For the second week running, fertility and ageing were the focus of an online event held by the Progress Educational Trust (PET), the charity that publishes BioNews. This time, the provocative title of the event was 'How Old Is Too Old to Be a Parent?'.
PET's director, Sarah Norcross, expressed her enthusiasm for this topic and opened the debate with several questions. Should there be an upper age limit to parenthood? Should our concern be focused on chronological age, or health more generally? Should the NHS foot the bill for complications?
Dr Sarah Stock, senior clinical lecturer in maternal and fetal health at the University of Edinburgh, focused on ageing and female fertility with a well-explained, data-driven presentation. Dr Stock showed how trends have changed over time, with more than 50 percent of first-time mothers now over the age of 30 compared to 20 percent in the 1970s. She also explained that while age is an important risk factor, it needs to be placed in context. For example, the rate of stillbirths is lower today than it was in the 1990s and early 2000s, because of advances in medicine since that time.
Dr Sarah Martins Da Silva, gynaecologist and senior lecturer in reproductive medicine at the University of Dundee, continued the discussion with a focus on the male contribution, which is often overlooked. Using the example of Bernie Ecclestone, who fathered a child at the age of 89, she explained why advanced paternal age can actually affect maternal health (during the pregnancy) as well as the future health and fertility of the offspring. Male ageing involves a reduction in semen volume, poorer sperm motility and an increase in DNA damage, although these factors are not always decisive when it comes to a man's ability to father a child.
Dr Anna Smajdor, lecturer in ethics at the University of Oslo raised some important ethical questions along with a few eyebrows. Her opening slide, entitled 'Young people should freeze eggs and sperm', challenged the audience to consider a variety of questions. Are ageing gametes harmful to offspring? Is it terribly harmful to be born to an aged parent, and if so, should society intervene by encouraging freezing? Then again, considering all the other things that can harm a child, are ageing gametes really such a problem?
Dr Smajdor gave thought-provoking examples, saying that most people would flinch at the idea of stopping someone from a low socio-economic status having a child, even if this were associated with a higher risk of harm. She added that IVF also carries many risks, and yet we actively encourage it. Dr Smajdor concluded that there are more important things on the table to consider than gamete age, and we need to think carefully about the role of harm in judging or regulating people's reproductive choices.
The final speaker, Professor Glenn Cohen from Harvard Law School, gave a lively and provocative presentation. He set out and then challenged a variety of possible justifications for restricting the age at which people can have children, asking us to consider how far removed this kind of thinking is from eugenics. Reasons often given to justify age restrictions are to protect the child – from growing up with the stigma of 'older' parents or losing their parent(s) at a young age. Yet Professor Cohen eloquently challenged this by saying 'are the circumstances so bad life would not be worth living?'
The first two questions posed by the audience were about changes in the risk of age-related morbidity, and the effect of paternal age on miscarriage. Dr Stock talked about the reduction in mortality rate, and how we've become better at predicting and managing risk factors. Dr Martins Da Silva explained that more research is needed to understand the paternal role in fetal development – for example, sperm contribute to the outer layer of the embryo, but the effect of this on implantation is still unknown.
Other audience questions concerned whether people are (or should be) choosing not to have children due to concerns about global cataclysms, whether informing young people about the decline of fertility to scaremongering (a question that will be addressed in an upcoming PET event), and whether and in what sense fertility should be considered a health need.
All of this led to a lively debate and disagreement among the panel, but the speakers were united in their answer to the final question 'Should UK fertility clinics remove age restrictions if using donor eggs?', to which they gave a resounding 'Yes'.
As a woman approaching her 35th birthday, with no plan of starting a family anytime soon, and having experienced some of the social pressures associated with this, I was a little apprehensive about attending this event. However, by the end I felt more reassured and informed about my reproductive choices, and curious about how – individually and collectively – we answer the question 'How old is too old to be a parent?'
PET is grateful to the Scottish Government for supporting this event.
Register now for PET's next free-to-attend online event 'An All-Consuming Problem? How to Protect Patients in the Fertility Market', taking place on Thursday 14 January 2021.