The latest figures from the UK Office for National Statistics show 107 women over 50 had babies in 2009, a 55% increase on the number for 2008, and 14 of these women were over 55 [Ref: Telegraph]. Since the birth of Louise Brown in 1978, the world’s first IVF baby, advances in Assisted Reproductive Technology (ART) have brought joy to millions [Ref: BBC News]; with the scientist who pioneered IVF treatment, Professor Robert Edwards, being awarded the Nobel prize for medicine in 2010 [Ref: BBC News]. However, with these advances controversy has also ensued. Some now see the biggest call on IVF to be age related fertility problems, caused by women delaying motherhood for too long, leading to concerns that IVF lulls women into a false sense of security. High on the agenda is the question of older mums through high profile cases such as Carole Hobson, the 58 year-old first time single mum who gave birth to twins this year [Ref: Daily Mail], or the Spanish mother, María Carmen del Bousada, who died in 2009 leaving behind two-year old twins she gave birth to aged 66. This has raised questions about whether women determined to have a child late in life are putting their own interests above that of the child and whether IVF clinicians should exercise greater responsibility and restraint with regard to who they agree to treat. At the same time, some fertility clinics have been accused of unscrupulous behaviour and irresponsibly marketing false hopes to people desperate to have children, when the reality is that IVF is unlikely to result in a child for many women over 40 [Ref: Daily Mail].

What are the regulations?
In the UK, there is no legal age limit at which a woman can receive fertility treatment, and no limit that is specified or enforced by the regulatory body the Human Fertilisation and Embryology Authority [Ref: HFEA]. Clinicians are required to meet the clinical best practice standard – that the patient’s health will allow them to go through the treatment and the potential pregnancy. They are also required by law to carry out a Welfare of the Child assessment before starting any treatment. This looks at factors which are likely to cause serious harm, either to the child to be born or to any existing child of the family, possibly including the eventuality that a mother might die before her child reaches adulthood or become unable to care for the child. Whilst many UK clinics will not treat women over the age of 50, dozens of babies are being born every year to women in their fifties who have had IVF at a British clinic [Ref: Telegraph]. Other women, including many of the ‘oldest mums’ hitting the headlines, have obtained treatment from other countries. Guidance from the National Institute for Clinical Excellence (NICE) recommends a maximum age limit of 39 for women obtaining fertility treatment on the NHS, so many older mums will find themselves paying for private treatment. However, charges from fertility experts and patients that NICE’s upper age limit is ‘outdated, heartless and discriminatory’ have prompted a review of the criteria for IVF [Ref: Guardian].

Bad for the mother or bad mums?
It is now widely accepted that younger women should be able to use ARTs to overcome the barriers that nature has placed in their way, so why deny post-menopausal women the same chance? Whilst some concerns have been raised about greater risks to women giving birth later in life, especially in relation to pre-eclampsia and diabetes [Ref: BBC News], greater concerns have been expressed about post-menopausal mothers struggling to cope with the demands of bringing up young children and being out of kilter with their peers [Ref: Telegraph]. Others argue that the proportion of IVF babies born to women in their forties is rising, so these older mums might not be as abnormal as we think, and there is no clear place to draw the line. From this viewpoint, decisions should be made on a case-by-case basis, and the choice should be down to the woman and the doctor who treats her [Ref: Guardian]. However, the death in July 2009 of María Carmen del Bousada [Ref: The Times] reignited debate about the ‘selfishness’ of post-menopausal women who have children and the irresponsibility of some IVF clinicians. Much commentary focused on the problems caused for children by having mothers who were statistically more likely to die, or become ill or infirm, before their children reached adulthood. In this view, concern about the welfare of the child born as a result of fertility treatment should provide a clear reason why much older mothers should be denied treatment. But others point out that there is a double standard here, in that older men are able to father children naturally and talk positively about the experience [Ref: The Times], so why should such a fuss be made when women do the same thing? No parent, whatever their age, can guarantee that they will not become ill or die before their children are grown up, and some women are healthier in their 60s than others in their 20s. If it is assumed that children love their parents whatever age they are, can being born to an older mother actually damage the child?

False hope or better options for 21st Century mothers?
Whilst much of the debate has focused on post-menopausal women, broader concerns have been raised about the IVF industry offering false hope to women and fuelling an unhealthy approach to parenthood as another lifestyle choice. Advances in techniques for egg freezing have brought this aspect of the debate into sharper focus. Until recently egg freezing was primarily offered to young women in extreme situations, such as those requiring cancer therapy. But recognition of the importance of the age of the eggs to the success of IVF, coupled with the development of vitrification techniques with success rates comparable to the use of fresh eggs of the same age, has led some clinics to offer egg freezing services to healthy women [Ref: The Times]. The purpose of the service is to allow women to improve their chances of having children later in life, if that turns out to be desirable or necessary for them. According to Dr Gillian Lockwood, Medical Director of Midland Fertility Services, so-called ‘social egg freezing’ could come to have as positive an impact on women’s lives in the future as the introduction of the contraceptive pill in the 1960s. [Ref: Focus on Reproduction]. However others, such as the IVF pioneer Lord Robert Winston, argue that there is a danger in over-emphasising arguments around choice and individual autonomy and that some fertility clinics are playing an ‘expensive confidence trick’ on women by failing to underline the low success rates associated with egg-freezing,  and IVF more broadly. [Ref: Daily Mail]. In the context of competing demands for women of an education and a career, alongside the difficulties of finding Mr Right, advocates argue that advances in ART are offering more and better options to women with regard to their choices about motherhood. Critics fear turning parenthood into just another lifestyle choice, to be fitted around the demands of a career and busy social life, and encouraging a generation of selfish ‘Bridget Joneses’ tying to ‘have it all’ [Ref: Daily Mail]. Some, such as journalist and writer Liza Mundy argue that it is an unforgiving work culture that doesn’t see childbearing for female employees as convenient that is driving the growth in late motherhood, not a widening ‘exercise of choice’ [Ref New Atlantis]. But champions of older mums dismiss such concerns as paternalistic, arguing that women are capable of weighing up such risks, costs and benefits for themselves. Is it time to applaud the possibilities of late motherhood opened up by IVF or to draw a line under attempts to defy the female biological clock and wake up to the necessary constraints and responsibilities of parenthood?