When grandmas have babies Test-tube twins to a 53-year-old

Arthur Caplan

November 23, 1992|By Arthur Caplan

A 53-YEAR-OLD California woman gave birth Nov. 11 to twins. Giving birth at 53 is remarkable enough, but even more remarkably, the woman had the babies even though she had lost the ability to make eggs.

Mary Shearing and her 32-year-old husband, Don, created the twins using eggs donated by a woman in her 20s. The eggs were then fertilized using a process known as in vitro fertilization.

The eggs were surgically removed from the donor and mixed with Don's sperm in a laboratory dish; some of the resulting embryos then were reimplanted in Mary Shearing's womb, where they became Amy Leigh and Kelly Ann.

I heard about the birth of the twins on TV. The newscaster said that Mary Shearing was the first woman to successfully give birth after menopause to twins.

But the ethical issues raised when a 53-year-old woman uses donated eggs to get pregnant are not so simple. Not because a couple is somehow too "old" to be parents. But because the procedure may be too dangerous for the children who are created in this way.

Mary Shearing and her husband, Don, went public last October about their efforts to have a child. They and their doctors at Martin Luther Hospital held a press conference to a rapt audience of dozens of journalists, at which they announced that Mary was the oldest post-menopausal woman ever to become pregnant.

The media quickly grabbed the story and ran out to find people who didn't think what the Shearings were doing was such a hot idea. Some professional hand-wringers, including me, wondered whether it was a good idea for a 53-year-old woman to face the rigors of pregnancy. Others expressed concern about whether it was fair to bring a baby into the world knowing that the kid would be entering high school about the time mom was applying for Medicare.

Don and Mary Shearing weren't very worried about the age factor. "While it is important," Mary said, "it is not something you run your life by."

Their doctor, David Diaz, noted that Mary was in good health and was very fit, making her chances of having a successful childbirth equal to those of a younger woman.

Lots of couples fell asleep arguing about whether grandmoms ought to have babies. But the birth of the twins ought to remind us that more than adult choices and preferences are involved when technology is used to make a baby.

Mary and Don Shearing's twins arrived three months early. One of the 28-week-old twins weighed 2 pounds, 2 ounces, at birth; the other 2 pounds, 12 ounces. They are very low birth weight, very premature babies. And they are the reason we need to proceed more cautiously in using egg donation and in vitro fertilization to permit older women to get pregnant.

Premature babies face some very dismal statistics. About a quarter of all children born at 28 weeks die. Roughly one in 10 have severe bleeding in their brains that can cause retardation and other problems. Thirteen percent have chronic lung failure. Nearly a quarter have significant physical or mental impairment.

Premature babies spend a lot of time in neonatal intensive care. The cost of one day for infant intensive care is $2,500. Bills of $50,000 to $100,000 are not at all uncommon for preemies the size of the Shearing twins.

Extreme preemies also face a 30 percent chance of having to go back to the hospital for a long stay at least once during their first year of life because they get another serious illness.

The technology to rescue extremely premature very low birth weight babies is so new that there is relatively little information on how these kids do as adults.

Families like the Shearings ought be free to have kids without requiring the permission of the government, ethicists or anyone else. But when it comes to reproductive technologies, it is silly and morally irresponsible to behave as if medical science knows what it is doing when it does not.

There are very real risks when older women get pregnant. These can, however, be explained so a woman can choose what she wants to do. The problem with using egg donation in menopausal woman is that it poses very real, even fatal risks not only to the mom but to her babies. There is a very good chance that older mothers will not be able to carry a pregnancy safely to term.

So not only do we need to consider the health of the mother, but also the legal ambiguities about maternity that arise when donor eggs are used, the downside of having older parents and the real risk that any children who result face a real risk of being born too soon so soon that they risk death or permanent severe disability.

It seems rude, even cruel to say that a technology that holds out the promise of having a child to a desperate woman or couple ought not be used because it is too risky. Still, the doctors and couples who want to use this technique must remember that they are experimenting with the lives of children who cannot give their consent.

Arthur Caplan is director of the Center for Biomedical Ethics at the University of Minnesota Medical School.

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