Testing the Limits : Thanks to bold new technology, a woman can give birth in her 40s, 50s and 60s. But should she?

There are careers to juggle, toys to avoid stepping on, earaches to have treated and play dates to arrange. The diapers mount up, and so do the bills from the baby-sitter and the pediatrician. Most days, Lynn Grossman-Getoff and her husband, Peter Getoff, are so busy caring for 15-month-old Emily that they give little thought to the fact that they arrived at parenthood at an age--and via a route--that trouble some people.

But sometimes, reality hits home. “You are dealing with so many stages of life at one time that it’s disorienting, to say the least,” Grossman-Getoff said. “You’re dealing with all the issues of a young mother--and, at the same time, menopause.”

Using eggs donated by a younger woman, Grossman-Getoff, a West Los Angeles family therapist, gave birth when she was almost 45--six years older than her husband, a social worker. She is well aware that her age by no means thrusts her into the book-of-records category for first-time mothers, a distinction held by a 61-year-old Italian. Still, by using ovum transfer and high technology to conceive when her own body was at a stage called perimenopausal, Grossman-Getoff entered an arena where science is dueling with physiology--and where, at the moment, no one is quite sure who is winning.

Donor eggs and bold new procedures that prepare an aging uterus for pregnancy are enabling women to test the biological limits of maternity. Doctors in this field stress that such procedures are still new and are by no means widespread, with only 50 to 75 babies born to post-menopausal women around the world in the last three years. But, they concede, sacred societal notions about motherhood are suddenly on the line.

The issue came to prominence not long ago when a 59-year-old British woman went public with the fact that she had just given birth to healthy full-term twins. Her announcement added fuel to the debate about high-tech reproduction: If men can embark on parenthood at any age, shouldn’t women have the same option? Is a post-menopausal woman physically capable of raising an infant? Will she live to see her child grow up? Does a child get a fair shake in a household where Parents magazine arrives alongside Modern Maturity?

To Dr. Mark V. Sauer, a professor of obstetrics and gynecology at USC who is among the leading specialists in egg-donor pregnancies, such questions reduce to a matter of individual choice between a patient and her physician.

“If we have reproductive choice in this country and we have technology that works,” Sauer said, “then why deny the choice?”

But another pioneer in post-menopausal pregnancy, Dr. Ricardo Asch of the University of California, Irvine, said that even though his clinic imposes no age limit for what are sometimes called third-party pregnancies, some kind of guidelines are needed.

“In the case of using egg donations for someone who underwent normal menopause, you’re not treating pathology,” said Asch, a dean at UC Irvine’s School of Medicine. “You’re just challenging physiology, the normal events that happen to a human being.

“I have mixed feelings about this, I really do,” Asch said.

Not surprisingly, parents who have benefited from ART, or assisted reproductive technology, are not so ambivalent.

Working through the technological steps that saw his sperm mixed with a donor’s eggs, then inserted into his wife’s womb, required “a certain stamina,” Peter Getoff recalled. “There was so much at stake, and there was a sense of unreality to it.”

But in a culture where “we mess with Mother Nature in lots of other ways,” many people still cling to “some very rigid and idealized notions about how things should be in terms of motherhood,” Getoff said.

“For me, I just have very strong feelings that a woman has a right to have a child fairly late in life.”

Getoff and his wife are unusual among ovum-donor parents interviewed by The Times in that they readily agreed to be quoted by name and were comfortable revealing their ages. More typical was the 49-year-old mother in the San Francisco area who asked that she be called “Laura” and that her husband, 62, be referred to as “Sid.” These are made-up names; Laura said she was worried about personal security, adding that when she discusses post-menopausal reproduction on television, she does not disclose her real name or hometown.

What is true is that Laura and Sid were married for 30 years before they became parents. Married young, they dreamed of a big family, six kids at least. But nature failed to cooperate. No specific cause could be isolated for their failure to conceive, making treatment a challenge.

The couple went through seven cycles of in vitro fertilization. They tried a procedure in which a fertilized egg is inserted directly into a woman’s Fallopian tube. Again, no luck. There were other treatments, such as hormone injections and intrauterine injection of Sid’s sperm into Laura.

“Nothing worked. We never even got a nibble,” Laura said.

Laura was well into her 40s by the time she was ready to consider adoption. She found the process troubling.

“Adoption takes so long,” she said. “And you have to sell yourself, like a product.”

