Should we impose an age limit on IVF?
Posted: Wednesday 3 June 2009
Yes Dr Peter Bowen-Simpkins
Spokesman, Royal College of Obstetrics and Gynaecology
The maximum age at which a woman can receive IVF treatment varies from about 40 in NHS clinics to 50 in private clinics. It is normally accepted among fertility doctors that women over 50 should not be treated unless they are still having their periods. After that, they should not receive IVF unless there are very exceptional circumstances, such as a woman who had had a serious disease that had left her infertile.
The Human Fertilisation and Embryology Authority issues a code of practice, which we are expected to abide by. They look at our decisions when deciding whether to renew our licence. One of the primary things that we have to consider when deciding whether to offer IVF is the welfare of the child. The age of the mother is a very significant factor in their welfare.
When women are in their fifties and sixties, there are important medical risks to both mother and baby before the baby is born, even if the woman feels well. The most important risk is the likelihood of hypertension (high blood pressure). Normally this is not a huge problem, but in pregnancy it has a much more important place.
If the blood pressure is raised, women can develop preeclampsia, which can lead to growth retardation in the baby. Depending on how well the baby is doing, there may be other dangers. Women have an increased risk of getting late onset diabetes into their fifties and being pregnant can tip the balance. If they develop Type 2 diabetes, it can cause problems with the pregnancy.
The other problem that can occur is a higher incidence of antepartum haemorrhage (bleeding from the birth canal) before the baby is born. It can endanger the baby's life and the mother's. Most women over 45 end up with a Caesarean section because the bones of the pelvis don't stretch. This may lead to problems such as deep vein thrombosis which are more likely the older you get.
After the baby is born, the main concern is looking after it. A young baby is very time-consuming and older women don't adapt so easily.
Clinics abroad that treat older women perhaps do it for financial gain, rather than for the sake of the baby. The mother is intent on having a child and there is a view in society that a woman has a right to do so. But nature precludes it in later life for good reason.
People say, "Men have babies much older so why shouldn't women?". But the woman is the prime carer and is usually considerably younger than these older fathers. The 66-year-old is a single woman with no children of her own and no dependants. Who is to look after this child when she dies? Who is to look after her? When the child is 15 and doing its GCSEs, she will be 82. Is that fair? It is easy to see why the general view is that this is selfish.
A 45-year-old is very different from a 65-year-old. You can't stop people from going abroad to have IVF treatment. But it is the NHS that has to pick up the bill if things go wrong.
No Dr Gillian Lockwood
Medical director, Midland Fertility Services
To impose an age limit on IVF is arbitrary and unkind and does not reflect underlying health issues. It is true that the older a woman gets, risks associated with pregnancy go up. But they are still relatively low compared with the very strong desire for motherhood in later years. To assume that women can't recognise the risks and weigh up the decision is woefully paternalistic.
The medical view in countries where IVF is regularly given to women in their fifties is that as long as the woman is in good health at the outset - doesn't smoke, has normal blood pressure and is a healthy weight - she is likely to come through without significant problems. Donor eggs come from women under 35, so the risks of a pregnancy miscarrying are very low. It is vital that only one embryo is transferred, though, as more can be very dangerous.
By contrast we are often keen to help young women with very serious health problems to conceive. I have done IVF with women who have had kidney transplants or have very severe diabetes, even though they may have a curtailed life expectancy.
A fit 55-year-old can expect at least 25 years of heathy active life; a woman in her sixties might look and feel very young. It depends entirely on the individual case. It is vital to assess psychological state and find out what the motivation is. Do they have a support network - a partner, extended family and any experience of looking after children? The vision of the beautiful baby asleep in the Moses basket is not the reality. They need to be able to cope with looking after a teenager.
A lot of women see education, career and financial stability as a prerequisite for having a baby. By the time they get there, biological time has run out. Often they have held off, desperately hoping the right man was just around the corner. There are often very good reasons for waiting - they may have been caring for elderly parents.
In all cases the child's welfare is paramount. But lots of children conceived the old-fashioned way grow up as carers for elderly or disabled parents. Half of babies are made by accident. In my experience, a woman willing to put herself through the difficulties of IVF has made a very considered decision.
Evidence suggests that children born into unusual circumstances tend to receive better-quality parenting. Older people tend to be financially and emotionally more secure. The 66-year-old is independently wealthy and would be able to afford a nursery nurse.
I don't believe that older women should be a priority for donor eggs on the NHS when a shortage means that some women who have had chemotherapy can't get them. But if a woman can afford to go abroad for treatment, why not? Motivations for having babies down the centuries have been mixed.
It worries me that it is so difficult for older women to get support on IVF. If a man becomes a father in his sixties, it is "cigars all round", although women have a much longer life expectancy.
(From The Times - May 28, 2009)
see the wonderblog post on this subject too
