As an AP woman bears children at 74, ethics of fertility treatments and necessary restrictions must be grappled with

Gita Aravamudan

When 74-year-old Erramatti Mangayamma delivered twin girls at a private nursing home in Guntur, Andhra Pradesh, after IVF treatment, she set a world record. But even as she made headlines all over the country, several ethical and medical questions which had been raised before, have resurfaced.

A team of doctors shepherded her through the IVF procedure and monitored her health till she delivered her babies through a Caesarian operation. They said they had not done anything that goes against the law, which was true in a sense €" because there is no law. The Assisted Reproductive Technology (Regulation) Bill, 2017, which continues to lie in cold storage, is the only proposed legislation which deals with a situation like this.

Chapter IV, Para 37, Subpara 7 (a), of this Bill says "Assisted Reproductive Technology services shall not be available to a woman below the age of 18 years and above the age of 45 years". But since this Bill has neither been tabled nor passed, these are just a set of guidelines which can be flouted with impunity, as they cannot be enforced.

Meanwhile, the very flawed and superficial Surrogacy Bill, which does not address any of the real ethical questions with regards to IVF and surrogacy, is all set to become law.

Members of the Indian Society of Assisted Reproduction (ISAR), Indian Fertility Society (IFS) and Academy of Clinical Embryologists (ACE) in a joint statement have expressed their deep concern over the fact that such incidents are becoming more common now, since there is no way to keep a check on them. In 2017, Daljinder Kaur from Amritsar, Punjab, gave birth to a baby at the age of 72. Several other women in their 50s and 60s have also had babies through IVF. In fact, Mangayamma herself was inspired to try having a baby after a woman in her neighbourhood who was in her late 50s had one through IVF.

As in the case of Mangayamma, it is possible that all these women had to use eggs sourced from younger donors. Gynaecologists say that women are most fertile between the ages of 15 and 30. As their age increases after 40, they are more likely to produce eggs and embryos with chromosomal abnormalities. Women beyond the age of 45 undergoing IVF may have to use donor eggs, especially if like Mangayamma they have no proven history of fertility.

The Surrogacy Bill specifies the surrogate should be between 18 and 35 years of age and should have proven fertility. It also excludes a number of young people who could have babies using surrogates. But it does not set any age limit for commissioning parents, and it does not even consider such pregnancies in which the over-aged mothers themselves can technically be surrogates.

The other question is, how viable would the sperm of an 80-year-old man be? If that too was taken from a donor, what would the baby's genetic connection to the parents be? If there is no connection, the whole exercise makes no sense, especially given the medical repercussions of pumping a 70-year-old woman with hormones.

It is all the more alarming when viewed from the perspective of the children. Mangayamma will be 80 years old by the time her children turn six. Her husband will be well into his 80s. When the children are in their crucial teenage years and need the support of their parents the most, they will be in their 90s. What will happen to the children if they are orphaned at an early age? Did they ever ask to be born this way? How is it fair to them?

Fertility experts feel very strongly that this growing trend of using IVF to satisfy the demands of over-aged parents is setting a detrimental precedent. One doctor who runs a fertility centre, who wished to be anonymous, said, "I get quite a few older couples asking for treatment. They could have lost an only child, or they may have never conceived. All their stories are sad and convincing. But I draw a very definite line." Others felt that such "unethical" practices give fertility treatment a bad name.

The question is, when there is a definite age limit for parents wishing to adopt children, why is there none for those opting for fertility treatments or surrogacy?

The whole business of making babies through artificial means is engulfed in issues of ethics. These range from questions like what should be done with unused viable embryos (after all, they are nascent life forms), to who is eligible to be a commissioning parent, and who can be a surrogate.

Any law which is passed should take each of these issues into serious consideration if it needs to be effective. For instance, when foreign couples were banned from coming to India for fertility treatment, there was also a ban imposed on bringing in or sending out embryos created by foreigners from India. This meant that embryos which some couples had left here in cold storage to use at a later date were stuck in limbo. They are also life forms which could, if planted in wombs, grow into human beings.

Unless the 2017 ART Bill, which is definitely more comprehensive and inclusive, is updated, tweaked and passed at the very earliest, this already deteriorating situation in the world of fertility treatments will only go from bad to worse.

Also See: A 74-year-old woman from Andhra Pradesh gives birth to twins: Why pregnancy after menopause isn’t as safe for everyone

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