It may have made for a warm, fuzzy story with a 74-year-old becoming a mother to twin babies in Andhra Pradesh’s Guntur city on Thursday.
But with India’s average life expectancy at 70, how ethical is it for a fertility clinic to facilitate such procedures?
A day after Ahalya Nursing Home run by Dr S Uma Shankar in Andhra Pradesh’s Guntur town assisted the birth of Mangayamma’s (74) twins through in-vitro fertilisation (IVF), experts TNIE spoke to shared their outrage at the hospital’s lack of sensitivity, as the future of the twins appeared to have been completely lost sight of.
Gynaecologists and IVF specialists are fuming, with some even asking for the doctor who facilitated it to be put behind bars. The doctor, they alleged, unfortunately didn’t bother to think of either the condition of the woman or the future of the babies. They demanded a law to discourage any such misadventures in future.
Dr K Chandra Reddy, consultant IVF expert at the London IVF Clinic in Vizag, was appalled. “We need to have some moral and social obligation before taking up IVF for elderly couples as the welfare and future of child should also be kept in mind,” he said.
Also, restricted supply of blood from mother to baby due to the size of the placenta may affect the physical and mental health of the child. That apart, who will take care of the child born to an elderly couple after them? He said both the health and emotional condition of the mother must be kept in mind before going for IVF. In his view, IVF is unethical for elderly women.
Dr Manjula Annagani, a well-known gynaecologist in Hyderabad, saw it as an incredibly irresponsible decision morally, ethically and medically. “First, it’s not her egg, the egg is from a younger woman. But the sperm is her husband’s, who also has an aged sperm, which is most likely to contain DNA abnormalities. Second, pumping the lady up with hormones for as long as the incubation period, increases the risk of breast and uterine cancer dramatically, which may put the woman’s life at risk.”
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She further said, “Twins mean the babies are going to be pre-term. Pre-term babies have high risk of physical and mental deficiencies. So, the probability of having two children with deficiencies means more effort for the caretaker, which neither of the two parents will be able to provide. Additionally, it’s not even a medical miracle. It would have been a miracle if her own eggs were used. Or if she was a surrogate for her daughter who was unable to have children by medically providing her uterus.”
Dr Kamini A Rao, founder and Medical Director of Milan in Bengaluru, wondered whether the doctor who decided to go ahead with the treatment had a conscience at all. “The doctor should be shamed and the government has to step in and punish the doctor in question. From lactation issues to raising a child at that age is definitely going to be problematic. It is not just enough that a woman is walking and talking. There are many things to consider before administering IVF. She is not a baby producing machine. It is sad but that doctor is responsible for orphaning two children in just few years.”
Calling it completely unethical and pressing for immediate need of a legislation to curb such incidents in future Dr Sangeetha S Anand, a consultant in reproductive medicine, Manipal Fertility at Manipal Hospitals, said: “Definitely having children at the age of 74 is completely unethical. ICMR guideline mentions that the combined age of the parents for adopting children must not exceed 110 and for having a baby should not be more than 45 years. Even if parents are wanting to use donor sperms or eggs, the age limit prescribed is within 45 years.”
The Guntur hospital, however, defended its decision. “The elderly couple came to the hospital with a desire to have a child through IVF method and were well aware of the risks. We treated them after explaining the risks, where the success rate was only 10-20 per cent. In this case, it succeeded,” said a close aide of the doctor who handled the case.
Not surprisingly, Andhra Pradesh Medical Council chairman B S Siva Reddy was cagey, saying: “I will only able to comment on the issue after our general body meeting.” Dr B Shireesha Rani, MD (Gynaecology), Vizag IVF Centre, said the ideal combined age for a couple to opt for IVF should be 100 years, since it would help them raise the child for at least 25 years.
However, Dr Rama Devi Kolli, infertility specialist in Vijayawada, saw it as an achievement. “It is a good thing that a new record was set, where a woman in her 70s delivered twins. IVF procedures are something that people come to doctors voluntarily for. If a doctor refuses to do it, the couple will go to another doctor. However, the social aspects should also be taken into consideration while delivering at an advanced age, as they will not be fully involved in raising the child,” she said.
Another infertility specialist Dr Veeramachineni Padmaja sought explicit guidelines on administering IVF. “Just like adoption rules, where the couple’s total age should not be more than 90 years, in infertility treatments, there are proposals under the good practicing guidelines that the couple’s age should not cross 100 years,” she pointed out.Dr Hanumanth Rao, Registrar of the Telangana State Medical Council, while describing it as a achievement, said, “Socially, I would not recommend it as bringing up children is a struggle. Imagine what the 70+ couple would be going through. The matter is not just of giving birth, but also nourishing the children.”
Pressing on the need of setting up an upper age limit for IVF, Dr Nirmala Chandrashekhar, Consultant Obstetrics, Gynaecology and Gynaec Oncology at BGS Gleneagles Global Hospital, Bengaluru said, “There should be an upper age limit for IVF as chances of maternal and neonatal morbidity and mortality are significantly higher at advanced maternal ages.”
Dr Jaideep Malhotra, president of the Indian Society of Assisted Reproduction told TNIE, “Such incidents not only show the careless attitude of the doctors but also the apathy of the government.”
In Kerala, Dr Ramgopal M Pillai, Senior Fertility Consultant at Samad Hospital, pointed out that IVF at 74 is not illegal, but the future of the parents and the twins must be taken into account. Dr Cimmi Noble, infertility specialist with Ananthapuri Hospitals in Thiruvananthapuram, said there is no ethical issue in conceiving at 74, but does it all end with child birth? “Since the mother is aged, the children many not get the care that they would have got from a mother of child-bearing age,” she opined.
Dr Anupama R, Director and Chief Consultant, Pran Fertility Centre in Thiruvananthapuram, wondered, “Who will take care of the children after their time or what if their health deteriorates? The hormone treatment necessary for aged couple itself might have taken a toll on the mother. In good conscience I would never be able to advise anyone to do this.”
In May last year, 63-year-old K Senthamizh Selvi from Gobichettipalayam in Erode delivered a baby girl through IVF treatment given at a private fertility centre here, after being married for 42 years. Infertility consultant Dr D Senthamarai Selvi who administered IVF to Senthamizh Selvi, said: “Of course the child would face problems as the elderly parents could easily be mistaken for grandparents in social gatherings. Also, the geriatric parents won’t be as active as their younger counterparts.”
Dr S Chandralekha of Iswarya Fertility Centres in Madurai, said, “Encouraging and performing IVF on geriatric mothers is unethical and not advisable.”Retired professor and former head of the department of obstetrics and gynaecology at Madurai Medical College Dr C Shanthi said, “By virtue of being medical professionals, there is a need to gauge the parents’ decision on ethical grounds, not ignoring the child’s future. There has to be a social binding than mere fulfilment of the couple’s wishes.”
As Madurai-based psychiatrist Dr M V Preethi pointed out, “In the pursuit of fulfilling the elderly couple’s desire, the child could potentially be robbed of a normal childhood. There are high chances for such children to be autistic, have learning disabilities and lack social skills due to excessive pampering.”
(Inputs from Lalitha Ranjani @ Madurai, Anil S @ Kochi, Chetana Belagere @ Bengaluru and Oishani Mojumdar @ Hyderabad)