Past-due pregnancy

CHICAGO

THERE'S NO MEDICAL REASON TO PREVENT HEALTHY WOMEN IN THEIR 50S FROM TURNING BACK THEIR BIOLOGICAL CLOCKS AND HAVING BABIES WITH DONATED EGGS, RESEARCHERS SAY IN THE BIGGEST STUDY OF MOTHERHOOD AFTER MENOPAUSE.

THE STUDY LOOKED AT 77 WOMEN WHO PARTICIPATED IN THE UNIVERSITY OF SOUTHERN CALIFORNIA'S ASSISTED-REPRODUCTION PROGRAM BETWEEN 1991 AND LAST YEAR. IT FOUND THAT THERE WERE NO INFANT OR MOTHER DEATHS AND NO SERIOUS HEALTH PROBLEMS IN THE BABIES.

THE OLDER WOMEN WERE LIKELY TO HAVE CAESAREAN BIRTHS AND FACED HIGH RATES OF PREGNANCY-INDUCED DIABETES AND HIGH BLOOD PRESSURE. BUT THOSE CONDITIONS ARE TEMPORARY, TREATABLE AND NOT REASON ENOUGH TO EXCLUDE THEM FROM TRYING TO GET PREGNANT, THE RESEARCHERS SAID.

PREVENTING THEM WOULD BE AGE DISCRIMINATION, SAID LEAD RESEARCHER DR. RICHARD PAULSON.

"NOT ONLY DO I NOT HAVE A PROBLEM IN ALLOWING THEM TO BECOME PREGNANT, I WOULD HAVE AN ETHICAL PROBLEM IN DENYING THEM," HE SAID.

WOMEN ARE NOT BIOLOGICALLY DESIGNED TO BECOME PREGNANT AFTER THEIR BODIES STOP RELEASING EGGS. THIS OCCURS ON AVERAGE AT AGE 51. BUT WITH BABY BOOMERS LEADING LONGER, MORE ACTIVE LIVES, 51 IS NOT AS OLD AS IT USED TO BE. AND MORE AND MORE WOMEN WHO POSTPONED MOTHERHOOD UNTIL IT WAS TOO LATE TO GET PREGNANT WITH THEIR OWN EGGS ARE CHOOSING TEST-TUBE FERTILIZATION WITH EGGS DONATED BY YOUNGER WOMEN.

SOME DOCTORS WORRY THAT BECAUSE OF THE OLDER WOMEN'S ADVANCED REPRODUCTIVE AGE, PREGNANCY MIGHT BE DANGEROUS FOR THEM OR THEIR BABIES.

SOME ALSO SAY IT IS UNETHICAL TO ALLOW WOMEN TO BECOME PREGNANT IF THEY MIGHT NOT LIVE TO SEE THEIR CHILDREN GROW UP. THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE'S ETHICS COMMITTEE SAYS EGG DONATION FOR POSTMENOPAUSAL WOMEN SHOULD BE DISCOURAGED.

"WE'RE HAVING OUR OWN GRANDKIDS -- WE JUST SKIPPED HAVING KIDS," SAID ST. LOUIS UNIVERSITY VOLLEYBALL COACH MARILYN NOLEN, WHO GOT PREGNANT WITH TWINS AT AGE 55 WITH EGGS FROM A WOMAN IN HER 20S. SHE WAS INVOLVED IN THE STUDY.

NOLEN SAID SHE AND HER HUSBAND TRIED FOR 10 YEARS TO HAVE CHILDREN, TURNING TO EGG DONATION AFTER SHE HIT MENOPAUSE. IT WORKED ON THE FIRST TRY. "FOR US IT'S JUST A DREAM COME TRUE," NOLEN SAID.

