How old is too old? Age limits for access to assisted reproduction

In 2011 the Czech Republic was preparing to change the law regulating assisted reproduction technologies (ART). One of the first proposals was to impose an age limit for women of 55 years (but no age limit for men). Before this, there was simply a recommendation from the Czech ART Ethics Committee that access to such treatments should be limited to women under the age of 47. The main arguments for the higher age limit was that it would respect women's reproductive rights and also there are benefits to late parenthood. But, in the words of the 1980s Czech hard-rock band Katapult, 'How about the children — do they have a place to play?' My colleagues and I decided to ask the children.

In a short questionnaire, respondents were asked the following questions: 'Thanks to the technological advances of contemporary medicine, people have a chance to freely decide when they want to have children. However, children cannot choose the age of their parents. How old would you like your mother and father to be when you turn 20 (for respondents younger than 16 years) or 25 (for those aged 16 and over), if you had a magic wand? Why?' Almost 1,200 children and young adults aged between 11 and 25 years old responded to the survey. We were taken aback by the results: 89 percent of respondents would prefer their mother to have had them before the age of 30 (the most preferred ages were 20—24), and 94 percent of them would prefer their father to have had them before the age of 35 (the most preferred ages were 25—29). The older the respondent's parents, the younger they were made by the magic wand. It was very touching to read the answers to the open-ended question 'Why?'. Children's responses were sometimes loving, sometimes critical and sometimes harsh. Even though they were often child-like in their formulation, we found them mature, valid and wise. (You can read them for yourself in our article 'How old is too old? A contribution to the discussion on age limits for assisted reproduction technique access'.)

Reactions of our Czech as well as foreign colleagues and other specialists to the research were more surprising than the results. Interestingly, the results themselves were not challenged — we all somehow think that it is better to have young parents. But we were questioned on our methods — the magic wand cannot be a tool for serious research, it was argued. Then the validity of the results — its practical value — was questioned. The most common objections were: 'Children have a poor perception of time', 'Children do not understand the course of life', 'Kids are not rational', 'We should not jump just because kids whistle'.

The methodological doubts have been countered in our previous article 'Can a magic wand plausibly be used in serious psychological research?'. Before our research was complete, the Czech law regulating ART was approved with an age limit of 50 years for women and none for men — a whole generation above the age preferences of the children we surveyed. We do not suggest that society should crawl into people's bedrooms and determine when they can or cannot have children. But we believe that if society (in the form of technology) intrudes into people's lives then the discussions about risks and consequences cannot be limited to the question 'Is a person in this age able to bring a child to adulthood without any serious damage?'. The parent-child relationship is much more complex and not limited to a period of 20 years.

When dealing with bioethical problems, ethicists stress the necessity of balancing gains and losses for individual. Professor Salman Rawaf, at the Seventh Geneva Conference on Person-Centred Medicine in 2014, identified 'high expectations and increasing demands' as one of the biggest challenges for health systems. 'Managing patient expectation' in fertility treatment is assumed to be one of the most effective support techniques. Maybe the discussion about the age limits for ART should be broadened even further, taking into account society as a whole — including what our children think.