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The Age-Old Question: The Impact of Age

7 January 2013
Appeared in BioNews 687

The Progress Educational Trust's (PET) 2012 annual conference 'Fertility Treatment: A Life-Changing Event?' concluded with a session entitled 'The Age-Old Question: The Impact of Age'.

Professor Susan Bewley began the discussion by asking the question: 'Who Benefits From Women Becoming Unfit to Reproduce?' The answer: the industry which profits when it can do nothing to change the biological reality. The biological reality is, Bewley posited, that female reproductive health decreases with age. Gynaecological complications such as pre-eclampsia and stillbirth, on the other hand, increase.

Lamenting Department of Health figures which show an increase in women over the ages of 35 and 40 giving birth, Professor Bewley stressed that although humans are living longer, the age of reproduction and menopause is not changing. IVF doesn't solve the delay – it perhaps compensates for about 35 percent of the reproductive health of women between the ages of 35-40. Bewley regarded this as a public health issue, and asked: how does society help these women?

Sex education focuses on teaching girls how to have safe sex, but doesn't teach them that they're more likely to become infertile than they are to conceive. Professor Bewley argued that secondary school girls and girls in their twenties should also be informed that spontaneous abortions increase with age. If girls were well-informed in their twenties, she asked, would they still decide to have children at a later age?

Next, Louisa Ghevaert asked 'What's Age Got To Do with It?'. Ghevaert discussed the postcode lottery which dominates access to IVF treatment in England and Wales. Although NICE, National Institute for Health and Clinical Excellence, recommends that three cycles of IVF should be available on the NHS, only 27 percent of IVF centres offer two cycles. Age, Ghevaert notes, is used to limit access to IVF services and as a budgetary limitation to cut costs.

She gave two examples of how age is used to discriminate in the provision of IVF services. The first concerned Andrea Heywood who, at the age of 24, failed to meet the minimum age requirement of 30, set by the guidelines of her local Primary Care Trust (PCT). Ghevaert argued that PCTs use age to set arbitrary, unfair and discriminatory standards.

The second case was that of Donna Marshall, who was initially considered too young when her PCT set the age requirements at 35-39, and too old when the policy was later changed to the age range of 30-34. In response to the effect of these policies, NICE has proposed to remove the lower age limit and increase the maximum age to 42.

Ghevaert considered the discriminatory effect of PCT governance in light of a new legal landscape. She reminded us that the Equality Act 2010 bans direct and indirect discrimination on the basis of age, and that this specifically includes the provision of healthcare. However it comes with a massive proviso, which Ghevaert believed could be used by PCTs to maintain their current practice. Similarly, the standards of equality in the Public Sector Equality Duty can be evaded by public bodies where they see fit.

There is a glimmer of light: the burden of proof in the Equality Act has been removed so that the court must assume that a breach of equality took place, unless a contradictory account can be shown. That said, Ghevaert believed that IVF services are likely to become more fragmented under the new GP-led commissioning services, and that the only solution to the age problem is a centralised policy.

Finally, Dr Gillian Lockwood took to the stage to present 'Past Their Sell-By Date? Fertility Implications of Deferred Motherhood', which examined the implications of women postponing childbirth.

The average age of childbirth in the UK is now 29, higher than it has been previously. Lockwood discussed the experiences of countries such as Sweden and Denmark, where there are state-led incentives to encourage earlier childbirth, but women are still putting off having a baby.

As Lockwood boldly put it, half of graduates will be childless at 45 because they started to have children too late, in an attempt to postpone until it was the right time to have a baby. In a similar vein to Bewley, Lockwood argued that women 'can't botox their ovaries'.

Lockwood touched on the potential for women to routinely freeze their eggs at a young age, when healthy, for future use. They could then search for 'the one' while their eggs waited safely in the freezer.

However, this isn't without consequences. Lockwood argued that deferred motherhood leads to a significant generation gap and a population of lonely, only children - a pattern which is likely to repeat itself in subsequent generations. Social consequences aside, so-called 'social' egg freezing is not covered by the NHS and can be prohibitively expensive, at around £3,000 to 4,000.

Ultimately, Lockwood acknowledged, it's difficult to get women to want babies when their age says that they can, despite various governments encouraging them to do just that.

Several interesting comments from the floor followed, including a particular concern about the social and financial burden of childrearing, which can take precedent over biological reality. Ghevaert highlighted the need for better family-friendly working hours, to encourage members of a more squeezed younger generation who are struggling (for example) to get a mortgage.

Another audience member asked whether the NHS should be offering a routine AMH (Anti-Müllerian hormone) test to determine egg health. Dr Lockwood highlighted the clinical limitations of the test, and its limited usefulness in informing women whether they should have a child 'now or never'. Professor Bewley saw this idea as an opportunity for the industry to profit, rather than provide any real benefit.

The session provided a very topical and informative discussion, enjoyed by all. Last, but definitely not least!

PET is grateful to the conference's gold sponsors, Merck Serono, silver sponsors London Women's Clinic and bronze sponsors Ferring Pharmaceuticals.

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