Letter: Fertility treatments for older women

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The Independent Online
Sir: Your excellent and well-balanced leading article 'Having babies at two score years and ten' (21 July) correctly questions what is ethically wrong in treating older women and where one draws the line. The interests of any prospective child must be of paramount importance, and these will depend on the particular circumstances of a given couple's request. This is why the Human Fertilisation & Embryology Authority (HFEA) should recommend that fertility centres have a broad-based ethics committee with a significant lay-member contribution, since a consensus decision can then be made after receiving independent counsellors' reports on particular requests, as we routinely do. We do not want any more legislative controls, or a set upper-age limit.

Professor Colin Campbell, Chairman of the HFEA, has indicated that the Authority takes a dim view of older women seeking advice overseas. Are we then to expect that our hard-pressed immigration authorities will be asking personal questions to women of 50 and over whose proposed destination is Rome?

There is, however, a more important issue concerning the controls thEat now exist on fertility treatment and their effect on predicteTHER write errord outcome, which the media has not considered. This has particular relevance to the management of older women.

The HFEA has concerns about the risk of multiple pregnancy, and hence the limit that only three eggs/embryos may be transferred with IVF, and other related treatments. However, the risk of a multiple pregnancy occurring in women over the age of 40 treated using their own eggs is minimal, and older women are being positively discriminated against, since they have a lower chance of becoming pregnant now than they did in 1987, when a more flexible policy was in force (ie 14.8 per cent compared with 19.2 per cent per cycle).

Hence, some women now travel overseas to receive treatment where the rules are less rigid, or they request egg donation from younger women. In 1993, 47.6 per cent of recipients have become pregnant with egg donation from younger women in our centre, and this would apply to recipients of any age.

The fundamental determinant as to who can or cannot achieve a pregnancy is now dependent on the quality of the eggs and of the embryos generated from a given individual, or donor, rather than on the previously assumed importance of sperm quality, since we are now able to inject a single sperm directly into eggs, achieving a pregnancy rate of 36 per cent in those in whom this could not occur naturally, or indeed with conventional IVF.

Yours faithfully,

IAN CRAFT

London Gynaecology & Fertility Centre

London, W1

22 July

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