Giving birth at 74: Issues in debate around setting an age limit for IVF

Tabassum Barnagarwala
Most countries that have a law range the upper limit for IVF between 40 and 50 years. (Getty Image)

A 74-year-old woman from Andhra Pradesh was recently recorded as the oldest in the world to give birth to twins through in-vitro fertilisation or IVF. While her doctor has said both babies and mother are stable, the medical community has expressed ethical and medical concerns over conception at such an advanced age.

Birth of the twins

Erramatti Mangayamma, 74, visited Ahalya Nursing Home in 2018 after 57 years of marriage and multiple failed attempts to conceive. IVF expert Dr S Umashankar fertilised her husband E Raja Rao s sperm with a donor s eggs and placed them in her uterus. On September 5, she delivered twins through a caesarean procedure.

In 2016, Dajinder Kaur, 70, had delivered a boy through IVF in Haryana. At the same Haryana clinic, a 66-year-old woman had delivered triplets in 2010.

Why this is a concern

The average life expectancy of an Indian woman is 70 and of a man 69, and the medical community has expressed concerns over future of children born to such an elderly couple. The very day after the delivery, the twins father, 80, suffered a stroke.

Medical technology has reached a stage where we can get even a 90-year-old pregnant. But we refuse; there are complications that can risk human life, IVF expert Nandita Palshetkar said.

Pregnancy in old age poses multiple risks hypertension, diabetes, convulsions, bleeding, and cardiac complications to name a few. Dr Ashok Anand, head of the gynaecology department in Mumbai s J J Hospital, said the womb of an older woman has to be prepared by injecting hormones for the foetus to grow for nine months. Also, a woman of that age cannot breastfeed.

Erramatti Mangayamma welcomed twins at the age of 74. (Source: ANI/Twitter)

Can a doctor face action?

The Indian Society for Assisted Reproduction (ISAR) issued a notice to Dr Umashankar after he delivered Mangayamma s twins. In response, he deregistered himself from ISA. Internationally this pregnancy is being condemned. Everything could have gone wrong. It sets a wrong precedent, Dr Jaideep Malhotra, president of ISAR, said.

Several experts have demanded punitive action, saying the Indian Council of Medical Research (ICMR) should deregister his Andhra Pradesh centre. But with no law in place a Bill is pending the assisted reproductive technology (ART) industry continues to operate in a grey zone.

In 2005, when ICMR drafted guidelines for ART, it had not set an age limit keeping in mind that reproductive rights were a fundamental right for a woman.

We amended the guidelines after an elderly woman in Haryana gave birth through IVF. Since the Bill on ART has not been passed yet, legal action against such clinics is impossible. We expect ART clinics to self-regulate, said R S Sharma, scientist at ICMR. He said ICMR is considering issuing a notice to the clinic for indulging in an unethical practice.

In the absence of a law

Globally, an estimated 15% of couples are infertile. The Assisted Reproductive Technologies (Regulation) Bill, 2010, states that in the Indian social context, children are old-age insurance . The Bill proposes the upper age limit at 45 for women and 50 for men to undergo the IVF procedure. As of now, several centres rely on ICMR s 2017 guidelines that recommend the same age limits. Even for adoption, the total age of the couple must not exceed 110 years.

With increasing life expectancy, doctors are in talks with the government to increase the IVF age limit to 50-52 years for women. Until then, several experts self-regulate, some counsel senior citizens to drop the idea, and others refuse them IVF treatment.

The counter-view

Societal pressure to have children, the fear of living without support in old age, and the loss of an only child often encourage couples. A lot of couples tell us they want an heir to pass their life s earnings to, said Meerut-based IVF expert Sunil Jindal, who conducted IVF for a 52-year-old woman who had lost her son.

Some doctors argue that childbirth is a personal decision and each inpidual has the right to make that choice after counselling.

Still, a doctor has to conduct tests for the heart, bone structure, diabetes, blood pressure to judge the feasibility of pregnancy. At J J Hospital, a 60-year-old woman was recently found medically fit to conceive.

Laws in other countries

Most countries that have a law range the upper limit for IVF between 40 and 50 years. In the US, the upper limit for IVF is 50, and for ovum donation, 45. In Australia, guidelines prohibit IVF beyond menopause (52 years). In the UK, 42 is the age limit for women to seek free insurance under National Health Service. In Canada, the age limit is 43.