News that a 66-year-old Romanian in January (2005) became the world's oldest recorded mother added fire to an already impassioned debate in Britain about restrictions that should be imposed on those seeking fertility treatment.
Those in favor of a relatively relaxed regime have argued that women even in their 50s can give birth naturally and that women who become pregnant without medical help do not have to meet regulatory requirements. Those calling for tighter regulation say science should improve upon nature and should seek out model parents who will live long enough to see their children grow up, free from inherited diseases or psychological trauma.
"A child is not a human right. A child is not a consumer good. But the in-vitro fertilization (IVF) industry treats it as both," journalist Christina Odone argued in a debate on the issue on BBC radio. "This is not about satisfying adults, but it's about satisfying children's needs."
In the opposite camp is Professor Ian Craft of the London Fertility Centre (a private institution), who thinks there is a case for relaxing the rules. "You don't have to go through any of these things (regulations) to have a baby naturally," he said in response to Odone.
Britain's regulatory body, the Human Fertilisation and Embryology Authority (HFEA), on January 13 launched a consultation, closing April 7 - entitled `Tomorrow's Children' - to sound out public opinion on the level of regulation needed to ensure the welfare of children yet to be born.
As it stands, those seeking IVF are screened for HIV and hepatitis and their general practitioners are consulted on their medical and psychological suitability for parenthood.
On the question of age, national health IVF clinics set an upper limit of around 40, though it varies from clinic to clinic. The private sector does not have an official age limit, but could refuse treatment to older women on medical grounds.
Odone argues it should be as difficult to be accepted for IVF as to adopt and that an upper age limit should be fixed. "I think we should have criminal checks; we should have an upper age limit. If the child is going to be in their teens and the mother is going to be in the late 70s, then we are talking about a very worrying situation."
Those seeking to adopt children can in theory be any age over 21. They can be single or in a same sex relationship, but they have to undergo a lengthy series of assessments to establish their ability to provide a stable home for children who have already lost one set of parents. Enquiries are made of local social services and the police. In addition, applicants are examined by their doctors and asked to provide at least two personal
Felicity Collier, Chief Executive of the British Association for Adoption and Fostering, says there are important differences between parenting through IVF and adopting a child, who probably is not a new baby, probably comes from very difficult circumstances, and is not genetically related to its new parents. But she argues there are useful lessons for the IVF regulators to draw from the adoption rules. The association is still working on a fixed response to the HFEA's public consultation.
Collier, however, favors maintaining aspects of existing regulations on suitability for IVF and improving on them. "There is need to have some basic checks. There should be references from general practitioners. I think there has to be a level of responsibility. People can't have an automatic right to fertility treatment," she said.
In the case of IVF treatment, using donor eggs or sperm, she said there should be an additional requirement that the parents will eventually tell the child their genetic background. "When you are parenting a child that is not genetically related to you, there are particular challenges," she said. "People who are genetically unrelated, should give an undertaking to be honest with the child."
The HFEA has said its goal is to establish a balance between adults, whose lives can be ruined by the inability to conceive, and the children they may eventually have. "There must be a reasonable, proportionate, fair and practical system that delivers an appropriate level of protection for children without unjustifiably hindering the treatment of people who need medical help in having a child," says Suzi Leather, Chair of the HFEA. "We have to strike a difficult balance between the interests of prospective parents and the needs of children."
Its task is to regulate any research or treatment involving the creation, keeping and use of human embryos outside the body, or the storage and donation of human eggs and sperm.
It also has to provide guidelines to clinics on interpreting the requirement set by the Human Fertilisation and Embryology Act that IVF treatment should only be provided after the welfare of any child born as a result has been taken into account.
It is these guidelines, drafted more than a decade ago, that the public consultation is designed to reform and new guidelines should be published later in 2005.
The world's first test-tube baby was born in Britain in 1978, but it was not until 1991 that the HFEA was set up in the wake of the 1990 Human Fertilisation and Embryology Act.
The Act itself is to be reviewed, but the government has said it is unlikely a new bill will appear on the statute book before 2008. Some have argued the HFEA is also in drastic need of reform or even scrapping to make way for a more efficient body.
Whatever its faults, the British authority has served as a model across the world, with similar regulators being set up in France, Canada and parts of Australia. And although the level of regulation is hotly debated, very few question the need for some kind of regulatory body to exist.
"The public would be deeply concerned if such a sensitive and controversial area was not properly regulated," says Leather.