Journey to life brings soul-searching questions
USING donated eggs from a younger woman is the option offered by fertility clinics for many women in their 40s as the most likely way to cross the infertility barrier.
Women opting for egg donation at the Sims IVF Clinic have an average of 42 and 90% of the 150 major cycles of egg donation a year at the clinic are carried out on women over 40. Most UK clinics won’t offer women aged 45 IVF using their own eggs because there’s only a one percent chance of success, says Zita West Group manager Anita O’Neill, adding, ‘hundreds of women in Ireland have babies every year through egg donation’.
Declan Keane, who runs ReproMed.ie, which helps Irish couples with fertility options, sees about 80 women in their 40s going for egg donation annually.
“Many have been along thefertility journey using their own eggs and IVF hasn’t worked – the finger’s being pointed at the quality of their eggs,” says Keane, who helps women access egg donation inclinics mainly in Spain and the Czech Republic, where ‘culturally, there’s no problem donating eggs’.
While the normal cut-off age in European clinics is 48-50, Keane has had one woman ‘just over 50’ accepted for egg donation at a Greek clinic.
“She got pregnant – it’s not age that’s important when you’re carrying the baby. You’re looking at blood supply to the uterus and that normal uterine capacity is retained.”
Egg donation has revolutionised fertility for older women whose eggs have diminished in quantity and quality. But the journey brings soul-searching questions, queries of the heart that may take years to navigate.
“Any woman contemplating egg donation has the classic conflict between heart and head. The heart doesn’t want to countenance it, but the head says ‘this is what we can do to make it probable that we will succeed, not probable that we will fail’. It can take years to come to a decision,” says Dr David Walsh, Sims IVF medical director.
The grief of relinquishing one’s own fertility potential, of accepting it’s no longer possible to have a genetic child, can take a long time to process, agrees O’Neill.“Women who’ve had a long fertility journey with several failed IVF cycles resign a lot better to egg donation than someone who has been trying to conceive on her own, has an ovarian reserve test and is told in one short conversation that she’s infertile and her only option is egg donation. These women are hit hardest. They struggle to come to a decision.”
At Sims, where counselling to look at implications of their decision is mandatory for all couples considering egg donation, counselling psychotherapist Ann Bracken says clients need support around genetic grieving, forming a healthy bond with the child and whether to disclose the egg donation to the child.
“If couples perceive the donor as someone who wants to help them give life, they accept the donor more easily and attach to the child in a healthy way.”
Mary Casey counsels egg donation patients at Tralee’s Scotia Clinic.
“They have to grieve what they thought their future would be – they’ve built maybe 10 years of married life around the prospect of having their own genetic child. They worry the child won’t look anything like them. They worry about not knowing the child’s health history,” says Casey, adding that not bonding with the child is rare.
“Often when people get pregnant, they tend to block out how it happened. And the woman knows her blood is keeping the baby alive in her womb.”
When it comes to the issue of telling the child that they resulted from egg donation, most would-be parents don’t want to. “The major reason is not wanting people to know your business when you live in a small town or village,” says Casey, adding that the ratio is about 70:30 in terms of those who don’t want to tell, versus those who do. Whether to tell the child is a question with no simple answer,” says Walsh.
“With adoption it’s eminently sensible to tell the child. But an adopted child is not born of a commissioning parent and the adoptive parent is not the birth parent. With egg donation a child comes into existence that never would have. These children are parented by an act of will – it’s not surprising that on average they’re better parented.”
Bracken also believes there’s no black or white answer. “It’s anonymous donation – when the child has information, what do they do with it as an adult? They can’t get any more information.”
“Yet, everybody now accepts that an adopted child has a right to know they’re adopted. Why should children born through egg donation be any different? The truth isn’t always comfortable, but it’s a lot easier to live with than a lie. And truth has a way of coming out – invariably, if a woman’s having egg donation she’ll tell someone, maybe her best friend, so it’s no longer a secret.”
