How Old Is Too Old?

By Christine Gorman

Jonie Mosby Mitchell is three months pregnant and thrilled about it. She and her husband adopted a baby girl three years ago, and they are eager to produce a sibling for her. Nothing unusual about that, except for the fact that Mitchell is 52. She went through menopause years ago.

Mitchell's pregnancy represents one of the latest and most extraordinary achievements of infertility science. By treating his middle-aged patient with hormones, Dr. Mark Sauer, at the University of Southern California, was able to essentially reverse the effects of menopause. Using an egg from a young woman and artificial insemination with sperm from Mitchell's husband Donnie, Sauer was able to establish the pregnancy. Mitchell is not even Sauer's oldest patient. He is also helping a 55-year-old woman, who has a 30-year history of infertility and was too old for in vitro fertilization when it was introduced in 1978. "She had given up hope of ever having a child, and came to me hoping for a miracle," says the sympathetic doctor.

Such miracles are now possible. Expensive, but possible. But is this an appropriate use of technology? When Sauer first used the technique, it was to help younger women who had gone through menopause prematurely. But after publishing his results last October, he was besieged by requests from middle- aged women hoping to turn back the clock. Should they be helped?

Not everyone in the field is enthusiastic. Some professionals fear that these new techniques will only encourage women to delay pregnancy. "There is a time and place for everything," says Dr. Georgeanna Jones of the Jones Institute for Reproductive Medicine in Norfolk, Va. "Women should know that their eggs age. They need to plan for their families and careers so they can have children earlier." Most in vitro clinics are reluctant to accept patients over age 40. The reason is primarily practical: the success rate for such women is minimal, though donor eggs can certainly improve the odds. Natural childbearing is also rare in this age group. Only 1% of the 4 million U.S. babies born in 1988 had mothers between ages 40 and 45, and less than .04% were born to women over 45.

From a medical standpoint, there are two problems with very late childbearing: health risks to the fetus and to the mother. After age 40, the risk of fetal abnormalities is substantial: the incidence of Down syndrome, for example, rises to 1 in 40 live births. (Using donated eggs from a young woman presumably reduces the risk.) The mother meanwhile faces increased risks of diabetes, obesity, high blood pressure and other complications of pregnancy -- all of which can harm the unborn child. These problems are usually manageable, however, if the woman's health is generally good.

The ethical and social concerns are trickier. Jonie Mitchell will be 70 when her child graduates from high school. She is unlikely to live to see that - child's children grow up. But such considerations have not deterred men from fathering children while in their 50s, 60s and even 70s. "If I can raise him or her until age 30, then he should be able to make it on his own," says Mitchell. She notes that her own mother had nine children and is still going strong at 86.

Psychologists point out that older parents are more likely to be emotionally and financially stable, even if they lack the stamina to chase a toddler for hours on end. "From the kid's perspective one could argue that it would be nicer to have a mother who can run faster than the kid," says Dr. Ellen Wright Clayton, a pediatrician and law professor at Vanderbilt University. But, she says, "the child's other alternative is not to exist." Not many 50- year-olds want to be pregnant, and not many can afford the $10,000 or more it takes. Clearly, says Clayton, "if these women want to have babies this badly, then these babies are going to be loved."

With reporting by Pat Cole/Los Angeles and Barbara Dolan/Chicago