A 62-year-old Spanish woman recently gave birth to her third child by way of in vitro fertilization (IVF) despite the refusal of help and support from a series of gynecologists who all told her that a safe and successful pregnancy would be nearly impossible for her. Now, she and her baby are both healthy. And she’s not the oldest woman to defy such expectations: a 72-year-old Indian woman also gave birth to a healthy child earlier this year after IVF. In both cases, the pregnancies were without major complications.
Nevertheless, these maternal success stories have fueled heated debates about whether an age cap should be placed on the availability of IVF. In the context of these stories and discussions, professor and physician Dominic Wilkinson wrote in Oxford University’s popular philosophical blog Practical Ethics about four common arguments against permitting older women to have IVF and why they are flawed. The four he lists are:
1. Having an older mother is harmful.
2. Being pregnant while older is harmful.
3. IVF doesn’t work in older women.
4. IVF shouldn’t be publicly funded.
These objections are common, and they all turn out to be deeply flawed. Nevertheless, many countries make it difficult or impossible for women to undergo IVF after a certain age. In the UK, for example, where Professor Wilkinson works, women cannot receive IVF after age 42. With so many individuals and families being affected, these claims merit scrutiny.
The claim that having an older mother is harmful to the child is based on the expectation that the mother will die while the child is still young. This, in turn, is ostensibly very harmful to the child – so much so as to render the child’s life not worth living. Conceding that this potential for harm is real, Wilkinson notes that this objection fails to reckon with how long women typically live. According to the American Social Security Agency, a woman in the United States turning 65 years old today can expect to live to be 86.6 years old. In Spain, the average woman lives 85.5 years. Therefore, the youngest child of Lina Alvarez, the 62-year-old Spanish woman who gave birth after a controversial yet utterly successful IVF, can reasonably expect to live to see her mother for over the first 20 years of her life. As a result, it is difficult to justify why women of her age or in their mid-40s should be forbidden from trying to have a child on these grounds. As Professor Wilkinson puts it, “[T]his argument only works if we think that the lives of children born to older mothers are going to be so bad that it would be better that they had never been born.” While the loss of a parent is surely sad, it seems implausible that an otherwise good life in which someone grows up with his or her mother well into adulthood is not worth living. Furthermore, such critics seldom advocate to make natural conception of a child illegal for middle-aged to older women. If women over 42 can legally conceive children without IVF, then it is unfair to restrict others from doing so with IVF.
The second objection Professor Wilkinson addresses is that pregnancies are harmful to older women. The fact that older women have higher rates of medical complications during pregnancy is indeed borne out by empirical data. However, Wilkinson observes that objecting to providing older women with IVF on this basis fails to reckon with the more general fact that the vast majority (around 80%) of older women encounter no such problems. Thus, Wilkinson concludes:
There are good reasons for women to be aware of those risks of complications, and to take them into account when making decisions about whether or not to become pregnant. But for women without major health problems already, the risks of pregnancy are not so high that they can’t go ahead.
Given older women's general rates of success with pregnancies, demanding anything more than informed consent and a considered decision seems excessive. If a woman in her mid-40s or later gets pregnant, she will most likely be fine during and after the pregnancy.
The third criticism Wilkinson examines is that IVF does not work for older women. The aforementioned success stories notwithstanding, such critics believe that IVF generally fails to work for women beyond their early 40s. Wilkinson identifies some sloppy thinking here too. This line of argument tends to invoke reputable studies revealing low birth rates among an irrelevantly narrow set of subjects: women being fertilized with their own eggs. More realistically for modern IVF, older women receiving eggs from younger donors have virtually the same success rates as younger women. Besides, a low rate of success does not, in and of itself, merit a legal prohibition against a woman’s right to try anyway.
The fourth and final argument Wilkinson explores is based on the premise that IVF should not be publicly funded. Such critics note that resources would be more justly allocated toward more pressing ends such treatments for cancer. Wilkinson outlines a particular and a general flaw in this line of argumentation. First of all, someone committed to this line of criticism must hold that older women should not be able to get IVF as well as younger women. Yet, few critics advocate for such an outright banning of public support for IVF. More generally, Wilkinson notes that even if something should not be funded publicly, that does not mean it should be illegal. He writes: “[W]hether or not public IVF should be funded, these arguments shouldn’t stop someone paying for private fertility treatment, as Alvarez did.”
There may be some sound reasons why women might consider avoiding getting IVF as they get older. However, Professor Wilkinson offers a thorough and lucid account of why none of these reasons could justify a legal prohibition against women’s access to IVF based on age.
Perhaps in the words of Bill Nye, we should stop telling women what to do with their bodies: