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When Are You Too Old to Be a Mother?

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a blog by David Kreiner, M.D., F.A.C.O.G., East Coast Fertility, December 28, 2010

Rajo Devi Lohan, the world’s oldest Mom after IVF, using donated eggs, is dying at age 72. It was just 18 months ago that she gave birth.

When she was 70, Rajo and her husband Balla underwent IVF treatments in Baddhu Patti, India, to conceive their only child, Naveen. Now 72, Rajo is bedridden and doesn’t have the strength to lift 18-month-old Naveen. She has never recovered from her pregnancy. Her uterus ruptured after her c-section, and she suffered from internal bleeding. Rajo and Balla, farmers who have not received any education, say they did not know it was high risk to have a baby at their age, and claim that they were never warned of any possible complications by their doctor. The National Fertility Centre in Haryana, where Rajo received her fertility treatments, also helped another Indian woman, Bhateri Devi, give birth to triplets through IVF when the woman was 66. The center claimed no wrongdoing in performing IVF in either women.

Last year, another aged IVF “success,” Maria de Carmen Bousada (the oldest mother to conceive at the time with donated eggs) died.

My first thought in these cases was to extend my sincere condolences to their families and, in particular, to their children. My heart truly goes out to them. It is a great tragedy when a death occurs, especially when it is the mother of such young children. I hope and pray that Rajo and Maria’s families and friends find the strength to replace the love and nurturing typically given by a mother to her child.

My second thought, as a fertility doctor, was that once again the world of infertility was making the news because we continue to push the edges of what society views as acceptable.

IVF and Its Implications to Society

This is one of the hardest things about being a doctor in a cutting edge field such as reproductive medicine. We are often put in the position of making decisions with our patients that have even bigger implications to society than the individual patient. I do my best to look at each patient and each situation individually.

However, there does appear to be a point, even an age, at which the risk outweighs any potential benefit of biological motherhood. Women who have lived their lives with a burden of not being able to conceive a biological child often are psychologically stressed to the point of irrationality. It is up to the responsible physician to discern those individuals who are placing themselves, their potential future child and society at risk through IVF.
We dare not cross the boundary of acceptable societal ethical standards in our utilization of technology without guidance or conscience; otherwise, we can hurt our patients, our children we help create and society. There needs to be governmental control preventing aberrant, unethical use of technology, such as performing IVF on senior citizens.

Many critics state that beyond a certain age, it is unnatural to become a mother. It puts the family at risk for the mother not being around to help raise the child — as is occurring in the above examples — or not having the energy and stamina to raise the child properly.

At What Age Do You Draw the Line on IVF?

So where does a clinic in good conscience draw the line? At East Coast Fertility, we have a cutoff of age 50. This is admittedly arbitrary, and that limit is often broken when faced with an energetic couple where the woman is healthy enough to go through pregnancy as determined by an internist and high-risk maternal-fetal medicine physician. We recently celebrated our latest 54-year-old patient’s delivery of a healthy baby, which was highly reported in the press.

It may be impossible to agree on a proper upper age limit to have a child. Our policy may be inappropriate for others who have a completely different perspective. My responsibility as the physician offering assistance to patients in need of help with procreation is to the health of my patients, the well-being of the child and for the good of society.

Many women in their 50s have the health and energy to carry a pregnancy and bear a child with no more increased risk than many woman 10 to 20 years younger whose interest in achieving pregnancy we would never consider questioning. That being said, what about the risk that the mother may not still be around to raise the child to maturity? There is no question that a young healthy couple with sufficient financial support and emotional maturity is ideal for raising a family. But, happy, successful families can take on many different faces.

Single-parent families exist, survive and often thrive. One can never be certain that the condition of the couple at the time of conception will continue through the child’s birth or, for that matter, until the child has reached maturity. We do not know that a healthy woman of 30, 40 or 50 may not develop a lethal disease before a child has grown up. In addition, at least 50 percent of couples in the United States become divorced. One can argue that couples at risk of divorce should not get pregnant. I do not think that society is ready to conclude that any of these women should not be allowed to procreate.

For me and for our program, we have raised our bar to do the proper due diligence that our patients are healthy, will make potentially capable parents and have been adequately counseled regarding any risks. We utilize trained psychotherapists, consent forms, videos and personal discussions with our patients to achieve this. I don’t want to be “The Fertility Police,” but as a fertility doctor, my job is to help capable people build their families no matter how different those families may look to you and me — and without undue risk to patient, child or society.

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