Without fanfare, a few months ago, the Ethics Committee of the American Society for Reproductive Medicine
(ASRM) changed their position on pregnancy in women over 50 via donor eggs or donor embryos. This announcement was greeted with a near universal yawn from the media. Shortly thereafter Halle Berry announced her pregnancy at 46. Now this was deemed newsworthy, reigniting the debate yet again in the press of how old is too old to become a parent.
In the past, the ASRM and most fertility clinics in the US held that “fertility is the norm during reproductive years … infertility should remain the natural characteristic of menopause.” The Ethics Committee of ASRM came out this year with a new position that healthy, postmenopausal women between the ages of 50 and 54 should no longer be discouraged from becoming pregnant through fertility treatments using egg donation or donor embryo.
The reported success of oocyte donation to women in their 50s and early 60s suggests that pregnancy may be possible in virtually any woman with a normal uterus, regardless of age or the absence of ovaries and ovarian function. A woman’s reproductive age, once a dictate of nature, now can be artificially extended.
Should Infertility Treatment be Denied to Women of a Certain Age?
Some articles have implied that this change in ASRM’s position on pregnancy in women in their early to mid 50s is a ploy to increase the potential market for infertility treatment and egg donation; others see this as the natural progression of medicine. While the ASRM focused on the ability of a healthy postmenopausal woman to bear a child, they only touched on what’s in the best interest of the child throughout his childhood and adulthood in being born to older parents. The few studies that exist don’t find a reduction of parenting capabilities with parents in their 50s, but ASRM acknowledges that more study is necessary of parenting in the sixth decade of life.
There is one argument on what’s in the best interest of the child that I find particularly troublesome. Some argue that it is always in the best interest of the child to be born; thus, it is in the best interest of a child born to a woman in her 50s because his alternative would be to not exist. This argument seems troublingly circular to me. Following this logic, it would be in the best interest of a child to be born to parents of any age and any life expectancy.
Who Decides What is Too Old
Age is such a fluid concept. One person is old, both physically and mentally at 35, while someone else is the proverbial “young at heart” and flexible at body well into their 60s. Should spirit and ability be the determining factor, and how, pray tell do we determine those qualities? Should estimated number of future years be the criteria rather than actual age? What about the 20 something cancer survivor who needs donor eggs to become a mom? Does her prognosis of reoccurrence factor into the decision of whether to treat? But no matter how fluid we want to think of age, the truth is that we only have a finite number of years on this earth, and the universe of older parents will not be around as long as the general universe of younger parents.
What Older Parents “Owe” Their Child
A commentary by Susan Drummond suggests that rather than focus on age or life expectancy, we should determine whether to allow access to infertilty treatment based on the parents plans for care of their child if they die before she reaches maturity. Older parents owe their children “thoughtfulness and care of parental plans for sheltering [the] child within a capricious world.” Ms. Drummond, who gave birth to her second child at age 50, teaches family and reproduction law at Osgoode Hall Law School.
Ms. Drummond argues that infertility clinics must inquire of older parents what plans they have in place to provide for the child in case they die before the child has grown. “There is some latitude for them to query whether they can abide their role in bringing a child into the world whose small house may lie in ruins before the age of comprehension.” She thinks this approach should apply regardless of the age of the infertility patient.
A 72-year-old parent could convincingly answer that they have coupled with a caring 37 year old who will help their child come to terms with the inevitability of loss. Technology now allows that older parent to be male or female. A 25-year-old diabetic and his 26-year-old cancer-surviving partner may be longevity-challenged when she turns to assisted reproduction. A disabled couple may, like them, have made compensatory plans to deal with foreseeable fatigue and other contingencies related to the raising of their particular children. A single woman who has built a sturdy network of friends and family to step into a foreseeable breach may allay reasonable concerns about a child’s exquisite vulnerability to loss. An older woman in a polygamous relationship (as was a 70-year-old Indian woman who gave birth for the first time) may well have made a cosy enough place for a child to dwell. Two older gay men using the services of a 27-year-old gestational carrier and 24-year-old egg donor may have added to the strength of their union a rambunctious gang of fussing and eager supporters. Two married lesbians with a known gay sperm donor may well have over-secured the odds of ensuring that one of them is around…”
The ASRM Ethics Committee seems to agree. They encourage fertility clinics to discuss “short- and longterm parenting and child-rearing issues speci?c to their age. The age and health of the partner, if present, should be considered in this discussion.”
What do you think? Is there an age where infertility treatment should be denied? Who decides?
