Should an age limit be imposed Should an age limit be imposed
on on in vitro in vitro fertilization? fertilization?
Amanda Caster, Rong Hu, Amanda Caster, Rong Hu, John Brothers II, and Barry Sexton John Brothers II, and Barry Sexton
Bioengineering and Bioinformatics Summer Institute 2005
University of Pittsburgh, Carnegie Mellon University, Duquesne University, Pittsburgh Supercomputing Center
in vitro
in vitro Fertilization (IVF) Fertilization (IVF)
1) Removal of the 1) Removal of the human oocyte (egg) human oocyte (egg) from the ovary
from the ovary
2) Fertilization by the 2) Fertilization by the sperm of a partner or sperm of a partner or donor in a laboratory donor in a laboratory
3) Transfer of the 3) Transfer of the fertilized egg fertilized egg
(embryo) back into (embryo) back into the uterus
the uterus
History History
Louise Brown was first reported live Louise Brown was first reported live birth conceived by
birth conceived by in vitro in vitro fertilization fertilization in 1978 in England
in 1978 in England
The procedure was completed by Dr. Edwards and Dr. SteptoeThe procedure was completed by Dr. Edwards and Dr. Steptoe
The first baby conceived by The first baby conceived by in vitro in vitro fertilization in the fertilization in the United States was in 1981
United States was in 1981
Currently over 100,000 babies in the United States have Currently over 100,000 babies in the United States have been conceived through IVF
been conceived through IVF
Today a fertility hormone (FSH) is used to stimulate the Today a fertility hormone (FSH) is used to stimulate the development of several eggs which can be easily removed development of several eggs which can be easily removed from the female
from the female
The Issue The Issue
IVF offers a chance for infertile couples to have a IVF offers a chance for infertile couples to have a biological child
biological child
However, there is much debate as to whether or not However, there is much debate as to whether or not an age limit should be imposed on IVF
an age limit should be imposed on IVF
Proponents of an age limit point out the Proponents of an age limit point out the
complications of older women giving birth and complications of older women giving birth and reasons why an older parent is not as optimal as a reasons why an older parent is not as optimal as a younger one
younger one
Opponents of an age limit contend that every parent Opponents of an age limit contend that every parent has the freedom and the right to have a child, and has the freedom and the right to have a child, and older parents may in fact be more ideal
older parents may in fact be more ideal
1992 – 1992 – A British woman gave birth to A British woman gave birth to twins at the age of 59
twins at the age of 59
1993 – 1993 – Rosanna Della Corte gives birth to Rosanna Della Corte gives birth to a healthy boy at the age of 62*
a healthy boy at the age of 62*
2005 – 2005 – Adriana Iliescu Adriana Iliescu gives birth to Eliza gives birth to Eliza Maria
Maria Iliescu Iliescu at age 66* at age 66*
* World’s Oldest Woman to Give Birth (at that time)
Is Age an Issue?
Increasing Age of Parents Increasing Age of Parents
Won Won ’ ’ t Someone t Please Please Think of the Children!
Think of the Children!
We must think in terms of the We must think in terms of the
best interest of the child
best interest of the child
Some Stats Some Stats
In general older women In general older women have a higher chance of have a higher chance of miscarriage
miscarriage
Study conducted at Study conducted at Cornell University from Cornell University from 1991-1991-19961996
Over 2,000 pregnancies Over 2,000 pregnancies were examined in New were examined in New York hospitals
York hospitals
http://www.usnews.com/usnews/health/briefs/womenshealth/bb040712d.htm
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
< 30 30-34 35-39 >40
Some More Stats Some More Stats
Birth DefectsBirth Defects
http://cancerresourcecenter.com/articles/article33.html
5.2
15.2
47.6
0 10 20 30 40 50
Defects per 1,000 Live Births
35 40 45
Mother's Age
Some More Stats Some More Stats
Down syndrome (Down syndrome (TrisomyTrisomy 21)21)
1 in 1,250 for 25 year old women1 in 1,250 for 25 year old women
1 in 1,000 for 30 year old women1 in 1,000 for 30 year old women
1 in 400 for 35 year old women1 in 400 for 35 year old women
1 in 30 for 45 year old women1 in 30 for 45 year old women
http://www.marchofdimes.com/professionals/681_1155.asp
Are Some Parents Too Old?
