Having “miracle babies” at very advanced female age

A popular magazine just recently again ran a cover story about a prominent actress who, after prolonged IVF struggles, finally had a “miracle baby” through IVF at age 48. We want to be very clear that CHR was not involved in this pregnancy and, therefore, has absolutely no knowledge how this particular actress conceived her baby. Whichever way she did, we are very happy for her!

The time appears right, however, to remind, especially older patients who are still trying to conceive with use of their own eggs, that not everything that shines is, indeed, gold. What we mean by this analogy, is that, like all media, not everything that appears in print regarding IVF does necessarily reflect the truth and nothing but the truth. So, for example, the term “IVF” encompasses not only use of own eggs but also use of donor eggs. If a celebrity is announced to have a “miracle baby” by IVF, it does not necessarily mean that she had this baby with use of her own eggs. It also could be with use of young donor eggs.

At age 48-49 (at time of embryo transfer), such a baby, indeed, would likely be the oldest baby ever conceived if it, indeed, had been conceived with use of the mother’s own 48- or 49-year-old eggs. As we reported in last month’s VOICE, CHR after a literature search concluded that a CHR patient who a few weeks ago delivered a healthy baby after an embryo transfer 2 months short of her 48th birthday, therefore, likely was the oldest IVF patient in the world ever to have conceived and delivered after use of her own eggs.

When celebrities are reported to have “miracle babies” through IVF in their late 40s or even early 50s, they, therefore, much more likely than not, made good use of young donor eggs. Though egg donation is a wonderful treatment for many older women who no longer can conceive with use of their own eggs, and from a medical standpoint, these pregnancies are wonderful achievements and greatly appreciated, but they are not “miracle babies” because with donor eggs from young women in their 20s, pregnancies and deliveries even in the 50s have become rather routine for recipients, not only here at CHR.

It, therefore, is of great importance for older women to receive correct information, as to what their options are, and what pregnancy as well as delivery chances are with the various options. In principle, every premenopausal woman, especially if she is still regularly menstruating, still has chances with use of her own eggs. These chances are just very low in comparison to using young donor eggs, and get lower with advancing age.

Serving, likely, the oldest patient population among all U.S. IVF centers (and probably in the world), CHR sees women above age 43 (which we consider very advanced female age) on a daily basis. They most of the time consult with CHR physicians after having been told elsewhere that their only chance of pregnancy is egg donation. At best they are told, their pregnancy chances with IVF would be only 1-2%; even more often, the message they are receiving is that pregnancy chances would not be any better than trying on their own.

Coming to CHR, they then often are surprised to hear otherwise. Especially after age 45, IVF pregnancy chances with own eggs are, indeed, very low, but they are not 1-2%. What pregnancy chances at such very advanced ages are, will be determined by a number of facts: The most important statistical predictor of pregnancy chance after female age is the number of transferrable embryos a woman can still produce. CHR data very clearly demonstrate that, at this age, three or more embryos separate better from poorer prognosis patients. Consequently, older women with still good functional ovarian reserve (FOR) will always do better than women with very high FSH and very low AMH. Secondly, women who have no other adverse prognostic factors except for age, will, of course, do better than patients with multifactorial infertility.

All of this must be explained to older women with brutal honesty before considering them for IVF cycles with use of their own eggs. One final, important point can also not be omitted: Older women, of course, experience a much higher risk of miscarriages. At CHR, we have established this risk to be ca. 50% for women older than 43 up to age 48. This means that, in order to quote correct live birth rates, clinical pregnancy rates in this age group have to be cut approximately in half.

If patients are aware of all of these facts, and still chose to work with their own eggs, they are more than welcome to do so at CHR. If these patients are lucky enough to conceive and to deliver, they then really have “miracle babies,” giving CHR staff an opportunity to celebrate with our patients. And since practice enhances skills, we are grateful to every one of our older patients who gives us the opportunity to learn from managing their IVF cycles. As we have repeatedly stated in these pages, CHR learns from each of our patients. Without the trust of our patients in going with CHR physicians and scientists into sometimes unchartered territories, CHR, like most other IVF centers, would still, more or less automatically, send all women above age 42 directly into egg donation.

That we have learned not to do so and, even more importantly, have learned with patients’ own eggs to achieve pregnancies almost to age 48, is, therefore, primarily the consequence of our center’s patients’ courage to ask for such treatments, for which we are grateful.

This is a part of the November 2017 CHR VOICE.

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.