How late is too late?

The Telegraph returns to the subject of later motherhood this week, following on from the suggestion by the British Pregnancy Advisory Service that an increase in abortions amongst women of 35 and above was due to “scaremongering” about the biological clock which was leading women to assume that they couldn’t possibly be fertile in their late thirties and forties. The article cited the cases of women who’d happily and easily had children in their forties, and suggested that reduced fertility might have more to do with how healthy you are than your age. It even concluded with the point that there might be a “sexist agenda” in telling women that they needed to have children earlier.

You don’t have to have spent much time working in the world of infertility to know that this is one side of a very complex picture. Yes, of course there are plenty of women who can get pregnant very easily in their late thirties and early forties- but there are also many others who can’t and who feel angry that they were not made aware of the limited options that fertility treatment could provide. I talk to so many women who wish they’d started trying for children earlier and who are passionate about the need to educate women about the biological clock.

I’m aware, of course, that this is just one other side of the complex picture, but we do need to get the balance right – we don’t want to scare women unnecessarily, but unfortunately there are many women going to fertility clinics for the first time in their forties only to discover that despite feeling young and being healthy, their ovaries are no longer in top shape for conception.

I don’t want women to start trying to have children earlier because I have a sexist agenda – I want them to be aware that if they leave it until later, fertility treatment can’t wave a magic wand. Being fit and healthy is not going to stop the biological clock, the fact that you are still having periods in your forties doesn’t mean that you are still fertile and female fertility declines far more rapidly than male fertility. It’s unfair, it’s annoying, it’s frustrating – but talking about this isn’t being sexist, it’s just being honest.

The WoW debate

For those who weren’t able to be there, Saturday’s discussion on Fertility Myths at the Women of the World festival at the Southbank Centre for International Women’s Day proved to be a fascinating debate.  I was chairing a panel with obstetrician Dr Susan Bewley who is known for her concerns about women leaving it later to conceive, Zita West who runs a very popular and successful fertility clinic in Central London, Jody Day founder of Gateway Women which supports those who are childless by circumstance and Jessica Hepburn who wrote a powerful memoir about her experiences of fertility treatment.

Each of the speakers began by giving their own brief introduction, and we then launched into a discussion about fertility myths. The key theme which we returned to time and time again during the discussion was age, and how so many women are still under the misapprehension that IVF offers a solution to age-related infertility. Susan Bewley spelled out some key facts about women’s fertility which many of the audience weren’t aware of – the alarming increase in the miscarriage rate once women are in their forties, and the fact that we stop being fertile up to ten years before the menopause itself.  She explained that although the age at which women’s periods start has got younger as we are stronger and healthier, the average age at menopause has remained firmly stuck at 51.

There were some really interesting questions and comments from the audience, and a lively discussion about why women were leaving it later to have children and how to address this.  As a generation encouraged to delay motherhood, to work hard and have careers, many women who are now in their late 30s and early 40s are finding that following a male career pattern of establishing your position before thinking about starting a family doesn’t fit with a female reproductive pattern – but how we begin to change this is a real challenge.  Why do so many women find it hard to meet the right partner to have children with? Do we think too much about potential obstacles before we have children? Are men enjoying the chance to delay fatherhood at the expense of women’s fertility? Is teenage pregnancy really such a bad thing? Are we guilty of glorifying motherhood?

Thanks to the brilliant panel and the audience too.  In conclusion, it’s clear we can’t change the female biological clock, and perhaps we need to start thinking about how we change society and our own attitudes – your thoughts or suggestions are welcome!

‘Generation IVF’ – does it exist?

You may have heard about the forum organised in New York last month for women struggling to conceive who had experienced unsuccessful IVF. It is an important subject because it is so often ignored but looking at a review of the forum this morning, I was interested to read about an apparent “Generation IVF” of women who “were raised to believe that science can surpass Mother Nature in the tricky dance of conception”.

I know there are women who will leave it until they are approaching 40 to try to get pregnant and hope that fertility treatment will help if they’re too late – but I think most women in this situation are there by circumstance rather than by the assumption that IVF offers miracle solutions to reproductive ageing.  I wonder whether the situation is slightly different in the US where the marketing of fertility treatments does seem to be more aggressive and where there is not the same regulation around clinics and the reporting of success rates.

