Age-discriminated IVF Access and Evidence-based Ageism: Is There a Better Way?

Abstract

Access to state-funded fertility treatments is age-restricted in many countries based on epidemiological evidence showing age-associated fertility decline and aimed at administering scarce resources. In this article, we consider whether age-related restrictions can be considered ageist and what this entails for a normative appraisal of access criteria. We use the UK as a case study due to the state-funded and centrally regulated nature of in vitro fertilization (IVF) provision. We begin by reviewing concepts of ageism and age discrimination in gerontological scholarship and contend that it is analytically useful to differentiate between them when considering age-restricted health services. We then argue that criteria to access IVF could be considered indirectly ageist so far as they rely on an age-related evidence base that manifests ageist categorizations of persons. Lastly, we examine whether there could be more normatively desirable alternatives to devise criteria to access fertility treatment, considering “lifestyle” as a potential candidate. We conclude, however, that lifestyle-based discrimination is problematic because, unlike age-based discrimination, it risks exacerbating existing socioeconomic and ethnic inequalities.

Involuntary Childlessness, Suffering, and Equality of Resources: An Argument for Expanding State-funded Fertility Treatment Provision

“…Lifestyle-related diseases, and the poor health outcomes with which they are associated, are more common among disadvantaged groups; the mechanisms that influence their emergence, are often influenced by social and cultural environments, occupational status, wealth, education, and other factors. Similarly, as I have argued elsewhere with respect to age-related restrictions to access fertility treatment, “the global phenomena of reproductive aging, whereby the timing of the first child moves further along the life course, is heavily politically, economically, and socioculturally constrained” ( Cavaliere and Fletcher, 2022 , 1000). My contention is that women are often deemed personally and morally responsible for age-related infertility, and that this overlooks both these women’s circumstances and broader socio-political trends, such as, for instance workforce feminization that structurally determined these women’s ability to conceive unassisted.…”

“…Some clinical commissioning groups limit access to three cycles to women under thirty-six, whilst others offer only one cycle of treatment ( HFEA, 2021 ). For a discussion of IVF funding and age-related infertility in the UK, see ( Cavaliere and Fletcher, 2022 ).…”

Negative ageism and compassionate ageism in news coverage of older people under COVID-19: how did the pandemic progression and public health responses associate with different news themes?

“…For example, whether an ageist narrative was covered on the front page may suggest different levels of salience vis-à-vis other news topics. This study also did not differentiate between ageism and age discrimination in the new themes, based on whether implicit notions of 'unjust' are presumed, as suggested by recent research (Cavaliere and Fletcher, 2021). Adopting a fourth age social imaginary approach, which acknowledges the interplay between biological and social aspects of ageing and social categorisations, may allow a more nuanced understanding of discrimination or 'othering' of old age in contemporary society (Higgs and Gilleard, 2020).…”

Interference with and abuses of sexual and reproductive health and rights: a new proposal for classification and terminology

“…Assisted reproductive technologies (ART) have been denied to those who do not fit the standard married, heterosexual, cisgender picture [76]. Also upper age limits for treatment have been applied [77]. Obstructions to, or denial of, access are possibly better terms than restrictions.…”