Is there a right age for IVF? – Health News

In 2017, a woman in Haryana— believed to be at least 70 years old— reportedly gave birth to a son. Incidentally, the baby was the first for Daljinder Kaur and her 79-year-old husband Mohinder Singh Gill after nearly five decades of marriage. In fact, the clinic where Kaur underwent the in-vitro fertilisation (IVF) had helped another woman Rajo Dev to give birth to a daughter at the age of 70 years in 2006. Similarly, in 2019, a 73-year-old woman, Mangayamma Yaramati, in Andhra Pradesh gave birth to twin girls with her 82-year-old husband Sitarama Rajarao, all thanks to IVF.

IVF—a type of assisted reproductive technology (ART) used for infertility treatment and gestational surrogacy—is considered a boon for women trying to conceive, especially in a country where not being able to bear a child also comes with stigma attached. However, considering the ethical boundaries and health risks involved, a question arises—how old is too old for someone to undergo the procedure?

In India, there is an age restriction for women (50 years) and men (55 years) under the Assisted Reproductive Technologies (Regulation) Act, 2021, a law that aims at the regulation and supervision of ART clinics and assisted reproductive technology banks, prevention of misuse, and safe and ethical practice of ART services.

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Doctors cite declining fertility and quality of eggs, issues in sperm quality and production along with co-morbidities of older age, which make pregnancy risky for both the mother and the child, as a major reason behind the age restrictions. At the same time, legal experts are of the view that everyone’s rights, including that of a child born out of such a pregnancy, make age limit an important factor. Amid this black and white distinction of biology and law, lies the grey area of sociology where individual autonomy and reproductive rights also become causes for concern and something that warrants attention.

Factors at play

While there are a number of factors at play, such as the patient’s age, health and the type of treatment, specialists say a conventional IVF treatment has a 25-40% success rate and is best suited for women over 35 years with unexplained infertility or obstructed fallopian tubes. IVF has a variety of methods that are customised to meet specific demands. This treatment increases egg production using medication. Natural-cycle IVF is also an option for women who are still ovulating that harvests eggs in sync with the woman’s natural menstrual cycle.

There is also an option of minimal stimulation IVF that uses fewer medications and is less expensive and risky. For low sperm count, there’s an option called intracytoplasmic sperm injection (ICSI), which involves injecting live sperm into a person’s eggs in a laboratory. In the event where the egg quality of an older mother is not up to the mark, the success rates are increased by IVF using donated eggs. In the condition when there is no sperm in the ejaculate called azoospermia, the treatment is done with ICSI and testicular sperm aspiration/micro testicular sperm extraction (TESA/microTESE). Doctors say that for couples with genetic issues or recurrent miscarriages, preimplantation genetic testing (PGT)—a form of prenatal genetic diagnosis where abnormal embryos are identified—allows transfer of genetically normal embryos and can improve results.

Despite all these medical options, doctors warn against the potential health risks associated with later age pregnancies in women as co-morbidities like hypertension, diabetes, cardiac disease and osteoporosis become common with age and increase the maternal health risk during pregnancy.

“With increasing age, the quality of egg decreases (having higher risk of chromosomal abnormalities), the likelihood of miscarriage and chromosomal abnormalities is increased. Additionally, reproductive medicines may cause the body to react less positively. While age is undoubtedly important, it’s not the only factor. The state of the uterus, general health, sperm quality, and even lifestyle choices can influence IVF success,” says Dr Archana Dhawan Bajaj, a gynaecologist, obstetrician and IVF expert at Nurture IVF Clinic, Delhi.

In older women, low birth weight or preterm delivery, diabetes throughout pregnancy (gestational diabetes), hypertension (pre-eclampsia), and other pregnancy problems such as in C-section, or caesarean section, and stillbirth are more common and embryos are more likely to have chromosomal abnormalities, which can result in genetic problems in the progeny such as Down syndrome.

“Despite the fact that assisted reproductive technology makes it possible to become a parent later in life, it is important to consider the dangers involved and make sure that postmenopausal decisions are well-informed,” adds Dr Bajaj.

