Mangayamma tried to fall pregnant for more than 50 years. At 74, she gave birth to twins.

For five decades, Mangayamma Yaramati felt burdened by her inability to conceive. She saw herself as a pariah among the other women in her small village in Andhra Pradesh, a state in southern India.

“People looked at me with accusing eyes as if I had committed a sin,” she told the Times of India. “Neighbours would call me ‘godralu’ [a slur for a childless woman]. But my husband stood by me like a rock.”

On Thursday, Mangayamma’s dream was realised. Having conceived via IVF earlier this year, she gave birth to twins via cesarean section at a hospital in Gunta.

She is 74.

Mangayamma is now believed to be the oldest women to have given birth, though the claim has not been formally verified.

She and her husband, an 82-year-old farmer named Sitarama Rajarao, sought the services of IVF specialist, Dr Sankkayala Uma Shankar, who consulted a board of gynaecologists, cardiologists and paediatricians before proceeding with treatment, according to local media.

Dr Shankar told The Washington Post that Mangayamma had produced a birth certificate verifying her age (which has incorrectly been reported elsewhere as 73), and that because she had experienced menopause, the pregnancy was achieved via a donor egg and Rajarao’s sperm.

“The [pregnancy] was smooth. There were no complications,” Dr Shankar said. “She only had respiratory issues, but that was taken care of.”

While mother and babies are doing well, the BBC reported that Rajarao had been hospitalised due to a stroke he suffered the day after the delivery.

The ethical debate.

The news of the twins’ birth has reignited debate around whether doctors should facilitate pregnancies in older women.

From a purely medical point of view, it’s certainly becoming easier. As Shannon Clark, a professor of maternal and fetal medicine at the University of Texas Medical Branch, told The Washington Post, while a woman’s eggs deteriorate in quality and quantity over time, her uterus “is not subject to the same age constraints”. In other words, with the use of a donor egg, some women are able to carry babies in their 50s and beyond.

It’s certainly happened before. In 2017, an Indian woman believed to be 72 years old gave birth to a healthy boy, and in 2006, a 66-year-old Spanish woman delivered twins.

The arguments raised by critics, though, are typically ethical ones around the ability of parents to provide ongoing care for their child.

In Australia, the ethical guidelines for the use of assisted reproductive technology (eg. IVF) don’t specifically address cases involving women of ‘advanced maternal age’ (the term typically used by doctors). But they do require that it’s undertaken “in a manner that minimises harm and maximises the benefit” to all involved, including the resulting child.

“ART activities should not commence without serious consideration of the interests and wellbeing of the person who may be born as a result of that activity,” the guidelines state.

Mangayamma and her husband aren’t phased by such criticism. Prior to his stroke, Rajarao was asked by the BBC about his plan for the children should something happening to he or his wife. He replied, “Nothing is in our hands. Whatever should happen will happen. It is all in the hands of God.”