How old is too old to be a parent?

Do you think there should be a cut-off age after which people shouldn’t have children? Or is it fine at any age at which it is remotely feasible? And is it right that we ponder this subject so much when it comes to women having children later in life, and yet barely raise an eyebrow when Mick Jagger has a baby at the ripe old age of 73?

The subject has been back in the news again after Dame Julia Peyton-Jones, former director of the Serpentine Galleries, became a mother at 64. It isn’t clear how she had her daughter, although we can be sure she didn’t use her eggs and that she may well have paid for a surrogate to carry the baby too.  I know we all feel and act younger than our grandparents may have done at the same age, but she will be 80 by the time her daughter is 16 – and I can’t help wondering what it would be like for a 16 year old to have an 80 year old mother? Or what it would be like to be responsible for a teenager when you were 80?

Of course, the other problem with news stories like this is that they muddy the waters when it comes to NHS funding for fertility treatment, as many people seem to assume that it is the NHS which is footing the bill for older women to try to have babies. In fact, in most areas there is limited funding for women up to the age of 39, and often nothing at all beyond that. At most women of 40-42 will get one cycle, but if you are older, there is no likelihood of funded treatment.

Age matters for men too

DownloadedFile-17We don’t need reminding about the female biological clock, but what doesn’t get mentioned nearly as often is the fact that age has an impact on male fertility too. This really interesting article explains that male levels of testosterone actually start to decline when men are in their thirties, and that older men can take up to five times longer to conceive.

The author says that there’s a need for more information about male fertility and age, and that men need to be encouraged to discuss these issues with their doctors.  Apparently in general men are 80% less likely than women to go to the doctor – and a recent study for Infertility Network UK found that nearly half of men would not feel happy discussing fertility with their GP.

When we call for more fertility awareness and education, there’s often a response from those who feel that women already know quite enough about this issue – but it’s clear that men certainly don’t.

New research on how late you can leave it

One question many women ask when they’re thinking about starting a family is “How late can I leave it?”. Many of us are simply not ready to try to conceive when we’re at our most fertile in our twenties, but leaving it until our thirties or forties can lead to worries that maybe we’re going to encounter problems along the way.

Now, researchers have come up with a computer model which suggests when you should start trying to have children based on the size of family you’d like (yes, I know – just one would make most fertility patients very happy…).  Anyway, according to this model if you want to have three children, you should start trying by 23 to have a 90% chance of success, or by the age of 32 if you’d like just one child. They factor in IVF separately in their tables, which gives a slightly higher chance of success and it is presented in a table which makes it very easy to understand.

These figures are general and can’t be used to show your individual chances of success, but at the same time they do raise the realities of the difference that age makes when considering pregnancy and parenthood. There’s often criticism about this kind of research from people who say that it puts pressure on women – and no one wants to worry people unnecessarily – but at the same time, we can’t ignore factual information because we don’t like it. I’ve seen so many women in their mid forties who assume that they must still be fertile because they are fit and healthy, look much younger and are still having periods – but none of those things guarantee that you are still fertile. The oldest person to get pregnant using IVF with her own eggs was 46, but this was such a remarkable and extraordinary case that it was reported in a scientific journal – see here 

Although this new research can’t be used as a certain predictor for any individual, it does give a clearer picture of the difficulties women can face. It is true that many will go on to have children if they start trying for a family in their late 30s, but others won’t and it is important that everyone is aware of the realities of age and fertility. You can read more about the research in New Scientist here 

 

 

 

How late you can leave it – again…

So, the debate about when women should get pregnant goes on… When fertility specialist Geeta Nargund called for fertility education, it soon turned into a heated discussion about whether doctors should be telling people when to get pregnant (which, if you read what she actually said, Geeta Nargund hadn’t).

Not long afterwards, Lord Winston, still one of the country’s best-known fertility experts, said that he thought that delaying motherhood was a good thing, and that there were many advantages to waiting to start a family. Now the Chair of the British Fertility Society, Adam Balen, has added his voice to the debate, pointing out that it is important that women are aware of the risks of trying to get pregnant later – you can read his remarks, and a reply from Lord Winston here. The “row” may be largely manufactured by the Daily Mail, but it continues to raise important points about the biological clock and women’s awareness of their fertility.

