Dearest:   My guests tonight in Power Surge are the co-authors of the new book, 
"Rewinding Your Biological Clock: Motherhood Late In Life".

JUDITH SACHS is no stranger to Power Surge and is the author of 20+ health books. 
She is a professor and lecturer and has conducted workshops for major corporations, 
such as in the area of stress management. Judith has appeared on many major TV 
talk shows and is welcomed as a frequent guest on radio broadcasts around the country.

DR. RICHARD PAULSON is a pioneer in the area of reproductive science and in vitro 
fertilization and egg donation for couples coping with fertility problems. He is the Chief of 
Reproductive Endocrinology and Infertility at the University of Southern California School 
of Medicine in Los Angeles, and the director of the University of Southern California 
Infertility Center.

Perhaps the leading authority on egg donation in the U.S. today, Dr. Paulson headed 
the team that successfully performed in vitro fertilization using a donor on the woman who 
became the "oldest" new mother in the world a 63 year old woman, whose child today is 
two years of age :)

Dearest:   It's a pleasure to have you both as guests in Power Surge, Judith and Dr. Paulson. 
I suppose many of us may be wondering why a woman of 63 would subject herself to the 
obvious risks involved with childbirth at her age. Can you share your thoughts on this, please? 
Thanks and again, welcome:)

(Judith Sachs will be typing for both herself and Dr. Paulson)

Judith Sachs:   Thanks, it's nice to be here. The truth of the matter is that we did not 
know her actual age, but it just goes to show you that the desire to reproduce is stronger 
than any other drive other than survival.

Dearest:   Had you known the truth of her age, would you still have proceeded with the 
procedure? 

Judith Sachs:   Probably not. We know so little about obstetrical risks beyond 55 - which 
is actually the age limit that our facility recommends for women of advanced reproductive 
age using egg donation.


Dearest:   Interesting. I wonder what your thoughts are regarding societal changes, such as 
younger women wishing to develop careers and having children being put on the proverbial 
back burner. Have societal changes had a great affect on women's decisions to have 
children much later in life? 


Judith Sachs:   In our society, men have been able to father children well into their 
60s and 70s, not having to worry about their careers. While we don't suggest that women 
wait until after menopause to have children, this technology levels the playing field.


Dearest:   It's interesting that women may undergo the emotional desire to bear children 
later in life, perhaps after menopause, while men may physically be able to reproduce. 
Shouldn't counseling be recommended to older couples? 


Judith Sachs:   We always recommend counseling to older couples - some facilities 
require it - but like the protagonist of our book, Sarah, who's 48, some women may 
find that this is the time of life when they're finally ready to start a family. 
Even if they had an earlier family that they were very happy with, they may be in a 
new marriage or a marriage to a younger man, and find that the consolidation of 
everything they're feeling results in a strong desire to parent. 


Dearest:   Fascinating. Thank you both.  
Leeny, go ahead with your question, please.


Leeny98:   I was just operated on for breast cancer and I have very bad hot flashes. 
I had 33 treatments of radiation. Is there anything on the market that I can take, and 
that will work for me? 


Judith Sachs:   Most doctors do not recommend HRT (Hormone replacement therapy) 
for any woman who's had breast cancer until they've been disease free for 5 years. 
However, we've had women who have become pregnant via egg donation after this 
period of time. 


Dearest:   Let me remind you that this isn't a menopause chat, per se. Perhaps our 
guests can respond to your questions.


Judith Sachs:   Sometimes, the Clonodine patch is helpful - you should ask your doctor 
(oncologist and gynecologist) before considering any type of treatment that's been 
popularized by the media. 


Dearest:   Judith and Dr. Paulson, what is the success rate of egg donation in older women? 


Judith Sachs:   The national average is about 30 percent per attempt but our clinic in Los 
Angeles is doing better than 60 percent in the last two years. We wanted to point out how 
much more successful this is than IVF with your own eggs after the age of 39. 


Dearest:   What is the most commonly used fertility technique or protocol? 
How does it compare to egg donation? 


