Debate

Should there be an Upper Limit for IVF Treatment?

When 66-year-old woman, Bhateri from Haryana district, gave birth to triplets with the help of IVF, concerns were raised over the age of becoming a mother by assisted reproduction. We ask two leading experts their opinion on the issue

What perturbs is not whether such a case is plausible or not, but ethical side of it. It is a very sad picture how technology can be altered from boon to bane. Science today has presented us with options, but it is imperative that they are used judiciously both by the practitioner and the parents, so that it doesn't become an abomination.

Using technology, a woman of any age can become pregnant using donor eggs. However, experts opine that conceiving at an age of 50 and above is not being attentive of the repercussions it will bear on the child. Nature has permitted women to become pregnant only till a certain age, because parenthood just does not imply giving birth, it also entails giving a healthy future and childhood to the little ones which cannot be expected from parents who themselves are medically not strong and young enough to successfully deliver the needs of the young children.

IVF should be restricted to women till the age of 50 years, as it is well proven that pregnancy at higher age is associated with risks to the mother as well the baby. There are greater chances of high blood pressure, convulsions, diabetes in the pregnant woman and thus the chances of growth restriction, prematurity, genetic defects and consequently mortality are high in children born to older mothers. Bringing a new life when one is not very sure if they could provide them with a quality life is a question that should be strictly governed by law. I therefore, urge the Indian Government to take this matter on priority and prevent many innocent lives from being lost.

The birth of triplets to Bhateri also highlights the risks as all the babies born have a birth weight of less than 1.5 kilo grams which enhances and compounds all these risks already discussed. In the UK— the birth place of IVF (1978), there are strict regulations under the HFEA (Human Fertilisation and Embryology Authority) where all the 78 ART clinics have to follow these regulations. Under this law, only one or two embryos are to be placed in the womb of the woman, numbers change to three only in very exceptional scenarios like previous multiple failed attempts.

One of the most important determinants is the number of embryos that we transfer into the womb of a woman in a particular cycle. So if we transfer one, then chance of multiple pregnancies is very low, if you transfer two, it is about 25 per cent, if you transfer three or more, it is higher.

In India, Assisted Reproduction or IVF is under the purview of Indian Council of Medical Research and there are only guidelines and no law/ regulation yet that could strictly look in to this, due to which, minimum number of embryos used is three, leading to multiple pregnancies. Therefore, it becomes imperative that till such laws come into effect, all IVF practitioners use this technology righteously and stop celebrating the birth of triplets to a 66-year-old woman.

Should there be an age limit for becoming a mother? In actual fact, older women are likely to make very good mothers. They are mature and have spent a lot of time and energy in making the decision to have a baby, which means they are likely to be thoughtful and caring parents! While they may not have as much physical energy, they are likely to have many more financial resources! And they are much more likely to make better parents than 14-year-old unmarried girls (who society allows to have babies, just because they are capable of doing so biologically and do not need our permission to do so!).

What is the oldest age at which an infertility specialist should accept a woman for treatment? Is there a particular age at which a woman should be denied treatment? If so, then why and what should this age be? And who should decide? 'Menopausal mums' have grabbed much media attention, and have raised a number of controversies— which still remain unresolved.

Let's explore this in more detail. Let's suppose we decide, like some countries have done, that the age cut-off should be 45 and that women who are more than 45 should not be allowed to have IVF treatment, because they are 'too old'. Then what happens if a 46-year-old woman who is otherwise very healthy wants to have a baby? Is it fair to say 'no' to her just because she is one year past the cut off age? Why?

I agree that this issue does raise a number of ethical issues! Are IVF doctors being irresponsible (in order to earn more money) by agreeing to such requests? Is it fair for the child (who is likely to become an orphan at a young age, because his mother is likely to die in a few years)? Should society lay down guidelines (like it does for adoption)? Or is it a decision which the woman should make for herself? Are we being ageist by not allowing older women to use this technique, just because we think it is 'unnatural'? Isn't it sexist as well? When a 70-year-old man gets a 20-year-old woman pregnant, society applauds his virility and manhood! Why shouldn't we be happy to encourage older women who want to have kids as well? After all, this is their personal decision, and we should be happy to honour their autonomy. They are not harming anyone and if they are well off enough to afford IVF treatment with their own funds, presumably they are well off to be able to provide for the child's well-being, even after their death. Maybe in an Indian joint family, the child will be well-cared for, whether the birthing mother is infirm or not? One option would be to make independent counseling mandatory for older women, before they go in for donor egg or donor embryo IVF, so we can help them to make the right decision.