THE TWO BIOLOGICAL CLOCKSDoes time run out at 40 … or can you keep on trying?
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One woman’s story Like many older women with infertility problems, Rena*, a 53-year-old Manhattan lawyer, arrived at egg donation step by painful step. After getting married for the second time at age 40, she tried to become pregnant, but went through miscarriages, intrauterine insemination, injectable drugs, and three cycles of IVF with her own eggs. “Every stage was devastating because I couldn’t believe or accept that it wasn’t working. But if you want to have a child, you have no choice except to go on to the next step. And yet you may not be psychologically ready to move to a more aggressive step or adoption….the chances of success are so small and there is so much stress on your marriage,” she confides. At age 46, Rena finally decided to get on an egg donor list and had to wait about a year. Her first attempt at egg donation ended in a miscarriage. The second attempt resulted in a healthy pregnancy and the birth of her now 4-year-old daughter. Rena counts herself unusually lucky because with frozen embryos from the second donor, she was able to have another daughter, at age 51, so that her daughters are full siblings. When egg donation was first proposed to Alice*, now a 50-year-old patient at the Montefiore Institute for Reproductive Medicine and Health, she was unwilling to consider it. Married, at 36, with a successful career in sales, Alice had always wanted children and never thought she would have a problem. In her late 30s, she suffered from fibroid tumors and hemorrhaging, had several fibroid surgeries, and discovered that she had severe endometriosis. As a result, she was not able to try IVF when she might have been able to use her own eggs. At age 42, Alice was told that she should consider egg donation, but was so angry that she had wasted years, she could not accept the idea. Alice then discovered she had a cyst on her ovary and thought she might have cancer. After it was removed, she told herself, “I don’t have cancer and I still have my uterus, so I’m going to try to have a baby.” She is currently taking hormones to get into sync with the egg donor, and has her first IVF procedure scheduled.
Other kinds of costs Egg donation may offer hope to some, but it is not without drawbacks. Insurance does not cover the costs, so each recipient must pay for the egg donor’s medical tests and procedures, as well as $5,000-$7,500 for her participation, according to Dr. Witt. A single attempt at egg donation can run $25,000 unless it is shared. Alice and her husband are sharing the cost of the procedure with another couple who will use eggs from the same donor. There can also be a long wait of up to one-and-a-half years in any egg donation program, so older women may run out of time, especially in programs where there is an age ceiling. Then there are the unique emotional challenges of egg donation because the child’s genetic background can create more complicated family relationships. Rena was at first distraught not to be able to have a child genetically related to herself. She admits: “When my daughter was born, there was a kind of sadness because I couldn’t see anything of myself in her. But now that she’s 4, she actually has my personality and I have realized that I leave my imprint on her in other ways. It’s wonderful how that happens.” But Rena worries, “I hope I live to see my kids graduate from college.” “The struggle of a lifetime” Indeed, being a mother at 50 is not the end of the road, but rather the beginning of a different kind of journey, cautions Dr. Rosen. Sylvia Ann Hewlett, who had a third child through IVF, at age 51, after two children and four years of escalating infertility treatments, says, “It can be an enormously joyous journey. It is great to have my 5-year-old Emma at a time when I’m comfortable with my identity and not struggling. I feel I’m a more experienced and relaxed mother.” On the other hand, Dr. Hewlett is very careful about taking care of her health and looks because she doesn’t want to be taken for Emma’s grandmother or to stick out in Emma’s social milieu, and most of all because she wants to be around for a long time. The financial considerations are pressing as well. “By the time she’s ready for college, I’ll be deep into retirement and not earning money, so I have to think about paying for her college and saving for it now,” Dr. Hewlett says. She says she also faced disapproval from colleagues who wondered why she wanted to get pregnant again at 50. “This thing has terrible power. If you’re over 40, the desire to have a baby before it’s too late can kick in with ferocious intensity,” she wrote in Creating a Life. For some women, she says, it becomes “the struggle of a lifetime.” For older women who desperately want to have a baby, egg donation might be the answer. “If you have the desire, it doesn’t go away until you experience it, even if you can’t get pregnant on your own,” Alice says. “I’ve always wanted to experience giving birth and this is the only way it could happen….If you have a dream, don’t give it up until you’ve tried everything you possibly can.”
*Names have been changed for confidentiality.
Resources: • Creating a Life: Professional Women and the Quest for Children, by Sylvia Ann Hewlett, published by Talk Miramax Books, 2002 • Resolve, the National Infertility Association dedicated to providing education, advocacy and support for men and women facing infertility. www.resolve.org • Montefiore Institute for Reproductive Medicine and Health, Hartsdale. (914) 997-1060 • The Center for Reproductive Medicine and Infertility at the Weill Medical College of Cornell University at New York Presbyterian Hospital, New York City. (212) 746-1762 or www.ivf.org • Reproductive Medicine Associates of New York. (212) 744-1855 Reproductive Medicine Associates of New Jersey. (973) 971-4600