Cap on age limit for IVF could be allowed, but only with checks and balances

A newborn baby in an incubator (Representational image) | Photo: Adriana Loureiro Fernandez | Bloomberg

Bengaluru: Septuagenarians in India using in-vitro fertilisation (IVF) technologies have met with mixed responses. 

While IVF is becoming the most common infertility treatment, many countries, including the US, UK and Australia, have recommended age limits for accessing the technology. 

India, however, currently has no laws restricting IVF access for women of advanced ages. Consequently, in the last three months, at least two IVF-assisted births by women in their 70s have been reported from Tamil Nadu and Rajasthan. 

The idea of a 70-year-old woman giving birth to a child shocks the sensibilities of a lot of people. Though there is no legal age restriction, the state-funded Indian Council of Medical Research (ICMR) advises an upper age limit of 50 years. In 2017, the ICMR proposed the IVF Bill to regulate access to IVF based on age, but the Bill is yet to be taken up by the Parliament.

Why the call for age limit?

IVF is a taxing technique, requiring multiple hormonal interventions to a woman’s body. There is fear that women’s bodies at older ages cannot cope with these interventions as well as support childbirth.

There is evidence that repeated hormonal treatments can increase risk to cancer. Additionally, there are genuine concerns about the quality of life the child would get as the probability of the child’s parents living to nurture them until their teenage is relatively low. 

Even running around a toddler may be very exhausting for a 70-year-old unless there is more childcare support. Finally, there is the question of financial risk — right from paying for IVF treatment to providing for the child’s education and other requirements as they grow up. 

IVF typically takes several rounds and the chance of the treatment working reduces after the couple crosses 50 years of age. Lack of understanding of how septuagenarian parents may cope with these requirements, concern for the child’s welfare and a certain moral judgement on the ethics of women beyond menopausal age giving birth drive the calls for an age limit for IVF. 

The arguments sound scientific and logical — why allow women and couples take up this health and financial risk?

Yet, the government as an enabler of technology should not be making decisions on women’s reproductive rights. Do women after their menopause have reproductive rights? We would argue yes, because IVF is most often used to treat infertility and we should not judge if the reason for infertility is advanced age or any other biological reason.

Consider this: would you like to see governmental intervention in other examples of health risk (think excess sugar consumption leading to obesity) or financial risks (think stock trading or in our current landscape even putting money in a fixed deposit)? The choice to overeat or trade stock or employ IVF at age 70 are all personal choices and freedoms.

Banning individuals from enjoying their personal choice typically leads to opening up of underground businesses — this has been exemplified by the failure to stop alcohol consumption through prohibition.

Downsides of imposing a ban on IVF

Enforcing an age limit for IVF across many centres would be particularly difficult and monitoring its implementation would be nearly impossible given our capacity issues. 

Of course, lack of capacity is not a sufficient reason to forego regulating an activity, but if regulation encroaches upon individual liberties, alternative mechanisms to enable the desired outcome should be considered.

Imposing a ban may, in fact, stop the government and other agencies from talking about the issue and ensuring the safety of women of advanced age opting for IVF. A ban would also result in the complete loss of control over the entire process, when an elderly couple may choose to undertake the treatment. It can be argued that it is in precisely such delicate cases that regulation and safety standards are even more important.

Particularly in IVF, there is an essential requirement to educate couples about the risks associated with employing the technology at advanced ages. Governmental policies should inform on data/counselling that is being offered to prospective parents to facilitate their decision-making.

In many of the recent cases, the septuagenarians opting for IVF have confessed that social stigma associated with not having a biological child pushed them to choose the technology. This stigma is a societal problem that can only be tackled through greater awareness and bringing about societal change — stopping couples over 50 from having children through legal means will not get rid of the root problem. Educating and perhaps lowering the barriers to other ways of obtaining a child — adoption, for example — may have a higher benefit than trying to stop IVF beyond a certain age.

There is certainly a role for the media — the recurring success stories of 70-year-old parents paint a one-sided picture. There is no evidence on how many women have not been successfully treated with IVF and no disclaimer in the media reports.

Like there is mandatory requirements for cigarettes packs to show health advisory related to cancer risk, reports on IVF and IVF clinics could also carry risk advisories. Information regarding the probability of success of IVF treatments across age groups, and the probability of complications and health risks can be mandated by the government.

Should IVF not be regulated at all? 

Certainly it should be. There are many safety concerns with unregulated IVF centres not adhering to ethical standards for treating women and embryos. Last year, a Malaysian man was arrested in Mumbai for trying to smuggle live embryos sourced from an IVF centre. 

A ban would only increase such illegal activities. IVF centres need to be regulated to ensure women opting for IVF can undergo the treatment safely and the resulting embryos are preserved correctly. The need for IVF guidelines is urgent — particularly since the surrogacy bill passed in the Lok Sabha in August 2019 mandates a surrogate to be a woman of 25-35 years of age and a close relative. The increased difficulty for surrogacy may push more couples to adopt IVF.

Undergoing IVF is a personal choice — and banning it for certain ages is probably eroding constitutional rights of those individuals. Hence, a more comprehensive law mandating information sharing, protocols of consent, setting standards and a larger role for government in public education is needed. 

Shambhavi Naik, Research Fellow at Takshashila Institution, and her colleague Anupam Manur, Assistant Professor at Takshashila Institution have coauthored the article.