Judith Sachs:   It's in vitro fertilization with your own eggs. This means that your 
eggs are aspirated (removed) from your body and fertilized with your partner's sperm. 
They are then put back into your body as embryos. 
              
But our book is about much more than the medical aspects of this procedure. We talk 
about the emotional changes that happen in women over 45, and the stress to the relationship. 
It's a different kind of love story. 


Dearest:   Is there an age limit after which you won't perform in vitro fertilization? 


Judith Sachs:   Yes. We don't do it after 45, because success rates after that age are about 0, 
as compared with 60 percent for egg donation. 


Dearest:   Thank you. Mary, go ahead.


PianoMary:   How much more difficult is it to go through a pregnancy when you're older?  
When I "young" it was hard enough.


Judith Sachs:   The complication rate is only slightly higher for older women and you may 
find that your maturity makes it easier to adapt to the psychological stress. 
Also, women of this age who really want children find that the physical problems appear 
to be less because their mental state is so much more positive. 


Dearest:   I wonder about the utter confusion of the body of a women in menopause 
whose hormones are totally out of whack, suddenly being with child.  


Judith Sachs:   The hormones that prepare you for pregnancy will restore your hormonal 
balance - so there are fewer mood swings because you are in an optimal balance of 
estrogen and progesterone. For example, there are no hot flashes during 
pregnancy. And after delivery, you can breast feed the same as a younger woman can. 


Dearest:   Thank you. Lora, go ahead, please :)


LORACURA:   What percentage of women over the age of 45 are now searching for a way 
to become pregnant?


Judith Sachs:   The average age of patients coming to us for egg donation is 43. There's 
no way to know how many women want to be pregnant - those who come, are obviously 
interested. But there are a great many things that older women are just starting 
to do - and like astronauts, they can go on forever. 


Z J Gragg:   I have several friends with POF--in their 20's & 30's - can they have 
a baby this way?


Judith Sachs:   Yes. POF stands for premature ovarian failure, and it was for these women 
that egg donation was originally developed in the early 80s. Their success rate is the 
same as older women becoming pregnant with egg donation - it's the quality of the eggs 
(which come from younger donors with good quality eggs) that counts. 


Dearest:   What emotional factors might render an older woman a poor candidate 
for in vitro fertilization?


Judith Sachs:   Many women might see pregnancy as a cure for a bad relationship - 
so we are very careful to screen couples (as well as individual women) for their 
support system. We'd also be concerned about women who have clinical depression 
or other diagnosed emotional problems that require psychiatric medication. 


Dearest:   Thanks. KitKat, go ahead, please.


Kitkat4888:   How often do women become pregnant naturally after 45? I know of several 
instances when this happened.  


Judith Sachs:   It does happen. The oldest woman on record was 57, but most women's egg 
quality declines rapidly after 43, even if she's still menstruating, and pregnancies 
after 45 are rare. 


Dearest:   Gemzkat, your question for our guests?


Gemzkat:   Within 3 years, FSH went from 5.1 to 25.2.  I feel I'm going crazy.  
What do I do now?


Judith Sachs:   Elevated FSH levels means that you are nearly in menopause. Since fertility 
is lost early in the menopausal transition, if you're over 40, your chances of pregnancy 
are low unless you use an donor egg. As to feeling like you're going crazy, you may 
need estrogen replacement or many other complimentary treatments now available. 


Gemzkat:   Thank you.



CustomX311:   Can teens have an offspring of twins at that young age of pregnancy?


Judith Sachs:   Twinning in nature happens in 1 in 80 regardless of your age. By contrast, 
IVF and egg donation are associated with 25 percent multiple gestations (twins, triplets, 
etc.). This is due to multiple embryos being placed in the uterus at the same time. 
It's the same kind of thing if a woman ovulated more than one egg at a time. 


Dearest:   With this cutting edge reproductive technology and despite the ethical 
guidelines involving egg donation, aren't you and other doctors associated with this 
process finding a whole host of new legal issues coming forth?


