IVF At Any Age?: A Look at the Medical Dilemma
world's oldest new mom dies at age 69 (see our earlier blog post clarifying that PFC did not treat this patient), three years after giving birth to twins conceived through IVF. Maria del Carmen Bousada apparently lied about her age to the Los Angeles Physician who helped her become pregnant, creating a firestorm of criticism in the press.
The case demonstrates one of the most basic dilemmas that we face in helping women become pregnant: at what age is a woman too old to become a mother? Most of us might agree that a 25 year old woman is young enough to receive help, but that a 70 year old is too old. However, drawing the cut-off line at some point between these extremes is not easy. With the help of in vitro fertilization and donated oocytes, women like Maria can become pregnant at an age where nature would naturally prevent the possibility of conceiving. Typically, women run out of oocytes in their early 50s and without oocytes and the granulosa cells that surround them, they lose their ability to make estrogen. This natural process, called menopause, can happen earlier or later for a given individual, but the ability to get pregnant and deliver a healthy baby declines rapidly for women in their late 30s and on into their 40s. The age of the woman is a determining factor of her since a 40 year old woman is trying to get pregnant with a 40 year old oocyte, and these older oocytes dont perform well. For example, the older oocyte is not good at keeping track of its own DNA, as evidenced by the increasing incidence of genetic defects such as Down syndrome in older mothers. And as if this wasnt bad enough, the rate at which oocytes are lost from the ovaries (also know as a womans biological clock) doubles at about age 38. If this doubling didnt happen, we think that women wouldnt reach menopause until their early 70s. It is thought that the speeding up of the biological clock in the late 30s is natures way of clearing out the remaining oocytes, so that women lose their ability to become pregnant but are then around to raise the children that they already have. Based on natures model, we might consider limiting IVF treatment to women that are in their early forties or younger. But with donated oocytes, this limit can be pushed and there are no legal age limits for pregnancy. So, who gets to decide when its too late to become pregnant? As far as following "nature's model", is age different than other factors that lead to infertility? Do we make rules? And do the rules apply to men too, where nature doesnt have limits? Note: Pacific Fertility Center does have both lower and upper age limits in place.