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EDITORIAL
Year : 2016  |  Volume : 7  |  Issue : 3  |  Page : 103-104  

In vitro fertilization in older mothers: By choice or by law?


1 Department of Obstetrics and Gynaecology, GMC, Jammu, Jammu and Kashmir, India
2 Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India

Date of Web Publication21-Sep-2016

Correspondence Address:
Sudhaa Sharma
Department of Obstetrics and Gynaecology, GMC, Jammu, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-7800.191018

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How to cite this article:
Sharma S, Aggarwal N. In vitro fertilization in older mothers: By choice or by law?. J Mid-life Health 2016;7:103-4

How to cite this URL:
Sharma S, Aggarwal N. In vitro fertilization in older mothers: By choice or by law?. J Mid-life Health [serial online] 2016 [cited 2022 Aug 15];7:103-4. Available from: https://www.jmidlifehealth.org/text.asp?2016/7/3/103/191018

The in vitro fertilization (IVF) process that led to the conception of Louise Brown born on July 25, 1978, world's first test tube baby was hotly debated within medical and religious circles alike. Nonetheless, since Louise's birth in 1978, over 1 million children have been born using this procedure. At 20 weeks of pregnancy, a female fetus has 6–7 million of eggs. By the time the woman is 30 years, she will have lost nearly 90% of her eggs and at the age of 40 years, only around 3% of eggs are left. Most women are no longer able to become naturally pregnant in their mid-40s. However, while a woman's eggs have an expiry date, the uterus, where a fertilized egg will grow, does not.

“The bottom line is that the uterus can function just about until the death of the woman.”

Advancement in assisted reproductive techniques is extending the boundaries of biological reproduction. While it seems there are no longer biological constraints to pregnancy past menopause, the risk of dangerous complications associated with carrying a child and giving birth significantly increase as a woman ages. Generally speaking, any woman who reaches 35 years and beyond and becomes pregnant is called older mother.

How old is too old to give birth?? The answer to this question would have been obvious before, but recent advancements in fertility treatment mean, even a 60-year-old woman can do what was once unthinkable: Become pregnant and give birth to a healthy child. Separating the medical and ethical facts, surrounding advanced maternal age may not always be easy.[1]

Just because a woman of this age can physically become pregnant is the decision to do so ethical??

A 72-year-old Daljinder Kour delivered a healthy baby boy Arman Singh on April 19, 2016; 46 years after marriage and 20 years after her menopause. Desperate to have a child, Kaur's wish could be fulfilled through IVF. This is a second case at the National Fertility and Test Tube Baby Centre in Hisar, the first case was of 70-year-old Rajo Devi in 2006, who had given birth to a baby girl. The publicity surrounding the case of Maria Bousada, 66 years, who died 3 years after conceiving with donor eggs from an IVF in California, leaving behind her 2-year-old orphaned twins, sparked an ethical debate on age restrictions for access to infertility treatment. “Recreating Motherhood” by Barbara Rothman, a sociologist states that motherhood rests on three deep rooted ideologies-patriarchy, technology, and capitalism. He states that these technologies can potentially strengthen the prevailing patriarchal values, particularly in India, where there is immense pressure on the woman to become mothers and produce a healthy baby. The anxiety produced by the social pressure on women is further exacerbated by the evolving definition of infertility.

When offering IVF services to women, reproductive endocrinologists need to be diligent in balancing the desires of the patient to become pregnant; the potential medical problems women may endure during pregnancy and the best interests of the potential child.[1] Coming to the points, in favor of older IVF mothers, it is prejudicial to disallow older women to have children if it is considered acceptable for men to procreate very late in life. It also states that it is not uncommon for grandparents to raise children. Society must recognize individual's right to make responsible choices regardless of their life expectancy or age.[2]

In an article on ethical issues related to IVF, Banerjee stated, “I would suggest that except in most unusual circumstances it is not right to withhold fertility treatment on the grounds of interests of potential child.”[3]

When it comes to making mothers out of grandmothers, advocates of fertility treatment for older women may argue in terms of rights to have a family per se under Article 8 of the Human Rights Act/European Convention of Human Rights. Advocates of treatment of older women may also highlight the unfair ways in which women are treated for having families in their advanced years, while men who father children at equivalent ages are not judged, even celebrated for their virility.

Mianna Lotz, Lecturer in Philosophy, Macquarie University, says there is no research showing that women who have children will indeed miss out on the middle to later stages of their child's life; the assumption that such a child will be left isolated and unsupported is just an assumption!!

However, there are great concerns regarding health issues that will be found by an older mother undergoing IVF including hypertensive disorders, gestational diabetes, abnormal placentation, preterm deliveries, still births, and cesarean deliveries. It is not surprising that as maternal age increases above 50, factors contributing to maternal and neonatal morbidity and mortality also increase.

The deepest disagreement over advanced maternal age seems to be whether age is morally relevant to a woman's ability to be a “good mother” or not.

Pregnancy and child rearing by older women are described as gross, unnatural, and selfish. It has been argued that embarking on a family at extreme ages demonstrate gross selfishness.

Karl Lauterbach, a leading social democrat, stated that artificial insemination at an older age brings with it considerable higher risk of premature births and underweight babies and with that a higher chance of lasting damage. Those opposed to IVF for older women claim the welfare of the child is being lost amid the efforts to push the scientific boundaries even further. It may be stressed that the available eggs should be prioritized toward younger candidates.

Should in vitro fertilisation in older mothers: By choice or by law???

Assisted Reproductive Technologies (ART) have emerged as one of the most widely adopted and successful medical technologies in the last century. While giving hope to millions of couples suffering from infertility, ART also has presented new ethical, legal, and social questions that society must address.[4] There is no law against older couples using IVF treatment to conceive, but India's National Guidelines for Accreditation, Supervision, and Regulation of ART Clinics advise women over 50 years and men over 55 years against opting for the procedure.

Science has erased the upper age limit for women becoming pregnant. But it may be a time in our lives when becoming pregnant simply should not happen.

 
   References Top

1.
Banh D, Havemann DL, Phelps JY. Reproduction beyond menopause: How old is too old for assisted reproductive technology? J Assist Reprod Genet 2010;27:365-70.  Back to cited text no. 1
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2.
Ethics Committee of American Society for Reproductive Medicine. Child-rearing ability and the provision of fertility services: A committee opinion. Fertil Steril 2013;100:50-3.  Back to cited text no. 2
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3.
Banerjee A. An insight into the ethical issues related to in vitro fertilization. Internet J Health 2006;6.  Back to cited text no. 3
    
4.
Brezina PR, Zhao Y. The ethical, legal, and social issues impacted by modern assisted reproductive technologies. Obstet Gynecol Int 2012;2012:686253.  Back to cited text no. 4
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