Manda Epton exhales a long, steady breath as another contraction washes over her.
Her twins are coming early. Two weeks before her scheduled caesarean section at the Royal Hospital for Women in Randwick.
But there is no hint of panic in her voice. She is jubilant.
At 50-years-old, she has waited long enough to become a parent.
Ms Epton is part of a rising demographic of would-be mothers travelling overseas for IVF using eggs donated by younger women when all other avenues have failed.
Egg donation is the only viable IVF option for women aged over 45, yet these women exhaust all other IVF options, their emotional stores and their bank accounts before they give up on their own eggs.
The chances of a woman aged 45 or older giving birth to a live baby was 0.6 per cent per initiated IVF cycle and 1.3 per cent per embryo transfer cycle if she used her own eggs, according to Australian and New Zealand IVF data from 2016.
Their chances of taking home a baby rise to 19.1 per cent per initiated cycle, and 23.9 per cent per embryo transfer cycle if they use donor eggs, typically from younger women, the same report found. The odds are even higher at overseas clinics where the donors are even younger, IVF experts say.
But older women need to be aware of the greater risk of complications for mother and baby, reproductive experts say.
Becoming a mother at 50 was not part of Ms Epton’s plans. She had always wanted children, but her long-term relationships hadn’t stuck and the men she met in her late 30s already had families.
She spent roughly $75,000 on IVF cycles between her 39th and 45th birthdays using her own eggs.
“None of it worked and I’d run out of energy to keep going,” she said. The emotional stress of those years now a distant memory as another wave of contractions washes over her.
“I remember looking at all these magazines with older celebrities getting pregnant. No one tells you it was with donor eggs,” she said.
She threw herself into her co-owned business, Maud and Lil Organic Cotton. But selling baby toys became a cruel reminder as heavily pregnant women and parents toting newborns walked in and out of her store each day.
Shedding the 'ego of genetics'
No woman opts for donor eggs if there is any chance they can use their own, says Sydney reproductive scientist Dr Denyse Asher who works exclusively with women and couples who need donor eggs.
Her clients include older women, cancer patients whose treatments have damaged their own eggs, women with genetic conditions they don’t want to pass onto their children.
“They need to try everything else first, even when they know they have a very low chance of success, said Dr Asher.
“It’s very hard to come to terms with, but a woman who wants to have a baby is a very powerful force."
“It’s all about ego,” Ms Epton said. “It’s hard to let go of your own DNA.”
“But they’ve been with me for eight-and-a-half months now. My blood, my diet, my voice, my energy are a huge influence on what they are becoming.”
The younger the egg, the better the chance
Medical director of IVF Australia Associate Professor Peter Illingworth the success of egg donor embryo transfers "depends entirely on the age of the donor", not the recipient.
Success rates were significantly higher among women who used overseas clinics compared to those in Australia because the egg donors were usually younger - as high as 40 and per 50 per cent Professor Illingworth said.
Donors in South Africa and parts of Europe were paid for their eggs and their identity was confidential. Many women who choose to donate eggs were young university students who plan to use the payments to pay tuition fees.
In Australia, the average age of an egg donor was 32.6 years in 2016. The older the donor, the less chance of a live birth (24 per cent for donors under 30, 22 per cent for 30-34 year old donors, 17 per cent for donors aged 35-39 and 7.2 per cent for donors 40 and over).
The egg donation was also rising locally, accounting for almost six per cent of all IVF cycles in Australia and New Zealand in 2016, up from next to zero five years previously.
Roughly 90 per cent of Australian donors are recruited by the recipient, Professor Illingworth said. Often a sister, niece or the daughter of a close friend. It was illegal to pay donors for eggs and their identity must be disclosed.
Journey to motherhood is a flight to Cape Town
Ms Epton’s friend recommended Cape Fertility clinic in South Africa. Other friends had undergone donor egg cycles in Greece and Spain.
“There’s a sort of underground network of women in Sydney having these private conversations,” she said.
She emailed the clinic her own baby photos and more recent shots to help them find an egg donor who bore some resemblance.
“They came back with a brilliant match. She looked just like me,” Ms Epton said.
She chose a sperm donor from Denmark. The process was like online dating, except she was shopping for a donor who resembled her own family members.
“I wanted people to see the girls and think ‘oh they’re Manda’s babies,” she said.
Both her egg and sperm donor were in their early 20s.
She flew to Cape Town for the transfer: two embryos of 15 the clinic had created.
Seven weeks later and back in Australia, she was told she was having twins.
“I thought ‘An instant family, brilliant!’”
It was difficult to know how many Australian women were travelling overseas for egg donor transfers. UNSW's National Perinatal Epidemiology and Statistics Unit only collects data on donor eggs from Australian and NZ clinics.
But several local IVF clinics told Fairfax Media the numbers of women being referred overseas for egg donation had increased significantly in the past five years.
South African clinics were growing in popularity due to their relative affordability, and the exchange rate. Clients spent $10,000 to $15,000 including their travel and accommodation.
Dr Brownyn Devine at Monash IVF said she sent roughly 25 women overseas for donor egg embryo transfers every year.
“Over the years I’d say I’ve had 100 women go to Cape Town and had success [a live birth].”
One woman who successfully gave birth at 49 used the same South African egg donor to have a second baby at 51.
“Though 50 [year olds] are still reasonably uncommon, and we certainly don’t want all women coming through hospitals 50 and pregnant.”
Dr Devine stressed older mothers should not be discriminated against, but was clinically safer for women to give birth when they are younger.
Older women were at greater risk of complications including high blood pressure, pre-eclampsia, gestational diabetes, hypertension, bleeding complications, caesarean section, miscarriage, stillbirth.
Older mothers needed to be in “the peak of health” to carry a pregnancy to term and give birth, Dr Devine said.
Well-prepared for twins at 50
Seven days after giving birth, Ms Epton took her girls home.
“I’ve been a normal, crazy, no-sleep, parent ever since,” she said.
Her maturity was an asset, she said. “I’ve got my act together.”
A detailed roster coordinates a team of six family and friends who take turns sleeping over and staying the weekend.
She plans to tell her daughters how they were conceived as soon as they are old enough to understand.
“Being a mum is not about genetics. It’s about everything else, and these babies will know they are very, very wanted and very, very loved,” she said.
Dr Antonia Shand, Ms Epton’s obstetrician at the Royal Women’s Hospital’s Twins Clinic has treated a number of women in their 40s and early 50s who have given birth to twins via donor egg cycles from overseas clinics.
“Manda is just amazing,” Dr Shand said.
“She did so well because she was so well ... and getting to almost full term was fantastic.”
But some older mothers were not so well-prepared, Dr Shand said.
Birthing twins came with an increased risk of complications - particularly for older mothers - that women seeking multiple egg transfers needed to consider, Dr Shand said.
“These women are going overseas and having [multiple egg donation transfers] but the risks they are facing aren’t being explained to them and it becomes very hard for them to manage,” Dr Shand said.
“Single-embryo transfers is the way to go,” she said, backing Australian practice.
Ms Epton urged would-be parents not to wait.
“If you are serious about having kids you need to accept your fertility limits so you don't have to go through all the trouble I did,” she said.