TOPIC GUIDE: IVF
"It is irresponsible to provide IVF to women in their fifties"
PUBLISHED: 01 May 2013
AUTHOR: Tony Gilland
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INTRODUCTION
When Professor Robert Edwards, the Nobel winning scientist who pioneered IVF treatment, died In April 2013, the tributes poured in from scientists and families for the positive impact his work has had for millions [Ref: BBC News]. Since the birth of Louise Brown in 1978, the world’s first IVF baby, advances in Assisted Reproductive Technology (ART) have been substantial; one of the latest developments being the use of new ovarian tissue transplant techniques to allow a small number of women treated for cancer to naturally ovulate and conceive subsequent to their cancer treatment [Ref: Bionews]. 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 in 2011 [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. Whilst some fertility clinics have been accused of unscrupulous behaviour and irresponsibly marketing false hopes to people desperate to have children, advances in the field led NICE to update it’s guidance on what treatments should be made available on the NHS in February 2013, including an increase in the age at which women should receive some treatment on the NHS from 39 to 42 [Ref: Guardian].
DEBATE IN CONTEXT
This section provides a summary of the key issues in the debate, set in the context of recent discussions and the competing positions that have been adopted.
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, 141 women over that age gave birth in 2010 – treble the number that did so a decade earlier [Ref: Daily Mail]. Other women, including many of the ‘oldest mums’ hitting the headlines, have obtained treatment from other countries. In the United States, where there is no legal restriction on the age at which women can receive treatment, the American Society for Reproductive Medicine changed its guidance in spring 2013 from ‘discouraging’ treatment of women over 50 to arguing ‘particularly in the age range of 50–54’ that treatment is not ‘such a significant departure from other currently accepted fertility treatments as to be considered ethically inappropriate in postmenopausal women’ [Ref: ASRM]
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. Indeed, Janet Maslin-Bosher, who gave birth to twins at the age of 58 in 2002, was reported ten years on, to now be in favour of an age restriction for IVF treatment of around 50, despite her ten year old twins being her ‘joy and salvation’ [Ref: Daily Mail]. Others point out that there is a double standard in the debate, 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. With further scientific and technological advances to be expected, such as those potentially opened up by successful ovarian transplants [Ref: Telegraph], 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?
ESSENTIAL READING
It is crucial for debaters to have read the articles in this section, which provide essential information and arguments for and against the debate motion. Students will be expected to have additional evidence and examples derived from independent research, but they can expect to be criticised if they lack a basic familiarity with the issues raised in the essential reading.
‘My children are my joy and my salvation’ says 68-year old IVF mother of twins
Daily Mail 5 October 2012
What is society’s problem with elderly mothers?
Dr Daniel Sokol BBC News 26 January 2010
Should we impose an age limit on IVF?
Dr Peter Bowen-Simpkins V Dr Gillian Lockwood The Times 29 May 2009
FOR
IVF for women over 40 doesn’t address the root of the problem
Katherine Baldwin Guardian 20 February 2013
Woman who became mother at 57 admits she was too old for IVF
Josie Ensor Telegraph 6 November 2011
IVF for older women on the NHS is another example of how the mania for equality is wrecking society
Melanie Phillips Daily Mail 30 June 2010
IVF orphans who will always ask their mother: how could you?
Genevieve Fox Telegraph 16 July 2009
Fit for a baby at 66? Don’t kid yourself
Lesley Garner Telegraph 19 May 2009
AGAINST
Why I’m having my first baby at 51
Naomi Gryn Guardian 9 November 2012
Social egg freezing: time to come in from the cold
Dr Gillian Lockwood Focus on Reproduction September 2009
María del Carmen Bousada de Lara’s death does not mean she was wrong
Sarah Vine The Times 16 July 2009
Why older women turn out to be better mothers
Lowri Turner Daily Mail 21 February 2008
What’s wrong with the World’s Oldest Mum?
Jennie Bristow spiked 18 January 2005
IN DEPTH
Fertility: will we ever win the egg race?
