Forty years after in vitro fertilization resulted in the first test-tube baby, reproduction boundaries were once again pushed when Gina Reardon*, a New York corporate attorney, recently became the oldest woman so far to get pregnant with her own eggs through IVF at age 48. “When the doctors told me I was pregnant, I almost passed out,” she says. “They were all celebrating, but I was still shocked and didn’t realize what a historic moment it was.”
Reardon was newly married when she embarked on her quest to conceive. Though she’d had a son from a previous relationship when she was 41, she and her new husband were determined to have a child of their own. “I just didn’t get to it sooner,” she says. “I had been on the corporate climb for a long time, I was traveling a lot. My husband is 56, but we take care of ourselves, and most people think we are younger. My peers are having children later in life too, but they still thought I was crazy to have a baby at 48.”
Most fertility clinics won’t treat women over 43, and the first one Reardon visited told her that her chances of getting pregnant with her own eggs were 0.001. That’s how she found herself at Manhattan’s Center for Human Reproduction (CHR). One of the first IVF centers in the United States, it prides itself on being a last resort for women trying to conceive. “I remember the days when we wouldn’t treat women over 38,” says Dr. Norbert Gleicher, medical director and chief scientist at CHR, “but we’ve come a long way. A few years ago, if a woman got pregnant with her own eggs at 45, it was cause for a party. Now our goal is women over 48.” Science is still struggling to catch up with the increasing demand, though. Because the odds are so low for women over 43 to conceive with their own eggs, most clinics automatically recommend IVF with donor eggs, which has a higher rate of success.
IVF, in which a woman’s eggs are retrieved and mixed with sperm in a lab dish before being placed back inside her body to grow the old-fashioned way, can be an effective treatment for a variety of conditions, such as low sperm count, compromised fallopian tubes, endometriosis, and, yes, what is so impolitically referred to as AMA (advanced maternal age). Before determining whether IVF is an appropriate option, doctors at CHR do a battery of tests to determine the potential causes of infertility as well as whether the woman is capable of making viable eggs. (As with so many things in life, they look for quality and quantity.) The multiphase process typically involves medications that stimulate the ovaries so that multiple eggs mature and, when ready, injections are administered to give them an extra push. When the follicles that the eggs are housed in are deemed large enough, usually 16 to 18 millimeters, the eggs are retrieved using an ultrasound-guided needle and introduced to the sperm in the lab dish. When and if fertilization takes place, one or two embryos are then transferred back into the woman’s body.
Despite the ever-improving technique, Dr. Gleicher was curious why there remained such a precipitous drop in IVF success rates in women over 43 and embarked on a multiyear study. During his research, he discovered that the metabolism in the follicles where eggs grow speeds up as women age. “As a consequence, if we wait in older women for the same amount of time as we do in younger women before taking eggs out, we would get what we jokingly call hard-boiled eggs as opposed to soft-boiled eggs,” Dr. Gleicher says. “Once you have hard-boiled eggs, there is nothing you can do with them. We decided to take the eggs out of the increasingly hostile environment sooner in women over 43, often when the follicles are only 11 millimeters. Our results show many women who are automatically shipped off to egg donation have a better chance if their eggs are retrieved in this individualized and well-timed way.” The technique, known as HIER (highly individualized egg retrieval), is considered the couture of IVF—bespoke, intricate, and pricey. The treatments cost approximately $20,000 per round, and insurance does not often pay for older women to have IVF.
Dr. Alan B. Copperman, vice chairman of the department of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai, is taking a wait-and-see approach. “A woman is born with all of the eggs she will ever have in her lifetime. Unfortunately, by the time she is in her 40s, more than 90 percent are chromosomally abnormal. Freezing eggs before the age of 40 is a great strategy to enhance the likelihood that a woman in her 40s will have a genetic child. We congratulate the authors of the study on analyzing their data and believe in a very personalized approach to ovarian stimulation protocols, but we would need to see many more healthy pregnancies before making modifications to the current standard procedures and protocols.”
Since introducing earlier egg retrieval, Dr. Gleicher claims that CHR has seen a significant improvement in pregnancy rates in women over 43, though no one else Reardon’s age has thus far carried to term. There has not been enough research yet to determine precise success rates, and it is not right for everyone: Dr. Gleicher says that a woman must be able to produce at least three embryos to get up to a 10 percent chance of success. “I am brutally honest with women about how slim the chances are,” he says, “but despite the fact using donor eggs increases chances, I see a huge spectrum of women who want to use their own. They want offspring who are representative of their genetics; they want to see themselves in their children. Some are open to egg donation and make very rational decisions, but at CHR we believe it should be a patient’s choice.”
CHR’s highly individualized approach appealed to Reardon. “My husband was very opposed to donor eggs. He felt as if it wouldn’t be a true merger, and Dr. Gleicher gave me hope. I knew the minute I walked in it was the right place. It felt like a boutique.” Before beginning treatment, CHR insists that all potential patients have a full range of medical and psychological tests. “It’s like getting into Harvard,” Reardon says. “I knew I was well-prepared physically, emotionally, and financially, but I had to meet with a psychologist regularly to show I was of my right mind.”
Tests showed that Reardon was still producing a large number of eggs, which increased her chances, and her husband began injecting her nightly with medications to pretreat her ovaries. “My butt was so sore,” she admits. “It’s tough, but I knew what the risks were, and I was a champion for myself.” In just under a month, she was ready for egg retrieval, which produced two viable embryos that were implanted after being fertilized. One survived, and after the first five weeks, Reardon was considered out of the danger zone. “I told my family when I was in my third month, but I didn’t share how I got pregnant,” she says.
She kept working throughout her pregnancy and embarked on a regimen of massages, yoga, and acupuncture. Though she had gained only 25 pounds with her first pregnancy, this time she gained 48, much of it water. When her blood pressure started to head north, she had to undergo a cesarean section four weeks before her due date. Reardon’s daughter was born weighing 3 pounds, 6 ounces, and was healthy enough to leave the hospital after two weeks. “She’s thrived ever since. She is such a welcome joy,” Reardon exclaims.
“I offer women hope not to give up on their dreams and not to let the world determine if you are too old. We’re mavericks, but there are a growing number of us out there.”
*not her real name
Photo credit: Trunk Archive