Science takes motherhood into the golden years

On Dec. 29, 2006, the BBC broke the story on a 66-year-old women successfully giving birth to twin boys in Barcelona, Spain making her the oldest known birth mother in the world.

Identified later as Maria del Carmen Bousada de Lara of Spain, the mother and her story drew even more attention when de Lara revealed on a Spanish television show that she lied about her age to the fertility clinic that impregnated her.

Months later, Britain’s Telegraph newspaper reported that doctors diagnosed de Lara with breast cancer, a potentially fatal disease that could orphan her children before they even lose their primary teeth.

The case of de Lara’s has only added more controversy to the debate of whether or not to prohibit postmenopausal pregnancies.

Kerry Bowman, bioethicist at Mount Sinai Hospital and the University of Toronto’s Joint Centre for Bioethics, says many countries, including Canada, wrestle with this question daily.

“Society, including Canadian society, is struggling with this,” Bowman said. “Some of the fertility programs in Ontario are now struggling to decide … whether there should be any age limits. At this point there isn’t.”

Post-menopause refers to a woman’s ovaries that become inactive for more than a year. It usually occurs in women between the ages of 45 and 55. They therefore must rely on assisted reproductive technology such as in-vitro fertilization (IVF) to conceive.

According to Bowman, postmenopausal pregnancies can spark what’s called in ethics the ‘yuck-factor.’

“For example, pick an age, say having a baby at 55. ‘Yuck,’ that’s not normal. That’s weird,” Bowman said. “Are we just reacting because (a postmenopausal pregnancy) makes us squirm a little bit or… can we analyze it and come up solid reasons for why it’s wrong.”

Bowman points to the fact there are lots of men 50 and over having children. Celebrity examples include Larry King at 70 and even James Doohan (Scotty from the original Star Trek) at age 80.

Arthur Kaplan, director of the Center for Bioethics at the University of Pennsylvania and an advisor to current U. S. President George W. Bush, argues in an MSNBC article for an age limit of 65.Kaplan’s argument assumes older parents have a greater risk of dying before their children reach adulthood.

“Those are arguments,” Kerry said after reading the article. “But (Mount Sinai’s fertility specialists) have a lot of women … at 20 or 30 (years-old) that are running much greater risks because of their cancer background than these women at 55 that have nothing wrong with them.”

Bowman said despite the complications cancer may cause during a pregnancy, Canadian fertility clinics will rarely say no if their help is needed. Bowman and his colleagues believe that individuals should be allowed to make their own choices.

Kaplan’s article also argues for a “rigorous physical examination” test for postmenopausal women. He reasons that older parents are probably less physically energetic compared to their younger counterparts.

“We have disabled people… that cannot walk and will never walk again. (Disabled) women that want to have a baby. We don’t say ‘no’ to that,” Bowman said. “The arguments are if you’re 55 than you’re less inclined to get on the floor and play ball with your son or daughter. Well, some 25-year-olds don’t do that and we don’t discriminate against disabled people.”

A 2002 study, entitled “Pregnancy in the sixth decade of life,” used 77 postmenopausal women (with no chronic medical conditions) in their 50s who underwent 121 IVF procedures.

The results showed 45 live births from IVF with body weights and average fetus age numbers comparable to natural births or births not using assisted reproductive technology.

“This is not bad at all in terms of outcomes,” Bowman said. “The biggest question is not just what is the right decision, but who should make that decision.”

Such arguments make it very difficult for someone to arbitrarily cut-off a postmenopausal pregnancy due to age. Bowman uses 50 years as an example.

“What will happen is we’ll get a woman who’s 49 and 11 months and help them and then we’ll end up getting a woman who’s 50 and one month that we send home,” Bowman said. “I mean what’s really the difference?”

In Toronto, Bowman recommends handling it on a case-by-case basis with very careful analysis.

“It’s not just ‘is it the right decision?’ It’s ‘is it the right decision for her or us as a hospital?'” Bowman said. “Generally the Canadian thing (is) as much as possible … (that) we as health care workers try and mind our own business. As much as we can we try and pull back.”

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