Nevertheless, Laura and Sid had adopted a baby boy when they received a call from their fertility specialist, Dr. Geoffrey Sher.

“It was December, 1991, and egg donation wasn’t being talked about,” Laura recalled. “But they said they were having a lot of success. So I said sure.”

Three months later, Laura was pregnant after her first attempt at receiving a donated egg.

“It took me three months before I really believed it,” Laura said. “I kept doing home pregnancy tests, just to make sure.”

That child, a boy, is now a year old, and Laura is trying to become pregnant again.

Sher, whose Pacific Fertility Center has clinics throughout California, cites remarkable success rates for pregnancies attained through egg transfers.

More than half of his clinic’s donor-egg recipients are post-menopausal, Sher said, noting that menopause normally occurs between 40 and 55. But regardless of the age of the recipient, “assuming she has a healthy uterus and the donor is under age 35,” Sher said, the birth rate per attempted embryo transfer is 56%.

Hormone preparations enhance the “friendliness” of an older uterus, Sher said. A notable example is a 53-year-old patient of his from Central Europe, who is now in her second post-menopausal pregnancy.

Because egg donation is illegal in her country, that patient would not permit her name or the country she resides in to be used in this article. But in a telephone interview, she and her husband said they had tried for many years to have children by more conventional means. They said they ignored the reproachful relatives and friends who chastised that they would be in their 70s when their children entered college.

“Listen, we are very healthy. We don’t look the age we are. And you can die also at 35,” the woman said.

Her husband, 55, sloughed off concerns that he might not live to see his grandchildren: “Ah, but that could happen also if I had a child at 35.”

Age is relative, this couple insisted. In birthing classes to prepare for the arrival of their daughter 10 months ago, for example, it was the younger parents who were uncomfortable in their presence--not the other way around, they said.

“If the relationship with the child is good, age doesn’t matter anyhow,” the woman said. “I remember when I was a very young child, I thought anyone who was 20 was terribly old. At 40, I thought they were dead.”

Although Sher has not been confronted with patients in their 60s or 70s who are seeking to become pregnant, he believes strongly that physicians cannot arbitrarily draw an age line.

“We do not discriminate on the basis of age, marital status or sexual preference,” he said.

“What we are here to do is to responsibly enhance the human condition, using technology to enhance that condition. We’re here to help people have families.”

But even some of Sher’s own patients falter in the face of time. Laura, for one, has decided not to try for any more pregnancies after her 50th birthday. Still, she supports other women in her age group who might decide to push beyond that limit.

“I think people should mind their own business,” Laura said. “If people want to have a baby in their 50s, they’re going to raise that child. No one is asking them to do it. Just the fact that you want to have a baby at that age tells me you’re not an old 50.”

But 50 remains the magic number, the age when an unseen buzzer goes off and people get edgy about pregnancy. In many circles, a 49-year-old pregnant woman is a source of amazement, a miracle of human fecundity, while a 50-year-old in maternity clothes is more likely to be viewed as a grotesque curiosity.

“There is a psychological barrier at 50,” agreed Carole Lieber-Wilkins, a West Los Angeles psychotherapist who counsels couples undergoing fertility treatment. “But that used to be 40. Now it’s really common for 40-year-olds to be having their first children.”

Anne Adams, a New York journalist who until recently published a newsletter geared to older parents, predicted that as egg donation becomes more common, 50 will seem less significant.

“As science and people’s desires to procreate collide to push the age frontiers out, it seems to push what we regard as old parents further out on the timeline,” Adams said.

“I’m not saying people will ever stop scratching their heads at a 58-year-old woman who wants to experience pregnancy, and I still don’t think most people are going to opt to get pregnant at 60,” she said. “But I think the shock value will wear off.”

But Sher maintains that questioning the motives of a 50-year-old woman who wants to have a child is a reflection of outdated values.

“It just so happens that women lose their fertility over the age of 40 for reasons that applied when the life span was 50, not 70,” Sher said.

The 55-year cutoff age that he has imposed at his Los Angeles clinic is arbitrary, USC’s Sauer said. “It’s simply that my comfort level gets stretched beyond that, because I do have a problem with longevity issues.”

Sauer said 18 of the 29 women older than 50 whom he has worked with since 1990 have become pregnant. One 51-year-old had triplets, Sauer said; a 55-year-old patient gave birth to twins.

