How old is too old to give birth?

July 27, 2009
Accounts of post-menopausal women having children have become a news staple over the past decade. From a UK perspective, a number of cases have been particularly prominent, these include: 60 year old Liz Buttle, who allegedly declared her age as 49 when receiving fertility treatment prior to the birth of her son in 1997; Lynne Bezant who was known to be 56 before receiving treatment that resulted in her giving birth to twins in May 2001; 62 year old Patricia Rashbrook who gave birth to a son in July 2006, having travelled to the former Soviet Union to achieve her conception with the aid of maverick Italian specialist Severino Antinori; and Elizabeth Adeney who, by giving birth just shy of 67, became Britain’s oldest mum.

Amanda Blue’s excellent Cutting Edge documentary The World’s Oldest Mums (Channel 4, 23rd July 2009) examined the cases of four women who were all at or near the age of 70 when the film was made.

Jenny Brown: 72 year old Jenny is “bursting to be a mother” and is seeking a clinic willing to help her to do so. The film shows her applying to, and being turned down by, the Bridge Centre in London and later trying to contact fertility specialists in Eastern Europe to fulfil her dream.

72 year old Jenny is seeking a clinic in the former Soviet Union willing to help her to have a child

72 year old Jenny is seeking a clinic in the former Soviet Union willing to help her to have a child

Rajo Devi: Currently, the oldest mother in the world is 70 year old Indian Rajo Devi. Partly due to the social stigma associated with childlessness, India is becoming a major centre for the fertility treatment of older women; more than half of the 200 patients at one IVF clinic featured in the documentary are aged over 50.

Rajo Devi became a mother at 70 and (at the time of writing) is the oldest mother in the world

Rajo Devi became a mother at 70 and (at the time of writing) is the oldest mother in the world

Mary Shearing: Interviews with 16 year old twins Amy and Kelly, reinforce the fact that fertility treatment to allow postmenopausal women per se is not a new phenomenon. The fact that their mother Mary Shearing has only recently turned 70, however, emphasises that the boundaries of possibility (and acceptability?) are certainly shifting.

Mary Shearing gave birth to twin daughters in November 1992 at the age of 53

Mary Shearing gave birth to twin daughters in November 1992 at the age of 53

Maria del Carmen Bousada de Lara: The saddest story in the documentary, concerns Maria del Carmen – saddest both in terms of the circumstances under which she came to find herself seeking fertility treatment, and the fact that she died a few weeks after the filming of her interview (see here for news report).

Maria

Maria died from ovarian cancer when her twin boys were 2 years old

With three brothers but no sister, Maria faithfully fulfilled the expected role and devoted much of her adult life to caring for her widowed mother. It was to Maria’s great misfortune that her mother lived to be over 100. It was only after this time that Maria felt able to seek fertility treatment, covertly flying to the USA and lying about her age to do so.

Is it right to give elderly women help to get pregnant?
What insights do these case offer regarding the ethics of helping post-menopausal women to have children? These four examples illustrate some of the arguments presented both in favour and in opposition to allowing fertility treatment for older women.

Arguments in favour
Advocates of fertility treatment for older women may argue in terms of individual autonomy, or may speak of rights, either rights to have a family per se, or more specifically under Article 8 of the Human Rights Act/European Convention of Human Rights, for the right to privacy. It is also possible to frame arguments in terms of the suffering of childlessness. In the case of Rajo Devi, it is clear that the stigma is greater; in her culture it is considered bad luck to encounter a barren woman on the street before lunchtime and in consequence her recent pregnancy has brought additional relief from ostracism (against this, it might be argued, we ought to challenge prejudice, not pander to it).

Advocates of treatment for older mothers may also highlight the unfair way in which women (in western culture, in particular) are villified for having families in their advanced years, whilst men who father children at equivalent ages are not judged in the same way, and may even by celebrated for their virility. Eric Clapton, for example had three daughters in his late 50s, and Rod Stewart‘s seventh child was born when he was 60.

Arguments against treatment
For many people there is an inherent ‘yuk’ factor regarding older mothers. How can this moral repugnance be substantiated? It has been argued that embarking on a family at extreme ages demonstrates gross selfishness. This, however, can be a misleading oversimplification. Whilst it may be the case that a woman has put career development before family (there is some evidence of this in the case of Jenny Brown, for example), there may be other reasons for the delay. As demonstrated in the case of Maria del Carmen, it was actually a lack of selfishness that resulted in her leaving it so late to start a family, since she had devoted her life to caring for her mother. Regardless of the motivation, Robert Winston is amongst several commentators warning women not to assume that IVF will routinely provide them with a family at a later stage (see Career women given ‘false optimism’ by fertility clinics).

Those opposed to fertility treatment for older women may argue that there are health risks for the mother, and risks that her children will likely lose their mum at a tender age. Taking each of these in turn; it is certainly true that becoming a mother late in one’s life can take a terrible toll on the body. Mary Shearing comes across as a remarkably active 70 year old – we see her in the film water-skiing and working out in the gym. She was, however, ‘only’ 53 when she had her twins. Rajo complains of ongoing stomach pains after the birth and, although it is not expressly suggested in the documentary, there may well be a connection between the fertility treatment received by Maria and her subsequent ovarian cancer.

