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Discussing the Risks of Pregnancy with Advanced Maternal Age

Dr. Gleicher discusses some of the physical challenges for older women who carry a pregnancy. CHR believes this shouldn't discourage you from trying to conceive, but rather that you choose a clinic that assesses your entire medical history before treatment. Any existing conditions that could interfere with the pregnancy should be recognized and addressed before fertility treatment.

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Hello, I'm Dr. Norbert Gleicher. I'm the medical director and chief scientist at the Center for Human Reproduction. I want to talk to you today about the risks of getting pregnant at older ages--let's say between 45 and 50. That obviously includes, first and foremost, the risk of NOT getting pregnant. That risk is obviously quite high if a woman at those advanced ages works with her own eggs. If donor eggs from 20-year old egg donor are used, then pregnancy chances are obviously very high. And therefore, for patients in this older age group, there is a very difficult decision to be made between relatively small chances with use of their own eggs and much better chances with donor eggs. But this is really not the main theme of what I wish to address today. What I really want to talk about are the risks of getting pregnant at an older age. And in general, all risks of pregnancies increase with advancing maternal age. It doesn't matter what the risk is. Uniformly, every single risk gets bigger as women get older. You may have read recently in the lay press that a study was published which demonstrated the significant increase in myocardial infarction, heart attacks, in women who go through pregnancy. That is very likely the result of older women in larger numbers going through pregnancy. And it is just one example of what happens or what can happen when older women are trying to carry a pregnancy. Now, I do not want you to misunderstand what I'm saying here. The fact that all medical risks increase as women get older does not mean that they increase to a level that necessarily prohibits older women from getting pregnant or should prohibit older women from even trying to get pregnant. That is by no means what I'm trying to say, but what I am trying to communicate here is the fact that once a woman decides to go through pregnancy at an older age, we have to be more careful in assessing whether this patient is still suited physically (as well as mentally) to go through the stress of pregnancy. And pregnancy is a stress on every organ in the body including the skeleton. Spinal problems increase in pregnancy. Problems with joints increase in pregnancy, and of course medical problems in general do. We, therefore, here at CHR and many of our colleagues, after age 45, do a much more detailed diagnostic workup on patients before we take them into treatment. Once again, this does not mean that if you have a medical problem you are automatically disqualified from going through pregnancy. What it means is that if you do have a medical problem, we rather know about this before you get pregnant so that we can make the necessary preparations and be ready should this medical problem cause some difficulties during pregnancy. But one thing we do not want to happen to you, as well as to your physicians (and that will not be us because by the time you're pregnant you're under the care of an obstetrician and advanced ages usually under the care of a high-risk obstetrician), We do not want our colleagues to be surprised because then you usually run behind the problem. We like to run ahead of the problem. And therefore, it is so important that we assess our patients' well-being and advanced ages before we have them conceive. Thank you.

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