For some couples, the hardest part of IVF may no longer be simply getting pregnant. It may be reaching the age at which the law says they can no longer continue treatment.A recent case from Gujarat has brought that question into sharp focus. Fertility specialists say several couples have had IVF cycles interrupted or abandoned after one partner crossed the statutory age limit, including cases where treatment had already begun or embryos had already been created. In one case reported from Gujarat, a woman was 47 and her husband was 54 when they began their first IVF cycle. The attempt failed. By the time they were nearing a second cycle, the man had turned 55, the upper age limit prescribed for men under India’s assisted reproductive technology law. The couple stopped treatment. Her case is not isolated. Many couples are forced to stop treatment after crossing the statutory cut-off, even after previous unsuccessful IVF attempts, miscarriages or medical complications have delayed the process.The development has triggered a larger debate: Should IVF eligibility depend on a fixed age cut-off, or should doctors be allowed to make an individual assessment based on a patient’s health and the stage of treatment?The question is especially striking because reproductive medicine has already demonstrated that pregnancy can sometimes be achieved at ages far beyond natural fertility. In 2019, Andhra Pradesh woman Erramatti Mangayamma became a mother to twin girls after undergoing IVF at the age of 74. Her case remains one of the most extraordinary examples of how assisted reproduction can overcome some of the biological limitations imposed by menopause.Must Read | From petri dish to pasture: The story of Assam’s first IVF-born Lakhimi calfTo understand what happens to fertility after menopause, why IVF does not simply reverse ageing, and what doctors consider before treating women at an advanced age, we spoke to Dr Neelam Suri, Senior Consultant, Obstetrics & Gynaecology, Indraprastha Apollo Hospital, Delhi.What happens to fertility after menopause?Menopause marks the end of a woman’s natural reproductive years. With increasing age, the number and quality of eggs in the ovaries decline, and after menopause, ovulation stops. As a result, natural pregnancy is no longer possible. However, menopause does not necessarily mean that the uterus can never carry a pregnancy. The uterus can, in some circumstances, respond to hormonal preparation and support an implanted embryo even when the ovaries are no longer producing eggs.Can a woman become pregnant through IVF after menopause?Yes, pregnancy may be possible through IVF in carefully selected post-menopausal women. In women of advanced age, IVF generally involves an important distinction between the egg and the uterus. When ovarian reserve has significantly declined, donor eggs may be used to create an embryo. The embryo can then be transferred into the uterus after the uterine lining has been prepared with hormones.Story continues below this adThe Indian Menopause Society has also identified oocyte donation as an effective approach when ovarian ageing has significantly reduced the availability of a woman’s own eggs.However, being technically capable of carrying a pregnancy does not mean that pregnancy at an extremely advanced age is medically low-risk.If the uterus can carry a pregnancy, what is the biggest concern at an advanced age?The major concern is the woman’s overall health and her ability to tolerate pregnancy. Pregnancy places considerable demands on the heart, blood vessels and other organs. These demands become increasingly important when a woman is in her 60s or 70s.Story continues below this adDoctors have to assess conditions such as hypertension, diabetes, cardiovascular disease, kidney disease and obesity before considering whether pregnancy would be medically appropriate. At very advanced maternal ages, pregnancy can carry substantially higher risks of complications such as high blood pressure, pre-eclampsia, gestational diabetes, blood clots, cardiovascular complications, premature delivery and Caesarean delivery.Also Read | Wife can use donor sperm only if husband proved infertile: Centre to courtWhat about the risks to the baby?The risks are not limited to the mother. Advanced maternal age is associated with increased risks of pregnancy loss, premature birth, low birth weight and other pregnancy complications. When donor eggs are used, the genetic risks associated with egg ageing are more closely related to the age of the egg donor than to the age of the woman carrying the pregnancy.A twin pregnancy adds another layer of risk. Carrying twins places greater demands on the mother and increases the likelihood of premature delivery and other complications.Story continues below this adSo, what makes a pregnancy at 74 different from a pregnancy at 40 or 45?Age is important because the likelihood of underlying medical conditions rises as a person gets older. A woman in her 70s is more likely to have cardiovascular, metabolic or other age-related conditions that can complicate pregnancy. Even in the absence of an obvious illness, pregnancy itself places additional physiological stress on the body.Therefore, the issue is not simply whether implantation is possible. It is whether the woman’s body can safely tolerate pregnancy and whether adequate maternal and neonatal care is available.Does informed consent mean a woman should be able to choose IVF at any age?Story continues below this adInformed consent is an essential part of fertility treatment, but consent alone does not mean that every requested medical procedure must be provided.Doctors also have a responsibility to assess whether a treatment is medically appropriate and whether its foreseeable risks are acceptable.This becomes particularly important in extremely advanced-age pregnancy, where the potential medical risks can be substantial. The ethical discussion therefore involves several principles: reproductive autonomy, the doctor’s duty to avoid disproportionate harm, responsible medical practice and consideration of the welfare of the future child.Does the child’s welfare also become part of the ethical discussion?Story continues below this adA fertility treatment decision involves not only the person seeking treatment but also the child who may be born as a result. At extremely advanced parental ages, doctors may need to consider questions about long-term caregiving, the parents’ health, the possibility of serious illness and who would care for the child if the parents were no longer able to do so.That does not mean that older people are inherently incapable of being good parents. Rather, it means that fertility treatment at an exceptionally advanced age raises additional questions that would be less prominent in younger patients.Is pregnancy at 74 something other women should see as a possibility?It should be regarded as an exceptional medical situation, not as evidence that pregnancy at 70-plus is routinely safe or that IVF can make pregnancy possible at any age. The ability to achieve a pregnancy in an individual case does not mean the same treatment would be appropriate for another woman.