Whatever your views on the subject, it doesn’t alter the fact that proper fertility education can only ever be a good thing. There are all kinds of reasons why women delay having children – often more to do with circumstance than choice – but being well-informed about the lifestyle factors that can influence your fertility can be hugely beneficial whatever age you may be,

Should women be encouraged to get pregnant earlier?

images-1There has been a lot of misunderstanding and misinterpretation in the current debate about fertility education and whether women should be having children younger which hasn’t been very helpful. Fertility consultant Geeta Nargund’s letter to Education Secretary Nicky Morgan about fertility education has sparked a fierce debate.

We’ve had angry replies from those who say that women already know all about the biological clock, that pushing them to have children earlier is adding too much pressure to already pressured lives and that schoolgirls should not be encouraged to be defining themselves in terms of their reproductive capacities.

Fertility education is not just about age

As someone who is very much in favour of fertility education, I think we need to be clear about what it actually means. It doesn’t mean telling girls that they need to have babies by 30. It’s about allowing them to make informed choices. It’s about teaching girls and boys that sexually-transmitted infections, eating disorders, smoking, weight, excessive drinking and recreational drugs, including bodybuilding steroids, can all have an impact on your future fertility. It’s about making girls and boys aware that fertility does have time limits and that treatments such as IVF can’t do anything to turn back the biological clock.

Do women really understand the biological clock?

Despite the protestations that women know all they need to about their fertility, most specialists in the field see people every day who don’t really understand how age impacts on their chances of success and who expect IVF to be able to offer solutions when they are older. In fact, IVF is far less successful for older women – it’s a treatment for fertility problems not for age. Fertility specialists are sometimes reluctant to spell out to women whose treatment hasn’t worked that this is most likely to be down to age, and success rates for IVF sink to single figures for women over the age of 42.

There has been a lot of focus from those who think women already know about their fertility on the fact that women can still successfully get pregnant in their late thirties and their forties. Of course they can – but not everyone will be able to – and this debate is about preventing heartache for the group who feel they didn’t know the facts.

The other thing that has been entirely ignored in the discussion is the miscarriage rate which goes up as your fertility declines. Women of forty and over are more likely to miscarry than to have a baby if they get pregnant. It’s a horrible fact and not one that most of us like to think about, but it’s true. It’s all very well to keep insisting that women can still get pregnant at this age, but pregnancy is not the aim – it’s a baby.

Fertility education isn’t about telling girls what to do – it’s about educating people, that’s boys and girls, about the choices they make that can have an impact in the future.

 

Is freezing a feminist issue?

I was at a seminar recently where the idea that egg freezing would lead to more equality between the sexes was debated – if women were able freeze eggs when they were younger, it was argued, they wouldn’t need to worry about their biological clocks. Women could have children when they wanted rather than in the time frame that nature specifies, thus making them more like men. It was pointed out that men have been freezing sperm for decades and yet when women are given the chance to freeze eggs, we suddenly raise all kinds of ethical issues.

It’s an interesting argument, but is egg freezing really a way of making women more equal?For a start, it’s a costly business and is only ever likely to be available to those who can afford to pay. And it’s often not until a time when female fertility is already in decline that most women have the money – or the inclination – to freeze their eggs.

The other concern for those who freeze is that having a store of eggs in the bank could lull them into a false sense of security. Women are sold the idea of preserving their fertility but fertility isn’t something you can pickle in a jar – and freezing your eggs isn’t a guarantee that you will eventually have a baby or even viable embryos. The eggs have to survive thawing, they have to fertilise, develop and implant. Success rates are not high.

So is egg freezing a feminist issue? Will it allow women to stop worrying about their declining fertility? Is it empowering them or is it storing up future disappointment?

Is an egg-freezing party really the best place to inform yourself?

120px-2_eggsApparently it’s the latest thing in the States and is set to arrive on our shores soon – the egg-freezing party hosted by a doctor who calls herself the “egg whisperer” who will tell you all you need to know about freezing – and offer you discounts on her freezing service if you go along to a party, or host one yourself.

I’m all in favour of people knowing more about the realities of egg freezing, but I’m not entirely convinced that a party organised by someone who is trying to sell her egg freezing service is the best way to do that.  What women really need is impartial advice about this, a real assessment of their chances of producing viable eggs and honesty about the age-related decline in egg quality as well as quantity. The truth is that egg freezing is not likely to be able to offer a successful “extension” to your fertility if you are already in your forties, and yet many of the women who look into this as an option are older – apart from anything else they are more likely to be able to afford to pay for it as egg freezing is a costly business.

