COMMENTARY

How Old Is Too Old to Become a Parent?

Peter Kovacs, MD, PhD

Disclosures

October 15, 2013

Viewpoint

Age is probably the single most important parameter affecting reproductive success. A woman's chance to conceive starts to decline at around the age of 30, and over 45 it is very rare to achieve a successful pregnancy. This is due to the reduced number of eggs available for fertilization as well as to their poorer quality that leads to increased aneuploidy rates with age. Women who delay childbearing can expect a longer time to succeed, more need for ART, and smaller family size. ART may compensate for some of the reduced chance but cannot make up for all of it. Pregnancies that are conceived in women over 35 are complicated by higher miscarriage and stillbirth rates; medical complications during pregnancy are more common too. Maternal mortality rates are also several-fold higher.[1,2,3,4]

Women over 40 are more likely to require donor eggs to achieve a pregnancy when compared with younger women. An embryo that is created from a younger woman's egg will have a high chance to implant, so women even after reaching natural menopause still have a chance to achieve a successful pregnancy. However, they need to be aware that these pregnancies are still complicated by more hypertensive complications, low birth weight, and need for operative delivery. This could be due to immunologic causes because of the genetically completely foreign embryo or due to underlying medical problems mainly affecting the recipient's cardiovascular system.

A child born to older parents may face relationship or emotional problems with his/her parents due to the big age gap. On the other hand, older parents are more likely to be able to provide the financial needs required to raise a child. The availability of social egg freezing is another issue that will likely result in more pregnancies among women of advanced reproductive age. Freezing eggs at a younger age allows women to study and start a job before they interrupt their professional career with a pregnancy and delivery. These women will probably not have big families that may have consequences to society. These women may also be diagnosed with medical problems or may be affected by undiagnosed medical issues by the time they decide to use their eggs, which may complicate the pregnancies and may lead to a higher rate of maternal morbidity/mortality.

Therefore, care providers have to be very careful when counseling women about pregnancies at an older age. Women should be encouraged to try on their own at a young age. Those who for various reasons cannot complete their desired family size early on should undergo a thorough medical evaluation before their own or donated eggs are used. An upper age limit should also be set to avoid problems like the one discussed in the article and to make sure parents will be there for their children until their children at least reach adulthood.

Abstract

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