How old is too old Challenges faced by clinicians concerning age cutoffs for patients undergoing in vitro fertilization

Author:
Robert Klitzman, M.D.

Abstract:

Objective:
To study how IVF providers view and make decisions concerning age cutoffs and futility (e.g., whether they establish clear cutoffs, and if so, where).

Design:
In-depth interviews of approximately 1 hour.

Setting:
Telephone.

Patient(s):
Interviewees: 27 ART providers (17 physicians, 10 other providers) and 10 patients.

Intervention(s):
Not available.

Main Outcome Measure(s):
Attitudes and decisions concerning age cutoffs were assessed.

Result(s):
Providers face several challenges and dilemmas concerning both the content and the process of decision-making about age cutoffs—what age cutoff to use for potential parents (women both using and not using their own eggs) and potential fathers (whether to consider the father’s age, and if so, separately or only with the mother’s age); what criteria to use in these decisions (how much to consider vs. weigh the mother’s autonomy vs. the future child’s well-being); how to make these decisions (e.g., “gut feelings” or perceptions of public opinion); who makes these decisions (e.g., physicians on their own vs. a formal ethics or Quality Assurance committee); and how to present/frame these issues to patients (e.g., how much to discourage older women). Patients’ responses to age limitations vary (e.g., minimizing or feeling exceptions to the risks; or lying about their age).

Conclusion(s):
These data, the first to explore how providers make decisions about age cutoffs for patients, raise several critical issues. Although the American Society for Reproductive Medicine has addressed several concerns, the present data suggest additional questions and challenges, including inherent uncertainties and ethical conflicts, and have important implications for practice, policy, research, and education.

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