When Dr. Vicken Sahakian met Carmela Bousada at his Los Angeles fertility clinic, it never occurred to him that his newest patient was also his oldest.
Bousada was 66 years old, but according to Sahakian she claimed to be 10 years younger in order to qualify for in vitro fertilization treatments.
After selecting egg and sperm donors who were decades younger than she was, Bousada had an embryo implanted in her uterus and was well on her way to becoming a mother.
In December, Bousada made headlines when she gave birth to twins. Now 67, she is widely believed to be the world's oldest person to give birth.
Bousada's babies were born seven weeks premature by Caesarian section at a hospital in Spain. The twins were healthy, though doctors had feared that Bousada might not survive the operation. They called family members to her hospital bedside just in case.
Sahakian, who was not present at the birth, said, "we are so lucky that it ended up going the way it did. Thank God everyone is healthy."
But Sahakian also said he never would have treated Bousada had he known her true age, because of the medical risks to the patient and her babies.
"I can't believe how irresponsible she was. I'm very angry with her," he said.
According to Sahakian, the paperwork Bousada filled out at the clinic included a birth date of May 1, 1950. Sahakian said he never asked her for identification because there was never a need for it.
"You go to a doctor for medical help," he said. "I am not an investigator. This is not a police state."
Still, Sahakian was willing to treat a woman he believed was in her mid-50s -- a practice other specialists say is precarious.
Fertility experts say few mainstream clinics treat women more than 50 years old because of health risks to the mother and the baby. Complications can include hypertension, diabetes, low birth rate and early delivery.
"Certain situations could be so serious that your kidneys could shut down and you could die," said Sahakian.
The fertility industry is largely unregulated. There are no laws restricting a patient's age -- only voluntary guidelines that doctors may choose to follow.
The American Society for Reproductive Medicine does not recommend implanting an embryo in women after menopause. The average age of menopause is 51.
So why would Sahakian and a handful of other doctors perform the procedure on older women?
He said he disagrees with industry guidelines. "I don't think it should be linked to menopause at all. That age has been moving upwards."
Before accepting a patient, Sahakian said he requires older women to go through testing to determine if they are physically fit to carry a child.
"You have to be in perfect health conditions. No hypertension, no diabetes, nothing," he said. "Most women in their 50s won't qualify."
But he does have an age limit in mind, at least for single women. Sahakian believes it is unethical to help a woman 55 or older conceive if she doesn't have a partner to help care for the child.
"I want to make sure she has enough years in front of her to raise the child. It's my ethical concern," he said. "I have the right to follow my own morals."
But if the older woman has a younger man, that's a different story.
"If you have a partner and you're 57, healthy, no medical problems and you're married to a 42-year-old man, what's the difference between that and a 57-year-old man married to a 42-year-old woman?" he asked.
It's the age-old double standard. Even Sahakian admits it exists. Older men frequently father children -- the late actor Tony Randall became a father at 76, and Larry King sired children at 65 and 66 -- while news of Bousada's motherhood has sparked some controversy.
Sahakian says older women should carefully weigh the dangers before deciding to undergo IVF, noting that, in addition to childbirth, women must endure the physical exertion of carrying the child.
Some fertility specialists, such as Dr. Richard Paulson of University of Southern California's Keck School of Medicine, worry that other women, hearing of Bousada's twins, will put off a pregnancy believing that they have time.
"The biological clock is ticking. If you wait to have a child in your 50s, it's possible, but you'll be using a donor egg," Paulson cautioned.
Sahakian has a more sober prediction: "I think there's going to come a day when someone's going to die -- either the woman or the child -- and there's going to be a lawsuit."
That, he believes, will set a precedent, causing medical malpractice insurers to impose age limits.
"The system will probably control itself eventually," he said.