Rielle Hunter Beat the Odds

We know that former presidential candidate John Edwards may announce that he fathered Rielle Hunter’s baby [2]. But how did she become pregnant in the first place? No, not the obvious—“Oops! I forgot the birth control!” How did Hunter beat the extraordinary odds, given her age, to conceive the child naturally?

Hunter was a few weeks shy of her 44th birthday when she gave birth to Frances Quinn some 19 months ago, meaning she conceived her first child a few months after she turned 43. Estimates of a woman’s natural fertility at this age vary, but the statistic most often circulated is that a 43-year-old woman has a 1 to 3 percent chance of becoming pregnant through sexual intercourse during a given month. That’s compared with a 20 percent chance for a healthy 30-year-old woman and 5 percent for a 40-year-old per menstrual cycle, according to the American Society for Reproductive Medicine, the professional organization of infertility doctors. Surprisingly, numbers are hard to come by for women older than 40, so fertility doctors generally make their best guess. Although some doctors believe that a woman who already has given birth to many children would have an easier time getting pregnant in her 40s, others say that's up for debate. The comparison selects for the mother of many, who already has demonstrated her fertility, while a new mom in her forties might be trying to get pregnant for the first time.

As a woman ages, her egg supply diminishes, and the eggs that are leftover have an increased risk of chromosomal abnormalities. Female fertility starts declining in the mid- to late-30s and accelerates dramatically after age 40, when 60 percent of women are infertile. By age 43, 96 percent cannot conceive naturally, says Dr. Sherman Silber, an infertility specialist at St. Luke’s Hospital in St. Louis and author of How to Get Pregnant [3]. It’s not clear how long Hunter and Edwards’ dalliance lasted, but even if they managed frequent hookups during his frenetic campaign schedule and during the few days a month when she had ovulated and was most fertile, the likelihood of her becoming pregnant was still remote.

The chances of Hunter bringing a baby to term are even worse, since some third to a half of 43-year-old mothers miscarry. That’s because at least half of embryos created with a typical 43-year-old’s eggs are abnormal and either lack a required chromosome or contain an extra one. If the mother doesn’t lose the pregnancy, her chance of giving birth to an infant with Down syndrome is one in 49. Pregnancy for older women is no picnic, either. She faces a higher risk of hypertension, diabetes, and heart attack.

Given these odds, was Edwards simply unlucky to be the father of a surprise love child? We don’t know whether Hunter wanted to become pregnant or was trying to, but it’s a scenario worth entertaining, especially since she has been unflatteringly portrayed as a predatory seductress. The anti-Hunter faction will wonder: Did she view Edwards as her last chance to have a child and lie about being on the pill? Or worse, was she trying to boost her chances of conception by secretly taking fertility drugs?

Even if Hunter were taking fertility drugs on the sly, it wouldn’t have helped the odds of conception significantly. The most commonly prescribed pill, clomiphene citrate, helps infertile women ovulate, but it would have made Hunter pump out at most an extra egg or two in addition to the one her body naturally produces every month. The drug also has a downside of thinning the uterine lining, which makes it harder for an embryo to implant. In any case, the majority of Hunter’s 43-year-old eggs would be chromosomally abnormal. Even if she somehow managed to wrest a sperm sample from her lover and hightailed it to the nearest fertility clinic to have her ancient eggs fertilized in a lab through in vitro fertilization, her chances of becoming pregnant would only rise to 10 percent.

Perhaps Hunter really did believe Edwards was “so hot” [4]and simply wanted a good time. Maybe she opted out of birth control because she knew these depressing stats and believed she had little chance of becoming pregnant. Maybe she presented the information to Edwards, and he made a calculated bet to forego a condom, too. If so, did they rely too heavily on statistics? According to Dr. Kutluk Oktay, a reproductive endocrinologist at New York Medical College-Westchester Medical Center, who studies fertility preservation and diminished egg reserve, the rates of “spontaneous pregnancy” might actually be higher, since lower stats are often influenced by studies with women experiencing fertility problems. A healthy 43-year-old woman could expect her chances of conceiving naturally to be closer to 3 to 5 percent during a given cycle, he argues. Dr. Richard Paulson, a fertility specialist at the University of Southern California Medical School, agreed there was a lack of data of natural conception for fertile women over 40. He said he’d heard so many anecdotes about 43-year-old women getting pregnant on their own that he estimated the number could be much higher.

The second factor is that such statistics are averages. They might include the woman who underwent premature menopause in her mid-30s as well as Fertile Myrtle who reproduced well into her 40s. Every woman is different, and she should never rely on these figures to make important fertility decisions. “If you show up at an infertility doctor at office at age 43, we know you’re going to have a hard time getting pregnant,” says Paulson. “However, we just don’t know how many 43-year-olds are getting pregnant naturally in the privacy of their own bedrooms.” Apparently, we can add the mistress of a presidential candidate to the list.