Image credit: Us Magazine
I think thst based on sll those variable described every case shpuld be evaluated singularly for it’s own specifics. We cannot have a one rule fits all kind of approach!
Nice and informative paragraphs and articles thanks for sharing this site…
Great post about women health awareness for infertility issues.
My husband and I would desperately love to have a child. We want an egg donor with my husband providing the sperm. We are both healthy and have a backup custodian for the child should we depart early. My husband is 72 and I am 73. We both work full time and have an active lifestyle. Can you recommend anyone/clinic that could help us?
A good place to start is a frank conversation with your primary care physicians.
I am at the early stage of all the test before IVF with donor egg. I feel really confuse and worried because, even though I deeply, I mean we deeply ( me and hubby) want to have our own child… go through the experience of pregnancy and all the excitement that this brings, I am worried that the hormones level that I would have to go through would lead me to future health issue ( I have strong family history of breast cancer and I am 47). I was considering adoption as the other alternative, my husband not so convinced of this.
Would like to know if anybody can give me their insight on this, although I know that ultimately is a personal choice. Thanks.
Aysha, this is a question that you should specifically ask a breast cancer specialist. I understand completely your concern, but although I’m not a doctor, I would assume the answer might depend on the type of breast cancer that is connected to your family. In my opinion if you have a strong family history of breast cancer, a consultation with a breast cancer specialist would be something I would do regardless of considering IVF.
Nice informative Post Dawn, And an interesting topic to discuss, I think there shouldn’t be an age limit in fertility treatment.Today science has enough power that we get the best result without any failure. One can go through IVF treatment for a better result. Thank you for sharing this post, which must be helpful to the needy.
That’s an interesting point I hadn’t thought of.
It is an interesting debate. Especially as some European countries are legally placing age limits that unwittingly are leaving frozen embryos in limbo because the parents are more older than the age limits allow.
I’m happy to see this. I’ll be 51 this month and my husband and I are going to try IVF with donor eggs. I am American, living in Europe, and I’ll be returning to the States in a few months to go through the process. Europe makes things so difficult. I’m tired of people telling me I’m too old when I’m in much better shape (emotionally, physically, and financially) than most 20 and 30 year-olds! My husband’s mother had her 6th child at 46 (unplanned), and she’s 83 today and in great shape- better than most people my age! Like anon said, we can all die, not just older mothers.
the ethics committee has been careful not to set any hard and fast rules. their recommnedation is that egg donation be discouraged over age 55, enven if the recipient is healthy. this seems like a reasonable guideline. Generlly clinics set their own rules, and many cut off donation after 50 or 52. We have no rules and have two 57 year olds in the pipeline. but there does need to be a ceiling somewhere. We should follow the guideline unless it is for a second baby. Who would deny replacement of frozen embryos after a previous donor cycle just because she has passed a milestone?
Another issue to deal with in the 45-55 year group is the definition of “healthy”. is mild controlled hypertension ok? These ladies are headed for toxemia. is mild diabetes ok? How about obesity? How much is too much of that?
Dr. Massey, you raise a good point that patients and doctors have differing definitions of “healthy” and even amongst infertility doctors there is not agreement. I spoke with a high risk obstetrician once who said they were never consulted until after the pregnancy occurred, and then they were the ones “left holding the bag” so to speak. I thought she had a good point.
Adoption can be a wonderful option for some couple, but it’s not a decision that should be made lightly. Suggesting adoption in a flippant way ignores the financial and emotional costs of adoption.
IVF Treatment, I completely agree with your point, but am confused about who was flippantly suggesting adoption.
shouldn’t it really be up to the woman/couple? Men have always had the opportunity to have children whenever they want – and many do have them at much older ages.
I do agree, however, that a reponsible parent (at any age) will plan for what happens to their child if they die. Many don’t, however.
anon, you’re right that age is not a limit for men; however, most often the man has the child with a much younger woman so that at least one parent has a longer life expectancy. Now, with IVF and egg donation or embryo donation, the woman herself is also older. Her husband/partner may be younger, but most often in cases I’ve seen the woman is single or with a man of similar or older age.
This is a tough call for me. Before going thought IF I wouldn’t have hesitated to say there absolutely should be an age limit on going through fertility treatment. But now that I’ve gone through it, I hesitate to judge anyone’s decision when it comes to IF. I guess it depends upon your perspective of where you are coming from. As an outsider it’s easy to say what someone should do but if you’re living through it or have gone through it your perspective changes especially with how our society looks down upon and outcasts the childless.
Greg, you raise such a good point. Once you’ve walked in the shoes of someone trying desperately to have a child, it is much harder to judge.