IVF at 74: A medical miracle or breach of ethics?

Last week, 74-year-old Mangayamma Yaramati made history after giving birth to twins following treatment with in-vitro fertilisation (IVF) – potentially becoming the world’s oldest birth mother. However, the news has been controversial, with fertility experts in India expressing criticism that the procedure was performed on a woman at such an advanced age. 

Mangayamma (identified by some reports as Erramatti Mangayamma) delivered the twins via Caesarean section last Thursday at a facility in the Guntur district of Andhra Pradesh. According to IVF specialist Dr Sankkayala Uma Shankar, who performed the procedure, no complications were experienced during the pregnancy and the infants are in good health – although Yaramati was taken to the intensive care unit due to stress. Going forward, however, he is optimistic about Yaramati health. “I don’t think she will have any major health issues in the post-delivery period,” Dr Shankar said. “However, she cannot breast-feed the babies. But no worries. We can feed the babies with milk obtained from the milk bank.”

Mangayamma spoke of the stigma and shame she experienced for having been childless since marrying her husband in 1962. “We tried many times and saw numerous doctors, so this is the happiest time of my life,” she said. Her husband, 80-year-old Sitarama Rajarao (who has since been hospitalised following a stroke), said “it is due to the grace of God and doctors that I have now become a proud father of two baby girls. God has answered our prayers. This is the happiest time of my life.” 

“I cannot express my feeling in words,” added Mangayamma. “These babies complete me. My six decade-long wait has finally come to an end. Now, no one can call me infertile any more.”

The couples’ happiness notwithstanding, the fact that they were allowed to undergo IVF at all has provoked criticism from numerous fertility experts. A joint statement issued by the Indian Society of Assisted Reproduction (ISAR), the Indian Fertility Society (IFR) and the Academy of Clinical Embryologists read “we are deeply appalled to know about such unprofessional conduct of some health providers in misusing current Assisted Reproductive Technologies (ART) procedures. It is deplorable omission of ethics, morality and misuse of ART.” 

“Whether the issue is an ‘emotional question’ or not, the controversy and ethical debate is likely to persist.”

“The doctor should be shamed and the government has to step in and punish the doctor in question,” said Dr Kamini A. Rao, medical director and founder of Milan. “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 [a] few years.”

Explaining some of the risks of the pregnancy, Hyderabad-based gynaecologist Dr Manjula Annagani noted “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.” 

“Twins mean the babies are going to be pre-term. Pre-term babies have [a] 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.” 

It has been noted that IVF, per the Artificial Reproductive Technology Bill, 2017, should be available to women aged between eighteen and 45. “This isn’t a random number,” said IFS president Dr M. Gouri Dev. “If you look at the rules and regulations for couples in India who are looking to adopt a child, there is a rule that the combined age of the parents cannot be more than 100. This is to ensure that the child is taken care of in case of the loss of life of one of the parents.” 

Dr Shankar has said “she was referred to us by a medical board who declared she was healthy enough to go through the procedure. To me it was just another case.” He did not comment on the ethics of the situation, deeming it an “emotional question”, instead stating “it is another world record. Mangayamma and her husband are also happy.” Whether the issue is an ‘emotional question’ or not, the controversy and ethical debate is likely to persist.