Britain has a Human Fertilisation and Embryology Authority, which makes rules on the circumstances in which doctors may carry out fertility treatments. On the very day that the authority issued its second annual report, it would have been insensitive to deliver a public reminder of how easily its rules can be circumvented by those able to afford the price of an air ticket. Yet Dr Antinori's work raises a difficult question: should doctors routinely refuse fertility treatment to older women?
Since such treatment is rarely paid for by the National Health Service, the issue is more one of ethics and practicality than public policy. Some women are so desperate to have children that they will continue to pay for treatment year after year, hoping against hope that the doctors may enable them to give birth. In deciding whether to do so, specialists must consider two questions.
Ethically, they should ask whether there is anything wrong or unnatural in helping women to defeat the processes that render them infertile as they become older. If so, it is hard to know where to draw the line. In the 10 years to 1991, the number of women between 35 and 39 who gave birth rose by half. But motherhood and old age have never been incompatible; the Guinness Book of Records includes a woman who gave birth to a healthy child in 1891 at the age of 59. In the Bible, Abraham's wife, Sarah, bore Isaac at 90 - after a medically successful but socially disastrous exercise in surrogacy involving her handmaiden, Hagar. As life expectancies rise and society changes, more women are choosing to postpone childbearing until after they have worked for some years. If the delay will help them better to love and support their children, the trend is not necessarily to be regretted.
Yet there are practical reasons to think twice about fertility treatments for older women. Because egg donation is more troublesome than sperm donation, there are not eggs enough to go around. Given this shortage, doctors are right to weigh the welfare of the child that will be born before implanting those scarce eggs into older women. A mother in her mid-fifties may find it hard to to get up in the night to feed her baby; five years on, her physique may be unable to take the strain of scrabbling around the floor with her toddler. There is also the greater risk of turning a child into an orphan if its parents are septuagenarians before it reaches its teens.
In the end, however, doctors should remember that good mothers can be over 50, just as bad mothers can be under 20. Common sense suggests they should be sceptical of older women who want to bear children; but they should resist attempts to impose a firm age limit, and treat each case with the sympathy and dignity it deserves.Reuse content