by Richard J. Paulson, M.D., and Judith Sachs
W.H. Freeman & Co., 1998
Reviewed by
Review
When 63-year-old Arceli Keh gave birth in 1996 and became the oldest woman in the world to do so, society openly criticized the physicians and technology that allowed this defiance of nature. In Rewinding Your Biological Clock: Motherhood Late in Life, her physician, Richard Paulson, champions the right of older women to give birth while presenting the volatile issues awaiting those who choose this path.
The author's fascination with the reproductive process, sympathy toward infertile couples, and dedication to helping them is obvious. "Giving birth may be the most important job we do on earth, because no matter what we have accomplished as individuals, it is only as we impart our knowledge, love, and caring to another generation that we imbue civilization with a sense of history. It's in having children, of course, that we live on after death," writes Paulson, who is chief of reproductive endocrinology and infertility at the University of Southern California School of Medicine.
For women over 46 years old, egg donation is the only way to become pregnant. Paulson hadn't intended to make history with Arceli Keh - she lied about her age. But, for those who worry that older mothers represent a trend, fewer than 200 women in the world over 50 years old have used egg donation and given birth. Indeed, the path is a risky one with a 60% chance of complications and a caesarean section very likely.
Giving the book a firsthand feel are chapters containing the fictional narrative of Sarah, a 48-year-old character who is a composite of many older women trying to become pregnant. The story follows her through assisted reproductive technologies (ART) where eggs and sperm are manipulated to aid with pregnancy, and the accompanying hopes, fears, conflicts, and worries.
The book traces the history of ART and provides detailed descriptions of the procedures involved, as well as a background on basic reproductive biology. To keep his text lively, the author has peppered it with interesting facts. For example, 80% of a woman's eggs are reabsorbed, even before birth; when sperm enters an egg, it takes more than 18 hours before the two sets of DNA intermingle.
Numerous psychological issues for egg recipients are also examined: guilt, jealousy, anger, worries whether they will love the child, dealing with the reality that they may never see their child reach adulthood, and what to do with leftover embryos (whether to save them, donate to those who want to adopt, or have them destroyed).
The author counters just about every argument possible on why older women shouldn't use ART: that they missed their chance, they're selfish, the technology should be reserved for young women with ovarian problems, and it's not in the best interests of the child. He points out the hypocrisies that these arguments highlight: society seems better able to accept a teenage mother despite her immaturity and possible inability to care for children; and while older fathers are considered virile, older mothers are viewed almost as freaks. The author worries: If we make the judgement that older women shouldn't become parents, where would it end? Would it filter down to young women, so their health, intelligence or psychological state would have to be evaluated before they could become parents? Throughout the book, Paulson asserts that the best parents are not those of a certain age but those who share the characteristics of being loving, caring and committed.
Ethical, legal, and religious issues abound in this book, from whether the egg has become a commodity to whether intergenerational egg donation (among family members) threatens the family structure. (If a father or mother donates gametes to a daughter, what is the child's relationship to them?) He quotes ethicists who are critical of postmenopausal women giving birth because it's not appropriate, natural, or attractive, and puts women in the role of simple baby makers. The author argues that science is always intervening in nature, whether by medically treating infections or by performing heart surgery. Natural doesn't always mean better, cancer being one example.
And though Paulson believes everyone has a legal right to be a parent, he's clear-sighted enough to say they don't necessarily have a moral right. Is it right for a women to give birth if she knows she'll never see her child as an adult, or for a doctor to implant multiple embryos with the risk that selective reduction - aborting some so the others will survive - may have to be performed? "Some of these may be legitimate concerns," says Paulson, "but do they really justify withholding treatment from those who would benefit from it?"
He argues that if members of society truly claim to be pro-choice, they should not only be for contraception and abortion, but also for reproductive technology. "As we decided in the abortion debate of the 1970s, if the government can't interfere with your termination of a pregnancy, they certainly can't interfere with your inception of one - by any means possible," says Paulson. "Postmenopausal pregnancy is simply a new way of respecting individual choice," he adds.
Paulson wonders whether things will progress to the point where parents will select the gender of their baby or buy eggs and sperm on the Web. Perhaps he is naive, believing that couples won't push eventually for the ultimate designer embryos (and the ability to choose the characteristics of their child), but instead will work to simply reach their full reproductive potential.
In the future, technological advances may make some of these issues obsolete. For example, an older woman's inability to conceive using her own eggs may not be a result of damaged DNA (as is often thought), but of impaired cytoplasm that provides enzymes and nutrients for a plethora of metabolic reactions including DNA replication and fertilization. Injecting cytoplasm into an egg has already resulted in several pregnancies. Paulson describes other techniques, including one in which the older woman's egg nucleus is placed in the cytoplasm of a younger egg after that nucleus is removed. He predicts that cytoplasmic donation will eventually replace egg donation, and dreams of a time when researchers will develop synthetic cytoplasm.
The author concludes that even though the criteria for egg donation are too lax, there are no real alternatives. After all, 10 years ago it would have seemed utterly impossible for a 63-year-old woman to give birth. "By assisting the delicate coupling of egg and sperm, we can insure that a portion of all individuals will still be here if they want to be, centuries after their own demise," he says. Though most people are still shocked when women become pregnant after menopause, Paulson proposes that perhaps when the field of reproductive endocrinology is able to make strides in designing the perfect birth control method or eliminating genetic illnesses, pregnancy late in life will be accepted.
This book is not only for older parents thinking trying to conceive. It's for anyone who wants to learn how medical technology impacts upon society.
Jeanine Barone is a nutritionist and exercise physiologist who specializes in writing about travel, fitness, food, and health.
Gary Inzana is a sometime illustrator who occasionally finds himself in a fortuitious situation. Lately he can be found wishing on a star or wandering the streets of New York City.
"No matter how much a woman or a couple wants a child, using a donor can be a tricky emotional issue. One reason that human beings opt to reproduce is that they wish to combine their DNA, and that of their family, with the DNA of the one they love. . . . If you think it's tough for society to contemplate a 50-year-old in maternity clothes, think how much tougher the choice is for the 50-year-old. Naturally, this new beloved individual will represent her husband, but the child will not be her biological offspring."
Atlanta Reproductive Health Centre WWW - provides links to sites dealing with infertility, miscarriage, hormone disorders, and reproductive surgery, as well as newsgroups and mailing lists on infertility and pregnancy.
International Council on Infertility Information Dissemination - a good source of information on the diagnosis, treatment, and prevention of infertility. Contains fact sheets on fertility tests and drugs, and fertility technology news.
American Society for Reproductive Medicine - maintains an excellent site with relevant patient resources, an infertility FAQ, state infertility insurance laws, and information on how to select an IVF program.
Assisted Reproductive Technology News - archives of papers from the Eubios Ethics Institute, a nonprofit organization.
Resolve - a nonprofit organization providing patient advocacy resources, information on infertility, and links to other infertility-related support groups and organizations.
You may purchase this book (288 pp, hardcover) directly from:
Or purchase from another recommended location listed on our Web Bookstores page.
