According to an article published in the Nov. 4, 2005 issue of the New England Journal of Medicine, the past decade has seen a remarkable shift in the demographics of childbearing in the United States. The number of first births per 1,000 women 35 to 39 years of age increased by 36 percent between 1991 and 2001, and the rate among women 40 to 44 years of age increased by a remarkable 70 percent. Additionally, in 2002, 263 births were reported in women between 50 and 54 years of age.

Most media attention paid to older moms has been favorable, inspiring a female business-school student who declared on a nationally televised segment of CBS's "60 Minutes" (entitled "The Biological Clock"), "I plan to be super fit, super in shape when I'm 40, 50. And if I'm physically able to do it, then I will have a child at 55."

Yet, how old is too old, and how realistic is it for a young woman today to expect to delay her childbearing into the later decades of her life?

You Can Be Healthy, But Fertility Still Decreases
Women tend to think that if they go to the gym, eat healthy, take vitamins and really take care of themselves properly, then they should be able to have a baby. Women need to separate general health and reproductive health and be aware that fertility DOES decrease with age no matter how well you take care of yourself.

Yes we do have the technology to help older women achieve pregnancy, yet there are much higher risks associated with advanced maternal age.

The effect of maternal age on the outcome of pregnancy is best assessed by examining the source of the risks: those associated with using older eggs and those from having an older "carrier." Egg issues result in declining fertility, miscarriage and babies with chromosomal abnormalities such as Down's syndrome. Carrier issues include gestational diabetes, hypertensive complications and stillbirth.

So what about the notion of delaying childbirth until a maternal age of 45, 50 or older?

Is a "Cutoff Age" Discrimination?
In my program there is currently no cut-off age for a woman requesting assisted reproductive procedures to get pregnant. Many programs do use a cutoff age which is usually arbitrarily determined by the doctor. I feel that this is age discrimination since there are no studies that indicate that there is a specific age beyond which pregnancy should not be attempted.

If a program has a cutoff age of 45, can the doctor tell the 46 year old that her risks are appreciable different from the 45 year old? They can't.

Patients and their partners should be informed about the potential risks and allowed to make their own decisions about treatment just like they do in all other areas of medicine.