Maternal mortality or maternal morality?
A critique of proposals to introduce maternal upper age limits for Assisted Human Reproduction services in Ireland.
The process of in-vitro fertilization for post-menopausal women is an issue which generates fevered publicity, rancorous debate, and ethical dilemmas. Since the 1990s, assisted human reproduction (AHR) via IVF has become more affordable, widespread, and successful. While IVF is most commonly used to treat pre-menopausal women struggling with fertility issues, at an increased level, postmenopausal women are seeking treatment to implant fertilized embryos long after their own natural egg production has ceased. In recent months, the Irish Department of Health has taken steps to regulate the provision of AHR services in Ireland. This article aims to contribute to the legal and ethical discussion surrounding maternal age limits, considering current medical facts, ethical principles, and alternative models of AHR. If there is an age at which reproduction is deemed too risky, should formal legal restrictions be placed on access to infertility treatment based on age? Is that consistent with international cedes of human rights that recognize a right to reproduce? Should doctors support the autonomy and desire of older women to reproduce, or in fact should state-regulated infertility programmes seek to actively outlaw AHR for older patients?
Banh, David; Havemann, Dara L.; Phelps, John Y. “Reproduction beyond menopause: how old is to old for assisted reproductive technology?” Journal of Assisted Reproduction and Genetics 27 (2010): 365-370.
Berryman, Julia C. “Perspectives on later motherhood.” In Motherhood, by A. Phoenix, A. Woollett and E. Lloyd. London (2010): Sage Press.
Buckley, Dan. “Irish living 2.5 years more than in 2005.” The Irish Examiner. 29 December 2017.
Caplan, Art L.; Patrizio, Pasquale. “Are You Ever Too Old to Have a Baby? The Ethical Challenges of Older Women Using Infertility Services.” Seminars in Reproductive Medicine 28 (2010): 281- 286.
Daniel, Lincia. “Fertility treatment: How old is too old for pregnancy and parenthood?” British Journal of Midwifery 14 (2006): 341.
Department of Health. General Scheme of the Assisted Human Reproduction Bill. Dublin (2017): An Roinn Sláinte.
Department of Health. “Government approves the drafting of the Assisted Human Reproduction Bill.” Press Releases - An Roinn Sláinte, 3 October 2017. Available at: https://health.gov.ie/blog/press-release/government-approves-the-drafting-of-the-assisted-human-reproduction-bill/ (Accessed December 1, 2018).
Edwards, Robert Geoffrey. “Pregnancies are acceptable in post-menopausal women.” Human Reproduction 8 (1993): 1542 - 1544.
Gleicher, Norbert; Weghofer, Andrea; Barad, David. “Too old for IVF: are we discriminating against older women?” Journal of Assisted Reproduction and Genetics 24 (2007): 639 - 644.
Klitzman, Robert L. “How old is too old? Challenges faced by clinicians concerning age cutoffs for patients undergoing in vitro fertilization’.” Fertility and Sterility (2016): 216 - 224.
American Society for Reproductive Medicine, “Frequently Asked Questions About Infertility - What is In Vitro Fertilization?”, www.asrm.org/detail.aspx?id=3022 (Accessed December 1, 2018).
Paulson, Richard J., and Mark V. Sauer. “Oocyte donation to women of advanced reproductive age: ’How old is too old?’.” Human Reproduction 9 (1994): 571 - 572.
Pennings, Guido. “PostmenopausalWomen and the Right of Access to Oocyte Donation.” Journal of Applied Philosophy 18 (2001): 171 - 181.
Reynolds, Melissa. “How Old is Too Old: The Need for Federal Regulation Imposing a Maximum Age Limit on Women Seeking Infertility Treatment.” Indiana Health Law Review 7 (2010): 277 - 304.
Robertson, John A. “Patient selection for organ transplantation: age, incarceration, family support, and other social factors.” Transplantation Proceedings 21 (1989): 3397 - 3402.
Salihu, Hamisu M., Aliyu, Muktar H.; Bosny, J. Pierre-Louis; Alexander, Greg R. “Levels of Excess Infant Deaths Attributable to Maternal Smoking During Pregnancy in the United States.” Maternal and Child Health Journal 7 (2003): 219 - 227.
Savulescu, Julian. “Consequentialism, reasons, value and justice.” Bioethics 12 (1998): 213 - 237.
Smajdor, Anna. “The Ethics of IVF over 40.” Mauritas (2011): 37 - 40.
Ubelacker, Sheryl. 2015. “Quebec’s high cost of funding IVF without an age limit, a cautionary tale.” Global News Canada. 19 October 2015.