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Assisted reproduction: we need to talk

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AMA President Dr Michael Gannon has called for the “mother of all debates” over the funding and regulation of assisted reproduction following revelations that a 63-year-old Tasmanian woman has become a first-time mother using IVF technology.

Dr Gannon criticised the mother’s decision to use IVF to conceive a child at such an advanced age as “selfish and wrong”, and said the community needed to consider carefully who should have access to assisted reproduction technology, and the consequences it can have for children, parents and broader society.

“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,” the AMA President said. “This must not be narrowly viewed as a women’s rights issue. Nor is it about ageism.”

Dr Gannon, who is a Perth-based obstetrician, sparked a firestorm of comment after he responded to news of the birth by commenting on Twitter that the use of IVF to have a child so late in life was “madness”. He said the not only were women “not designed” to give birth in their 60s, but the decision disregarded the rights of the child and the burden on taxpayers.

Critics accused Dr Gannon of making a moral judgment about the mother and downplaying the role of the father, who is 78 years old.

But the AMA President said there were compelling medical, social, financial and ethical reasons for ensuring that such cases did not become commonplace.

Most IVF clinics in Australia do not offer treatment to women beyond the age of 53 years, and the Tasmanian mother went overseas to be impregnated with a donor embryo before returning to Australia and giving birth at 34 weeks at Melbourne’s Frances Perry House private hospital.

Dr Gannon said there was good reason why Australian IVF services would not treat a woman so late in life.

He said that from around the age of 30 years onward problems associated with pregnancy and birth gradually increased, including miscarriage, chromosomal abnormalities, pre-eclampsia and the risk of stillbirth: “None of this is avoidable, and no amount of anti-oxidant supplements or kale smoothies can arrest the inevitability of ageing”.

By the time women were in their 50s and 60s, the effect of ageing on their blood vessels meant they were more susceptible to blood clots, heart attacks and strokes – “a potentially high price to pay to have a baby”.

Dr Gannon said the baby, because it was born premature, also faced an elevated risk of health problems such as breathing difficulties and jaundice, and would be more vulnerable to chest infections, asthma, diabetes and hypertension later in life. Because it potentially missed out on crucial in utero brain development, the child could also experience learning problems and developmental delay.

Costs to society and taxpayers also needed to be considered, he said. It cost about $2500 a day to care for a baby in the Neonatal Intensive Care Unit, much of it subsidised by the taxpayer, and such demands diverted resources from other parts of an already-stretched health system.

He said the decision of couples denied IVF in Australia to seek treatment overseas was “not simply an expression of choice, or a case of ‘user pays’. The health system picks up the bill”.

Dr Gannon said the birth of a child to a 63-year-old mother was not what the pioneers of IVF had in mind when the developed the technology 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,” he said. “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.”

Adrian Rollins

 

 

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