Fixing an age limit

While doctors do concur that a generalised age limit is difficult to establish, they perceive the age limit under ART law set by the government inclusive of the risk factors of an old-age couple as parents along with the rights of the child, for the “greater good” of society and most importantly what can be generally “suitable” to a population. They point out the general life expectancy, fitness level, education, awareness, and morality as factors behind setting an age limit, at the same time recognising that each person’s health may be unique and doctors can accordingly evaluate and advise.

“The upper age limit for IVF pregnancies is difficult to determine. Due to the potential risks to the health of mothers and children, the ART Act in India places a 50-year age limit for women. For anyone considering undergoing ART procedures, compliance with these standards is essential. It is equally important to consult with a certified IVF expert or fertility specialist. Rather than imposing a general age limit, it is critical to evaluate the appropriateness of IVF depending on each person’s health and situation,” says Dr Bajaj of Nurture IVF Clinic.

Does it mean that no one above the age of 50 years should have a baby? “That is not correct,” says Dr Rajeev Agarwal, an IVF specialist and medical director at Renew Healthcare, Kolkata. “One should also see the government’s perspective because it has to formulate a law which is suitable for everyone. The moment you bring an exception, especially in India, people exploit that facility finding loopholes,” he adds.

Dr Rupali Goyal, an obstetrician, gynaecologist and infertility specialist at Apollo Hospitals, Delhi, acknowledges that there is a variegated population in the country in terms of fitness levels and that old age pregnancy is not always completely unsafe. “Pregnancy in a later age group poses a lot of high risk to the health of the mother. It’s not about giving birth to a child, it’s about taking care of the child and the future of the child. It’s not about knowing the technology, it is about the fact that it has to be used in the right manner with the right results,” she adds.

Legal challenges and reproductive rights

Legal experts are of the view that putting a restriction on age limit raises the question of the right to reproductive autonomy, the right to privacy, and the right to family life, all of which are an inherent part of the right to life guaranteed under Article 21 of the Constitution.

Jayna Kothari, a senior advocate at the Supreme Court, notes that fixing an upper age limit is arbitrary. “The right to reproductive autonomy is an integral part of the right to life. Fixing an upper age limit for women and men, is a violation of this right, as it deprives people of their right to reproductive autonomy. Instead of fixing any upper age limit, it can be left to be decided in each case, based on the health of the woman, and the decision taken by the doctors on her capacity to have children,” Kothari says.

Recently, the Union ministry of health and family welfare, in its reply filed before the Supreme Court to a PIL challenging several provisions of the Surrogacy and ART Act, including the upper age limit, said that the reasons for prescribing an upper age limit for ART Services under Section 21(g) of the ART Act, 2021 include ensuring a child’s well-being throughout their upbringing until the age of 18 years, requiring parents who are in good health and financially stable, a responsibility justified by India’s average life expectancy of around 70 years.

Incidentally, the 2005 Indian Council of Medical Research (ICMR) guidelines, issued by the Union ministry of health, has no recommendation on the upper age limit for recipients of donated oocytes or embryos for IVF.

Advancement of science and technology has changed the natural boundaries of women’s reproductive capabilities, says SC advocate Mohini Priya, adding: “With the aid of hormonal therapies and donations, women who have reached menopause can now consider pregnancy. Delayed marriages and the desire to start a family after establishing a stable career are additional factors supporting the need for an increase in the upper age limit for pregnancy.”

“The evolution of laws and regulations regarding fertility issues, reproductive rights of women, age limits, consent, human rights, and the growing trend of women pursuing pregnancy beyond the current legal age limit of 50 years, and men beyond 55, must strike a delicate balance between protecting individuals’ autonomy and safeguarding the welfare of children born from assisted reproductive technologies (ART),” says Priya.

Meanwhile, Kashish Aneja, a Delhi-based advocate who works on matters related to health laws and policy issues nationally and globally, says that the current age restrictions balance out both the needs of advanced-aged parenting and health concerns of the child involved.

“The argument in support of parenting at an advanced age is the principle of procreative liberty or the right to reproduce without interference or limitation but rights are not without limitations and the state has the right to impose reasonable restrictions giving due consideration to both parental health, child’s health, rights of children and duty of parents among others,” he says.