Health & Science
Rielle Hunter Beat the Odds
Conceiving a healthy child naturally at 43 is pretty rare.
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We know that former presidential candidate John Edwards may announce that he fathered Rielle Hunter’s baby. 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. 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.
Sarah Elizabeth Richards is the author of Motherhood Rescheduled: Five Women, Five Quests to Stop the Biological Clock to be published in summer 2010. Get the latest by joining the mailing list at www.motherhoodrescheduled.com.
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Comments
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Giant misconception
By: bigtenfan80 | Wed, 09/23/2009 - 07:56
An irony at the very least. Edwards lost his son in a car accident when his wife was almost 47, and then she had 2 more children after that, so she was at least 47 when the first one of them was born. Even if she had extensive help (IVF, etc.) vs. getting pregnant without help (I don't remember the complete story), he had to know that women in mid to late 40's can get pregnant and carry a child to term. We can only imagine the disucssions between John and Elizabeth when this first came to light....
Deceptive math
By: Ongaku | Wed, 09/23/2009 - 03:44
RE: Remember that these are "per month" pregnancy rates. 3% per month means about 30% are pregnant after a year.
I would agree that with 12 different women each with a fertility rate of 3%, the odds are 36% that one would end up pregnant after a month. The 12 'trials' are independent, so you can compute the joint probability as 1 - .03^12.
But for the same woman, the trials are not independent.
Another way of looking at it:
Suppose I have a box of coins, half of which are weighted so that they never come up heads. The odds for a random coin coming up heads are only 25%, as off the bat 50% have no chance, and you only have a 50% chance of the remainder. Would you allow me to select a coin at random and flip it as many times as I liked before agreeing to bet and still offer me 25% odds that it will come up heads?
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We just don't know how many 40+ are getting pregnant naturally?
By: donaldsg | Tue, 09/22/2009 - 19:06
Surely fertility doctors are not the only source of information here? You often read stats about the birth rate for mothers of different age groups so couldn't someone simply extrapolate from that data?
more anecdotal evidence
By: donaldsg | Tue, 09/22/2009 - 19:02
I also conceived and gave birth to healthy babies twice in my early forties without any miscarriages or complications. In fact, after the birth of my first child my doctor said that given my age I shouldn't wait too long before trying to get pregnant again. The usual recommendation is one year, but he suggested six months. I conceived very quickly and as a result my kids are only 17 months apart. On the other hand, we know three couples, ranging in age from late 20s to late 30s, who for the past few years have been either trying seriously to conceive or are simply having unprotected sex and waiting to see what happens and none of them have managed it yet. And judging from other friends' experiences with multiple miscarriages, I'd say I was pretty lucky. Fertility probably varies enormously and there's no reason to think that Hunter did anything more than accidentally get pregnant.
The math can be deceptive.
By: Andrew Wolfe | Tue, 09/22/2009 - 18:13
Remember that these are "per month" pregnancy rates. 3% per month means about 30% are pregnant after a year.
Maybe it runs in the family
By: nj_mom | Tue, 09/22/2009 - 15:28
I had a healthy baby at forty-one. My grandmother had a child at forty-three and my mother-in-law told me that her own mother was in her early forties when she was born. It would be interesting to see if there are families like mine with a history of late childbearing on both the maternal and paternal side.
about those reproductive health centers
By: Ammj | Tue, 09/22/2009 - 10:47
I have two teenage children and insanely, have decided I want another. I am 43 and this journey has been probably one of the most discouraging, stressful and draining experience of my life. While all of my "numbers" are outstanding, and I was told "you are years away from menopause" the next sentence was "but your odds are very slim to none". Bypass sex and move right to IVF ($10,000 please). I went the clinic route for a while but really got tired of the, "everything looks great but since you are old, this probably won't work". I would say two things: one, I personally know many woman who have conceived naturally after 40 and they aren't just urban legends: if I saw them on the street, I could say hello and they would actually recognize me. Two, there is a lot of money involved--this is a business, people--a really big, mostly cash paying business. And, because of (appropriate) ethical concerns, research is not conducted on women trying to get pregnant naturally. The ones who succeeed are not in the stats. I think that reproductive endocrinologists know a lot, but they sure don't know everything. I have moved on to the plain old fashioned way (ok, with a little acupuncture thrown in....).
not so anecdotal
By: tokidoki | Tue, 09/22/2009 - 10:44
While the author admits there may be some discrepancy between women who are proven to be quite fertile, versus those that are attempting to conceive for the first time, I really don't think conceiving naturally in your 40's is all that difficult or has such a detrimental affect on the possible child either. I grew up in a community around several Down's Syndrome children - only one of these was conceived by a mother of Advanced Maternal Age. All of the others were born to women between the ages of 16-30. I'm not saying the risks and difficulties of concieving at an "older" age aren't realities, but perhaps the stats are skewed a bit.
I mean, look at Michelle Duggar, pregnant with #19 also in her early 40's.