Dominic Wilkinson, @Neonatalethics
Reports that a 62-year-old Spanish woman has given birth after IVF treatment have led many to question whether there should be age limits with such treatment. Lina Alvarez, a doctor in north-west Spain, isn’t the oldest person to have had success with IVF. Earlier this year, in India, Daljinder Kaur is said to have given birth at the age of 72, prompting calls from the Indian Medical Council for a ban on fertility treatment in women over the age of 50.
In many countries where there is funding assistance for IVF there is a limit to obtaining treatment over a certain age. In Britain, for example, the bar is set at age 42. But Alvarez received private treatment. So why care about her age? And what business is it of the rest of us whether she has access to IVF?
There are several arguments that typically surface in debates about age and fertility treatment – and they are all deeply flawed.
1. Having an older mother is harmful
It is sometimes claimed that children will be harmed if older mothers are allowed access to IVF. This might be because older mothers will not be able to meet the physical demands of lifting, playing with and caring for a small child. It might be because it would be a bad thing for a child if their mother were to die while they are still young.
However, in some countries women of Alvarez’s age on average can expect to live to the age of 85. This means most older mothers around her age will live to see their child grow up and leave home. Many children already receive regular care from grandparents (44% in the UK) and we do not usually think that this is bad for the child. While some older women may struggle with the physical demands of childcare, that will also be true of some younger women.
Essentially, this argument only works if we think that the lives of children born to older mothers are going to be so bad that it would be better that they had never been born. However, this isn’t at all likely.
2. Being pregnant while older is harmful
Doctors sometimes worry about high rates of complications with pregnancy in older women. Older mothers do have higher rates of a number of medical problems during pregnancy, including high blood pressure, diabetes, and premature labour. But most won’t. One study found that around 80% of women aged over 45 had no major medical problems during pregnancy and more than 80% gave birth at full term.
There are good reasons for women to be aware of those risks of complications, and to take them into account when making decisions about whether or not to become pregnant. But for women without major health problems already, the risks of pregnancy are not so high that they can’t go ahead.
3. IVF doesn’t work in older women
National fertility treatment guidelines in the UK justify not providing NHS IVF treatment to women aged over 42 because of low success rates. For example, the live birth rate following IVF in women over the age of 44 is only 2%.
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Yet these “success” rates are based on IVF treatment with the woman’s own eggs. For women who receive donor eggs or embryos, the chances of a live birth are based on the donor’s age, not on that of the recipient. Where the egg donor is young, older women have the same sort of chances of “success” with IVF as younger women. Donor eggs also avoid the increased risks of major chromosomal problems in the baby (for example Down syndrome) that are seen in older mothers.
4. IVF shouldn’t be publicly funded
People may feel that in a stretched public health system there are other important priorities to fund rather than paying for fertility treatment. For example, funds could be directed instead to improving staffing levels in birthing units, screening for infection, or cancer treatment. But this argument could apply to any fertility treatment, not just for older women. If we are going to provide at least some publicly funded IVF treatment, we should make sure that we provide it fairly, and consistently.
But whether or not public IVF should be funded, these arguments shouldn’t stop someone paying for private fertility treatment, as Alvarez did. One important question is whether patients who have private fertility treatment should have to pay the public health system costs if they later develop medical complications, or their child is born prematurely. One London obstetrician reported large strains on maternity services from women who had received IVF treatment overseas. Usually, in a public health system, we don’t make patients pick up the bill for costs that result from their own free choices. But in cases like this, one possibility might be to require patients to take out medical insurance policies before they access private treatment.
None of these points mean that it is necessarily a good idea to have children at a later stage in life. There are good reasons to advise (if possible) having a child at an earlier age, when fertility rates are higher, there are fewer health risks and IVF is less likely to be needed. There are also good reasons to make sure that women who seek out fertility treatment are fully aware of the risks involved and perhaps for doctors to decline treatment where risks are deemed to be very high. But ultimately, this could apply to younger as well as older women. As such, strict age limits on access to IVF are discriminatory and not justified.
Dominic Wilkinson, Consultant Neonatologist and Professor of Medical Ethics, University of Oxford
This article was originally published on The Conversation. Read the original article.