Feb. 15, 2011 -- A mother's love takes many forms. For Kristine Casey, 61, it meant giving the gift of motherhood to her infertile daughter by carrying and giving birth to her own grandson.
With the help of hormone supplementation, Casey, who had gone through menopause 10 years earlier, became pregnant during her second round of in vitro fertilization, the Chicago Tribune reported.
She carried full term and gave birth via Cesarean section to Finnean, her first grandchild, last week at Prentice Women's Hospital in Chicago. Although Casey's daughter, Sara Connell, 35, had been unable to carry a pregnancy to term, her egg and her husband Bill's sperm were used in the procedure, making the couple Finnean's biological parents.
"The idea of having a family member being open to doing this for us was so extraordinary for us," Sara Connell told the Tribune.
Casey, who is retired, told the Tribune that giving birth to her own three daughters were three of the happiest days in her life and she believed that serving as a surrogate to her daughter was a spiritual calling. She had kidney complications after the birth that were quickly resolved.
Casey's husband, William, who spoke on behalf of the family, said there'd be no further comment to the media after their interview with the Tribune.
Mothering in the 60s
In the world of surrogate parenting, the Connell's scenario is not as uncommon as you might think. The first case of such an arrangement dates back to 1987 when a South African woman gave birth to her triplet grandchildren. More recently, ABC News' "Good Morning America" spoke with 56-year-old Jaci Dalenberg of Wooster, Ohio, who gave birth to triplet girls that she carried for daughter Kim Coseno in 2008.
The Uterus Goes on Forever
While age is a limiting factor for the safety of such late-in-life surrogacy, hormonal supplementation and the use of donor eggs make pregnancy possible even in women who have gone through menopause.
"It works despite the woman being post-menopausal because the uterus continues to respond to hormones forever," says Dr. David Cohen, an obstetrician and ethicist at the University of Chicago. "After menopause, you have to supply the hormones in the form of pills, shots or vaginal creams."
The age of the eggs and the ovaries, which would normally provide those hormones, is more of a concern for getting pregnant later in life, he adds, but in the case of surrogacy, the egg is provided by the biological mother. Those synthetic hormones, given before in vitro fertilization would most likely be continued into the first trimester, Cohen says, when the placental hormones would take over.
What does become more of a concern in the case of Casey and late-in-life pregnancies such as hers is the health of the gestational mother.
"The data suggests that the risk to the mom has been much higher in people who are older," Cohen says.
Although each case must be evaluated individually, the risk of high blood pressure, gestational diabetes and risk of miscarrying tend to be higher.
"The biggest issue is that the vascular volume -- the amount of fluid floating around the blood vessels -- increases dramatically in pregnancy and the demand on the heart to push that volume around is greater" he says.
"An older heart doesn't have the same strength to accommodate that volume as a young heart does. The older blood vessels also don't have the same elasticity so the risk of getting high blood pressure is clearly higher."
But age isn't always the best indicator of maternal suitability, Cohen notes, and "someone at 61 might seem healthier than another person at 49. Thankfully, in this case, everything worked out fine."
Ethical, Emotional Concerns of Grandma Surrogacy
At first mention, the idea of a grandmother giving birth to her own grandson sounds like a genetic nightmare, but because the Connells contributed the egg and sperm, the risk of genetic abnormality was actually quite low. From an emotional or even ethical standpoint, however, this arrangement might still raise concerns.
Is it ethical to put an elderly mother at increased risk of complications by allowing her to be a surrogate? Would carrying a grandchild that is then handed over to the biological parents create psychological turmoil in the grandmother?
Surrogacy in any case can be ripe with emotional complications as gestational mothers become attached to the child during pregnancy and may be less willing than expected to part with the child, even though it is not biologically theirs.
Even if the surrogate is no stranger but a family member, such as a sister, there might be similar attachment issues. In this case however, grandmother surrogacy might actually be one of the least complicated scenarios for surrogacy, notes Dorothy Greenfeld, a clinical psychologist who counsels patients at the Yale Fertility Center.
"I don't see it as particularly emotionally complicated," she says. "She's probably so overjoyed to be able to do this for her daughter."
Given that Casey was already going to play a somewhat maternal role in the child's life as his grandmother and that she is no longer at mothering age (and less likely to want to raise the child as her own), the situation is less complicated than others, she adds.
Indeed, Casey told the Tribune, "From the very beginning, the moment I've wanted is the moment the baby is in their arms. I've been clear since after my third child that I didn't need to have any more children, and as much as I will be delighted to be a grandmother, I don't want to take a baby home."