Mature Motherhood

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by Arthur Leader, MD
Winter 2005

In vitro fertilization with donated oocytes has artificially extended a woman’s reproductive age. Now any postmenopausal woman can become pregnant. The greatest increase in multiple pregnancy rates in the United States is in the post-menopausal age group.

It’s one thing for a 57-year-old woman to conceive spontaneously. But is it ethical to put three people at risk (the child or children, the egg donor and the recipient herself) so that a woman who has delayed childbearing for “personal reasons” until her menopausal years can become pregnant?

Women aged 50 years or older, who are well screened and in perfect health and who conceive with donated eggs from young women, are putting their lives – and that of their fetus – at risk for a host of physical problems. They’ve been shown to be at increased medical risk of hypertension (tenfold), diabetes (fivefold), pre-term (threefold) and operative delivery (twofold) and placental abruption. The incidence of these complications increases markedly in women older than 55. Moreover, irresponsible practitioners who continue to transfer three or more embryos to these women – thereby creating high-risk multiple pregnancies – further augment these risks.

The interests of children aren’t served by the application of this technology to menopausal women. A premature operative delivery as one of two or more low birth-weight multiples isn’t in the best interest of any child. Parenting is a physically demanding experience and older women and their partners may not have the stamina in their 60s and 70s to meet the needs of growing young children and adolescents. Is a child well served by having a mother who is old enough to be her grandmother or who dies before the child’s 18th birthday? Is a child likely to be adversely affected, both socially and emotionally, by having much older parents? We don’t know. But in couples where both partners are old, how secure are their parenting abilities and their ability to financially support a child (or children) into young adulthood?

And what of the egg donor? The Assisted Human Reproduction Act of 2004 made donor payment a criminal offence in Canada so that this activity is either covert here or pursued in the United States at a cost of $40,000 per attempt. In exchange for monetary compensation, egg donors put themselves at risk for a less than noble cause. Those risks include severe ovarian hyperstimulation, pelvic infection and bleeding. And we don’t know the psychological impact of egg donation on women later in life, nor do we know if children, on the death of an elderly mother, would seek out their egg donor, much like the children of donor sperm insemination have done.

Advanced age raises concerns about health, finances, and emotional and real support systems. The goal of in vitro fertilization was intended to assist those who otherwise would be denied the experience of pregnancy and parenthood. It wasn’t intended to make that assistance eternal.

by Norm Barwin, MD

Now Abraham and Sarah were old and well stricken in age; and it ceased to be with Sarah after the manner of women ... And the Lord visited Sarah as he had said and the Lord did unto Sarah as he had spoken. For Sarah conceived and bare Abraham a son in his old age, at the set of time of which God had spoken to him.” – Genesis 18:11, 21:1

Today’s technology makes it possible for older women to have successful pregnancies with a lower risk to both the mother and baby. The risk of abortion and genetic abnormalities are greatly reduced because of the ability to freeze the ova of young women or through the use of donor eggs. Technical and safety issues are no longer relevant when considering whether older women should be given a chance to bear children.

Reproductive technology is far ahead of ethics and the law. The issue of whether it’s safe or even possible for women over a certain age to conceive and have a normal pregnancy and delivery is no longer debatable. What’s relevant is whether it’s reasonable for older patients to have the right to use this technology.

Today, scores of women postpone motherhood – they often don’t get married until a relatively older age. As adults, the children will then be able to look after their elderly parents, saving the state a potential cost.

From the physician’s perspective, doctors should have the choice as to whether to offer treatment. The same criteria should be applied when treating single women or a lesbian couple – the physician must feel comfortable that there is adequate family support and that the patient is emotionally and financially able to support a family.

The argument that it’s unfair for a child to have such older parents doesn’t stand up. For one, many children born to young parents may also suffer parental losses. An older parent has thought through the consequences of having children who will be loved and wanted. In addition, older individuals are now physically fitter and living longer lives.

Most important, providing the ability to have children is positive from both the parent’s and the child’s perspective. They’re fulfilled and wonderful parents with happy and loved children – and they’re exercising a basic right. So why is this any different than an older patient having the right to a heart transplant or cosmetic surgery?

Decades ago, childbirth for a woman in her 40s was rare and considered dangerous. Today, it’s extremely common. So why not break that barrier for a vibrant, healthy and energetic woman in her 60s?

About the authors: Arthur Leader, MD, FRCSC, is Professor of Obstetrics/Gynecology and Medicine (Endocrinology) at the University of Ottawa. He is also Chief of Reproductive Medicine at the Ottawa Hospital. Norm Barwin, MD, FRCOG, is Director of the Broadview Fertility/Gynecology Clinic in Ottawa. He teaches at the University of Ottawa. Dr. Barwin is also a member of the Order of Canada.

This article first appeared in the September 2005 issue of Parkhurst Exchange magazine (pp. 36–37). Copyright 2005 by Parkhurst Publishing. Reprinted by permission.