There’s a growing debate about companies providing egg freezing for employees after a couple of US companies offered this to staff – but what hasn’t been so widely reported is that this move was an extension of existing fertility packages which also offered funding for IVF. Perhaps that might be a more welcome move…

If you’re interested, you can read more about egg freezing parties in this article from the Evening Standard

A question of egg freezing

I’ve just been watching this really interesting documentary by Al-Jazeera journalist Amanda Burrell who is trying to decide whether to freeze her eggs as she approaches her forty-third birthday. It’s a fascinating look at egg freezing through the eyes of a childless woman who is wondering whether she really wants to be a mother, and whether she should consider freezing her eggs.

We are often told that women know all too well about the biological clock and that we don’t need to keep reminding them – and yet the huge gaps in Amanda Burrell’s knowledge show that the message is still not really getting across. Of course, she was aware that female fertility declined with age – but she had little idea of the reality of what happens in your late thirties and early forties. She is delighted when a doctor tells her that her ovarian reserve is better than might be expected for her age, but appears to quickly gloss over what he also explains to her – that this doesn’t guarantee the quality of her eggs.

Freezing is discussed as an “insurance”, but even with a good ovarian reserve, freezing your eggs at 43 is going to be a pretty huge gamble.  Amanda gradually becomes more aware of this, but what isn’t ever fully explored is the fact that even with good quality frozen eggs you are still at the start of a journey as anyone with experience of fertility treatment will know. Eggs have to fertilise, embryos have to implant – neither of which can be guaranteed – and when you are using eggs produced at the age of 43, your chances of having a miscarriage even if you did get pregnant are high.

This is a fascinating look at the reality of being a single childless women approaching the end of your fertile years. It’s also an incredibly brave documentary as Amanda explores her thoughts and feelings about motherhood, childlessness and egg freezing. Do watch it – http://www.aljazeera.com/programmes/aljazeeracorrespondent/2014/12/motherhood-ice-201412492641993386.html

Fit and healthy doesn’t always mean fertile

I was listening to a woman talking yesterday about access to IVF for women in their mid-forties. She thought the NHS should fund treatment for women who were past the age of 42 (which is the current cut off recommended by NICE) if they were “fit and healthy”.  It’s a point of view that some may share – that age isn’t as important as how you look after your body and that those who eat well, who exercise and who appear younger than their years must still be fertile.

In fact, fertility doesn’t work that way; of course, being fit and healthy is always going to help, but by the time you reach your mid-forties, it’s your personal biological clock which is more important when it comes to your chances of conceiving –  and that’s not something that any amount of healthy eating can alter.

The HFEA success rates for IVF show this very clearly; women who are 35 and under have an average chance of success of 32% but for 38-39 year olds this is already reduced to 20%.  Once you get into your forties, the decline is very sharp – for a woman of 40-42 there is a 13% chance of success, at 43-44 that drops to 5% and over 45s have a less than 2% chance of getting pregnant with IVF.  So no matter how fit and healthy you may feel, your chances of IVF success in your mid-forties are very low.

It’s a difficult message, and one that we don’t always want to hear – but the one thing IVF cannot do is turn back the biological clock.

Kirstie Allsopp speaks out on fertility

I have a new-found respect for TV presenter Kirstie Allsopp for speaking out about fertility and the biological clock. If you haven’t heard about it, you can read her comments in an interview in the Telegraph here, but to summarise she said she thought we needed to be more honest about the biological clock. She suggested that as we all lived much longer, it was perhaps time to think differently about the order in which we did things and that having children and settling down earlier, and going to university later might be a better way.

Inevitably, she’s come in for a lot of criticism – often from people who haven’t read what she actually said and from those who see her thoughts as some kind of reactionary anti-feminist stance. In fact, what she’s suggesting is far from reactionary or anti-feminist.  It’s actually quite radical, and I think she may be right.

She went on to explain herself very clearly in this debate on Newsnight, where she spelled out that she wasn’t just talking about young women thinking differently, but about young men thinking differently too. We may live longer, but the average age of the menopause hasn’t changed and if people want to have families, it’s both men and women who need to think carefully about when they do this.

We don’t want to scare young women, to make them limit their choices or to prevent them achieving their full potential – but doing things in a different order doesn’t have to be limiting. As a society we tend to have rather negative and judgmental views of women who have children very early, but the handful of women I know who had children in their late teens and early twenties have all gone on to have very successful and fulfilling careers – and are getting on with the rest of their lives post-children at a time when many of their contemporaries are finding themselves on the fertility treadmill.  Maybe it’s time we did rethink the way we do things?

You may not think Kirstie is right, and of course it isn’t always going to be right to have children earlier for all kinds of reasons – but hats off to her for being brave enough to speak out and raise the issue.