Wednesday, August 12, 2009

AMA: Advanced Maternal Age or just Appearing More Advanced?

Upon returning from a quick visit with A. and our fabulous 15 week 5 day baby, we were presented with the option for an amnio. Not that there have been any indicators for problems, but if you want to do one, now is the time. Now, hmmm, wasn't there a very good reason I used a 26 year old egg donor and a 31 year old surrogate? Oh yeah, to precisely LOWER such risk factors as downs syndrome and miscarriages and endless testing. So if I was 26 years old right now and knocked up, would this same doctor be telling me all these risks and making me decide if I would terminate or risk losing a healthy pregnancy with an amnio? Probably not. He would say you are at low risk at 26 years old and would probably imply that there wasn't a pressing need for an amnio unless there is family history. He'd then proceed to scoot me out the door.

But I am not 26 years old. I am a 38 year old who got another woman pregnant with another woman's egg. So does this change anything? Not really. But does this pregnancy somehow appear more risky because I appear to be at advanced maternal age even though I had nothing to do with this pregnancy? Shouldn't I be getting that same scoot out the door with relief that I am young and low risk? Instead I am feeling like a woman who has to decide between two risks - a down syndrome baby or a miscarriage of a healthy pregnancy from an amnio. I thought my options between horrible and extra horrible were finally over now that I was pregnant. So why do I feel pressure to do an amnio? Is it the worst case scenario in me always believing that I will be the one that always falls in that 1% chance? Way to set a person into unnecessary panic.

So this is making me feel rather advanced in maternal age even though my pregnancy is not. I mean really, at this junction what really matters about my age? I'm completely cut out of the reproductive part of this story so isn't my age meaningless? At worst people could call me an "old" mother. But sticks and stones, a-holes, sticks and stones. By my own body clock, yes, I am 38 years old. I will be 48 when this child is 10 years old and at the starting line of adolescent frenzy. I will be 58 when the child is 20 years old and finishing up college. I will be 68 when the child is 30 years old and I start badgering him or her to get married so I can see some grand kids before I croak. I will be 78 when the child is 40 years old, and God help us all, hopefully their sperm or eggs haven't shriveled up like mine had by then.

After 3 years of IVF, ectopics, miscarriages, am I prepared to raise a donor egg child that might have downs syndrome? Nope. But am I equally prepared to lose a healthy pregnancy that we've spend thousands of dollars on and went through emotional chaos about because I was given an option for an amnio? Nope. So I am left to soul search through this trying to believe that I'm not going to get screwed over again and again and again. I should be at low risk as a 26 year old, but I am so used to being at high risk for everything. Don't I at least deserve to reap the benefits of my egg donor after giving up so much of myself and my sanity to have this child?


Infertile In the City said...

Big choices. Not ones I would like to think about too much (can't they do the less advanced tests - no amnio?). Uggh.
It is nice that the doctor is treating you like the person you are (the mom)!
As always, excited for you!

Pam said...

One reason that doctors tell those of us of advanced maternal age to use donor eggs is that our chances of success take on the odds of the age of the donor. Whereas my chances of success with my 48 yr old eggs are practically nil, our 24 yr old donor has a much higher chance of success. At the same time, her eggs also of a much lower chance of producing a child with a birth defect, unlike my much greater chance. Given that, it sounds like the OB treating your surrogate (whose age has no bearing in this particular decision) really doesn't understand ART and how the odds work.

Sorry you've been placed in this position. But thrilled you're at 15w6d. Good luck.

FET Accompli said...

Maybe you could start out with the less invasive tests - our doctors were able to tell us with "close to certainty" that our babes did not have down syndrome, and we did not do an amnio.

Dora said...

I'm shocked that you're being pressured to do an amnio. I'm 46 and carrying a child conceived with a 23 year old's egg. Amnio was NEVER on the table. The risk of the amnio is coniderably higher than the risk of anything being wrong with my daughter. My OB asked if I wanted a nuchal scan. I had the nuchal and bloodwork at 12 weeks and further bloodwork at 16 weeks. All the results were terrific. No need whatsoever for the big, scary amnio needle.

AMA, my ass! Sounds like that dr is not at all well informed.

Shinejil said...

What about doing the level II ultrasound and quad screen, if it would help you feel less concerned? Neither has the risks of amnio or CVS, and together you'd be less likely to get a disturbing false positive.

The chance of Downs in a 26 yo is way lower than the chance of m/c from an amnio, from what I've read.

We personally skipped the tests, though I'm 34 (in part because insurance refused to cover anything). I thought the anxiety these tests often provoke would be worse for me than chancing having a special needs kid. But we're in different boats here, so I understand your worries and confusion about what's the best option.

Whatever you choose, I hope you find reassurance, continued support from your care provider, and lots of things to be excited about in the coming weeks.

Sue said...

Amnio wasn't even suggested for me with my DE pregnancy. We just did the level 2 ultrasound and the quad screen, with all risks calculated based on the age of our 21 year old donor. Would you be asking for amnio if it hadn't been offered? Good luck with your decision. Whatever you do will be the right choice for you.

Me said...

I wish I had even one single shred of advice. But I don't. Just wishes that you find the answer that's right for you and then don't look back.

From Here To Maternity said...

I was 36 when I got pregnant with my own eggs (IVF). The geneticist said he wouldn't recommend amino based soley on my age. I did the AFP and the nuchal scan and used the results from those two tests to decide against the amnio. I doubt this helps but thought I would share my experience. Sorry this is another source of stress. All the best to you.

luna said...

you probably already decided what to do by now, so I just wanted to lend my support for whatever your decision.

K asked if we wanted her to do an amnio when she was just 20yo, and we all thought the risk of m/c and stress to her were far worse than the chances of a problem being detected. and of course, then what? I realize adoption is different, but you get where I'm going, right?

anyway, be at peace with whatever you decide.