Fertility expert weighs in on controversy of world’s oldest parents

The elderly Indian couple who made headlines earlier this month after becoming the world’s oldest parents, got to bring home their twin girls earlier this week, after both the septuagenarians and the babies spent time in the ICU.

Erramatti Mangayamma, 74, gave birth to full-term twins on September 5 in the city of Guntur, in the Indian state of Andhra Pradesh.

However, reports soon emerged that Mangayamma and her husband, Sitarama Rajarao, were in intensive care soon after the birth — Mangayamma for birth-related precautions and Rajarao for a lung infection, NDTV reported. Both parents have recovered and went home with their children on Sunday.

Read more: 74-year-old woman in India may be the oldest ever to give birth after delivering twins

The record-breaking birth sparked questions about the ethics of the birth

The “medical miracle” birth was met with controversy, as some people congratulated the parents while others questioned the ethics behind the children being born to such elderly parents.

Dr. Angela Lawson, a psychologist working with Northwestern University’s fertility clinic and an associate professor the Feinberg School of Medicine, explained why she’s concerned about older couples giving birth at later stages in life than normal.

“My concern is that — understanding an adult individual’s ability to make choices for themselves and their reproductive futures — they’re also making a decision that is going to influence that potential child,” Lawson told Insider in an interview. “What we can surmise in this situation — and in other situations where parents are in their 60s, 70s, 80s — is that those children, in all likelihood, will not have a parent who will survive to adulthood for them.”

In the US, “providing donor oocytes or embryos to women over 55 years of age, even when they have no underlying medical problems, should be discouraged,” according to the American Society of Reproductive Medicine,

According to a report from the The National Center for Biotechnology Information, the 2017 India Council of Medical Research drafted a bill for assisted reproductive technology, suggesting an upper age limit on eligibility for women to 45 years old, though it doesn’t necessarily bar women from participating in the procedure.

“Of course, as a physician, one would assume that they are going to conduct the necessary — or make sure that the necessary medical evaluations have been conducted to assess risks health risk for the woman and the pregnancy and the potential children,” Lawson said.

The practice of IVF for advanced age parents is not technically illegal as long as the parents give informed consent, Lawson said.

IVF, or in vitro fertilization, has enabled infertile women and older women to bear children, though it may pose some associated health risks. There has been a steady increase in the number of older women giving birth since the 1980s, and “women ages 40 to 44 had 114,730 of the 3.8 million babies born in 2017; women 45 and older had 9,325,” USA Today reported.

As a psychologist at a fertility clinic, Lawson said it is her job to inform patients pursuing more advanced types of fertility treatment on potential psychological and ethical issues that might arise.

In the case of parents being of particularly advanced ages, Lawson described “what a psychologically traumatic experience it is to have to grieve your parents’ death at such a young age,” citing research and anecdotes from children and adults who have experienced it.

She also added the “psychologically difficult task” of having to take on the responsibility of caring for an older parent at a young age.

“I know that there are individuals who say, ‘Well, they should just be happy to be alive,'” Lawson said. “I think you can be happy to be born and to have the experience of being alive … but that doesn’t mean that your lived experience is going to be a generally positive one, if you have no family to care for you.”

NDTV reported that the twin girls were looked after by the elderly couple’s relatives while the Mangayamma and Rajarao were in the ICU. A niece of the couple told the news outlet that relatives would help relieve some pressure on the elderly parents to care for the children.

“We have an extended family of 15 to 20 people who are all willing to take care of the babies,” she told NDTV.

While scientists continue to advance the medical aspects of IVF procedures to reduce potential medical risks to older patients — including the use of gestational carriers — it doesn’t necessarily mean that the ethical questions behind it will go away, Lawson said.

“By working with a younger woman who would be the gestational carrier, you can reduce some of those risks,” she said. “But the children are still going to be born to older parents, and so the children are always going to face these same kinds of risk.”