healthy, postmenopausal women between the ages of 50 and 54 should no longer be discouraged from pursuing pregnancy via donor eggs or embryos. Their statement read in part: "The reported success of oocyte donation to women in their 50s and early 60s suggests that pregnancy may be possible in virtually any woman with a normal uterus, regardless of age or the absence of ovaries and ovarian function. A woman's reproductive age, once a dictate of nature, now can be artificially extended."
Delivering a healthy child via assisted reproductive technologies (ART), with donor eggs or not, is, in fact, not possible for "virtually any woman with a normal uterus"--even those younger than 35 who experience the greatest success with reproductive interventions.
Around the globe in 2012, 1.5 million total fertilization cycles were reportedly performed, resulting in 1.1 million failed cycles. That's roughly a 77 percent failure rate. In the U.S., 2010 data (the most recent available from the Centers for Disease Control) shows a 68 percent failure rate. Live births resulting from donor egg cycles in women older than 48 in the U.S. is reportedly 439 out of roughly 1,100 attempts, but these figures do not account for cancelled donor cycles.
To be sure, over the last decade, there have been several sensationalized media reports of a very small number of women in the postmenopausal age group and older birthing babies. Rajo Devi, a seventy year-old woman in India, supposedly birthed a baby girl and a handful of women in their 50s and 60s have given birth. But a look behind the headlines reveals a 35-year landscape of ART -- including donor egg cycles -- that continue to fail far more often than is reported and publicly discussed, particularly in older women.
The ASRM's decision to encourage clinics to open their doors even wider to postmenopausal women reverses their 2004 policy stating that "fertility is the norm during reproductive years ... infertility should remain the natural characteristic of menopause." They attribute this policy shift to changing social norms linked to delayed age of parenthood and to gender equality, contending that because men may father children well into their senior years, denying women the same opportunity is prejudicial.
While some men do father children later in life, they do not face the same risks as pregnant older women, which can include possible uterine growth restriction, preeclampsia, and hypertensive disorders that place severe stress on a woman's cardiovascular system--and the fetus--due to increased blood volume and flow. Evidence-based research investigating the risks to infants who are born from older parents are few and far between. Some studies have associated older fathers to chromosomal abnormalities such as Down and Klinefelter syndromes, new dominant mutations resulting in congenital anomalies, and an increased risk of autism and schizophrenia. According to the ASRM, the medical risks associated with donated eggs or embryos to older women are still largely unknown, but some studies do reveal a higher risk of low birth weight and fetal mortality.
In the United States there are virtually no compulsory regulations on egg donation or ART in general, making it a "reproductive tourism" magnet for women and men living in countries that do have restrictions. Worldwide, egg donation and its accompanying health risks -- and bioethical and marketplace conundrums -- are lightning rods for controversy. As a result, countries like Austria, Italy and South Korea have passed laws making egg donation illegal. In 2004, Canada banned the sale of eggs but does allow for altruistic donation. In Norway and Germany, donor eggs are banned, but donor sperm are not. Australia, Brazil, Israel, and the United States impose the fewest restrictions on what is allowed in the open market.
With the average cost of one donor egg cycle spiking as high $30,000, the ASRM's decision to court older women will likely add even more domestic and foreign revenue streams to a medical business that, despite its high failure rates, continues to grow exponentially.
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