IVF pioneer slams 'irresponsible' IVF unit
A fierce ethical debate erupts over IVF after revelations a 62-year-old Tasmanian woman becomes a mother.
A 62-year-old Tasmanian woman gave birth to her first child in Melbourne this week. This story made headlines – and rightly so, given the circumstances.
The child was conceived overseas, via IVF, using a donor embryo. The baby girl was delivered by caesarean section at 34 weeks gestation. The mother was supported by her 78-year-old partner.
When asked to comment, as an experienced obstetrician/gynaecologist and president of the Australian Medical Association (AMA), I described the whole episode as "selfish" and "wrong". I stand by those words.
This case should open a broader debate about assisted reproduction in Australia, and the issue surrounding the obstetric care of women returning home pregnant after "treatment" overseas.
This must not be narrowly viewed as a women's rights issue. Nor is it about ageism.
As a community, we need to consider the rights of the child, the rights of society, the responsibilities of proper parenting, the health of the parents, the health risks to the child at birth and beyond, and the costs to the health system and the taxpayers that fund it.
This is not what Steptoe and Edwards had in mind when they developed IVF in the late 1970s. This amazing technology has brought much joy to many across the world. But just because medical science can do something does not mean we have to do it, or should do it.
We are learning more about the risks of being conceived from older sperm, but the fact is that the involvement of the male of the species in human reproduction is measured in minutes, if not seconds.
Then let us consider the age of the mother. Using a woman's own eggs after 42-43 years is rarely successful. The average age of natural menopause is 51-53 years. Most IVF clinics in Australia will have a policy to not offer treatment to women over this age.
There are good reasons for this. There is a gradual increase in the incidence of adverse obstetric outcomes from age 30. This includes infertility, miscarriage, chromosomal abnormalities, diabetes, pre-eclampsia, caesarean section and stillbirth. These risks relate to the increasing age of the eggs, the womb and other organs. None of this is avoidable, and no amount of anti-oxidant supplements or kale smoothies can arrest the inevitability of ageing.
Our blood vessels, as we reach our 50s and 60s, become harder and less elastic. Women this age are more susceptible to blood clots, heart attacks, and strokes – a potentially high price to pay to have a baby.
Ageing is natural and inevitable. Older women are more likely to have degenerative conditions and/or chronic disease. As we get older, we slow down.
What about the demands of parenting the child? Most 32-year-old mothers (and fathers) will tell you how hard it is bringing up a child. I genuinely hope that this child has her 80-year-old mother at her 18th birthday party. Her father will be 96.
This baby was born at 34 weeks. Babies born six weeks premature are inevitably admitted to a Special Care Nursery. They face higher risks of respiratory problems, infection, and jaundice. The child may be more vulnerable to chest infections and asthma as it grows up.
Why was baby delivered early? Growth restricted babies have higher rates of chronic disease like diabetes and hypertension in adulthood. If it was delivered early on purely maternal grounds, it had no chance to prepare for it – potentially missing out on crucial brain development, and being at increased risk of learning problems and developmental delay.
This baby is receiving care the equal of any in the world. But it comes at a price. A bed in a special care nursery costs around $2500 per day. Who pays for this? Even with private patients, the community pays most of the bill – through our taxes which fund the Commonwealth's contribution to inpatient care, and through our pooled health insurance premiums.
Limited health resources are further stretched. When this nation can properly fund General Practice and mental health services, we can talk about more money for private IVF.
I would love to see savings quarantined for women's and children's health. Let's have greater investment in health education, get waiting times for public urogynaecological appointments down, enhance obstetric services for mothers who speak English as a second language, and close the gap in the perinatal and infant mortality rates suffered by Aboriginal children.
The IVF ''treatment" in this case took place overseas. In most countries, there are no rules or regulations governing assisted reproduction. Most states in Australia have lax legislation with any limits of treatment provided coming down to the ethics of individual doctors and clinics.
To our credit, Australia leads the world in rates of the safer process of single embryo transfer. Sadly, there is little legislative protection to stop the unscrupulous use of multiple IVF cycles to desperate older women who have single digit percentage chances of success.
Some couples will not be told that it is unethical to try with their own eggs after age 42-43, where success rates are low. They will look overseas for IVF. But invariably they will choose to come home for antenatal care and delivery.
It is not simply an expression of choice, or a case of "user pays". The health system picks up the bill for care in pregnancy, any complications at birth, from prematurity, and any long term sequellae. Not to mention the inescapable chance of children being orphaned based on average life expectancy statistics.
Stories like this cannot become the norm. Let's talk to Australian women and men about starting their families in their 20s, not normalise the dubious use of medical science and powerful hormones to wake the womb from its normal, physiological, post-menopausal sleep.
We need to have a debate about the funding and regulation of assisted reproduction. It is the mother of all debates – one we need to have openly, honestly and responsibly.
Dr Michael Gannon is president of the Australian Medical Association.