When the biological clock runs out

The number of Canadian women giving birth in their 40s has tripled in 30 years – but not without some help. But in-vitro fertilization has its limits, and it doesn't work for everyone

By Jennifer MacMillan

September 1, 2009 / The Globe and Mail

Sylvia Braithwaite was 46 years old when her dreams of getting pregnant fell to pieces.

Sitting in her doctor's office, she listened as he told her it was time to give up. After two years of expensive fertility treatments and an international search for a donor egg, Ms. Braithwaite's physician said it was time to face facts: her biological clock had run out. Her hormones were changing, and she would likely enter the early stages of menopause in a few years. A pregnancy would do more harm than good, he warned.

Ms. Braithwaite and her husband, Michael, had been trying to conceive since just before their wedding – she was 44, he was 36, and it was the second marriage for both. After a failed round of in-vitro fertilization, the Braithwaites went into debt to pay an agency in Argentina $10,000, with plans to travel there to have an egg from a paid donor implanted in Ms. Braithwaite's womb.

But when her doctor advised Ms. Braithwaite to stop trying to get pregnant, the couple cancelled the procedure and told the agency they wanted their money back, minus a $4,000 deposit. After more than a year of wrangling, they've only been able to get about $1,000 back.

“I don't want any other people trying to have a baby to get scammed like that,” Ms. Braithwaite said. “They're under enough pressure.”

The number of women in Canada having children in their 40s has tripled in the past 30 years, but not without a great deal of help. Many have turned to in-vitro fertilization to facilitate the process using their own eggs, but the practice has a low success rate since the quality of women's ova deteriorates quickly after the age of 35.

“ There's only so much we can do in spite of all the technology. ”— Fertility specialist Dr. Marjorie Dixon

A very small number might be fortunate enough to know someone willing to donate an egg out of goodwill, the only kind of egg donation allowed under Canadian law. Those without a charitable donor, like the Braithwaites, look overseas for a paid donor at their own risk.

Through donor eggs, rare cases of women giving birth well into their 50s and even 60s have made headlines, sparking debate over just how old is too old to be a mother. Last week an expert panel recommended that Ontario's health-care plan cover the cost of IVF for anyone unable to conceive on their own, including same-sex couples and people who want to be single parents. But not for women over 42.

The panel members say it's a cost-benefit decision based on the very low chances of a woman over 42 getting pregnant through IVF, not a judgment on the ideal age for parenting. Indeed, if the recommendations are implemented by the Ontario government – they're currently under review – women over 42 will still be able to get fertility treatments provided they pay for them.

But age limits on parenthood are reasonable, says Margaret Somerville, director of the McGill Centre for Medicine, Ethics and Law. Dr. Somerville says only a minority of ethicists subscribe to “absolute rights to reproductive freedom,” which would permit a woman to have a baby at any age by any means – from cloning to paying a surrogate to give birth.

Dr. Somerville believes there should be limits on who gets public funds, including the cut-off at 42. Only about 40 per cent of women who get pregnant after 42 carry their baby to term.

“It's discrimination in a certain sense, but the only way to handle it ethically and fairly is to put the child first,” Dr. Somerville said. “Everyone else's claims are secondary.”

Australia, where the government pays for about half the cost of IVF, has no age limit for the treatment. Peter Illingford, head of one of the country's most prominent fertility clinics, said public funding of IVF has been strongly supported by lobby groups since it was introduced in 1990.

“I sat on a government panel about five years ago that recommended an age restriction at 43, but the government looked at it and decided it was discriminatory,” Dr. Illingford said, adding that women under 35 have about a 30-to-40-per-cent chance of success with IVF, while those aged 41 and 42 have about a 10-per-cent chance. He said most fertility specialists will treat women over 45 only in extremely rare circumstances.

“Beyond 43, the chance of success gets vanishingly small.”

Complicating the issue is the fact that there is no accepted definition of a successful IVF pregnancy rate. No provincial or national regulating body exists to mandate when fertility treatments are ill-advised, and opinions and guidelines vary from one doctor or professional association to another. The American Society for Reproductive Medicine, for example, considers treatment futile only if the chance of getting pregnant is less than 1 per cent.

Toronto fertility specialist Marjorie Dixon said patients in their 40s are often “flabbergasted” when they're told just how slim their chances are.

“They think we can fix it with IVF, but we can't,” Dr. Dixon said. “There's only so much we can do in spite of all the technology.”

Toronto fertility counsellor Jan Silverman said many of the people she counsels who are in their 40s are unaware of the difficulty of getting pregnant later in life.

“We're all misled by media stars who are probably using donor eggs,” she said. “They read about someone having twins at 45 and think, ‘Hey, I'm in good shape, I go to the gym. I should be able to do that too.'”

Both Dr. Dixon and Ms. Silverman were part of the panel that drafted the age-restriction recommendation for Ontario. Should the government opt to implement it, “the panel fully realizes the frustration that will cause for women who are just over the cut-off,” said Carol Herbert, dean of medicine at the University of Western Ontario and another panel member. “But we had to look at the best possible outcomes for the most possible people at the least possible cost so it's fair and transparent across the province.”

Kerry Bowman, a medical ethicist at the University of Toronto, believes that 45 would be a fairer cut-off age.

“The number of women who spontaneously have children over 42 is significant,” Dr. Bowman said. “It takes couples a long time when they're struggling with infertility to cycle through their options. One could criticize them for marrying or partnering late, but it's not as simple as that.”

Ms. Braithwaite agrees that 45 would be a good age limit, particularly since both her mother and sister got pregnant at 42. She and her husband are now waiting to adopt a child through the Children's Aid Society, and say they would have registered for adoption much sooner if they had known just how long the odds are against getting pregnant with IVF.

“You believe in the experts and if they think this is going to happen, you want to do your best to make it happen,” she said. “And then you realize the odds were never that high. So why put people through that process?”