Yet the novelty element of this kind of parenthood is clear even to Sauer: “Every time we take on a 50-year-old, to me I still think of it as experimental.”

In the view of UC Irvine’s Asch, the uncharted nature of this technological territory is cause for concern. Asch has performed embryo transfers on women older than 50. He has also used the procedure to aid much younger women who wished to become pregnant but experienced premature ovarian failure.

“Technology so far is dictating” reproductive age limits, Asch said. “That is where we need to examine where we are going with all this.”

Scientific progress is one thing, Asch said. “But from there to say that there should be no limits at all to reproductive freedom is a mistake. I think we need guidelines. We need to agree to limits, as a society, and among the medical community.”

But for those contemplating such procedures, the limits may be more pragmatic. High-tech pregnancies are expensive and generally little if any of these costs are covered by insurance. Lynn Grossman-Getoff estimated the cost of conceiving Emily at about $12,000--high enough that she is not sure she can afford another such pregnancy.

Financial constraints have been a major concern for another of Sauer’s patients, who asked that her identity be disguised. “Fran Jones,” as this 44-year-old, unmarried attorney from Sacramento asked to be called, said her earlier attempts at pregnancy--using her own eggs and donor-inseminated sperm--cost her about $3,500 per attempt.

Since her projected success rate using that method was only about 5% to 10%, Jones said she turned to a younger sister for an ovum donation.

“You continue to read these stories about these 59-year-old ladies who’ve had twins, and you figure why not give it a shot,” she said.

Besides, she added, “I guess I’ve always wanted to be pregnant. I’ve always wanted to have my own baby. I would have preferred to do it the more traditional way, but it didn’t happen to me.”

Relationship after relationship failed to work out, Jones said. Before she knew it, she was 41 and worried that her childbearing years were winding down.

That description squares with stories psychotherapist Lieber-Wilkins said she has heard time and again in her counseling work.

“Part of the myth that really gets me is this idea that women have just kind of postponed pregnancy because of their careers,” Lieber-Wilkins said. “The truth is, most of the women in my practice have been going through infertility treatment for years.”

Many of these women have similar profiles as Jones--women who had never met “the right man” or a man willing to have children at the same time they were. So women of 40 and older who seek out high-tech reproductive options are probably not doing it as a lark, Lieber-Wilkins said.

“The very nature of high-tech reproduction doesn’t allow for frivolity,” she said. “It’s expensive, it’s time-consuming, it’s grueling on your body--and it’s hard on a relationship.”

Should the process succeed, the struggle to become pregnant may pale in the face of raising a child in a world that is not accustomed to vintage parents.

“They’re walking in the dark,” said Christi Taylor-Jones, the author of “Midlife Parenting” (Veracity Press). “There are no role models.”

Older parents may seek to dismiss the age issue, Taylor-Jones said, “but the reality is that they may not be alive when their kids have kids. They may be old and healthy--but they may also be ill and elderly, and their kids are going to have to take care of them, just at the point when they’re getting their own lives launched.”

As the editor of a short-lived magazine called “Over-30 Parenting,” Taylor-Jones, of Los Angeles, said she talked to many older mothers who reported intense feelings of isolation.

“They were a kind of island. Their friends their own age either had grown kids, teen-agers or no kids,” she said. And while “20-year-old mothers often defer to their own parents” for information, most older mothers and fathers felt uneasy soliciting guidance from their elderly parents.

Taylor-Jones also found that older parents often came face to face with complicated expectations that did not mesh with the reality of raising children at any age.

“They think because they are older that they really ought to be able to do this thing called parenting,” she said. “But parenting is sort of like an earthquake. No one is prepared for it.”

Earthquakes are touchy subjects in Southern California these days. But at Sauer’s office, near USC, temblors have earned a spot in the folklore of high-tech medicine. One of Sauer’s patients, Jones, the 44-year-old attorney, recalled that her first attempt at embryo transfer took place the morning of Jan. 17, only hours after the 6.6 Richter-scale quake that jolted Los Angeles.

As she left the hospital following the procedure, Jones said, Sauer gave her an affable smile.

“If this one works,” Sauer told her, “we’ll have to remember to shake all our eggs up in the future.”

Maybe a sense of humor goes with the turf in the sphere of assisted reproduction. In Central Europe, the 55-year-old first-time father has vowed that the first compound phrase he will teach his daughter is: “That is not my grandpapa. That is my papa.”