Judith Sachs:   There have been very few legal issues dealing with egg donations. 
Most of the problems have been related to surrogacy (where another woman carries the 
pregnancy for a couple). But with egg and sperm donation, there have been guidelines 
already set by ethicists, doctors, and legislators, so it's pretty clear cut what should and 
should not happen. 


LORACURA:   Approximately what is the cost of this procedure, if I may ask and does 
insurance cover any of it? 


Judith Sachs:   The total cost is about $15,000, including the $3000 compensation to the 
donor. There are states, such as MA and ARK, which mandate insurance for infertility, 
but in most places in the US, it's out of pocket. 



PianoMary:   We know that older mothers are more likely to have children with Down 
Syndrome.  Is this still the case with egg donations and older mothers? 


Judith Sachs:   Excellent question! Just as the pregnancy rate is determined by the 
age of the eggs, so is the health of the offspring. Therefore, with egg donation, 
there are fewer miscarriages, and very few birth defects - the same as in any woman 
the age of the donor which generally is in their 20s. 


Sue:   Are most of your patients trying for that first child or for more children? 
Have you had people come back for a second child?  


Judith Sachs:   About half the patients are having their first baby where as others have 
had children before, usually in previous marriages. Yes, we've had several who come 
back again for another child and they may use their frozen embryos for another child - 
or try again with the same donor. 



LeChienFou:   Thank you.  I am 42 and perimenopausal and I never had kids before.  
Will egg donation be successful for me like others? What I mean is, will my fluctuations 
in hormone levels, even with taking estrogen, be a problem?


Judith Sachs:   It doesn't matter if you've been pregnant before or not, also, your age 
isn't a factor. You would be just as likely to get pregnant with egg donation as a 20-yr old. 
             
We control your hormones by supplementing estrogen and progesterone and turn off your 
own cycle with another medication. 


Dearest:   How does the process work once a couple has undergone counseling and the 
woman has been deemed healthy enough to undergo this procedure and pregnancy, 
what happens next? 


Judith Sachs:   We match her to an egg donor of her liking - there can be a match in 
hair color or perhaps educational level.  And after that, their cycles are synchronized 
so that it's as if the donor's eggs are ripening at the same time as the uterine lining 
of the recipient is preparing to receive an implanted embryo. 
After matching, the whole process takes about 6 weeks.


Dearest:   This may seem like a far-fetched question, but do you know of a case where a 
woman has gone to all this trouble and been dissatisfied with the results? 


Judith Sachs:   No. These women are so motivated and so carefully screened that this 
has not occurred to our knowledge. 



LORACURA:   How much information do the parents get about the "donor" i.e. health issues, 
background etc. and what happens when the child starts asking questions later in life . 


Judith Sachs:   Recipients are matched anonymously or non-anonymously, and therefore can 
have as much or as little info as they like. We deal with the issue of disclosure in our 
book - most psychologists feel that it's best to tell the child (and the rest of your family) 
and we agree with that. 


Dearest:   How, if at all, does it differ from telling an adopted child? 


Judith Sachs:   It's about the same. In some of our accounts, the mothers have started telling 
their children very early in life, before they understand what reproduction means. One 
woman said her evening prayers and included "the generous lady who made it 
possible for us to have you in our lives." 


Dearest:   How lovely :) Have you ever found yourself recommending 
adoption, as opposed to in vitro? 


Judith Sachs:   Yes. If the perspective mother has medical diseases that would make pregnancy 
risky, we recommend either gestational surrogacy (with or without an egg donor) or adoption. 


Dearest:   The 63 year old woman, did she have an uncomplicated pregnancy?  


Judith Sachs:   She had mild diabetes and mild hypertension, and she delivered by caesarian 
section--a healthy baby, no complications for the mother afterwards. 


Dearest:   It's absolutely mind-boggling :) Thanks so much.
Mary, go ahead.


PianoMary:   You've mentioned couples before - would you do this for a single woman as well? 


