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Q&A: Motherhood at a late age

Fertility specialist, Dr. Jane Miller of North Hudson IVF Center for Fertility and Gynecology in Englewood Cliffs, N.J.,  discusses how she helped a 56-year-old woman conceive twins.
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In November 2004 Aleta St. James caused a global stir when, just a few days before turning 57, she became one of the oldest women ever to give birth to twins.

Some called the motivational speaker a "miracle mom." Others called her crazy. Medical experts began to call for age limits on childbirth.

Her advanced age heated up the debate of "how old is too old to have a child?"

Beyond the medical ethical hand-wringing, the question remains, how did she do it?

On Sunday "Dateline NBC" explored the journey from the start of her high-tech treatment through the first birthday of the twins, Gian and Francesca.

St. James became pregnant through in vitro fertilization and donor eggs. St. James' fertility specialist, Dr. Jane Miller of North Hudson IVF Center for Fertility and Gynecology, Englewood Cliffs, N.J., spoke with about the lengthy procedures that allowed St. James to conceive.

Q. How did you first meet Aleta St. James?

A. Aleta was referred to me by Dr. Jonathan Scher who asked if I would take her on. At the time she was 53. Dr. Scher said that she was in great physical and emotional health. I said, 'I’ll do my job but will you follow her afterwards? I don’t want to dump someone in your lap who is not fit to carry [a baby to term].' We help people conceive and follow them for the first trimester and then we send them back to the perionatalogist.

Aleta is a lovely, warm person who has taken great care of herself. She was convinced that she could get pregnant at her age. I appraised her of the fact that at her age it was unlikely that she had any eggs in her ovaries, despite the fact that she had periods. If she did have eggs they were undoubtedly not fit to produce a normal child. But she was convinced that she could do this on her own.

Q. What was involved in the process?

A. The first thing I had to do was form a relationship with her and have her realize that I had her best interest at heart. I wasn’t just going to satisfy a whim of hers. I wanted to give her facts and let her make the decision. I would let her do whatever she wanted as long as it wasn’t dangerous.

Her menstrual cycles were becoming irregular, so I started to talk to her about egg donation, because she sincerely wanted to have a family and she’s been waiting for this for a long time.

Upon examination I found that her uterus was enlarged because of fibroids, which are very common in women of all ages and especially in their late 30s and on. The uterine cavity was too large; it was distorted because of the fibroids.

At first she was adamant that she did not want surgery. So we charted her cycles and she finally realized that with the irregular cycles that things weren’t happening. She agreed to egg donation.

We went through the selection process of egg donor. It’s a whole emotional process, too.

Q. Is it difficult for older women to accept using donated eggs?

A. For most women egg donation is Plan B. It's rare that they come in for donor eggs. They want to use their own genetic material. But if that's not possible, donor eggs are Plan B.

Aleta stated that it was a donor egg. It makes people more accepting when they see pictures of perfectly normal beautiful kids.

In the past 10 years, there have been times celebrities have had babies and made it public that they have used their own eggs. But in the profession we know who has used donor eggs and who didn’t. But when they claim they used their own eggs, normal people think, 'If she could do it I could do it.'

After everyone of these people gets pregnant, I get a rash of phone calls from women in their 50s. I have to remind them it was donor eggs.

Q. Did she get pregnant right away?

A. Sperm was supplied by a friend of hers and we did the egg retrieval. She continued her hormonal treatment, but she did not get pregnant on the fresh embryo transfer. Fortunately, the donor was prolific and we had excellent embryos that we had frozen. But I implored her to let me make her uterus normal. Because of the fibroids, it was not a good cavity. She said she’d think about it. She didn’t contact me until seven or eight months later when she agreed to surgery.

After surgery, we prepared the uterine lining as previously and did the frozen egg transfer. Then she took five days of progesterone before transfer and two weeks later she's pregnant.

Then two weeks later, I saw two gestational sacs. Normally with embryo transfer, we like to transfer two fresh because we figure that each blastocyst transfer has about a 25 percent chance of it making a baby all the way to take home. We're weighing the odds between no pregnancy and 50/50. On frozen eggs, even though they go into the freezer with great quality, they’re slightly less efficient than fresh. So we transfer three frozen blastocysts. She ended up with twins. Since she was using donor eggs from a young donor, there was a decent chance these were going to go the distance.

Q. Were there any special concerns because she was having twins?

A. I called Dr. Scher and said, 'You’re going to kill me. She’s got twins.' He said, 'No problem.' We followed her for the first trimester, we watched for all the things that could happen. I watched her blood pressure, blood glucose and for premature dilation of the cervix.

She had the usual complaints of anybody who was pregnant. It was absolutely no different from any pregnancy.

Q. Given some medical qualms about older women getting pregnant, why did you take her as a patient?

A. I would rather have someone of her health be pregnant at her age than someone in their late 20s, early 30s who is morbidly obese with high blood pressure and diabetes.

I was willing to help her because she had medical clearance. I don’t believe I have the right to make judgments whether someone can have a child or not. I can refuse treatment and I have, usually on medical grounds. I don’t like to refuse treatment on moral grounds.

If I have to, I always try to find a medical reason. I don’t believe it’s my right to say, 'I don’t like your social situation or your occupation or you’re a nasty person.'

She was a woman with a head on her shoulders who understood what being an older mother would entail. We had long conversations. This was something she sincerely wanted. Did I have qualms about it? No, I did not.

Q. Have you gotten more calls from women in their 50s looking to have babies because of all of the attention around her?

A. Yes. I have had women come in who aren’t in a relationship, who have never had sex, in their 50s, but always had the fantasy of having a child.

A few actually want to go the distance. What many don’t understand is that this is a serious medical treatment. When I explain to them what is required — medical screening and clearance, X-rays of the uterus and sometimes they need surgery to remove fibroids and take injectable medications — they shy away from it.

Q. What about the ethical concerns over her age?

A. What about older men? When they father a child, they say ‘Atta boy.’ She had a good social network around her. On the one hand, it’s tough. I can’t make the decision that because someone doesn’t have a large family, I can’t treat them. Usually when I choose not to treat someone there’s a real, clear medical complication. That was very important.

Everybody’s situation is unique. I have people in their late 20s, early 30s come to me and I want to say, 'why don’t you get a puppy?' They are in no position to have a child. When you ask them, they say, “Well, everybody else is.” These are people who are not in good physical shape, they’re not stable emotionally.

Everyone asks, is it natural? If nature intended us to have children at the right time, we’d all be giving birth in our late teens, early 20s.

But society and the way our lives go, that’s not feasible. Is it natural to have kids when we should? It doesn’t work that way.