Low ovarian reserve

If you’re trying to conceive, you will be aware of your ovarian reserve but when you are starting out on your fertility journey, this isn’t something you will have come across before. Our potential to produce eggs declines as we get older, but the rate at which this happens is different for everyone – so some women may be diagnosed with a low ovarian reserve in their thirties or even twenties, which often comes as a real surprise as there may be no other signs of any decline in fertility at all.

If you want to know about your ovarian reserve, I was interviewed about the emotional impact by Allie Anderson for an article for NetDoctor the other day which you can read online here.  It is important that we talk about this issue more often and more openly. Fertility specialists may suggest using donor eggs if they feel the ovarian reserve is so low that IVF is unlikely to be successful, but for women this may seem a huge and unexpected step and is certainly one which needs thought and counselling.

Anyone who is using donor eggs or sperm will find it useful to contact the Donor Conception Network who can provide information, help and support.

Should companies be offering egg freezing?

images-10So, Apple and Facebook are to offer to pay for female staff to freeze their eggs as part of a concerted effort to expand the “benefits” they offer to women – but is egg freezing a benefit? Does it really “empower” women? Is offering them something that is so uncertain to enable them to keep working through their most fertile years really to be commended? Is it egg freezing that women want, or is it working environments which make it easier for them to consider starting families earlier in life?

I can’t help thinking that when big companies offer to fund egg freezing for staff, it gives the whole concept a credibility it may not deserve. No one can be certain that they have “preserved” their fertility by freezing eggs – it’s still a relatively new technique, and outcomes are far from certain – but women are being encouraged to believe that this can solve the problem of the female biological clock.

The other side of this, which didn’t get as much media coverage, is that Apple and Facebook also offer funding for fertility treatment and sperm donation – and that is something that I can see being far more helpful to far more women.

What do you think? Would you welcome a company funding egg freezing? Would you like your employer to pay for fertility treatment? Or is it all just one intrusion too many into your private life?

Fertility MOT testing

One of the subjects which came up during the recent debate about whether women are leaving it too late to try to start families was the idea of fertility MOT testing – for anyone who isn’t familiar with it, this usually involves a series of tests for women which look at the ovarian reserve in order to predict whether a woman’s fertility is already in decline.

Of course, it can give some very useful information about your hormones and your ovarian reserve, but there does seem to be some misunderstanding about the limits of this kind of testing. It’s important to remember if you’re opting for a fertility MOT that it’s only giving part of the picture. Most of these tests focus on hormones, but you can have perfectly good hormone levels and be unable to get pregnant naturally if you have blocked fallopian tubes.

You’d also need your partner to have tests too, as male fertility problems are just as common as female ones. And even if you had every test under the sun, nothing can guarantee that you won’t have a problem further down the line.  Many couples with fertility problems go through test after test, and yet experts can never find a reason why they aren’t getting pregnant. Estimates vary as to how many couples are left with no cause for their fertility problems, but unexplained infertility is generally thought to affect between 10 and 25% of those who are having difficulty.

So, fertility MOT tests are fine if you want to find out more about your ovarian reserve, they can indicate that you may have a problem but what they really can’t do is guarantee that you are not going to have difficulty getting pregnant further down the line.



‘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..


Fertility research hits the headlines again…

Today it’s a story about the ovaries of women who’ve been through an early menopause being “reawakened” by researchers in Japan and the US using a new technique.  The first baby has been born using the technique which involves taking out the ovaries, cutting them up and treating them before returning them to the top of the fallopian tubes. Apparently this has led to follicles starting to develop in 8 of the 27 women in the study, and one has now had a baby.

It sounds exciting, and the idea that there could be a way to help women whose ovaries have stopped producing eggs prematurely is fantastic – but unfortunately this is another example of a headline that will have raised the hopes of many women and yet is  highly unlikely to make any difference to their current situation. The problem with the reporting of new developments in research is that it is hard to keep them in perspective. Remember, this is a research study and it’s not something the staff at your local fertility clinic are going to be able to offer you next week – or even next year. It’s still very much at the experimental stage and only one of the 27 women in the study has actually had a baby using this technique although another is expected. We have no idea why it worked for these two women and not for the others, and far more research is needed before it would be able to be offered to on a wider scale.

Of course, we want to know about new advances, but if you monitor the headlines you’ll find news of a “breakthrough” or an “exciting new development” every few weeks – and many seem to disappear without trace afterwards. I was glad to see that the BBC had put the story into perspective by interviewing Professor Nick Macklon and Professor Charles Kingsland but it’s difficult not to get excited when research teams produce a treatment that could change your life if it worked –  try to remember that it can be a very long journey from research to reality. You can read more about the study here 




Could your mother’s menopause predict your fertility?

Do you know how old your mother was when she reached the menopause? If you’re trying to conceive, it’s a question worth asking.  A new study from Denmark published in the journal Human Reproduction has found that your ovarian reserve – that’s the number of eggs you have left in your ovaries – may be linked to your mother’s age at menopause.

We know that ovarian reserve declines as a woman gets older, but this study has found that the decline appears to be faster in women whose mothers had an early menopause (that’s before the age of 45) compared with those whose mothers had a late menopause (that’s after the age of 55).  Apparently, your fertility starts to decline about 20 years before your menopause – so if you have an early menopause, your fertility will have been affected at an earlier age too.

The authors don’t want to alarm women unnecessarily, and make it clear that their research doesn’t suggest that your mother’s age at menopause will necessarily predict  your chances of pregnancy at a certain age  What they have found is a link between ovarian reserve and your mother’s age at menopause which supports the theory that heredity may play an important role in reproductive ageing.

So, if you are worried about how late you can leave it to have a baby, one factor which you should at least consider is how old your mother was when she reached the menopause. If you find out that she was in her mid-forties, it may be worth thinking about having your own ovarian reserve tested sooner rather than later.

You can read more about the research here