Judith Sachs:   We don't discriminate against single women, but want to be assured that 
they have a really good support system - friends, family parents, etc. before they 
become pregnant. 



Cinda:   You mentioned that you control fluctuating hormone levels, do any of these 
hormones you give the women for this have an affect on the child's health?  


Judith Sachs:  Since we're restoring the premenopausal hormonal state, it's just like any 
30 year old having the hormones she'd have during her pregnancy - this is obviously 
optimal for the child inside her. 


Dearest:   I assume you recommend these women continue the HRT after delivering, yes?


Judith Sachs:   You don't need to supplement during breast-feeding, but afterwards, yes.


LeChienFou:   My question is more of a psychosocial one:  Dr. Paulson has treated some 
celebrities who I think, based on age, must have had Egg Donation.  But the celebs are 
keeping this a secret. Doesn't this give a wrong message to the public about the length 
of a woman's fertility???


Judith Sachs:   We keep the details of all women's treatment confidential. There are 
many women who celebrate their pregnancies, like Madonna and Demi Moore, and others, 
who don't want anyone to think of them as Mommies--whether or not they're celebrities. 


LeChienFou:   Yes, but the women choose to tell the public that this was a "regular" 
pregnancy. At age 50.


Judith Sachs:   At age 50, natural pregnancy may occur (the oldest woman was 57), 
but it would be unusual. 


Dearest:   Exactly. I don't think anyone can assume a pregnancy at 50 isn't natural.


LeChienFou:   Thanks.


Dearest:   This has been fascinating. Judith and Dr. Paulson, any new cutting edge 
technology on the horizon? 


Judith Sachs:   In the future we'll be able to help women get pregnant with their own genes, 
by transferring only the nucleus (which includes the DNA) and using an egg that's had the 
nucleus removed from an egg donor. In this way, we'll still have the high
success rates, but the recipient will get to pass her genes along to her children. 


LeChienFou:   Why is the success rate of DE not better than 50% considering that the 
eggs are younger and the cycle is controlled.?  And what about HIV?


Judith Sachs:   Our success rate is 60 percent. Egg donation consistently produces 
the highest success rates of any fertility technology. The rate we're getting now 
reflects the current state of the technology, which will get better as the culture media in 
the laboratory improve. 
              
We screen all donors and recipients and their spouses for HIV, hepatitis, and syphilis. 



Cinda:   I have a friend who tried to have kids for years, couldn't and is now 
menopausal.  Would she still be a candidate? She is medically healthy, but doesn't ovulate? 
(She has adopted BTW)


Judith Sachs:   Absolutely. And her success would be higher than before, when she was 
trying with her own eggs. You don't need to ovulate for egg donation - the cycle is 
controlled by supplemental hormones. (We haven't said, also, that we test the husband's 
sperm to make sure that it can fertilize an egg. And even if it's deficient, we have 
a method called ICSI where we can isolate just one sperm and inject it inside the egg.) 


Dearest:   Judith Sachs and Dr. Richard Paulson, thanks ever so much for spending 
this time in Power Surge fielding our questions about egg donation and in vitro 
fertilization and the emotional, physical and sociological aspects of this fascinating 
cutting edge technology.
           
Anyone interested in reading their wonderful book, "Rewinding Your Biological Clock: 
Motherhood Late In Life" can pick up a copy at amazon.com.

Judith Sachs:   You're welcome, it's a pleasure to be here tonight.

Dearest:       Judith, Dr. Paulson, is there any other info you'd like to share with us? 
About book tours, seminars, media events?

Judith Sachs:    Thanks for your wonderful questions:0
               
Dr. Paulson will be in Philadelphia, Cleveland, Boston and Toronto this week on various TV 
and radio shows. Please send him an email for more info to: rpaulson@hsc.usc.edu

Dearest:       Thank you both. This was truly fascinating. I look forward to you returning 
to visit with us again very soon :)

Dearest:       Thanks, everyone, for coming. Goodnight.

Judith Sachs:   Thank you. Bye:)

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