Some prospective parents don’t think beyond the baby and toddler, says Dr Mary Wingfield, Merrion Fertility Clinic medical director. “They don’t think about when the child’s 15. They don’t ask what the child is going to think of it.”
Wingfield points out, however, that research on children shows that openness is very important.
“Most research shows that children like to know and if they don’t find out until they’re older, they can be devastated to discover their parent isn’t the biological parent.”
Helen Browne, co-founder and chairperson of National Infertility Support And Information Group, finds most couples are willing to tell their child. But she feels there aren’t sufficient resources to support them through that process.
“There’s a need for resources for parents, who’ll want to know when to tell their child and how to tell them.”
JEWELLERY designer Cheryl Finnegan’s pieces have been worn by Miley Cyrus, David Beckham and Maria Shriver. Based in Mexico City, Cheryl, 50, grew up near Chicago — eight years ago, she came to Kinsale to give birth to daughter Tallulah with the assistance of community midwife Mary Cronin.
“I became pregnant at 41. It was a complete accident. My whole fertile life, I’d never used birth control. I thought I didn’t have enough hormones! I was beginning menopause when I got pregnant — I’ve heard you can be quite fertile at that time.
“A baby was never in my plans. To be independent, successful in my career, supporting myself — that was my goal. When I found out, I thought ‘I really don’t need this’. For the most part the father didn’t want anything to do with it financially — I’d be on my own. It took about three months to realise I didn’t have to be the kind of mom society expects — the one who volunteers at the school, drives her kids to sporting events — but I could still be a great mom. I had no health concerns about being pregnant at 41. I felt I was 25. I’m a super-healthy eater. I exercise regularly. Doctors told me I was high risk for all kinds of problems because of my age. I took it with a grain of salt. I felt in my heart there was nothing wrong with this baby.
“Tallulah was due in July. That ruled out Mexico for giving birth — it’s blazing hot, it’s just before rainy season, there’s dust everywhere and everybody’s sick. I wanted a natural birth. I knew I’d love to be near water, to have clean, fresh air where the temperature’s 70 degrees or less. Then I thought ‘Ireland’. I’d visited Kinsale several years earlier and it had touched my heart. I Googled midwives in Ireland, saw a photo of Mary Cronin and thought ‘she looks lovely’. When I got in touch, she said my age wouldn’t be a problem.
“She advised arriving two months before my due date. I told her I wanted a water birth, — she told me where to rent a birthing tub. She had the perfect doula (support assistant) for me. It all fell into place. My labour was 30 hours. I walked through Kinsale with the doula and when I got pains, I’d stop and hold onto a building. It got very intense that night.
“Giving birth was the most exciting thing I’ve ever done. The doula got in the water with me and rubbed my back. When the baby was coming out, I gave her this look and said ‘ring of fire’ and she started singing the Johnny Cash song! Tallulah weighed 9lb 8oz — within hours I was walking upstairs.
“When I returned to Mexico two months later I felt overwhelmed. I was on my own. Tallulah was in a sling, breast-feeding, and I was on the computer and had my headset on. That’s when you start thinking ‘I can’t wait ‘til she sleeps all night, I can’t wait ‘til she’s four’. In Mexico, it’s common to have help in the house. I got a nanny. If I needed to get out in the evening, I’d ask a girlfriend, who also had a baby, to look after Tallulah — we did a lot of that.
“My big challenge in the first six months was getting post-thyroid condition. It makes you anxious and tense and depletes your milk supply. It’s likely to happen if you’re an older mum.
“Having Tallulah made me a better person — being single and career-oriented lends itself to being selfish. Having a child grounded me. I’m still amazed I have this little person that I’m responsible for and she relies on me for every waking moment. I’m her universe and she’s mine. The rewards erase absolutely any challenges.
“If I’d started when I was younger, I’d have had a dozen kids. I don’t know if I’d have been as happy. At 21, I was a disaster. At 32, I was dying my hair pink and carrying on. By the time I had Tallulah, I was more mature. I had a lot of confidence. I knew where I fitted in.”
