Parenthood: How old is too old?

Usually, the ethics committee of the infertility service at Brigham and Women's Hospital debates its way to a comfortable consensus. But not last month. Its question: When is a woman simply too old to become a mother?

The group found itself so deadlocked that it referred the issue to the hospitalwide ethics committee, to be addressed next month.

''The committee was grappling with the needs of the parents vs. the needs of the child, and that would take a Solomon to solve," said Dr. Randy Glassman, director of women's psychiatric services at the Brigham.

A decade after the first postmenopausal mothers began making headlines, the rights and wrongs of having a late-in-life baby are still under live discussion -- particularly in the wake of a new wave of age records and headlines. In January, a 66-year-old Romanian, Adriana Iliescu, gave birth to a 3.2-pound baby girl, Maria Eliza, conceived using donor eggs and sperm. In November, a New York motivational speaker named Aleta St. James gave birth to twins just before turning 57.

''It is never too late," she declared then. ''You are never too old."

These days, the debate is informed by considerably more medical data. Over the last decade, more than 1,000 American women in their 50s -- and a handful in their 60s -- have given birth to donor-egg babies, implanted in women with in vitro fertilization. In 2002, American women in their early 50s reported 286 births, and new mothers in their late 40s numbered more than 5,000.

But where to draw the line remains blurry, shifting from clinic to clinic and even doctor to doctor -- not to mention ethicist to ethicist. Medical opinions vary on what level of risk to mother and child is acceptable: In general, the older the mother, the riskier the pregnancy tends to be, even if she is using a younger woman's eggs.

Philosophical opinions differ as well, with some stressing the upside of bringing a desired child into the world and others stressing the downside of conditions that seem less than optimal.

''There's a basic right to procreation" said Alice Domar, a psychologist and director of the Mind-Body Center for Women's Health at Boston IVF, the country's biggest fertility clinic. And yet, ''I think every child born into this world deserves to have its mother see it into adulthood."

Specialists say it is largely social factors that are prompting the rise in older motherhood -- career women who postpone childbearing, late marriages or second marriages, longer and healthier life spans.

At American adoption agencies, prospective parents have long faced formal or informal age limits, usually around age 45. Among fertility clinics, which implant the donated eggs, 18 percent consider mothers who are 43 to be too old for donor-egg services, a recent survey found.

Others go much later. Dr. Mark V. Sauer of Columbia University, a donor egg pioneer, generally goes up to 55 -- which, he acknowledged, he set arbitrarily because his grandmother was 85 at the time, and he figured that if she'd had a baby at 55, she'd have seen the child through to age 30.

At Boston IVF, the informal cutoff has been at 50 for years, said Dr. Michael Alper, its medical director.

New England Fertility Centers, which has five centers in Massachusetts and New Hampshire, sets the cutoff at 52, probably the highest in the region, said the clinics' medical director, Dr. Vito Cardone. They have had no major medical problems with the older pregnancies, he said.

Among ethicists who have examined the issue, some come down harder on one side or the other. Philosophically, it is important to emphasize that the potential harm to a child from being born to older parents must be weighed against the tremendous good of being born at all, said John A. Robertson, a law professor at the University of Texas.

Even if a child ''faces some earlier-than-usual parental deaths or disability, you could hardly say the child has a had a terrible life because that happens," he said. ''It's an unfortunate experience but it's part of the vicissitudes of life."

Similar issues arise when cancer survivors -- who are at heightened risk for future cancer -- seek to have children, he said, and the American Society for Reproductive Medicine's ethics committee has decided that the chances of recurrence is not reason enough to deny them treatment.

In contrast, prominent University of Pennsylvania bioethicist Arthur Caplan responded to Iliescu's birth announcement by calling for the medical profession or state legislators to set age limits, albeit high ones: No single person over 65 and no couples whose ages total more than 130 should be considered eligible for help having children.

Iliescu ''hardened me up," he said. ''Come on now, you're starting to risk everybody's lives now."

''This is not a sexist plot," he added. ''I'm more interested in whether there's going to be a parent around for the 8-year-old."

He called the other ethicists' argument about the limited harm to the child a bad one: ''It presents any life as better than no life, and clearly if you're born premature and are dying in an ICU, it's kind of hard to argue that's better than not being born."

Medical data gathered in recent years shows that the risks of pregnancy, particularly to the mother, rise significantly with her age; problems with high blood pressure and diabetes become much more common, as does preeclampsia, a potentially serious disease of pregnancy that can force premature delivery.

It is theoretically possible for a premenopausal 50-year-old to conceive a child naturally, but the great majority of new mothers in their 50s these days use in vitro fertilization.

In rare cases, they also hire a surrogate to carry the child -- and it was a patient seeking to use such a surrogate who prompted the ethics discussion at Brigham and Women's because her own medical risk was no longer an issue. The hospital caps the age of women who seek to carry the child themselves at 49.

Even using donor eggs, the burden of pregnancy on an older mother's body is so great that Sauer likens it to running a marathon. He and his colleagues screen older women painstakingly for underlying health problems before proceeding with donor egg services.

But a report by the 2002 Journal of the American Medical Association on 77 postmenopausal women who attempted donor-egg pregnancies concluded that ''there does not appear to be any definitive medical reason for excluding these women from attempting pregnancy on the basis of age alone."

A Boston IVF patient, a woman who has just turned 50 and recently began the donor-egg process after years of failed attempts to get pregnant, acknowledged that the age-limit question is a hard one. But she and her husband are healthy, come from long-lived, tight-knit families, and would be sure to cushion the child in all possible ways from possible age-related problems, she said.

''I think people need to understand that [the decision] comes out of a lot of pain," said the woman, who asked to remain anonymous. And overall, she said, ''Maybe I'm deceiving myself, but we're not that old."

Carey Goldberg can be reached atgoldberg@globe.com.