THE NUMBER OF POSTMENOPAUSAL WOMEN SEEKING TO BECOME PREGNANT THROUGH EGG DONATION IS STILL SMALL. IN 2000, THERE WERE 255 BIRTHS NATIONWIDE TO WOMEN AGES 50 TO 54, UP FROM 174 IN 1999, ACCORDING TO THE MOST RECENT FIGURES FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION. THE CDC DOES NOT KEEP STATISTICS ON BIRTHS TO WOMEN OVER 54.

BECAUSE OF THE JAMA STUDY, "WE PROBABLY WILL SEE MORE OF THESE PROCEDURES DONE BECAUSE, UNFORTUNATELY, MEDICINE IS TREATED LESS AND LESS AS A PUBLIC GOOD AND INCREASINGLY AS IF IT WERE LITTLE MORE THAN ANOTHER COMMODITY," SAID BIOETHICIST ROBERTA SPRINGER LOEWY OF THE UNIVERSITY OF CALIFORNIA AT DAVIS.

SHE ADDED: "SIMPLY BECAUSE WE FIND WE CAN AND WANT TO DO SOMETHING DOESN'T MEAN WE OUGHT TO DO IT."

IN THE STUDY, THE OLDER WOMEN'S RATES OF PREGNANCY -- 45 PERCENT -- AND MULTIPLE BIRTHS -- 30 PERCENT -- WERE SIMILAR TO THOSE IN WOMEN A DECADE OR MORE YOUNGER WHO BECOME PREGNANT WITH DONOR EGGS. SO WAS THE BIRTH RATE -- ABOUT 37 PERCENT.

PREECLAMPSIA, A POTENTIALLY SERIOUS CONDITION INVOLVING HIGH BLOOD PRESSURE, OCCURRED IN 35 PERCENT OF THE OLDER WOMEN, AND GESTATIONAL DIABETES OCCURRED IN ABOUT 20 PERCENT. THOSE RATES ARE AT LEAST DOUBLE THE RATE IN YOUNGER WOMEN. ABOUT 78 PERCENT OF THE OLDER WOMEN DELIVERED BY CAESAREAN SECTION.

EGG DONATION IS AN ACCEPTED PRACTICE FOR HELPING INFERTILE WOMEN BECOME PREGNANT. EMBRYOS ARE CREATED IN A LAB DISH AND RECIPIENTS TAKE HORMONES TO PREPARE THE UTERUS FOR PREGNANCY. MANY PROGRAMS DO NOT ACCEPT PATIENTS OVER 50.

"WE HAVE TO HAVE A CUTOFF JUST FOR PRACTICAL REASONS," SAID DR. RALPH KAZER, WHO HEADS THE IN-VITRO FERTILIZATION PROGRAM AT CHICAGO'S NORTHWESTERN MEMORIAL HOSPITAL, WHERE THE CUTOFF IS 50. "IF SOMEBODY'S VERY OLD, IT'S NOT REALISTIC."

THE STUDY IS ONE OF SEVERAL IN THIS WEEK'S JAMA THAT FOCUS ON AGING.

ONE STUDY FOUND THAT HUMAN GROWTH HORMONE, TOUTED AS AN ANTI-AGING REMEDY, INCREASED LEAN BODY MASS AND DECREASED POTBELLIES IN ADULTS 65 AND OLDER, AS HAS BEEN SHOWN IN YOUNGER PEOPLE. BUT IT ALSO RAISED THE RISK OF DIABETES AND OTHER SIDE EFFECTS, AND THE AUTHORS CONCLUDED THAT THE HORMONE SHOULD BE USED ONLY IN RESEARCH.

ANOTHER STUDY FOUND THAT WEEKLY TRAINING FOR FIVE WEEKS IN MEMORY AND PROBLEM-SOLVING TASKS HELPED SHARPEN OLDER PEOPLE'S MINDS. AND OTHER RESEARCHERS FOUND THAT WALKING FOR AT LEAST FOUR HOURS A WEEK REDUCED THE RISK OF HIP FRACTURE BY 41 PERCENT IN POSTMENOPAUSAL WOMEN.