Are you Ever too Old to have a Baby? The Ethical Challenges of Older Women Using Infertility Services

From Seminars in Reproductive Medicine
Art L. Caplan, Ph.D.; Pasquale Patrizio, M.D., M.B.E.

08/20/2010; Semin Reprod Med. 2010;28(4):281-286. © 2010 Thieme Medical Publishers


Abstract

Older parenthood raises a variety of important factual and ethical questions. None of the questions have received sufficient attention despite the rapid expansion in the United States and other nations in the numbers of older parents.
We do not know much about the safety, economic, and psychosocial impact of these emerging practices on children or parents. Nor have there been many analytical considerations of the ethical issues raised. We argue in this article that there are reasons for concern when older persons seek to utilize fertility treatments, including the safety of pregnancy for older women, risks posed to children delivered by older mothers, issues around what constitutes safe conditions for having a child relative to the age of parents, and the importance of guaranteeing that someone will serve in the parental role should an older parent or parents become disabled or die.

To protect the best interest of children created by technology in new familial circumstances, internationally recognized and enforced standards for fertility clinics to follow ought to be enacted in making decisions about treating older parents seeking infertility services.

Introduction
Programs offering fertility services in the United States and other nations are increasingly faced with requests from women of advanced reproductive age seeking assistance in becoming pregnant. Oocyte donation, new drugs, the technique of single intracytoplasmic sperm injection, and in vitro fertilization (IVF) afford older women the opportunity to give birth well beyond the natural limit imposed by menopause, and more and more women are taking advantage of this opportunity.[1–4] With egg freezing transitioning rapidly into a therapeutic option, it can be anticipated that more and more younger women will freeze their eggs for future use either in old age or even after their deaths.[5]

Older parenthood does and should raise a variety of important factual and ethical questions. None of the questions have received sufficient attention despite the expansion in the numbers of older parents. We do not know much about the safety, economic, and psychosocial impact of these emerging practices on children or parents. Nor have there been many analytical considerations of the ethical issues raised. Although it is imperative that more be done to monitor and evaluate older parenting, which uses infertility technology including postmortem birth, this article will focus on the key ethical questions raised.

One core ethical question is how to describe older parenting (and postmortem) fertility treatment. Are these instances of human experimentation and should doctors providing these services be held to the standard ethical requirements governing clinical research? If new technologies are being tried in novel ways where the risks and benefits are not well known, there may be a case for insisting that infertility interventions for patients who are very old only be done by doctors who have constructed research protocols and had them approved by appropriate peer review bodies.

Other questions abound. Should infertility programs discourage, tolerate, or encourage pregnancy in old age? Or, instead, should ethical programs try to discourage and constrain who it is that can bear a child in their later years? Should restrictions be in place on advertising and marketing in magazines, the Web, and other forums for fertility services that target older persons? And should governments, private insurance companies, and other third-party payers pay for fertility treatments for older patients

for rest of articlego to:
http://www.medscape.com/viewarticle/726675