[stephenkhoo]

Making a case for IVF age cap

Published on Nov 26, 2011


Some may argue elderly menopausal women who opt for IVF do so knowing the risks and consequences, but in fact, society will bear some of the costs, especially the medical care of their offspring. -- PHOTO: AGENCE FRANCE-PRESSE
By Andy Ho, Senior Writer

THE authorities are drafting a new law to cover children brought into the world using in-vitro fertilisation (IVF).

Currently, Ministry of Health guidelines prevent fertility centres here from offering IVF to women over 45. I propose that an age cap be legislated, to give it the weight of law. Since menopause - the end of a woman's menstruation and thus her fertility - ranges from 45 to 55, the legislated age cap could be in-between, at 50.

The National Health Service in Britain advises its doctors not to recommend IVF to women over 40. But private fertility clinics in Britain generally cap it at 50.

Setting this practice in stone would be a good move because it would discourage women who are very much older than 50 from seeking IVF.

A statutory cap would prevent such women from doing it here, although determined menopausal women with the resources could always get it done overseas. But a law would ban the practice here, and send a very strong signal to discourage women from seeking it elsewhere.

We may think that local women in their 60s or older would be sensible enough not to avail themselves of IVF at that advanced age.

But as more women become very highly educated and postpone childbearing to later and later in life for the sake of their careers, the likelihood that elderly women may seek to have children becomes not implausible. It is such a possibility that must be discouraged.

Last year, a Ukrainian named Svetlana Krupenik gave birth to a girl at 50 with the help of IVF, after having tried for children for three decades. This example suggests that at 50, a pregnancy may yet proceed uneventfully, especially with good antenatal care.

In 2008, 57-year-old Briton Susan Tollefsen gave birth to her first child after IVF in Russia and Poland using her partner's sperm and donated eggs. Both mother and child were well at delivery.

Last year, a private clinic in London agreed to take her on for her second child at nearly 60. She later decided not to go through with it because of fears for her health. But the development provoked great debate in the country with Members of Parliament calling to cap the age for IVF by law. Ms Tollefsen recently agreed that she was too old when she had her child. Child rearing put a strain on her relationship with the child's father and they broke up.

Even older women have trod this dangerous path. In 2008, 70-year-old Rajo Devi Lohan of India gave birth two months prematurely to a girl. Her womb ruptured after the caesarean, so surgical repair was necessary.

Then she was diagnosed with an ovarian cyst that might have developed because of the female hormones used to get and keep her pregnant. Next, major surgery to remove the cyst was needed.

Just 18 months after giving birth at 70, she was bedridden and dying.

A women's fertility generally starts declining at about 30. By the time she is menopausal, her ovaries have stopped producing oocytes (eggs), so she can no longer conceive naturally. At that point, the only way to circumvent this natural limit on reproduction is to use IVF.

Menopausal women need hormone replacement therapy to prepare the womb for pregnancy and maintain it. But these hormones also make them more prone to potentially fatal blood clots.

Also, 'older' mothers usually require caesareans. Note that doctors call a woman who has her first baby after 34 an 'elderly primigravida' or 'elderly first time pregnant'. This is because such first pregnancies - way before menopause - are already at higher risk. They are more likely to need caesareans, doubling the risks of complications and death for both mother and child compared to normal labour.

'Elderly primigravidas' are more likely to develop diabetes and/or hypertension during pregnancy. The risk is also higher for placenta problems that can kill the baby or the mother during labour itself.

For women over 40, there is a 50 per cent chance of a miscarriage. If they do give birth, their children are more likely to be premature. These 'preemies' have triple the risk of developing cerebral palsy and mental retardation.

Preemies tend to have very low birth weights, which are linked to very high risks of potentially fatal lung problems, bleeding in the brain, and heart defects. They may also suffer vision loss.

When preemies grow up, they tend to have more health concerns than kids who were born full term with normal birth weights. They are more likely to need long-term, highly specialised medical attention to treat the genetic diseases or congenital defects they are more prone to. All this can only translate into increased overall health-care spending as all citizens are eligible for subsided care.

Some may argue that elderly menopausal women who choose to have children do so with their eyes wide open, accepting the higher risks and bearing all its consequences.

But in fact, society will bear some of the costs, especially the medical care of their offspring. Since the consequences of their decisions can impact society as a whole, capping in law the age at which a woman may have IVF is justified.