COMMENTARY

How Old Is Too Old to Become a Parent?

Peter Kovacs, MD, PhD

Disclosures

October 15, 2013

Tragic Outcome of Post-menopausal Pregnancy: An Obstetric Commentary  

Vasireddy A, Bewley S
Reprod Biomed Online. 2013;27:121-124

Background

Initially, in vitro fertilization (IVF) was offered to overcome the problem of tubal disease. As experience has grown with the treatments and as the technology has improved, IVF has become available to a wider patient population, based on more heterogeneous indications. Nowadays, it is offered to treat male factor, tubal, immunologic, hormonal, unexplained, etc. causes of infertility. Over the years, it also became evident that the treatment can be successfully completed with donated gametes (egg, sperm donation) or when the embryo is implanted into a surrogate's uterus. This has opened up new areas of use. The availability of such "nonclassic" methods also raises legal and ethical questions.

A trend in delaying childbearing can be observed in the past decades. Women in increasing numbers continue their education and seek a professional career. In modern societies, it also seems more difficult to establish stable relationships that could be the base of a family. The result of these changes is that more and more women start thinking about conceiving once they are already over 30.

The ovaries contain a finite number of eggs. Reduced oocyte availability and poorer egg quality are associated with increased reproductive difficulty as women age. While under 30 years of age, only 5%-10% of couples face infertility problems. By the age of 40, the incidence of infertility is over 40%. Over the age of 45, women rarely conceive on their own or with assisted reproductive technology (ART).

Age-related problems in the woman can usually be overcome with the use of donated oocytes. This commentary article discusses the ethical and biological aspects of oocyte donation at an advanced age in relation to a controversial legal case.

Commentary Summary

According to a 2011 report, an Italian court took a 1-year-old child away from a couple as they were considered too old to be fit parents at the female age of 57 and male age of 70. The child was conceived through ART treatment abroad.

The authors discuss that as women age, the proportion of embryos affected by aneuploidy increases, and this is a major limiting factor in achieving pregnancy in the late 30s and early 40s. The uterus also shows some signs of aging, probably related to suboptimal blood supply, but this seems to be less of an issue because the age factor can be overcome by the use of donated oocytes.

It is also known that pregnancies at the extremes of the reproductive years are associated with a higher frequency of medical complications (hypertensive complications, gestational diabetes, preterm delivery, stillbirth, operative delivery). A pregnancy conceived through egg donation in a woman with advanced age is also associated with an increased incidence of medical complications, so the use of "young" eggs does not prevent these complications.

Even if a pregnancy progresses uneventfully and results in the delivery of a healthy child, one has to consider the chronic medical problems and malignancies that affect women in the fourth through sixth decades of life when they need to raise the child. While one tries to help couples whose last resort is gamete donation, the interest of the offspring also needs to be considered. Should the parents become incapable of fulfilling their parental responsibilities, it will become the responsibility of the society to provide care for these children. Therefore, the authors feel that the fertility treatment of women of advanced age or even in menopause should be regulated to avoid future cases like that in Italy.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....