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September 20 2021
With development of assisted reproduction technologies (ART) it became possible for many couples to have children in their 40’s, 50’s, and sometimes even 60’s. Paternal and maternal age is increasing in most developed countries, whereas, a positive media portrayals of such parents, particularly celebrities, makes such choice socially acceptable. But what are the risks? Is there anything to think about except for potential medical issues? In some countries there are restrictions established by law as to the maximum age of prospective parents that may participate in assisted reproduction programs (including gametes donation or surrogacy, where such treatment is allowed). In other countries, and among them is Ukraine, the decision is within a discretion of medical specialists in charge of the ART program.
So, when does an advanced paternal age (APA) occur?
In case of a prospective father – as man ages, the number of de novo mutations in his sperm increases and a chance of a stillbirth or that a child would carry a deleterious mutation linked to disorders such as autism or schizophrenia increases proportionately (Kong, 2012). Yet, while the risk for stillbirth, in particular, may rise at the age of 40 and beyond, there is no clear paternal age “cliff” at which point offspring health risks dramatically increase (Smith, 2015; Urhog, 2017). Those risks may be circumvented through use of donor sperm.
In case of a prospective mother – often an advanced maternal age is defined as 35 years and beyond and is based on sharp fertility decline after mid 30’s and increasing risk of fetal genetic anomalies. However, if a woman will be carrying the pregnancy herself and using donor oocytes, concerns regarding maternal health increase with age, but may be considered as very significant somewhere be age of 50. A combination of donor oocytes and gestational carrier (surrogate mother) may mitigate both, fetal and obstetric risks for a woman.
What else shall be considered, in addition to health related risks?
There is a lot of research and information as to health related risks of APA, however, one obvious and extremely important issue often remains unaddressed. In particular, children born to mothers and fathers of advanced age, regardless of the age of the gametes (eggs or sperm) contributing to their conception and the age of the individual carrying the pregnancy, are more likely to experience the early health decline or early death of one or both of their parents, as compared to children born to younger parents (Zweifel, 2015).
Let’s look at statistical risks of death of advanced age parents by the time a child is 15 years old:
Of course each case is unique and in addition to statistics many other factors shall be taken into account. For example, a health and family history of each of the prospective parents, as well, as presence or absence of additional supporting individuals that may help rise and support a child to adulthood shall be taken into account. The bottom line is that every decision, especially the one that may influence a life and wellbeing of a child shall be taken responsively. Prospective parents shall always consider all pros and cons not only from their own perspective but also from the perspective of their future children.
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