Chronically ill over 40 and trying to conceive. Is it more than we can handle?
January 14, 2012 12:31 PM   Subscribe

Help my partner and I feel less anxious about combining pregnancy with chronic illness after 40 - or should we not even bother?

My partner just turned 40 and we decided it's time to make a last-ditch effort for a baby. We talked it over, and we think we'd be good parents; we have a stable home, good income, are both intelligent, both jobs offer time off/leave for the mom and dad, have family members in our home city and nearby to help out, and enjoy children/babies.

The issue is her health. She has avoided pregnancy until now because she's on a host of meds for chronic illnesses, inclucing:

Asthma inhaler (can't remember which kind - blue one?)
Prilosec for GERD - hers is bad, she's been hospitalized for it before

Partner says that she also has polycystic ovarian something that keeps her from ovulating naturally. PCOS? PCDD? not sure - but got off BC once and had no period for many months because of cysts. She says she cannot get off b/c pills until menopause because of fibroids/cysts.

Anyway shes totally fine getting off meds and trying for a baby and her dr. says she only needs to stop the Vyvanse and Aldactone and switch over to something like Tagament/antacids for the GERD and she should be fine.

But we're both worried that age plays a big factor in baby/mom's health too. We agreed that we would try to get pregnant for a few months and if it didn't take we'd give up. We don't feel strongly enough about children to do in vitro, surrogacy, fertility treatments, or anything like that but might consider adopting or fostering in the future. We are happy with our lives as-is and a child would just be a bonus, but she's terrified of being in chronic pain, miscarrying, birth defects, etc. and thinks its probably "too late" for us.

If you have gotten pregnant later in life (over 40?) and had chronic health issues, did you try to drop your meds cold turkey before getting pregnant? Her dr. says the health benefits of keeping the more critical meds in her system outweighs the risks. Me? I'm reading stuff and seeing possible side effects like cleft palate, stillbirth, etc. on the web but I know MeFites are smarter than Dr. Google :)

After discussing these issues we want to ask for a series of tests and scans if she does conceive that will help reassure us during the pregnancy. What should we ask for, and when?

Thanks for any info you're willing to share. I know its personal so if people want to respond privately throwaway email is fortysomethingbaby at gmail.
posted by Melusinewave to Health & Fitness (18 answers total) 1 user marked this as a favorite
It sounds very much like you're both approaching this as an ought-to-do rather than a want-to-do. I hear no passion for parenthood or urgent desire to experience pregnancy and birth in the tone of this question.

For that reason alone, I say don't do it. Age and health problems are secondary.

Her dr. says the health benefits of keeping the more critical meds in her system outweighs the risks.

This is absolutely true. Optimal maternal health is required for optimal fetal health and well-being. For example, stopping your partner's asthma meds and making her chronically mildly hypoxic can result in a fetus with intrauterine growth restriction.
posted by jesourie at 12:49 PM on January 14, 2012 [1 favorite]

First, you should know that it often takes even young, fertile couples with no problems a year of "trying." "A few months" is a very short window, especially if you may have problems conceiving.

"After discussing these issues we want to ask for a series of tests and scans if she does conceive that will help reassure us during the pregnancy. What should we ask for, and when?"

The most important question you should ask is of yourselves, before you get any prenatal scans or tests: If this test shows our child has a survivable birth defect or chromosomal problem or whatever, are we going to keep the pregnancy and raise a disabled child, or are we going to abort? It's possible one of your "reassurance" tests may not be reassuring, and our ob/gyn counseled us that the worst possible scenario was when a couple got the tests to be reassured everything was normal, and then it wasn't, and they hadn't discussed the possibility of what if it wasn't. It's a lot easier to deal with the emotions and cope as a team if you already feel pretty sure what your decision would be. (Of course you may change your minds in the moment, but at least you're starting from a place of having had the conversation.)

Are you seeing a perinatologist, who specializes in higher-risk pregnancies? A lot of these conversations out to be had with him. Most of my friends who conceived over 40 saw a perinatologist.

There are also fertility interventions short of "fertility treatments" -- like Clomid, a fairly inexpensive pill which stimulates egg production & release, and something I can't remember the name of that lengthens your luteal phase. There's a lot of steps between "try it naturally" and "giant needles."

Finally, over 40, you may find you are "too old" to adopt if you wish to pursue an infant adoption; U.S. parents giving their child up for adoption typically have many families to choose from, and some overseas countries are putting in hard age-limits. You would almost certainly be looking at fostering-to-adopt, which can be a heartbreaking undertaking.

If you're serious about having children, you need to have a more serious discussion than "let's have unprotected sex for three months and see what happens; if it doesn't work we can think about adoption, maybe, we'll see."

