Year : 2010 | Volume
: 1 | Issue : 1 | Page : 3--4
"Brave old" motherhood: Beyond biological boundaries
Rama Vaidya1, Rashmi Shah2,
1 Dean, Medical Research Centre, Kasturba Health Society, Mumbai, India
2 Ex. Senior Deputy Director, National Institute of Reproductive Health (ICMR), Mumbai, India
Dean, Medical Research Centre, Kasturba Health Society, Mumbai
|How to cite this article:|
Vaidya R, Shah R. "Brave old" motherhood: Beyond biological boundaries.J Mid-life Health 2010;1:3-4
|How to cite this URL:|
Vaidya R, Shah R. "Brave old" motherhood: Beyond biological boundaries. J Mid-life Health [serial online] 2010 [cited 2023 Feb 2 ];1:3-4
Available from: https://www.jmidlifehealth.org/text.asp?2010/1/1/3/66984
I do not accept any absolute formulas for living. No preconceived code can see ahead to everything that can happen in a man's life. As we live, we grow and our beliefs change. They must change. So I think we should live with this constant discovery. We should be open to this adventure in heightened awareness of living. We should stake our whole existence on our willingness to explore and experience.
Martin Buber, (1878-1965), Jewish Religious Philosopher.
Recent news of Bharati Devi, a 66-year-old woman giving birth to triplets on 29 th May 2010 at Hisar in North India must have surprised some and shocked many. She had conceived after 44 years of marriage through the in vitro fertilization (IVF) technique. Another Indian woman, Rajo Devi from North India, is the world's oldest woman, who, at 70 years of age, had conceived through the IVF technique and delivered a baby girl on November 28, 2008. The couple had expressed a desire for a second child because they also wanted a son. Sadly, Rajo Devi is now critically ill. These technical advances need to bring focus to multidimensional concerns. The multidimensionality of the problem is daunting. It has caused dilemma between egalitarians and elitists. The intense debate rages among those taking extreme positions for or against the application of oocyte donation to elderly women who are past their 50s. It is not only a matter of technological advance and its application by professional excellence. The problem involves medical, ethical, cultural and socioeconomic issues connected to individual choices versus community fiats. Some even consider the moral and spiritual dimensions to be important.
Internationally, pregnancies in postmenopausal women beyond 50 years through IVF techniques of donor oocytes are occurring and being recorded since the early 90s. In the United States, more than 539 births were reported among women over 50 years of age during 1997 to 1999 Some of these were twins or even triplets.As per the Human Fertilization and Embryology Authority, more than 20 babies are born per year in Britain to women over age 50 years of age through IVF technology. Mostly, postmenopausal women take this treatment for their infertility when they have not had any children. What is surprising is that Janise Wulf, a woman of California, USA, had opted for IVF at 62 years when she already had 11 children, the eldest being 44 and the youngest being 3 years old.
The news of the death of Ms. Bousada of Spain at 69 years, within 3 years after having given birth to twin boys, had disturbed the medical community offering IVF treatment to old postmenopausal women. Another postmenopausal woman from the Netherlands at the age of 50 years had an eclamptic fit after delivery and died of HELLP syndrome. She underwent treatment for postmenopausal pregnancy outside her country. The law in the Netherlands prohibits pregnancy treatment after the age of 45 years. Postmenopausal women above 50 years go through complications related to pregnancies. Increased incidence of maternal complications like gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, miscarriages, premature deliveries and higher rates of Cesarean deliveries are reported in childbearing over 50 years. As compared with younger pregnant women, postmenopausal mothers of 50 years and above have higher rates of low birth weight babies, small for gestational age, premature babies and perinatal mortality. This higher risk of pregnancy-related medical complications for women above 50-55 years seeking fertility treatment appears to be of greatest concern to the medical community at large and to the health policy makers also. It is mandatory for IVF specialists offering this advanced technique to weigh and balance the benefit/risk as per the existing health status of the individual woman. It is also their responsibility to inform, educate and extensively counsel advanced-age couples about the possible risks involved to the mothers and their offspring. Informed consents in that case would not than remain a mere formality.
Socioeconomic issues also loom large around the question of pregnancy at 50 years and above. Infertile Indian couples hugely experience social discrimination. It is particularly true about infertile women who are not allowed to participate in religious and other festive occasions. The sociocultural compulsions to bear a child are movingly depicted in the Indian literature, plays and cinema. Their anxiety and social withdrawal, besides their psychophysical health, impact their personal and sexual relationships. Knowledge, understanding and cognition about this social reality could stir us for an empathetic role. In the Indian context, IVF treatment, because it is not supported by medical insurance, is cost-prohibitive, and couples undergoing IVF treatment face a huge financial challenge. They often put their life's savings for the treatment or incur huge debts. Preventive measures for anticipated medical complications add to the cost of the IVF treatment. Care of multiple pregnancies with premature babies further adds to the financial burden. In the event of mother's near-fatal condition or death, problem of the care of the orphaned baby/ies become a major social and economic issue. It is often mentioned by media in published interviews of such couples that family members would take care and custody of the children if such a situation was to arise. It thus seems that either very wealthy will be able to afford this treatment or others desiring late-life pregnancy will have to incur debt at advanced age.
Ethically, it sounds unreasonable to deny pregnancy to postmenopausal women who, by choice, want to undergo IVF treatment even after she has understood about the involved risks. Could the denial or regulation in this context be only age discrimination or gender discrimination also? Men can procreate at advanced age and father children without any sanction by society or law. However, those who argue about gender discrimination fail to understand that men do not go through the risks involved in late-life pregnancy and delivery. Some wisdom will have to prevail among both community and professionals alike to critically self-determine age-limits and boundaries for the application of advanced reproductive technologies for postmenopausal motherhood. Newer technology and its diverse applications have brought complex medicosocial problems. Situations arising from this complexity demand fresh thinking with an open mind and collective endeavor to evolve socioculturally relevant guidelines that take into account an individual's choice, professional guidance and community consent.
It is important to mention that IMS members have informally debated and already expressed individual and, to some extent, views of smaller groups about setting up of age limits for offering IVF techniques to postmenopausal women. The "Great Debate" was spearheaded by Dr. Narendra Malhotra in response to Dr. Parul Kotdawala's view point, which, we editor's, have felt should be shared with a larger medical world. We think that Dr. Kotdawala has tried to draw our attention to the plight of elderly infertile women who experience immense psychological pressures from families and society. Her plea is to understand and cognize this social reality. The debate has taken place among presidents and senior members of some of the major Indian societies (FOGSI, ISAR, IFS, IMS, IAGE, etc.) interested and involved in mother and child health care besides fertility treatment. They, including Dr. Atul Munshi, President, Indian Menopause Society, have largely expressed deep concerns about the practices of postmenopausal motherhood through IVF technique without defining the age limits. The strong sentiments against "Practices of making Mothers out of Grandmothers" were related to obvious high risks of pregnancy and delivery at such advanced age, risks related to the IVF technique itself and multiple gestations. Some of them have also questioned about the quality of parenting with huge age difference of these parents with their children. By and large, the suggestion has been that IVF practitioners should abide by the Indian Council of Medical Research's general guidelines of 45 years as a limit for assisted reproductive technology. Some of them have also given official statement against late-life/postmenopausal women's treatment through donor oocyte IVF treatment. There is also a proposal of organizing a consensus meeting of the concerned societies. It will be important to engage women's organizations, social scientists, legal experts and policy makers in this dialogue.
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