Friday 20 October 2017

The fertility waiting game

Whether you're waiting for the right time to get pregnant or you're waiting to get test results back, the important thing is to arm yourself with information, writes Chrissie Russell

Three percent of all births in Ireland arise out of fertility treatment
Three percent of all births in Ireland arise out of fertility treatment

Whoever said 'time flies' obviously hadn't been trying to get pregnant. Months might fly by when you're on holiday or even looking forward to Christmas, but when you're waiting for little blue lines to appear on a pregnancy test, those 28 days can drag.

The whole business of conception can become a waiting game, waiting for the 'right time', waiting until you're ready, waiting to see if it's happened and, if it doesn't happen, then there's waiting for appointments, waiting for test results… all done with the tick of your biological clock getting ever louder.

One of the worst things about waiting is the sense of powerlessness, but there is another way, and that is taking control of your fertility and arming yourself with information.

"We need to be more into educating ourselves when it comes to fertility," says Declan Keane, founder or ReproMed fertility clinics. "Culturally we're not there yet, we just assume we'll meet the right person, settle down and have babies but it's not always that simple."

One of the biggest things he believes could stave off troubles down the line is if women, and men, took fertility tests in their 20s so they know what position they're in when it comes to their egg and sperm reserves.

"It doesn't mean you have to freeze your eggs or even do anything," says Keane. "But at least it gives reassurance. If you're a woman in your 30s and you know you have a low egg reserve, you might decide not to put off trying for a baby, rather than assuming everything is perfect and then potentially running into problems down the line."

The need to flag up issues early is because, like it or not, time is not on our side when it comes to reproduction. Articles about Hollywood's A-listers popping out babies well into their late 40s might have us thinking that anything is possible but the reality is that, physiologically, the best time to have babies is in your 20s, and from 30 onwards fertility starts to decline. But rather than bang on about the much hyped 'fertility cliff', let's focus on the good news instead, which is that there's an increasing number of options available if you're struggling to get pregnant.

They include blood and hormone tests to establish fertility, surgery (eg, to treat ovarian cysts), drugs that can stimulate ovulation as well as more invasive procedures like in vitro fertilisation (IVF), intrauterine insemination (IUI) and ICSI where a single sperm is injected into the egg, bypassing potential physical barriers impeding conception through intercourse.

Evolving technology is making it ever more possible to bypass physical problems and give nature a helping hand in reproduction.

"There's also the option of donor eggs and donor sperm," adds Dr David Walsh, medical director at SIMs fertility clinic. "There's actually very little that can't be overcome if you really have to, or want to, for most people."

But he agrees it's still best to act quickly in order to access the option best suited to your circumstances.

"Being pro-active is a good strategy," he explains. "If something isn't working out, move on to the next thing."

Often he sees couples who have been trying for two years and approaching their 40th birthday before seeking fertility treatment.

"After two years of trying, your chance of getting pregnant, each month, is only one tenth of the norm. It's better to get tests done and address potential problems sooner, after one year. In general then I think a rule of three or four applies - if any fertility treatment isn't working after three or four months, you need to look at the potential reasons. Share the problem and you'll share the solutions."

Keane agrees we shouldn't wait. "If you're under 36, I would suggest you try for at least a year before seeking fertility help," he says. "If you're over 36, try for six months, then look to get tests done."

Typically the cut off age for IVF, using your own eggs, in Ireland is 43 but for older clients wanting to go down the egg donor route, ReproMed will work with women up to the age of 50, though no older. "At a certain stage you have to think about a duty of care to the child," explains Keane.

And whilst age is undoubtedly an important factor when trying to conceive, it's important to remember it's not the only one.

Ian Claxton, from the Elmtree clinic (theelmtreeclinic.com) in Galway, specialises in fertility acupuncture and healthcare. He says it's vital we don't overlook the huge part diet and lifestyle plays in reproductive health. "A healthy 38-year-old with a balanced diet is in a much better position than an unhealthy 28-year-old who is overweight and nutrient poor," he says.

"Put it this way, a 51-year-old patient of mine who had had nine rounds of IVF (very expensive) which all failed, started with me last year and now has a healthy baby."

Also, whilst reproduction typically tends to be viewed as a 'female issue', problems with fertility are actually split even down gender lines with 40pc attributed to the female, 40pc to the male and 20pc unexplained reasons for difficulties conceiving.

But rather than sit waiting and wondering if everything is OK, don't wait - ask for help, it's out there and really can reap rewards.

At the Elmtree, Claxton reports an 80pc success rate of pregnancy in three months in clients.

At ReproMed, 60pc of IVF patients have a positive pregnancy test and 50pc an ongoing 'clinical' pregnancy (where a foetal heartbeat is detected at scan). With younger patients, under 30, the rate of clinical pregnancies rises to 65pc while in those over 40 it is 22pc. However, with a donor egg, even with women in older age brackets, there's a higher success rate of 70pc.

SIMs has similar results, with their successful blastocyst IVF (when the embryos are transferred into the uterus at five or six days, rather than the three-day period used in standard IVF) rates starting at 70pc and decreasing to just over 35pc for those aged 41-43.

Sometimes good things come to those who don't wait.

Fertility:  The statistics

● According to the WHO statistics for Ireland, one in six couples now has fertility issues

● The average age of first-time mothers giving birth is now 30.2

● Three percent of all births in Ireland arise out of fertility treatment

● The average cost for a round of IVF is €5,000 rising to €10,000 with donor eggs

● Typically women at 35 are half as fertile as they were at 25. At 40 you're half as fertile as you were at 35

● 82pc of couples (where the female is aged 35-39) conceive in the first year of trying and 90pc conceive within two years. This only differs slightly to couples where the female is aged 19 to 26, where 92pc conceive in one year and 98pc conceive within two years.

● According to figures from the CSO, Ireland had the second highest fertility rate in the EU in 2012. France had the highest and Portugal had the lowest.

● Spain, the Czech Republic and Denmark are some of the most popular countries for Irish couples seeking fertility treatment abroad.

Irish Independent

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