Should There Be an Age Limit in Fertility Treatment?
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?
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