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Highlights from PCRS 2015: Psychological Impacts of Later Parenting

Each year, a team of physicians and staff from Pacific Fertility Center attend the Pacific Coast Reproductive Society (PCRS) annual meeting in Palm Springs, CA. PCRS is a professional meeting and provides an educational forum for reproductive specialists, embryologists, nurses, scientists, and many others who work in infertility field.

The topic of Dr. Domar’s talk was “Counseling Couples Over 40 Years of Age.” The talk covered many psychological aspects of fertility treatment and parenting at an older age, especially for patients using donor eggs. She started by presenting data about how people in 2015 feel about being in their 40s and 50s: Most of us feel younger than our chronological age, especially as we compare ourselves with our parents’ generation.

We are, in fact, healthier and likely to live longer, but of course, the optimal age for reproduction has not changed. However, because they feel younger, older patients may have an unrealistic view of their own fertility and may overestimate their chances of successful conception with their own eggs. Furthermore, media reports of celebrities having children (often twins) in their 40s and even 50s—with no mention of the fact that these are often donor egg-derived children—lulls the public into thinking conception at an older age is possible, especially with modern fertility treatments.

But, in fact, births to women over 40 are increasing rapidly. Between 1996 and 2008 in the U.S., there has been a:

• 47 percent increase in births to women aged 40-44
• 133 percent increase in women aged 45-49
• 276 percent increase in women aged 50-54

During pregnancy, the research shows that the general psychological well-being of women over 40 is good, and there appears to be no higher rates of immediate postpartum depression in older moms.

Looking at families a little further down the road, Dr. Domar presented data on a study that evaluated 642 successful ART patients and their children, aged 4-11. There did not appear to be any negative impact on the children of moms who were older at the time of conception. In this study, however, couples in the older age group were less likely to show warmth towards each other and the older mothers were somewhat more likely to report depressive symptoms.

According to Dr. Domar, many studies have shown that older parents as a whole tend to provide more financial stability for their children. Plus older parents tend to be more wise and patient, and show great devotion and attention to their children as compared to perceptions from children of younger parents.

The overriding negative issue, however, is the lifespan of the parents and their ability to take care of themselves at an older age. Children of older parents report a fear of parental illness and death. A child born when his or her mother is 50 will likely be only 32 years old when his or her mother dies or becomes incapacitated. Many of us in the field share concerns with mental health professionals that these children may be at risk for becoming caretakers to their parents at a relatively young age.

These children are also very aware of the generation gap (or gaps!) between themselves and their parents. These children express an awareness of the difference between themselves and most of their peers with younger parents. Having older parents, some children themselves also felt old for their years. Some also expressed a sense of loss about never knowing their grandparents or having very frail and elderly grandparents.

Dr. Domar also discussed an interesting study that involved 20 women who achieved a first pregnancy at an average age of 45 and were then interviewed at age 60. The children of these moms were also interviewed. There were several themes that emerged from these interviews.

One theme expressed by the mothers concerned the physical limitations of late middle age, such as fatigue and slow recovery from illnesses. Some expressed envy of younger mothers, as well as a sense of being different from their peers, who were now often grandparents. Some expressed regret that they were unlikely to experience being grandparents themselves. There was also the awkwardness around strangers who weren’t sure whether or not they were the parents or grandparents of their children. However, these mothers also expressed that they were very close to their children and that motherhood had become the essence of their being.

Alarmingly, the children in this study were reported to express a preoccupation with death in general and the possibility of losing their mother early. Overall, the authors felt that older motherhood impacted negatively on their children.

Dr. Domar raised the concern that these issues may impact families not only created by donor egg treatment, but now the large number of women undergoing egg freezing to have children later in life. We at PFC share these concerns, which is why we do have age limits on women we will help to conceive. And we will continue to encourage marriage and family therapy counseling for those patients seeking parenthood at an older age.

- Carolyn Givens, M.D.
PFC Physician

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