|Adriana Iliescu, the 66-year-old Romanian who gave birth to a baby girl in Bucharest, in 2005. Doctors said she was the world's oldest recorded woman to give birth.
Photograph by: VADIM GHIRDA/AFP/Getty Images) , Postmedia News
Healthy postmenopausal women shouldn’t be discouraged from pursuing pregnancy using donor eggs or embryos, one of the world’s largest organizations of reproductive medicine says.
In a shift in its official stance on whether women of “advanced age” should be discouraged from achieving pregnancy, the ethics committee of the American Society for Reproductive Medicine now says that some women over 50 who are healthy and “well prepared” for child rearing are candidates to receive donated eggs.
The society sees it as a natural extension of what science can do. But not everyone agrees with the idea of artificially extending fertility past 50. The group’s guidelines strongly influence practice in Canada.
While infertility may be a natural consequence of menopause, the committee says that allowing women to conceive through egg donation “is not such a significant departure from other currently accepted fertility treatments as to be considered ethically inappropriate in postmenopausal women.”
The old statement, published in 2004, said that, given the physical and psychological risks involved, “postmenopausal pregnancy should be discouraged.”
While the data on the risks to older women and their fetuses is still scant, it’s more reassuring than what was available in 2004, particularly in women aged 50 to 54, says committee chair Dr. Paula Amato, a Toronto native and associate professor of obstetrics and gynecology at Oregon Health and Science University.
“The risks are still increased compared to younger women,” she said in an interview with Postmedia News. “But we’re not discouraging it.”
For women over 55, “substantial caution should be exercised” when considering egg or embryo donation, the committee says. The risks of gestational diabetes, pregnancy-induced high blood pressure and other complications increase the older the woman gets, and are particularly high after 55.
“We’re saying we have more data in the 50 to 54 age group, but we’re still discouraging it after age 55,” Amato says.
Egg donations have made it possible for virtually any woman with a functioning uterus, regardless of how old she is, to have a baby, the committee says. A woman’s own egg supply and quality shrinks over time; at menopause she stops releasing eggs altogether. But she can conceive using the eggs of a younger woman. As a result, more women in their 50s are seeking fertility treatments. Some have re-married, or married for the first time; others want to use frozen embryos left over from an earlier IVF cycle.
Meanwhile, younger women are putting their eggs in cold storage, freezing them until they’re ready to try to have a baby.
Nearly half the nation’s fertility clinics are offering “social egg freezing.” Some have also created and stored embryos for young couples. As a result, more people will be looking to have their freeze banked eggs or embryos thawed when they’re older and ready to be parents.
But, how old is too old?
In at least one case, doctors in Canada have transferred an embryo created by in vitro fertilization and conceived with donor eggs into a 57-year-old woman. The average age of menopause in Canada is about 52.
Experts say egg or embryo donation to women of an advanced reproductive age raises sticky social questions, notably, is it in the best interests of the child to have a mother old enough to be a grandmother? Just because we can do something, should we?
“When age creates a situation where you could have orphans, or someone who doesn’t have the health or the energy to parent — where your child is entering high school and you’re entering a nursing home — that’s not the ideal situation or what the child needs,” says bioethicist Arthur Caplan, director of the division of medical ethics at New York University Langone Medical Centre.
“The focus isn’t so much on trying to say older parents couldn’t be good parents. They have the resources, they have the wisdom,” he said.
“But the reality is that nobody, in spite of a lot of ideology, beats father time,” he said. “Health and energy begins to wane, and disease and disability starts to escalate in your 60s and 70s.
“I know we all want to believe that 50 is the new 30,” Caplan said. “But that’s more in the magazines than it is in anybody’s actuarial chart,” he said. “Most people faced with the prospect of becoming a parent at 60 would rather visit a psychiatrist than a fertility specialist.”
More seriously, he worries that too little is known about the risks.
Dr. Matt Gysler, president of the Canadian Fertility and Andrology Society, says that, in addition to an increased risk of uterine growth restriction and hypertensive disorders, pregnancy in older age places a significant stress on a woman’s cardiovascular system because of increased blood volume and increased blood flow. Other studies have shown an increased risk of maternal death.
Menopause isn’t the defining issue, he says. “It’s really an issue of trying to assess at which time the physiologic or health status of the mother no longer gives you a low, predictable risk.”
“Is a fit California woman who has exercised and not smoked for 30 years; is in good physical shape and goes through all the appropriate assessments the same as someone who is overweight and has all kinds of medical problems?” (The ASRM ethics committee says egg and embryo donation should be “strongly discouraged” in women with underlying medical problems that could make pregnancy even more risky.) “We don’t have the hard data on pregnancies in older women for the simple fact they didn’t occur before ART (assisted reproductive technologies),” Gysler said.
Some say it is sexist to suggest age limits should be imposed on a woman’s right to bear children when no one imposes a biological deadline on men.
“Certainly nobody would tell a man that he couldn’t reproduce after a certain age,” Amato said.
Those opposed to egg donation in older women argue that menopause happens for a reason, she said, and that it’s “unnatural” to extend the limits of reproduction. “But a lot of things we do in assisted reproduction counteracts what might be considered natural, so I don’t know that that’s valid.”
The main argument in favour of egg donation to older women is patient autonomy, Amato said, “and in this country, and in Canada as well, that sort of takes precedence over everything.
“People have the right to choose, to make their own reproductive choices. And that’s highly respected.”
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