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How old is too old to have a baby?

Fertility clinics should be required to enforce age limits when it comes to determining who can receive help through reproductive technology. And if they're not willing to do so, the government should step in, says ethics columnist Arthur Caplan.
Adriana Iliescu, the 66-year-old Romanian who gave birth to baby girl is seen in an intensive care in Bucharest
Adriana Iliescu, the 66-year-old Romanian who gave birth to baby girl on Jan. 17, rests at the Giulesti Maternity Hospital in Bucharest, Romania.Pool / Reuters
/ Source: contributor

Can someone ever be too old to be a parent? Several recent cases involving older single women having children have helped bring this issue into the spotlight and make it a topic of national debate.

At first glance, the question appears pretty straightforward — but it isn’t. In order to answer it there must be an agreement both on what would make a potential parent “too old” and who would enforce rules that limit access to reproductive technologies based on age.

So, how old is too old? Was Larry King of CNN too old when he had a child with his seventh wife at age 70?  Was Cheryl Tiegs who had twins at 52 too old? Geena Davis, twins at 48?  Tony Randall who had a child at 77 and died a few years later? James Doohan (Scotty from the original Star Trek) who had children at 80? Donald Trump, 58, 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 to become a parent, although the idea of Donald Trump mating makes the project a particularly compelling one.

The case of the 'world's oldest mom'
Assistance in knowing how old is too old has now been provided by a Romanian woman named Adriana Iliescu. The 66-year-old unmarried professor and writer gave birth by emergency Caesarean section to a baby girl on Jan. 17 at the Giulesti Maternity Hospital in Bucharest. She is now the oldest woman in the world ever to give birth. Her doctor, when asked why he would use reproductive technology to permit a 66-year-old woman to become pregnant, said he helped her because that is what she wanted to do, and because he was impressed with her faith in God and with her “determination."

Giving birth may be what Iliescu wanted to do, 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: Iliescu is too old to be having a baby.

Iliescu needed a doctor’s assistance because she is no longer able to produce healthy eggs of her own. Since she is single, donor eggs and sperm were used to make embryos. One of these embryos became her daughter, Eliza Maria. But, while Iliescu did indeed give birth to a baby, all the doctor did was allow her to become pregnant, not to have her own genetic child.

A morally unacceptable price
Why was this act so wrong? It was wrong because there was a terrible price to pay for using reproductive technology to make a 66-year-old woman pregnant.

Any woman over the age of 40 constitutes a high-risk pregnancy — the medical risks rise rapidly for mothers older than 40 and for their babies. These risks became terribly real in the case of Iliescu’s pregnancy. The child she delivered was born premature — a low birth-weight baby. This poses serious health problems for the baby, concerns that are made even more troubling by the fact that Romanian neonatal units are not up to the same standards as those in other, wealthier nations. In addition, Iliescu had to undergo an emergency C-section, not easy for a 66-year-old who must then go on to handle parenting duties by herself with a baby who may well have significant medical problems in the future.

Not as widely reported in all the hullabaloo about the "world’s oldest mom" is that Iliescu lost one fetus early on in her pregnancy and also gave birth to a stillborn baby in addition to Eliza Maria. Iliescu’s pregnancy came with two deaths, plus one premature baby whose fate remains unknown, and one life-threatening emergency C-section — altogether a morally unacceptable price.

But that is not the end of the challenges a pregnancy in a 66-year-old woman brings. Consider that when her daughter enters high school, Iliescu will be 80. Eighty! That should be the end of the argument. If you are 66 and single — man or woman — you should not be having a baby.

Age limits needed
My proposal is that anyone over 65 who is single should not be allowed to 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 a female at or near 55 years of age and hoping to become pregnant, then you should only be allowed to use reproductive technology if you can pass a rigorous physical examination. At age 66, forget it.

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

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

One question we asked was whether clinics would turn away couples in which both parents were 43 years old. Most would not turn them away, but a surprising 18 percent of clinic directors said they would. Twenty percent said they would not help a woman who was single become pregnant, while 53 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 would turn away women who state they are lesbians, while 38 percent said they would not help a couple who were on welfare and using social security checks to pay for infertility treatment.

Government should step in
Clearly there is quite a lot of screening already going on at fertility clinics. Some programs don’t care much about age or whether a patient is single or not, but others do.

If there is an age at which it makes sense to declare someone too old to use reproductive technology — and I strongly believe there is — then who should enforce this age limit? If you leave enforcement up to individual clinics they may decide to implement the rule, but given that their current screening practices are all over the map, this seems unlikely.

In light of the high risks at stake, the medical profession or state legislators should act. The race to create the world’s oldest mom should be declared over.

Arthur Caplan is director of the Center for Bioethics at the University of Pennsylvania.