Here, the HFEA publishes the IVF success rates for each age group nationally, and for each clinic – and so it is quite clear to anyone considering IVF that the success rates for a woman of 43-44 are 5% and for a woman of over 45 drop to just 2%.  The age cut-off for treatment in the NICE guideline also sends a message that IVF is not advised for women who are over the age of 42, and would only be suggested for women aged 40 – 42 who still have a good ovarian reserve.  For women in this age bracket the national success rate is 14%.

So what does drive women who are given very low odds of success to try IVF over and over again? The report says that the women at the forum talked about the pressure to keep trying even when the odds were very low, but where does that pressure come from? Should we blame clinics for agreeing to treat women who have a low chance of success? Or the media for hyped headlines about how fertility treatment can work and stories about celebrities who have had babies in their forties? Or is it something more fundamental to do with human instinct and the desire to reproduce?

Interestingly, the report says that the women of this Generation IVF have grown up with “the reproductive freedom to delay pregnancy” as if this is a given. Of course, women are free to prevent pregnancy, but they certainly don’t have the freedom to confidently delay it. I have never come across a fertility expert who would suggest that fertility treatment gives women the freedom to delay pregnancy either.  Education is obviously key here – we need to work harder to get the message across that IVF cannot turn back the biological clock – but can we lay the blame for hope against the odds at any one door?  I’d be interested in your thoughts..

 

Get Britain Fertile – what do you think?

You may have seen the campaign to “Get Britain Fertile” fronted by a poster campaign featuring TV presenter Kate Garraway made up to look like an older-than-she-is pregnant woman. The idea of educating women about fertility may seem to be a good one, but this campaign has already sparked considerable controversy.   Barbara Ellen, writing in The Guardian, points out quite rightly that the reason many women delay having children is not because they are career-obsessed or just enjoying their party lifestyles – it’s more often because they haven’t met a man who is ready and willing to think about becoming a parent.  On one women’s forum, the campaign was described as ‘patronising’ and ‘offensive’, and the National Student website headlined it as ‘all kinds of wrong’.

There is room for more education about female fertility. Although women are aware that their fertility declines with age, they don’t always know quite how early this begins to happen – and many still assume that fertility treatment is able to sort out any problems that may arise from leaving it late to conceive.  However, of all the women I’ve met who are trying to conceive later in life, there are very few who have left it late through choice; the vast majority are in this position because they hadn’t met the right person to have children with earlier.  I’ve lost track of the number of women who felt that they wasted years in relationships with men who “weren’t quite ready” or couldn’t decide whether they really wanted children.

Whatever one concludes about the campaign, I can’t see the point of the picture of Kate Garraway made up to look like an older pregnant woman which seems completely wrong on every front to me – What is it meant to be saying?  Are we supposed to be horrified at the idea of a wrinkly mother?  I suppose the advertisers have achieved their aim of “getting people talking” about the campaign, but perhaps not in the way that they might have intended.

 

Why 45 definitely ISN’T the new 35 when it comes to fertility…

According to the Daily Mail, 45 is apparently the new 35 when it comes to fertility with more and more celebrities giving birth in their forties. The article in question makes it sound as if fertility treatment offers not just hope but pretty much certainty to anyone who decides to try to conceive in their forties as apparently “scientific advances” have made conception at 45 and even 50 perfectly possible. The fact that many celebrities achieve this by using donor eggs or surrogacy does get a mention, but it isn’t made clear that this would be the only way for most women of this age to get pregnant – apparently the only downside to any of this is cost.

The reality is that fertility treatment for anyone in their mid-forties using their own eggs has an extremely poor chance of success.  The article celebrates the fact that women who use donor eggs have just as good a chance of success as their younger counterparts, but most couples would want to think carefully before jumping ahead and using donor eggs or sperm as this isn’t something to be undertaken lightly.

The reality is that we are only half as fertile at 35 as we were at 25, and by the time we reach 45 our chances of having a child naturally – or with IVF – are very low and the risks of miscarriage are very high.  Yes, there are ways around this using donor eggs or surrogacy – but these are more complex and costly treatments that come with implications that need thinking through.

So no, 45 is NOT the new 35 as far as female fertility is concerned.  There may always be away for celebrities with limitless funds who are determined to have a child to find a way around their biological clocks, but even they can’t yet turn back time and rejuvenate their own eggs.