Ask the Surrogacy Experts

“We found a wonderful woman willing to be our surrogate. We really like her, but she’s 45 years old, and we’re afraid that’s too old to carry the pregnancy. What age is too old to be a surrogate?” –Terry

 

Dear Terry;

It’s inspiring that women of all ages can be so generous. If you doubt, just search on Google for news reports of women delivering their own grandchildren… it’s truly amazing.

Everyone knows that women’s peak fertility occurs in their 20’s and then drops off rather dramatically into their 30s. But that loss of fertility is more related to the availability and quality of her eggs, and not her ability to become pregnant or carry a baby. If you only consider the ability of her womb to carry a fetus and deliver a healthy baby, women are quite fertile for many years beyond that.

Technically speaking, a woman can become pregnant until she hits menopause (usually at 48-55 years). There are recorded cases of women in their 50s successfully serving as surrogates. One Australian case was well-publicized where a 58-year-old woman delivered a baby for an infertile couple. In Nigeria, a 67 year old woman recently delivered a baby via IVF.

IVF doctors will generally medically accept surrogates up to 45 years old (but agencies place more strict limitations).  The test of a woman’s fertility is not in her age, but in her response to her endometrial stimulation. The stimulation protocol thickens the lining of a woman’s uterus and gets it ready to receive a transplanted embryo. The thicker the lining, the better the chances the transplant will take. Some women to do not respond well to this treatment at any age (they may need high dosages of the stimulation meds, or they may just suffer from poor fertility). Some women respond well into their advanced years.

There was a 2005 study in the Journal of Clinical Endocrinology & Metabolism that showed Pregnancy Rates did gradually decrease after age 45. Not many Intended Parents would consider a surrogate nearing 50 years old, but even in that age group the change in pregnancy rate was not very significant. Compared with women under 45 years, pregnancy rates for older women dropped from about 50% to 45%. That difference is notable, but ultimately not necessarily a deal breaker. Good medical therapy and an experienced RE can more than make up for that difference.

The real risk of an older surrogate is in possible complications. Older women have a significantly higher likelihood of complications and premature delivery. The same 2005 study showed that older women were more likely to require a C-section delivery, had pre-term deliveries and lower birth weight. That result is more troublesome… but is also not a deal breaker if Intended Parents are able to take extra precautions to ensure the health of the surrogate and the baby.

Certain chronic illnesses such as high blood pressure, diabetes and preeclampsia arise more commonly among women who become pregnant at an older age. However, staying fit and active can help offset potential problems. More than anything, a woman’s personal situation and general health will impact whether she can become a surrogate. There’s a full discussion about the top qualifications for surrogate mothers in the Surrogacy Guide.

The key here is to find a healthy, active surrogate, and a very experiences reproductive endocrinologist. Is your RE comfortable working with women of this age? Well-applied fertility treatments can balance many of the documented risks. A mock transfer can determine if the surrogate will respond to the stimulation protocol as well as any younger woman, or if she will need added meds, or is she is simply not a good candidate.

So if you may decide to hire a surrogate in her 40s, your chance of getting pregnant is not necessarily significantly less than a women in her 30s. But you should first check with your clinic on their assessment of her overall health and fertility. If you continue, also make plans to safeguard your surrogate’s well-being in her 3rd trimester. Be prepared that she may need additional oversight, possible bed rest, and an early delivery.

I hope this helps.
— Bill

 
 

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