The pregnancy of a 58-year-old woman in Hong Kong has sparked hopes for older women seeking to have children but also raised concerns about the risks of giving birth later in life.
Chan Lai-lai, wife of local actor Brian Wong Chak-fung, told the South China Morning Post on Saturday the recent announcement they were expecting their second daughter in September had been encouraging to a lot of women of a similar age in the city.
"In fact, many people have privately messaged me, expressing that it has become a source of hope for them. Some have attempted it once and have already given up," said Chan, referring to her successful in vitro fertilisation, a type of assisted reproduction service.
"I told them that if you give up after one attempt, you deprive yourself of a second chance. You need to regain a positive mindset to try again, and this requires time for adjustment."
Her pregnancy has attracted public attention at a time of increasing calls for the government to implement more measures to help older women give birth, including by allowing them to store embryos for as long as they want.
Apart from the IVF treatment, Chan also received injections to boost the chance of pregnancy and ensure the foetus' health.
She called on women who wanted to try IVF to assess whether they could accept the stress of repeated failures and the financial cost, adding the process required determination and sacrifice.
Dr Law Chi-lim, a specialist in obstetrics and gynaecology, said the oldest pregnant woman he had helped through labour was aged 48, with the baby the result of spontaneous conception, which "was very uncommon".
"Basically, it's very difficult for a woman in her fifties to conceive," Law said. "Advanced maternal age" describes anyone 35 or older and pregnant.
The median age for new mothers in Hong Kong has grown from 24.4 years in 1976 to 32.9 years in 2023.
According to a study by the Hong Kong College of Obstetricians and Gynaecologists, the proportion of women in labour aged over 40 rose from 4.5 per cent in 2004 to 10.7 per cent in 2014, based on the latest available data.
In the case of Chan, she decided to have another child because her elder daughter, born in 2019 when Chan was 52, wanted a sibling to keep her company.
Chan said that when she was carrying her first child she experienced gestational eczema, a skin condition that can occur during pregnancy, relatively high blood pressure and pre-eclampsia at delivery.
Pre-eclampsia is a serious complication typically characterised by high blood pressure and protein in the urine, which can be harmful to both the mother and the baby.
After experiencing a miscarriage last year, Chan underwent IVF treatment in Taiwan this year at a cost of HK$200,000 (US$25,716), which included daily injections into her abdomen.
Risks
According to Law, the chance of having a "test tube baby" is "rather low" for women over 40 with a 40% chance of miscarriage even when the initial attempt is successful.
That is why the government programme for scientifically assisted reproduction does not normally accept women over 40.
However, he added he would explain the risks and allow women to make their own choices without unduly discouraging them to go to the private sector to seek treatment.
Yu Kai-man, another specialist in obstetrics and gynaecology, said that pre-eclampsia could occur in about one of every 100 pregnant women, with the likelihood increasing for women of advanced maternal age.
Yu added that several medications, such as low-dose aspirin and heparin, could be used to help prevent it, but warned that progesterone taken by Chan to prevent premature birth would not be effective in all women.
He also added that in the city, about one in five pregnant women was of advanced maternal age, with one in 20 being over 40. This proportion is one of the highest in the world.
In June last year, Secretary for Health Lo Chung-mau cited studies indicating that the risk of miscarriage for pregnant women increased to 40% for those 45 or above. Furthermore, the risk of stillbirth for women 40 or above is three times that of women under 35.
Lo added that even if a woman successfully conceived through assisted reproduction, the likelihood of sustaining the pregnancy continued to decrease with age. For patients 41 or older, the success rate dropped significantly, reaching only 8.4% for those between 41 and 45.