Is 62 too old for a baby?

08 August 2016

Revolution in reproductive choices started in the 1960’s with the introduction of the oral contraceptive pill, legal termination of pregnancy, the use of donor sperm and then the introduction of IVF in the late 1970’s. Since then reproductive choices have continued to expand including prediction of genetic abnormalities in pregnancy, surrogacy, egg donation, genetic testing of embryos and the use of embryonic stem cells to attempt to cure disease.  Almost all of the scientific achievements have leaped ahead of legal or ethical controls, and the skills of scientists combined with the imagination of patients have led to many challenging situations. This is shown by two instances in the last weeks where IVF has been on the front page of the newspapers.  The first was selection of the gender of the embryos for family balancing and the second has been the 63 year old who delivered a baby following a donor embryo overseas. Natural reproduction for a women slows dramatically in the 40’s and almost invariably is finished by the age of 46 years.  Use of donor eggs or an embryo donated from a younger woman completely reverses this situation so that women after menopause are able to carry and deliver healthy babies.  This is not without risk, however, as pregnancy can become much more complicated with increasing age including high blood pressure, diabetes, blood clots and delivery problems.  This is further complicated by the fact that the genetics of the developing baby can be completely different to that of the mother and lead to problems. My objection to trying to extend reproductive life beyond that of menopause are in three key areas.  The first is that there is danger for the mother and her pregnancy to have a child beyond the age for which nature has determined is the safest period.  The second is that children should grow up with at least one parent who is able to interact and care for that child until adulthood.  If someone is 63 when they have their baby, that child will enter their teenage years when the mother is mid 70’s and in the case of the father in the early 90’s.  That is assuming that they are both healthy and are still alive.  The third issue is the inappropriate use of resources for couples who do not face the normal medical indications of disease or disability but have the mind set of disillusionment.  Modern medicine and its funding should be based around the consensus of what the general public think is the most appropriate use of their money for care. Once of the problems that we face in reproductive medicine is cross border reproduction whereby couples who can’t get something in one country will go to another country.  Around the world there are clinics that will provide virtually anything that people want for financial gain.  It seems odd that when you can’t do something in Australia you can get on an aeroplane and get it anywhere else in the world.  There is a need for harmonisation of laws and practices across the globe and in Adelaide we are involved in trying to get people together to agree on common policies based on ethical and safe medical principles. The situation we have seen this week did not occur in Australia because fertility doctors in this part of the world are ethical and there is a strong consensus within the medical peer group to avoid these sorts of practices. What we are struggling with is persuading our patients not to take risks by getting on an aeroplane and going to clinics with fewer ethical boundaries. Legislation around fertility treatment and age There are several levels at which fertility treatment and advanced age can be controlled in Australia.  The first is ethical guidelines put out by the National Health and Medical Research Council and by and large they are silent on this issue.  The second is the accreditation standards for Australian clinics run by the Fertility Society of Australia – again there is little guidance in this area.  The third is the advice from the Royal Australian and New Zealand College of Obstetrics and Gynaecology which strongly advises against assisted reproduction over the age of 45 years.  Finally there are state laws that regulate reproductive technology and these do not give much information. In Australia, fertility doctors try to avoid providing treatment after the natural age of menopause which can range between 50 and 54 years.  They are not able to prevent patients from going overseas to get treatment which would not be considered ethical in Australia. Professor Rob Norman Medical Director  
Back to Our Blog