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Excerpt: Are you ever too old to have a baby?

Can someone be too old to be a parent? A number of cases last year of single women in their midfifties having children raised this question. The question looks pretty straightforward, but it isn’t.

Can someone be too old to be a parent? A number of cases last year of single women in their midfifties having children raised this question. The question looks pretty straightforward, but it isn’t. In order to answer it, there must be agreement both on what values would make a potential parent “too old” and on who would enforce a rule that used age to limit access to reproductive technologies.

So, how old is too old? Was Larry King of CNN too old when he had a child with his seventh wife at age seventy? Cheryl Tiegs, who had twins at fifty-two? Geena Davis, twins at forty-eight? Tony Randall, who had a child at seventy-seven and died a few years later? James Doohan (Scotty from the original Star Trek), who had children at eighty? Donald Trump, fifty-eight, now making menacing reproductive noises in the context of his widely publicized third marriage? It is very hard to draw an absolute line and say what age is too old, although the idea of Donald Trump mating makes the project a particularly compelling one.

Assistance in knowing how old is too old has now been provided by a Romanian woman, Adriana Iliescu. The sixty-six-year-old unmarried writer gave birth by an emergency Cesarean section to a baby girl on January 17 at the Giulesti Maternity Hospital in Bucharest. She is now the oldest woman ever to give birth. Her doctor, when asked why he would use reproductive technology to permit a sixty-six-year-old woman to become pregnant, said that is what she wanted to do and that he was impressed with her faith in God and with her “determination.” Giving birth may be what Adriana Iliescu wanted, and she may well be a very determined person of great piety, but the doctor did something highly unethical when he helped her become pregnant. Adriana Iliescu is too old to be having a baby.

Iliescu needed a doctor’s help because she no longer can make eggs. Since she is single, donor eggs and sperm were used to make embryos. One of these became her daughter Eliza Maria. But, while she did give birth, all the doctor did was allow her to become pregnant, not to have her own genetic child. Why was this so wrong? It is wrong because there was a terrible price to pay for using technology to make a sixty-six-year-old woman pregnant.

Any woman over the age of forty is a high-risk pregnancy. Medical risks rise rapidly for both moms over forty and for their babies. They became terribly real in the case of Iliescu’s pregnancy.

The child she delivered was born premature —a low-birthweight baby. This poses real health problems for the baby, which are made even more troubling by the fact that Romanian neonatal units are not the equal of those in other, wealthier nations. The mom had to undergo an emergency C-section, not easy for a sixty-six-year-old, who now must take on mothering duties by herself with a baby who may well have significant medical problems.

Not as widely reported in all the hullabaloo about the “world’s oldest mom” is that Iliescu lost one fetus early in her pregnancy and gave birth to a stillborn baby when Elsa Maria was born. Adriana Iliescu’s pregnancy came with two deaths, one premature baby whose fate remains unknown, and one life-threatening emergency C-section—a morally unacceptable price.

But that is not the end of the challenges that a pregnancy in a sixty-six-year-old woman brings. Consider that when her daughter enters high school, her mother will be eighty. Eighty! That’s the end of the argument. If you are sixty-six and single, man or woman, you should not be having a baby.

My proposal is that anyone over sixty-five who is single should not use reproductive technology to have a child. If you have a partner, then your total ages should not be more than 130. And if you are female and at or near fifty-five years of age and going to carry a pregnancy, then you can use reproductive technology only if you can pass a tough physical examination. Sixty-six—forget it.

Who will enforce this age limit? Should we have a law, or can we leave it up to doctors at individual infertility clinics?

As it happens, I coauthored a survey of American reproductive technology programs led by Andrea Gurmankin of Harvard Medical School, which was just published in the journal Fertility and Sterility. The survey asked a number of hypothetical questions of clinic directors to try to figure out what values doctors use to decide who can and cannot use technology to become a parent in the United States.

One question we asked was whether clinics would turn away couples where both parents were forty-three years old. Most would not, but surprisingly 18 percent said they would. Twenty percent said they would not accept a woman who was single, and fifty-three percent said they would not deal with single men.

Age was not the only disqualifier. Three percent of programs said they would not accept a couple who were both blind from an accident. Seventeen percent said no to women who state they are lesbians. Thirty-eight percent said they would not take as patients a couple who were on welfare and using Social Security checks to pay for infertility treatment.

So there is quite a lot of screening going on at clinics already. Some programs don’t care much about age or whether you are single or not. Others do.

If there is an age at which it makes sense to say someone is too old to use reproductive technology, and I think there is, then who should enforce this policy? If you leave enforcement to individual clinics, they may, but their current practices, which are all over the map, make it seem unlikely. Still, the medical profession or state legislators should act. The race to create the world’s oldest mom should be declared over.

Excerpted from the newly-published "Smart Mice, Not-So-Smart People," by Arthur L. Caplan. Reprinted by permission of the publisher, Rowman & Littlefield.

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