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Last week, a 73-year-old Indian woman gave birth to twins. It was shocking reproductive news. And since you’re wondering, yes, that’s a record for the oldest person to deliver a baby, much less two babies. The new mom, Mangayamma Yaramati, and her husband, Sitarama Rajarao — who is actually nine years older than her, at age 82 — turned to assisted reproductive technology to conceive their twin daughters. Familiar concerns about medical ethics, along with the idea of reproductive technology generally, often emerge after cases like this make the news.
When the press came calling, the couple explained that they married in 1962, and then spent decades together trying to conceive without success. The couple said they recently learned of a neighbor in her fifties who used IVF to conceive, and they found renewed hope, along with the most crucial part of the process: a doctor willing to work with them. Using donor eggs and Rajarao’s sperm, the IVF treatment was successful on the very first round.
Unfortunately, in a turn of very bad luck (or perhaps a natural reaction to having newborn twins at age 82), Rajarao, the new dad, had a stroke the day after the birth. He is in the hospital being treated for the stroke while his wife Yaramati is expected to remain at the hospital for another few weeks for monitoring. That’s a rough start for the new family of four. And actuarial charts are not predicting much improvement for the family, at least not for long. Given the parents’ advanced age, it’s hard to know how much of their daughters’ lives they will actually see.
How Old Is Too Old?
While lawmakers in India have considered placing age restrictions on the use of assisted reproductive technology, no such law currently exists that would have prevented the IVF doctor from undertaking the treatment in response to the Yaramati-Rajarao’s plea for assistance.
Advances in technology have ushered in possibilities not previously conceived of (a little pun humor there) — gametes from a person who died decades ago can be used to conceive a child. And it gets even more interesting: not only can an embryo be carried to birth by a person genetically unrelated to the resulting child, and, as we see here, octogenarians are no longer necessarily being sidelined to the role of grandparents.
The Ian Malcolm character from Jurassic Park is best remembered for this apt observation: your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.
I spoke with Professor Judith Daar, dean of Northern Kentucky University’s Chase College of Law and chair of the American Society for Reproductive Medicine (ASRM) Ethics Committee, about this case. Professor Daar pointed to the ASRM guidelines which, while not binding, are the standards that most American fertility professionals look to for guidance. The ASRM guidelines discourage IVF using donor eggs or embryos (which are presumably required for a patient of advanced years) past a certain age, explaining that:
In view of the limited data regarding maternal and fetal safety, as well as concerns related to longevity and the need for adequate psychosocial supports for raising a child to adulthood, providing donor oocytes or embryos to women over 55 years of age, even when they have no underlying medical problems, should be discouraged.
When the woman does have underlying medical problems, the guidelines discourage treatment past the age of 50. And the guidelines specifically provide that it is “ethically permissible for programs to decline to provide treatment to women of [advanced reproductive age] based on concerns over the health and wellbeing of the patient and offspring.”
But discouraging isn’t banning. And this is an area where the world is nowhere close to a consensus as to where the line should be drawn, or whether there should be a line at all. On one side, some countries do provide a solid limit as to the age of a woman when assisted reproductive technology will no longer be permitted for conception. In Israel, that age is 45. In Japan, 43. On the other hand, it is not an uncommon argument that there should be no limit. After all, there is no limit on the age men are allowed to reproduce the old fashion way. And studies of children born to older parents generally do not demonstrate a negative impact on the children. So for those of you concerned with research-based policy making, it’s hard to find the data to support an age cutoff.
Professor Daar does not shy away from being a strong supporter of reproductive freedom. However, she told me, even through that lens, that this case seems to go too far. It probably doesn’t help that when Rajarao was asked who would raise the twins should something happen to him and Yaramati, he replied: “Whatever should happen will happen. It is all in the hands of God.” Well, sure. But that isn’t exactly a comprehensive parenting plan.
In any event, technological advances will continue to push forward, and will continue to challenge our ideas of ethical conception in new ways. I doubt Yaramati will be the oldest maternal birth recordholder for long. But let’s also hope that we see significant scientific breakthroughs in average lengths of life, so that she can spend a lot more time with her newborn twin daughters.
Ellen Trachman is the Managing Attorney of Trachman Law Center, LLC, a Denver-based law firm specializing in assisted reproductive technology law, and co-host of the podcast I Want To Put A Baby In You. You can reach her at babies@abovethelaw.com.