Are Some Parents Too Old?
Do older parents have the energy it takes Do older parents have the energy it takes to raise a child?
to raise a child?
Older parents may be unable to meet the Older parents may be unable to meet the emotional and physical needs required to emotional and physical needs required to properly raise a child
properly raise a child
A mother giving birth at 50 will be 68 when her child graduates high school Adriana Iliescu will be 84 when Eliza Maria graduates high school
What if the parents die of old age before the child What if the parents die of old age before the child is grown?
is grown?
Older parents are more likely to pass away during crucial Older parents are more likely to pass away during crucial developmental stages in the child
developmental stages in the child’’s lifes life
Thus, the child is short-Thus, the child is short-changed before even being bornchanged before even being born
At what point does the child have to take care of At what point does the child have to take care of his parents? Before the child is grown and has a his parents? Before the child is grown and has a life of his own?
life of his own?
Having older parents can place excess stress on the Having older parents can place excess stress on the child if they become ill
child if they become ill
Are Some Parents Too Old?
Are Some Parents Too Old?
Is It Fair to the Is It Fair to the
Parents?
Parents?
A Case of Desperation A Case of Desperation
Parents seeking IVF are out of other optionsParents seeking IVF are out of other options
“Success rates begin to decline after age 23. After age “Success rates begin to decline after age 23. After age 46, the chances are zero.
46, the chances are zero.””
Is it fair for a clinic to Is it fair for a clinic to take advantage of a take advantage of a parent
parent’’s undying hope s undying hope for success?
for success?
http://www.healthatoz.com/healthatoz/Atoz/d c/caz/repr/infr/infertility.jsp
http://www.dcmsonline.org/jax- medicine/2000journals/may2000/art.htm
Additional Additional
Complications of Complications of in vitro
in vitro Fertilization Fertilization
Risk of Multiple Births Risk of Multiple Births
38% of IVF births were multiple births compared 38% of IVF births were multiple births compared with < 3% in the general population
with < 3% in the general population
Risk of stillbirth or neonatal deathRisk of stillbirth or neonatal death
1% singletons1% singletons
4.7% twins4.7% twins
8.3% triplets8.3% triplets
Multiple births are greater burden on older Multiple births are greater burden on older
parents (on the mother during labor and on both parents (on the mother during labor and on both parents after delivery)
parents after delivery)
http://www.dcmsonline.org/jax-medicine/2000journals/may2000/art.htm
It It ’ ’ s Just Plain Unnatural s Just Plain Unnatural
The Other Side of
The Other Side of in vitro in vitro Fertilization
Fertilization
Topics To Be Considered Topics To Be Considered
Infringing on Patients’Infringing on Patients’ and Physicians’and Physicians’ RightsRights
Who Decides When It Is Too Late?Who Decides When It Is Too Late?
Information for AllInformation for All
The Benefits of Older ParentsThe Benefits of Older Parents
Population is Aging and Population is Aging and in vitroin vitro Fertilization Fertilization Methods are improving
Methods are improving
Doctors
Doctors ’ ’ and Patients and Patients ’ ’ Rights Rights
An arbitrary age = Inability for patients and An arbitrary age = Inability for patients and doctors to make a decision
doctors to make a decision
Physicians have been trained to assess Physicians have been trained to assess situations
situations
Why should we take that ability away from them?Why should we take that ability away from them?