"Her dr. says the health benefits of keeping the more critical meds in her system outweighs the risks. Me? I'm reading stuff and seeing possible side effects like cleft palate"

Generally, yes. I had to take a drug while pregnant that had, like, a 1/1000 chance (or something like that) of webbed toes. I freaked out for a while, but then I realized I had like a 1 in 2 chance of becoming really ill off the medication, which would be really bad for the fetus full-stop, and a 1 in 1000 chance is a) small and b) webbed toes aren't that big a deal and can be fixed. And even if they can't be fixed, so what? Cleft palate is a bigger deal, but can be fixed. Look at the risk to your wife, compare to the risk to the baby, and consider how fixable the risks to the baby may be.

But I think you really need to have a serious conversation with your wife and with a doctor specializing in higher-risk pregnancies about what your odds are of getting pregnant, what interventions you're willing to pursue ("none" is an okay answer; "some ultrasounds, a sperm motility test, and clomid" is an okay answer; etc.), and how badly you actually do want a child. Your current plan does not seem oriented to success but I'm not sure you understand that it's not easy to get a child through adoption either.
posted by Eyebrows McGee at 1:03 PM on January 14, 2012 [12 favorites]

An adopted child (me) says, unless blood means everything to you (and no judgment from me if it does), adopt. It sounds like, for the health of all involved, your route to parenthood might be best navigated circumventing pregnancy and gestation. Best wishes.
posted by emhutchinson at 1:15 PM on January 14, 2012 [9 favorites]

+1 to what Eyebrows McGee said, except that the physician you want to see is a reproductive endocrinologist (a fertility specialist), not a perinatologist. The perinatologist is for after you're pregnant. A reproductive endocrinologist deals with people who are trying to get pregnant, and specifically treats patients with polycystic ovarian syndrome. And if you've got both advanced maternal age and PCOS, you'll want to get to an RE first thing if you want your few months of trying to be your best shot. They would probably consider starting more medications to help with ovulation, such as Clomid and metformin (a diabetes medication that is also a treatment for PCOS).

IAAD/IANYD, but I would go with what your physician says on the medications. It is important to keep medical conditions under control, and there is no reason to stop the medications before you get a positive pregnancy test, especially considering how low your odds are of conception. I can't find the eMedicine article I usually quote from, but here is one website on odds of conception after 40:
"The fertility rate per month is only about 5% and even with in Vitro Fertilization (IVF), the most successful infertility treatment available, the pregnancy rate is only about 10% per try. This is due to the greatly reduced number of normal eggs remaining in the ovaries of a woman over forty."
(compared to a fertility rate per month of 20% in normal couples, and this is without considering the PCOS as a factor!)
posted by treehorn+bunny at 1:22 PM on January 14, 2012 [4 favorites]

Best answer: You know, I think you're putting the cart before the horse here. I would suggest your partner's first port of call should be to her OB/GYN for a baseline fertility workup. It is possible you are stressing yourselves out about a decision that has already been made for you.

This is information you should have regardless of the adoption question, which is a long and complex process with many ethical issues, variables and a tremendous number of forks in the road.
posted by DarlingBri at 1:27 PM on January 14, 2012 [7 favorites]

Seconding DarlingBri: as someone who's dealt with some serious GYN issues in the past few years, you need to know if pregnancy is possible with the fibroids and the PCOS. Location, severity, type, history of the conditions--all are factors. And she might learn something you're not anticipating. For example, a treatment such as removal of a fibroid might improve chances at pregnancy.
posted by ImproviseOrDie at 1:36 PM on January 14, 2012 [4 favorites]

It's very important to continue the Synthroid throughout. Not only is Synthroid harmless in pregnancy when given in the needed dose, not taking it, when it is needed, can cause miscarriage or other problems. The dosage required increases during pregnancy.
posted by Ery at 2:40 PM on January 14, 2012

The crazy thing is that when it comes to pregnancy, you just never know whether it'll be easy or not. I got easily pregnant at 35 and delivered a healthy baby. My close pal got easily pregnant at age 42 and delivered a healthy baby. My other close pal got pregnant at 32 and almost died due to a life-threatening pregnancy emergency; her baby did die. I hate to be so dismissive of your very real fears & issues but the truth is you just won't know whether or not your partner can/will get pregnant until you try.
posted by BlahLaLa at 2:45 PM on January 14, 2012

GERD will be a nightmare...Tagamet/Tums just won't do it. Even non-reflux-y people get reflux during pregnancy.