Laura Donnelly Telegraph 10 April 2011
Fertility: stop all the clocks
Victoria Lambert Telegraph 26 November 2009
In Favour of Freezing Eggs For Non-Medical Reasons
Julian Savulescu and Imogen Goold Bioethics 1 January 2008
The ethics of egg donation in the over fifties
Anna Smajdor Menopause International 2008
Cheryl Miller New Atlantis 2007
KEY TERMS
Definitions of key concepts that are crucial for understanding the topic. Students should be familiar with these terms and the different ways in which they are used and interpreted and should be prepared to explain their significance.
BACKGROUNDERS
Useful websites and materials that provide a good starting point for research.
A change in thought on having a baby after “the change?”
CBC Radio 27 March 2013
Time to Chill? Egg-freezing Technology Offers Women a Chance to Extend Their Fertility
Nancy Hass Vogue 28 April 2011
Freezing eggs – costly con or insurance against infertility?
BBC Radio 4 'Woman’s Hour' 14 April 2011
‘What on Earth have I done?’: Single mother, 58, gives birth to IVF twins
Helen Weathers Daily Mail 19 March 2011
An Ethical Assessment of Postmenopausal Motherhood Against the Backdrop of Successful Antiaging
Uta Bittner and Tobias Eicinger Rejuvenation Research, Vol 13, No 6 2010
How old is too old to give birth?
Bioethicsbytes 27 July 2009
The joys of being an older parent
Richard Parkes The Times 23 July 2009
New research challenges stereotypes about older mums
Macquarie University Physorg 8 July 2009
BBC Radio 4 ' Woman’s Hour' 14 January 2009
Reproduction and Responsibility
The President's Council on Bioethics March 2004
Children by choice: reproductive technologies and the boundaries of personal autonomy
R Alta Charol Nature 1 October 2002
Older Mothers – Facts and figures
Mothers 35 Plus
The Infertility Centre of St Louis
Pregnancy complications in older women
Elizabeth Eden HowStuffWorks
ORGANISATIONS
Links to organisations, campaign groups and official bodies who are referenced within the Topic Guide or which will be of use in providing additional research information.
IN THE NEWS
Relevant recent news stories from a variety of sources, which ensure students have an up to date awareness of the state of the debate.
Test-tube baby pioneer Sir Robert Edwards dies
BBC News 10 April 2013
Peak US fertility association green-lights IVF for over-50s
BioEdge 23 March 2013
Health service to fund IVF for the over-40s
Guardian 20 February 2013
Nearly half of births in England and Wales are to mothers over 30
Guardian 24 January 2013
Australia: successful pregnancy after ‘groundbreaking’ ovarian tissue transplant
BioNews 3 December 2012
Doctors may have unlocked secret of IVF success for older mothers
Telegraph 22 October 2012
Women could delay the menopause indefinitely with ovary transplant
Telegraph 4 July 2012
Number of babies born to women of 45 and over trebles in just ten years
Daily Mail 27 January 2012
The baby who’ll bring fresh hope of becoming a mother at 50
Daily Mail 4 April 2011
Doctors warn couples not to leave it too late to have a baby
Telegraph 28 January 2011
Boom in new mums in their fifties
Telegraph 31 October 2010
British IVF pioneer Robert Edwards wins Nobel prize
BBC News 4 October 2010
Australian 3 July 2010
More 40-somethings giving birth than ever
Guardian 25 May 2010
Oldest mother, Maria Carmen del Bousada, dies at 69, leaving baby orphans
The Times 16 July 2009
The fertility ‘con trick’: Egg freezing gives false hope to women, says Lord Winston
Daily Mail 2 July 2009
Doctors warn of risks to older mothers
Guardian 15 June 2009
Concerns over older mother trend
BBC News 12 June 2009
Woman of 66 becomes Britain’s oldest mother
Telegraph 28 May 2009
Professor Severino Antinori: ‘Mother-to-be too old at 66’
The Sunday Times 17 May 2009
World’s oldest mother wants to have another child
Telegraph 30 December 2008
IVF success rate for older women increases five-fold in a year
Telegraph 8 October 2008
30th Birthday for World’s first IVF baby
BBC News 14 July 2008
AUDIO/VISUAL
A change in thought on having a baby after “the change?”
CBC Radio 27 March 2013
Freezing eggs – costly con or insurance against infertility?
BBC Radio 4 'Woman’s Hour' 14 April 2011
BBC Radio 4 ' Woman’s Hour' 14 January 2009
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