Regarding the premature death of their mother, it is – of course – true that over the course of history mothers have generally died much earlier in the life of their children than is the norm today; indeed, many would have died during childbirth itself. Nevertheless, there does seem to be a qualitative difference between the possibility of a parent dying during your childhood and the likelihood that this will be the case. Maria’s case is a sad reminder of this reality.

Additionally, it may be stressed that donated oocytes are a relatively rare commodity within healthcare provision and since it is a biological truism that fertility treatment is less successful for older women than for younger, available eggs should be prioritised towards younger candidates.

If not age, what other criteria should be used to determine who gets the egg? Should priority be given to women who have not had children before? Several of the cited examples already had adult children, including Mary Shearing and Lynne Bezant. Should onset of the menopause be a cut-off point? If so, what about women who have early menopause (ie before 45) or even premature menopause (in women under 40) ?

Ability to pay is a likely factor, particularly since NICE (the UK National Institute for Clinical Excellence) has state that only women under 40 can receive fertility treatment paid for on the NHS, and some primary care trusts (e.g. Oxfordshire) have set a lower age threshhold for publicly funded treatment. Receipt of treatment on the basis of ability to pay is, of course, identified as a source of injustice against the poor.

Even private clinics may impose some age-related criteria. It is interesting to observe that both Liz Buttle and Maria del Carmen lied about their age to receive treatment, and other evidence suggests that they are not alone in this (see Thousands lie to IVF clinics in desperation to have baby). We must remember too that differences between one jurisdiction and another can lead to patients receiving treatment elsewhere, e.g. Maria going to America and Jenny’s attempt to follow Patricia Rashbrook and others in going to the former Soviet Union (see Older British women head abroad for IVF).

Cutting Edge: The World’s Oldest Mums was first broadcast on Channel 4 at 9 pm on Thursday 23rd July 2009. At the time of writing it is available via 4OD their catch-up service. BUFVC members can obtain a copy via their institutional representative in the usual way (TRILT ID: 0109BBFE).

(CJRW)


The Daily Politics Show – “Should we be more wary of genetic screening?”

February 9, 2009
Watch this edition of The Daily Politics Show via BBC iPlayer (freely available until February 10th 2009)

The Daily Politics Show

The edition of The Daily Politics Show broadcast on BBC2 on February 3rd 2009 contained an item on the use of embryo screening during IVF (see 00:15:42 to 00:22:25). The section begins with a short explanatory VT, which covers the technique of prenatal genetic diagnosis – PGD – and its uses in IVF, and some of the main ethical positions. The programme’s hosts – Andew Neil and Sangita Myska – then discuss the ethical implications of genetic screening and embryo selection with Professor Robert Winston. This short post summaries the main bioethical arguments put forward in this 7 minute clip, and suggests how it may be used in teaching.

Read the rest of this entry »


Superdoctors – Miracle cures

October 20, 2008

Robert Winston introducing the programme

Commenting in the second episode of the three part Superdoctors series that “one of the most exciting frontiers of our age is stem cells“, Robert Winston goes on to ask “how will these cutting edge technologies change the way that you, and I, and are children are treated?” (Start – 00:04:02). Stem cell therapy is at the beginning of its expected transition from the laboratory to the clinical application. The programme seeks to distinguish the hype from the genuine developments and to examine some of the hard decisions that need to be taken. Several of the key ethical issues associated with stem cell research have been considered in posts about other programmes (see for example Are hybrid embryos an ethical step too far? – The Big Questions and Bioethics Briefing – Stem cells). This episode, however, is particularly useful for consideration of two issues:

  • Public understanding of science and the management of expectations
  • Clinical trials and “therapeutic misconception”

Read the rest of this entry »


Genetic testing – Child of our time

January 31, 2008

In 2000, the BBC launched Child of our time, an ambitious experiment to record the lives of twenty-five children over twenty years. The aim was to establish how our genes and the environment combine to make us who we are and shape our personality. Sir Robert Winston (IVF – A child against all odds) the fertility expert and TV personality presents the programmes as they follow a series of newborns from before birth through to adulthood.

BBC Child of our time Homepage

 
BBC ‘Child of our time’ Homepage  

In this post we focus on two segments for the first series of Child of our time.  These are: Series 1 The journey begins (00:22:00 – 00:28:40) and  Series 1 – Birthdays (00:23:00 – 00:24:26).  Both episodes are available online, see bottom of this post for details about how to access them.

This bioethical discussion, focuses on one set of parents, Neil and Gillian Roberts, who decide to be genetically tested for the Angiotensin I converting enzyme (ACE) gene. It has been suggested that certain variants of this gene help increase stamina and efficient use of oxygen, and thus have been linked to success in sporting activities The father, a keen athlete and sportsman, suggests that both he and the future mother be tested for this variant to establish whether their new born might subsequently have a chance of inheriting it. The result (which appears in the ‘Birthdays’ episode) is negative and neither parent has this particular variant. Read the rest of this entry »


Follow

Get every new post delivered to your Inbox.