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.
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
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.
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.
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.
There has been a lot of media excitement about newly-released statistics showing an increase in the number of women in their fifties giving birth – and the lack of understanding about the subject is summed up by this article in the Telegraph.
According to the Telegraph, one of the reasons for the increase in the number of fifty-something mothers is “changing medical advice”. I am fascinated by this, and would love to be enlightened as to the nature of this changing advice. Most fertility clinics stop treating women once they reach 50, obstetric advice is clearly not encouraging women to get pregnant when they are older and the Chief Medical Officer warned recently that women should not risk leaving it too late to get pregnant. So, if anyone has any idea what “changing medical advice” the Telegraph is referring to, please let me know – let us all know…
The article also claims that IVF means that more women are willing to risk delaying having children – but fails to mention that IVF can offer nothing to women of 50+. IVF success rates are very low for women in their mid forties, and I have never met a fertility specialist who would offer standard IVF to a woman in her fifties as it would be a waste of time. Treating women with donor eggs is something else entirely, but even then, most fifty-somethings would need to travel overseas in order to find a clinic willing to treat them.
According to the Telegraph, “actress Tina Malone of Shameless gave birth to daughter Flame at the age of 50, after travelling to Cyprus for IVF treatment”. Well, no actually she didn’t. She had egg donation. It’s a very different thing and failing to clarify this is inaccurate and misleading.
The article also quotes a survey which it says found that “almost three-quarters of people do not think women should receive IVF to help them conceive beyond their natural childbearing years”. As IVF really can’t help women conceive beyond their natural childbearing years, I am not sure why anyone even asked the question. IVF is a treatment for infertility, not for age.
If reporters for national broadsheets seem not to understand the facts, perhaps we shouldn’t be surprised that so many women are confused…
There has been a lot of discussion recently about age and infertility, with some claims that it’s not as relevant as we’ve been led to believe. I was interested to see some new research from the University of Aberdeen which makes it very clear just how closely IVF success is linked to age. Interestingly, the research found that although the amount of time that a couple had been trying to get pregnant before treatment is relevant to the outcome, it doesn’t have nearly as much impact as age.
The researchers looked at data for more than 120,000 women, and found that women’s chances of success with IVF start to decline once they reach their mid 30s, but are then sharply reduced from the age of 37. For those who did get pregnant, the changes of having a miscarriage were also considerably higher in women of 38 and above.
You can read more about the research from the team headed by Professor Siladitya Bhattacharya here at www.abdn.ac.uk/news/
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..