Connie Chung's decision, at 44, to "take a very aggressiveapproach to having a baby" has fertility experts nodding inconsensus. "Aggressive," they agree, is what a woman her age hadbetter be if she wants to get pregnant.
The CBS television personality's public pronouncement about herprivate life, including her plan to cut way back on her workload aspart of the get-pregnant plan, reflects the "Oh my God, I forgot tohave children" panic of many career women today.
Age, as Chung herself admitted, is not on her side. Oldermothers have more infertility problems and miscarriages, and theirbabies are at risk for genetic abnormalities.
"You have to try harder at that age," agrees Dr. NorbertGleicher, chairman of obstetrics and gynecology at Mount SinaiMedical Center.
"Fertility potential is greatly reduced at that age. It takesthe average couple in their 20s four months to conceive. It willtake a woman in her 40s much longer and often never."
"Aggressive would be the approach of any woman past 40. Gettingpregnant can be a problem and often is," said Dr. Aaron Lifchez,associate director of the Fertility and Reproductive Endocrinologyclinic at Illinois Masonic Hospital.
Fertility in women peaks in the mid-20s, is followed by aprogressive decline, then nosedives about age 40.
Statistics aside, women over 35 comprise the most rapidlygrowing subgroup of first-time mothers as women marry later and delaychildbearing to establish careers.
Between 1986 and 1987, the rate of first births for women 35 to39 increased 8 percent, the largest reported for women in that groupsince 1943, according to the National Center for Health Statistics.
The rate of women 40 to 44 increased by 1 percent in the sametime period, but leaped more than 9 percent in 1988 - up 20 percentover 1985.
The numbers are still small. Nationwide in 1987, 5,658 firstbabies were born to women ages 40 to 44, and just 139 to women 45 to49. Many of those births were the result of medical advances. Womenwho earlier had no hope of having a baby finally were able to throughscience.
"If it hadn't been for the technology of the past couple ofyears, it never would have happened for me," said Carolyn Unger, whohad her first baby, through in vitro fertilization, at age 41 this year. She expects the number ofwomen like her to grow until "no longer will we be looked on as`older mothers.' "
The medical profession traditionally has branded fortysomethingmothers with such pejorative classifications as "post-mature,""pre-menopausal," "geriatric" - even "dangerous" - according to Dr. Donna S. Kirz, a Chicagoobstetrician who conducted a three-year study of older mothers. Herstudy found that when older mothers receive good care, "the risks tohealthy women 35 years and older may be no more than the risks toyounger" patients.
"When I was in training, we were warned not to treat women afterthe age of 35," said Lifchez, who has been in private practice for 17years. "Nowadays we see many (pregnant) women in their late 30s. Idon't think we're as concerned now about the risk to the baby or therisk to the mother in terms of being pregnant. Once pregnancyoccurs, the odds are overwhelmingly in favor of having a healthybaby. The struggle is getting pregnant."
Some conception problems can be solved by planning - simplytiming intercourse with ovulation.
And while many women at age 44 cannot conceive on their own,various fertility drugs, procedures and surgery can help make ithappen. Ninety-five percent of all infertility is hormonal - thewoman doesn't ovulate.
"If the problem is ovulation, in general, we can take care ofthat, but at age 44 or 45, a woman is already in or close tomenopause and the ovaries just won't put out," said Gleicher, who iseditor of the Journal of In-Vitro Fertilization and Embryo Transfer.
"Even once you conceive, the problems are not over yet, becauseolder women have a significantly higher miscarriage rate," cautionedGleicher. He said the numbers are difficult to establish becausesome miscarriages occur before women even know they are pregnant.
"However, from the in-vitro fertilization experience, we knowthat the miscarriage rate in women over 40 is at least 50 percent,"compared to 15 percent over age 30, he said. He termed it "verylikely" that miscarriage rates are the same for in-vitrofertilization and normal fertilization.
Other risks are associated with motherhood over 40. Chances ofhaving a baby with a chromosome abnormality increase steadily afterage 35 and rapidly after age 40.
"Those statistics are why we now recommend genetic evaluationfor mothers 35 years of age and older at the time of the birth,"Gleicher said. "Somebody who is 44 has a clearly significant risk ofa chromosomal abnormality."
"No woman is without a risk, no matter what her age," saidMelissa Caffarelli, a genetic counselor at the Reproductive GeneticsInstitute at Illinois Masonic Hospital. "The point at which we getreferrals for prenatal diagnosis is age 35, because at that point therisk of having a child with a chromosome abnormality is greater thanthe risk of the procedure."
Kirz, who practices at Rush-Presbyterian-St. Luke's MedicalCenter, calls older, first-time mothers "a particularly fun group."
"These tend to be highly desired pregnancies," she said. "Thepatients pay attention to their nutrition and health care duringpregnancy and experience the true joy of the childbirth."
Her 1985 study, published in the American Journal of Obstetricsand Gynecology, compared mothers-to-be ages 35 to 40 with pregnantwomen ages 20 to 25.
When she looked specifically at the healthy women from the oldergroup, and there were no genetic problems with the fetus, "it turnedout that there were very few problems with maternal age alone," shesaid. "Most of these pregnancies do very well."
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