* Patricia Rashbrook, had a son in 2006 when she was 62. The birth of her baby ignited debate in the UK about ethics of later motherhood.
* Susan Tollefsen became Britain’s oldest first-time mother at 57, following IVF treatment at a Russian clinic in 2008. (See story on opposite page.)
* Bhateri Devi Singh, an Indian woman who’d never previously had children, had triplets in 2010 when she was 66. She’s the world’s oldest mum to give birth to triplets.
* Spaniard Maria Del Carmen Bousada had twin sons in Barcelona in 2006 a week before her 67th birthday. The premature babies each weighed 3.5lbs. Mum developed stomach cancer soon after their birth and died when they were two-and-a-half.
* Eighteen months after she became the world’s oldest mum at age 70, it was announced in 2010 that Raji Devi Lohan from India was dying. Her womb ruptured after she had her daughter by Caesarian section.
Anne*, 42, gave birth to her daughter Jasmine two months ago. She and her husband received an anonymous egg donation at a Barcelona clinic. Jasmine is her husband’s biological child.
“I had fertility treatment over four years. I had two rounds of IVF. Each time during the two-week wait, I bled before the date you do the pregnancy test. It was horrendous. It took me a year between IVF treatments to get the courage to do another round.
“Then, out of nowhere, I had a natural pregnancy. We’d seen the heartbeat at six and eight weeks but at 10 weeks it wasn’t there anymore — I had miscarried. After that I felt I couldn’t go back for a third round of IVF with my own eggs — I was too destroyed. That was a turning point.
“We’d spoken about using donor eggs. It was something I didn’t really want to do. It was so scientific — it appalled me. But after that journey of years of trying, I couldn’t take any more risks, not when I only had a 5% to 10% chance of getting pregnant. With donor eggs I had a 55% chance — it was a whole different ball game.
“For me, the hardest thing about egg donation was the genetic loss, that when I go my genes are not going to be left behind. I still feel that sadness but it’s nothing like it was. I had a wobble when my baby was born. I was looking for similarities — who does she look like? There was that bit of sadness that I won’t have that. But the sadness is nothing like the gut-wrenching loss of infertility. It didn’t take anything from the fact that she’s 100% our daughter. I believe this little soul was meant to be with us and I wouldn’t swap her — she’s so priceless.
“I struggled with the fact that it was an anonymous donor. The doctor in Barcelona said ‘the donor is giving you a gift of life for your family’ — that really helped. We absolutely will tell our daughter how she came to be. We’ve kept the photos of us on the plane, we’ve got a beautiful short letter from the donor and a bit of information about her.
“As an older mum, I see younger mothers and wonder have I got the same energy. But many of my friends are mums in their 20s and 30s and we’re all knackered. We’re all talking about the same stuff — who’s got colic? Age doesn’t seem to enter into it. The main challenge is I won’t be around with Jasmine as long as I’d like to be.
“We’re financially stable and, as a couple, emotionally stable. Our priority is Jasmine. At our age, we have the time and space. When you’re younger you’re concentrating on career and travel and you’re in and out of relationships. Going out, travelling round the world doesn’t matter to us — our 100% focus is on Jasmine, on her well-being.”
— Helen O’Callaghan
* Name changed to protect identity.
Helen Browne
National Infertility Support and Information Group
“I remember going with a 45-year-old woman to collect her daughter from school. She’d had her at 41 with IVF. There was such excitement in her, seeing that child come out of school. I didn’t see it as much in the younger mums, who had other smallies with them. Her energy was powerful.
“Now the child is 10 and her mother still has that energy. She doesn’t have a high mortgage and she’s job-sharing so she can give time to the little girl — there’s no financial pressure, whereas younger people might have a financial burden.”
