Chances are, if you are in the medical community or have logged onto Facebook, you have read news headlines declaring that a 73-year-old woman has given birth to twins. Erramatti Mangayamma is believed to be the oldest woman to give birth; her husband is 80 years old. 

The information presented in the news is scarce, but we do know that the couple became pregnant with the help of in vitro fertilization (IVF), using donor eggs, and the twin girls were born via cesarean section on Thursday, September 5th. It was reported that the procedure was uncomplicated and both the girls and Mrs. Mangayamma are doing well. However, just mere days after the birth, it was reported that Mrs. Mangayamma suffered a stroke and her husband has had a heart attack! Now both are in the intensive care unit. Dr. Sanakayyala Umashankar has stated that Mrs. Mangayamma was put in intensive care because of the stress she endured while giving birth – and has been there for more than one week. Who is caring for the infants now?

Obviously, I hope that Mr. and Mrs. Mangayamma recover and that they can enjoy being parents. However, am I the only one that is absolutely flabbergasted? After reading countless threads on this story on Facebook, I don’t think that I am. This deserves a discussion and we shouldn’t be afraid to voice our concern over the unethical nature of this situation.

Older parents are increasingly utilizing assisted reproductive techniques, including IVF. Older women decide to utilize IVF for many different reasons. Some men and women have health conditions causing infertility. Others have spent their child-bearing years pursuing a career or other life ambitions and have simply waited too long. It is hard to say why Mrs. Mangayamma chose IVF at her age, but perhaps she and her husband were facing social and cultural stigmas for being childless. One article discussing the social shame of infertility in India stated, “the biggest problem with infertility in India is the social stigma childlessness carries.” 

Regardless of the reason, elderly women (yes, this is medically correct terminology) are more likely to face risks and experience complications leading to both medical and ethical challenges. Studies have shown that women over the age of 40 who use IVF have elevated rates of preeclampsia, gestational diabetes, preterm and very preterm delivery. The gestational age of these twin girls at delivery was not disclosed nor if Mrs. Mangayamma had any complications with her pregnancy.  

These babies were born to Indian parents in India. I work as a nurse in the United States and am not familiar with medical practice in India. However, the American Society for Reproductive Medicine, a highly respected organization in the U.S. medical community, stated in 2004 that post-menopausal pregnancy should be discouraged. Later in 2013, the ASRM stated that providers should discourage women greater than 55 years from implanting donor embryos. Dr. Sanakayyala Umashankar, the director of Ahalya IVF in India, is the doctor behind this madness. I am not sure he prescribes to ASRM. Why? Why would he risk the health of a mother and unborn babies? I think this is another case where #BigFertility strikes again. My suspicion is that Dr. Umashankar was motivated by money and fame. 

There are so many questions and concerns surrounding this situation. If I took the time to address each one, this article would be miles long. Instead, I’ll allow you to do some critical thinking and internal ethical exploration of your own. Here are some questions and comments to facilitate discussion: 

  • Healthcare costs are rising and resources are limited. Who is paying for the extra care, such as early hospital admissions, that older women who undergo IVF might require? Erramatti Mangayamma will stay in the hospital for an additional 21 days from the time of delivery for observation. In our hospital, an average stay for a mother who gave birth via c-section is 4-5 days. There are also immense costs for neonatal intensive care admissions as well. 
  • What about the father? Should the father’s age be considered when parents request IVF? The average life expectancy in India for men is 67 years old, the father in this scenario is already 80 years old. 
  • What about the welfare of the unborn children? Do children born to older couples have a suboptimal childhood experiences? Will these children become orphans before they even graduate from high school? Did we just birth children to be dropped into the foster care system when these parents pass? The fertility doctor, through his or her actions is helping bring a child into the world, who quite likely will be orphaned at a young age. Doesn’t she or he have certain professional obligations and responsibilities to this child? Further, do the twins deserve to know where they came from; that they were donor conceived? Thousands of donor-conceived people have a deep longing to know who they belong to, where they come from, and who they look like. You can watch our film Anonymous Fathers Day to explore the stories of women and men who are the children of sperm donors. 
  • Is the fertility doctor ignoring possible wrongs that IVF and pregnancy create in older women? Women who get pregnant at an older age and women who carry multiple fetuses have an increased risk for morbidity and mortality. Should doctors ignore these risks? Are doctors minimizing these risks for financial gain? 
  • What about the woman who “donated” her eggs? What about the risks that she undertook in the egg donation process? Do you think that egg donor knew that she was donating her eggs to a 73-year-old woman? Do you think the egg donor will care if the twins become orphans at a young age? Our film Eggsploitation explores how the fertility industry turns women into commodities for profit. Watch it here
  • Just because we can, should we? Research and technology have given us the opportunity to do some remarkable things. When has it gone too far?

Have something to add to this discussion? Let us know what you think! We want to hear from you! You can send your thoughts and comments to

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Author Profile

Kallie Fell, Executive Director
Kallie Fell, Executive Director
Kallie Fell, MS, BSN, RN, started her professional career as a scientist in the Department of Obstetrics and Gynecology at Vanderbilt University Medical Center utilizing a Master of Science degree in Animal Sciences with an emphasis on Reproductive Physiology and Molecular Biology from Purdue University. While assisting in the investigation of endometriosis and pre-term birth, Kallie simultaneously pursued a degree in nursing with hopes of working with women as a perinatal nurse. After meeting Jennifer at a conference, Kallie became interested in the work of the Center for Bioethics and Culture and started volunteering with the organization. It is obvious that Kallie is passionate about women’s health. She continues to work, as she has for the past 6 years, as a perinatal nurse and has worked with the CBC since 2018, first as a volunteer writer, then as our staff Research Associate, and now as the Executive Director. In 2021, Kallie co-directed the CBC’s newest documentary, Trans Mission: What’s the Rush to Reassign Gender? Kallie also hosts the popular podcast Venus Rising and is the Program Director for the Paul Ramsey Institute.