Is it acceptable for women to use fertility treatment to have babies when they have clearly gone beyond their ‘natural’ childbearing years? In May 2009, a woman of 66 became the UK’s oldest mother, following fertility treatment at a Ukrainian clinic using donated eggs and sperm [Ref: Telegraph]. How old can mothers possibly go? In India in 2008, two women have headlined as the world’s oldest mothers after both giving birth at the age of 70. Omkari Panwar, who gave birth to twins, and her 77-year-old husband already have two adult daughters but were reportedly determined to have a son [Ref: Daily Mail]. Later that year, another Indian septuagenarian, Rajo Devi, gave birth to a girl, and promptly declared her desire to have another baby [Ref: Telegraph]. Medical opinion has historically recognised that women having babies later in life carries a higher level of risk to their own health, and that of their babies, than pregnancy in younger women [Ref: BBC News]. Until recent times, it was considered more socially acceptable for women to have babies when in their twenties than in their forties and women’s ability to have children later in life was limited by their own biology, as they would simply be unable to conceive. But advances in Assisted Reproductive Technology (ART), particularly techniques such as egg donation [Ref: Wikipedia], mean that women are able now to have babies even when they have passed through the menopause and reached the end of their natural reproductive life. The question is not about women becoming pregnant accidentally or naturally at an age that some consider older than ideal, but about whether they should be helped to do this by doctors and technology. Should a line be drawn – and if so, where and by whom?

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 during the treatment and the potential pregnancy. They are also required my law to carry out a Welfare of the Child assessment before starting any treatment. This looks at factors which are likely to cause serious physical, psychological or medical harm, either to the child to be born or to any existing child of the family, possibly including including the eventuality that a mother might die before her child reaches adulthood, or become unable to care for the child. In practice, most UK clinics will not treat women over the age of 50. However, one London clinic has helped women to become mothers up to the age of 60 [Ref: Daily Mail]. Many of the news reports about ‘oldest mums’ refer to women who have travelled from the UK to obtain treatment from other countries. This is often referred to as ‘fertility tourism’, and regulators are concerned that women obtaining treatment abroad may expose themselves to increased health risks and other problems [Ref: HFEA]. However, others argue that if women cannot obtain the treatment that they want – and are prepared to pay for – in their home country, there’s no reason why they shouldn’t go elsewhere [Ref: BioNews]. 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 much older mums will find themselves paying for private treatment. But critics point out that the NHS still has to meet the costs of caring for these mothers and their babies in the (relatively likely) circumstance that there will be complications with the pregnancy and birth [Ref: Daily Mail].

Bad for the mother?
One obvious criticism of post-menopausal women using fertility treatment to have babies is that this subverts the laws of nature. But others counter that all fertility treatment is unnatural, indeed, that is the point of it. 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, and great joy is brought to these women, so why deny post-menopausal women the same chance? It is said that the phenomenon of post-menopausal women having children disrupts the generational order of things in society, and that a woman in this situation will be out of kilter with her peers [Ref: Telegraph]. Others argue that the age of motherhood is rising [Ref: Independent], as is the proportion of IVF babies born to women in their forties, so these older mums might not be as abnormal as we think, and there is no clear place to draw the line . In this view, 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. Parenthood is widely accepted to be a choice these days, and people have children for many and varied personal reasons. Why should older women’s reasons for choosing motherhood be any less valid than those of younger women? 

Bad for the child?
The death in July 2009 of María Carmen del Bousada de Lara, a single mother who had given birth to twins at the age of 66, reignited debate about the ‘selfishness’ of post-menopausal women who have children [Ref: The Times]. Ms Bousada learnt that she had a tumour before giving birth to her sons in Spain, and died when they were aged two, leaving the boys orphaned. 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. Defenders of older mums point to research suggesting that they can be just as good parents as their younger counterparts [Ref: Guardian] – in which case, decisions based on the ‘welfare of the child’ should arguably treat such cases more favourably. If it is assumed that children love their parents whatever age they are, how can being born to an older mother actually damage the child?