Going without ADHD meds could have a significant affect on her work performance.
posted by the young rope-rider at 3:10 PM on January 14, 2012

Definitely go see a reproductive endocrinologist. Many women get pregnant at 40 and do very well. S/he will also be able to help your partner with the other endocrine issues she faces in terms of Synthroid dosage (sometimes needs to be adjusted for pregnancy, but is really not a drug, just a replacement hormone) and also will be able to help with the PCOS issues. In any case, you'll know a lot more about what your actual fertility situation is once you meet with a good doctor.
posted by judith at 4:00 PM on January 14, 2012

Response by poster: You guys have given us a lot to think about - we chatted earlier after reading this and I'll be going with her for a dr. appt. at the beginning of February to ask about the baseline fertility test and go over our concerns with the ob/gyn. She has an endocrinologist who might be able to answer other q's or recommend another specialist as well, so thanks all.
posted by Melusinewave at 8:32 PM on January 14, 2012

Be aware that you can't ever test for all possible birth defects. If you feel that you can't handle a child with health or developmental problems, that is a huge red flag.
posted by metahawk at 8:35 PM on January 14, 2012

Response by poster: We have discussed the consequences of seeing test results that might make for difficult decisions down the line as well - we are on the same page there, and are grateful for all the input.

She says thanks for helping her realize that there's a much broader range of options than we had previouslly thought re: fertility/getting a second opinion, and for getting me on board with the dr visits.
posted by Melusinewave at 8:44 PM on January 14, 2012

I'm 40, have type 1 diabetes and Hashimoto's thyroiditis, and am pregnant.

I take (generic) Synthroid and wear an insulin pump. I see my endocrinologist every 2 weeks, and my perinatologist every 4 weeks. I get a full thyroid panel (simple blood draw) every 4 weeks so my endo can adjust my Synthroid dose -- it has to increase during pregnancy, and it's crucial that the dose be right. (too low a dose increases the odds of miscarriage.). My insulin needs change constantly, and I'm in charge of altering my doses, though I talk to both the endo and the perinatologist. THAT is freaking annoying, but really that's all -- annoying, and attention-consuming.

Two benefits of chronic illness and my pregnancy:
1) no one gives me shit for being 40. No one cares; it pales in comparison.
2). I get an ultrasound every time I turn around. No kidding; I get a level 2 ultrasound EVERY MONTH. Most women get, like, two ultrasounds, only one of which is likely to be level 2 (more detailed). That is incredibly reassuring, especially early on when I couldn't feel the sprout move yet. My non-chronic-illness mom friends are all totally jealous!

All that said, everyone above is right that she absolutely needs a fertility work up, and to talk to someone about the PCOS and fibroids. Odds are she will need SOME kind of medical assistance to get pregnant at all, but that may be well short of ivf. Clomid IUI cycles are only a couple hundred bucks, and not particularly invasive.
posted by kestrel251 at 8:46 PM on January 14, 2012 [1 favorite]

A regular OB/GYN is simply not well-versed enough in the type of fertility issues your wife has. She really does need to see a reproductive endocrinologist (not just a regular endocrinologist). She should start attending some RESOLVE meetings in your local area to learn more about the local RE's, and to figure out what questions to ask when she goes to the appointment.

A good RE will state what they think they should do to give you the best chance of getting pregnant on the first (assisted) try. If the conversation goes something like "Well, you could try Clomid, or you could try IUI, or you could try..." and it basically sounds like they are leaving the decision up to you, move along and don't work with that doctor. A dr. that takes that route will waste your time and also your money.

However you decide to proceed, best of luck to you both.
posted by vignettist at 11:31 PM on January 14, 2012

IANAD, but this line struck me:

We don't feel strongly enough about children to do in vitro, surrogacy, fertility treatments, or anything like that but might consider adopting or fostering in the future.

As a woman with PCOS, the chances are relatively high (especially given her age) that she will have to do fertility treatments of some kind. If she's genuinely not passionate enough about biological children to want to go that route (and I'm not judging!), then I would urge you to more strongly consider adoption.

But of course she should see a doctor first to have a workup done and discuss the state of her health as it relates to pregnancy.
posted by asciident at 8:06 AM on January 15, 2012

Seconding what vignettist says above: a regular OB/GYN and/or endocrinologist will not be able to give you the information you need. The concerns you raise are best addressed by a reproductive endocrinologist, who specializes in these issues. You want someone who sees a lot of 40 year old women trying to conceive, not someone for whom this situation is an outlier.
posted by judith at 9:52 AM on January 15, 2012

I'm surprised that people are jumping so quickly on suggestions to go to a RE. It's what I would suggest if I thought you really, really wanted to have a biological child but frankly it sounds like you're on the fence which means you should strongly consider not having a child.

My first step at this point would be to consider whether or not you can be happy volunteering with children, enjoying the children of friends, or simply continuing to live your currently happy and stable life.

However, I am somewhat in the minority as I do not see having children as the default--I think one should have really, seriously compelling reasons to have a child before bringing a new person into the world, possibly to suffer.

Best of luck to you both.
posted by the young rope-rider at 10:39 AM on January 15, 2012 [2 favorites]

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