Doctor’Doctor’s can still choose not to perform the procedure s can still choose not to perform the procedure
Rights equate ResponsibilityRights equate Responsibility
Patients have the ability to choose and must deal with Patients have the ability to choose and must deal with those consequences
those consequences
This is the same for physiciansThis is the same for physicians
Informed Choices Informed Choices
Informed Consent Informed Consent
Many in vitro Fertilization Clinics provide mandatory Many in vitro Fertilization Clinics provide mandatory information on:
information on:
Possible Medical Risks Possible Medical Risks
Procedure InformationProcedure Information
Psychological RisksPsychological Risks
Possible Birthing ProblemsPossible Birthing Problems
Contingency plans for possible problem situationsContingency plans for possible problem situations
Many clinics also use psychological counseling:Many clinics also use psychological counseling:
Look into possible long term issuesLook into possible long term issues
Make sure parents are ready to handle the childMake sure parents are ready to handle the child
If these informative measures are being If these informative measures are being
implemented, why is there a need for an age limit?
implemented, why is there a need for an age limit?
Older Parents are Bad?
Older Parents are Bad?
Benefits of Older Parents Benefits of Older Parents
Financial Stability Financial Stability
Fewer career pressures Fewer career pressures
Emotional maturity Emotional maturity
Child is not an accident Child is not an accident
Things Improve Things Improve
With Age With Age
Humans are living longer and Humans are living longer and
technology is improving technology is improving
Human Beings are living longer, so it isnHuman Beings are living longer, so it isn’’t as urgent to t as urgent to have children at a younger age.
have children at a younger age.
As life spans increase, the time period in which a As life spans increase, the time period in which a parent could live and support a child would also parent could live and support a child would also increase
increase
An arbitrary age limit would not take into account this factorAn arbitrary age limit would not take into account this factor
in vitroin vitro Fertilization methods are improvingFertilization methods are improving
Like most technology used overtime, the procedure will Like most technology used overtime, the procedure will continue to improve, moving towards even higher success continue to improve, moving towards even higher success rates
rates
This gives parents more time to choose when they want to This gives parents more time to choose when they want to have a child. A cutoff age would limit that choice.
have a child. A cutoff age would limit that choice.
Questions Questions
Given that technology is advancing to Given that technology is advancing to improve the quality of life, questions of improve the quality of life, questions of societal morality arise:
societal morality arise:
Is childbearing a woman’ Is childbearing a woman ’s choice? s choice?
Do the civil rights of youth carry through Do the civil rights of youth carry through to later in life?
to later in life?
Women
Women ’ ’ s Rights s Rights
Women have the right to choose to have a Women have the right to choose to have a child while they are younger
child while they are younger
Women, just like men, are constitutionally Women, just like men, are constitutionally guaranteed the right to happiness
guaranteed the right to happiness
Why would these rights (choice and Why would these rights (choice and happiness) become void in older age?
happiness) become void in older age?
Women Postponing Childbirth for a Career Women Postponing Childbirth for a Career
WomenWomen’’s rights were hard-s rights were hard-won. In 1972 the won. In 1972 the Equal Rights Amendment (ERA) was passed.
Equal Rights Amendment (ERA) was passed.
Women now have the right to be expected to be Women now have the right to be expected to be treated equally in the workplace.
treated equally in the workplace.
To pass a law limiting a womanTo pass a law limiting a woman’’s right to bear s right to bear children undermines the ERA and forces women children undermines the ERA and forces women to choose between a place at home or a place to choose between a place at home or a place equal to those of men in the workforce.
equal to those of men in the workforce.
Summary: Two Sides Summary: Two Sides
Should an age limit be imposed?
Should an age limit be imposed?
Statistics suggesting Statistics suggesting IVF later in life is IVF later in life is dangerous
dangerous
Moral questions Moral questions regarding child regarding child rearing
rearing
DoctorDoctor’’s right to s right to refuse treatment refuse treatment
Technological Technological
advancements in the advancements in the field
field
Civil liberties must be Civil liberties must be protected
protected
Patient’Patient’s right to s right to treatment
treatment