Anita O’NeillFertility midwife specialist and manager of London-based Zita West Group
“Women in their early 40s have certain expectations of themselves. They’re successful women in every other area of their lives — career, friendships — and this is their expectation of themselves as a mother. I’ve heard women say ‘I’ve managed a corporation but I can’t manage this two-week-old baby’.
“If you could wave a magic wand and make it an easier transition into motherhood, what new mums want is support — at every level. There used to be grannies, aunties, extended communities — we don’t have that anymore. Support would make it a lot easier, especially for older mums.”
Peter Brinsden, Medical director of Clane Fertility Clinic
“Although we defy nature quite frequently when we help people to have a baby, from both the point of view of the mum’s health and the welfare of the child, 48 to 50 is where we should stop. I don’t believe we have an absolute right to a child. We have a right to the chance to have one, but the right to that opportunity should stop at 50.”
Ann Bracken Counselling psychotherapist at Sims IVF Clinic
“Most people in their 40s are more financially secure. They have more wisdom and insight and are more mature. They’re more likely to be in a stable relationship so they can offer the child consistency. But there are losses. You don’t have as much energy. You try to make good the losses. If you can’t engage in active play with your child, you’d have them doing dance or sports. If they’re an only child, you’d ensure they have a good social network.”
Mary Cronin, Community midwife
“It’s hard for any new mum to get used to this other being in their life who’s going to use up their time. Whether that transition takes longer in older women I couldn’t say. The new mother needs to be mothered herself.
To have a mother on her own in the post-natal period isn’t natural. Women were always around, helping each other at this time. With a woman in her 40s, her own mother might be elderly.”
Mary Casey Counsellor at Scotia Clinic
“Often, older mums have been aunties for a long time. They’d have a very good awareness of children from having babysat. Their relationships are well-established. They may not have parental support, but they’ll have siblings. They’d be more rounded and secure in themselves.”
Dr Miriam DalyGP and Director of Women’s Health Programme in the Irish College of General Practitioners
“I definitely feel there’s no best age to be a mother. Having a new baby is a huge challenge for anyone. The sleepless nights mean the exhaustion is extreme at any age. Whether a mother’s going to be able to manage or not doesn’t have to do with age — there’s a huge complex interplay of many factors.”
Senior embryologist Declan Keane, who runs ReproMed.ie, tracks clinics around Europe and further afield that offer IVF and egg donation (ED).
His criteria are:
* Ease of access
* Best pregnancy rates
* Economic considerations.
ED can cost anything between €3,000 and €30,000. “Average for couples accessing a clinic in Europe is €7,000-€8,000. This includes cost of travel and hotel. Couples probably spend a week away from home.”
IVF costs between €4,500 and €6,000 in Ireland. ICSI, factored into this price range, usually accounts for about €500 to €900 of the cost.
* Visit your GP for health check. If overweight, lose weight. Quit smoking. Begin taking folic acid.
* Get hormone tests done – on day three of cycle and again on day 21 (of a 28-day cycle). Semen analysis test should also be done.
* Next port of call will be a fertility clinic. A GP will can refer you.
* Visit: www.repromed.ie; www.nisig.ie;www.donor-conception-network.org;www.oldermum.co.uk.
SUSAN Tollefsen became Britain’s oldest first-time mother at 57 following IVF treatment at a Russian clinic in 2008.
Three years later, she told a British newspaper that critics had a point when they’d said she was too old to become a parent.
At the time of conceiving daughter Freya, she pointed out that her partner was 11 years younger than her, saying he’d be there to care for the girl through her childhood.
But they have since split up, and Tollefsen has admitted her dream of having a baby cost her the relationship.
While she’s reported to have said she ‘has never regretted having Freya’, describing her as ‘the best thing I have ever done in my life’, she has been candid about the difficulties facing her: exhaustion, raising Freya on a small income that includes her pension and having little in common with the much younger parents of her daughter’s peers.
Tollefsen is reported to now believe that 50 should be the cut-off age for women seeking IVF.
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