Pregnancies in perimenopause and beyond

Changes in modem society have made it more common and acceptable for older women to bear children. Scientifi c advances and the advent of ovum donation have made pregnancies in older women feasible. The impact of advanced maternal age on the outcome of pregnancy remains controversial. When considering the contradictory physiological processes in pregnancy versus aging, it appears that pregnancy in the elderly menopausal woman could constitute a major maternal health risk. On the other hand, with appropriate antepartum and intrapartum surveillance, a successful pregnancy outcome can be expected in most cases. Patients should undergo medical and psychological evaluation before participation in an oocyte donation program in order to exclude those who will not be able to cope with the pregnancy physically or psychologically. The success of oocyte donation is not limited by age. Any woman with an intact uterus is a potential candidate. This raises the question of whether certain limits should be imposed in applying the method in older women. Any possible restrictions should be based on solid medical, psychological, and ethical grounds. Reproduction is a fundamental right in a free society. Denying oocyte donation to a population of women who must rely on it to procreate essentially negates freedom and harms women's reproductive choices. In order to clarify these issues, it is essential that lucent guidelines are established so that pregnancy can be achieved with minimal harm to mother and child. Nevertheless, taking into consideration the mother and child's welfare, it is our belief that an age limit should, after all, be applied. The precise determination of this age limit should be set locally, taking into consideration social and medical factors such as culture, religion, life expectancy, quality of medical care, and antenatal management. The new Israeli legislation draws the line at age 54.