IVF in your 40s is a long, hard road

Women de­lude them­selves if they think child­birth can eas­ily be post­poned into their 40s, writes Anne Fox

The Weekend Australian - Travel - - Health -

SIXTY is the new 40, 40 is the new 30 and 30 is the new 20. It’s an oftre­peated theme in to­day’s me­dia. Un­for­tu­nately, as I’ve learned to my cost, the way you look and feel does not de­ter­mine your re­pro­duc­tive age.

My part­ner and I did not se­ri­ously dis­cuss the pos­si­bil­ity of hav­ing chil­dren un­til I was in my late 30. When the topic was fi­nally broached, I ar­gued that my de­sire for fi­nan­cial in­de­pen­dence, along with our high-pres­sured ca­reers, and the im­pact that chil­dren would have on our lifestyle and re­la­tion­ship, would make hav­ing a fam­ily im­prac­ti­cal. Un­der­ly­ing th­ese con­cerns was a re­luc­tance which re­flected my own chaotic child­hood.

Af­ter some months of re­la­tion­ship coun­selling, I even­tu­ally agreed to try to have a child. How­ever, it was not long be­fore my de­ci­sion was tested by the dis­cov­ery that I had a fer­til­ity prob­lem.

Con­trary to pop­u­lar be­lief, this hardly made me unique: as we found out at our first con­sul­ta­tion with the fer­til­ity spe­cial­ist, in­fer­til­ity af­fects one in six Aus­tralian cou­ples.

There are nu­mer­ous causes, but from 39 on­wards, age is the most im­por­tant con­sid­er­a­tion. At 22, the chance of con­ceiv­ing each month is 25 per cent; but at the age of 36 that fig­ure has fallen to 15 per cent, and by age 43 it’s only 5 per cent.

Even more il­lu­mi­nat­ing are the mis­car­riage rates: 10 per cent for the 20-24 age group, 25 per cent be­tween the ages of 35 and 39, and a stag­ger­ing 50 per cent from age 40 to 44 — all of which com­pounds enor­mously the chal­lenge older would-be moth­ers face in achiev­ing a preg­nancy and car­ry­ing it to term.

No less fright­en­ing is the prob­a­bil­ity of chro­mo­so­mal ab­nor­mal­i­ties. At age 20, the risk is only 1 in 600, but by age 42 it in­creases to 1 in 39.

Reel­ing from in­for­ma­tion over­load, and some­what sobered by the odds we were fac­ing, we nev­er­the­less de­cided to em­bark on a round of di­ag­nos­tic tests.

When we first saw the fer­til­ity spe­cial­ist I had just turned 40. To our re­lief, most of the more se­ri­ous causes of in­fer­til­ity were elim­i­nated. The fi­nal test was to ‘‘ chal­lenge’’ my ovaries to de­ter­mine if I had gone through menopause early. This in­volved a se­ries of hor­mone in­jec­tions sim­i­lar to those used in IVF treat­ment. Af­ter some trial and er­ror, my ovaries fi­nally roared into life. As they had pro­duced nine eggs, it was rec­om­mended that we con­vert to an IVF cy­cle in or­der to make the most of this pre­cious har­vest. Some­what shell-shocked by this un­ex­pected de­vel­op­ment, but grate­ful that some­thing was at last hap­pen­ing, we pro­ceeded with the rec­om­mended treat­ment.

It was an un­com­fort­able, ex­pen­sive, and emo­tion­ally drain­ing ex­pe­ri­ence which, in the end, yielded only a sin­gle em­bryo that did not re­sult in a preg­nancy.

Dis­ap­pointed, but still hope­ful, we re­turned to the spe­cial­ist to dis­cuss our op­tions for fur­ther treat­ment.

The IVF ex­per­i­ment had con­firmed the ex­pla­na­tion for my lack of a men­strual cy­cle as ‘‘ hy­potha­la­mic amen­or­rhoea’’. The treat­ment rec­om­mended for this con­di­tion was ‘‘ ovu­la­tion in­duc­tion’’ — an ar­ti­fi­cial means of in­duc­ing a nat­u­ral ovu­la­tion cy­cle. This path of­fered a sim­i­lar chance of con­ceiv­ing as a healthy, fer­tile cou­ple but, at my age, that was still only 7 per cent per month.

When, af­ter two years, it be­came clear that this treat­ment wasn’t work­ing, my ad­vanc­ing age gave us no choice but to try IVF. This more ag­gres­sive form of treat­ment would dou­ble the prob­a­bil­ity of a ‘‘ take-home baby’’, to around 10 per cent per cy­cle.

We were hop­ing for bet­ter odds but, like nat­u­ral con­cep­tion, IVF preg­nancy rates are af­fected by age. The older a wo­man be­comes, the fewer eggs she has, and the fewer which ma­ture each cy­cle. The eggs are also lower in qual­ity and there­fore less likely to pro­duce a nor­mal, healthy child.

Un­for­tu­nately, IVF can­not com­pen­sate for this nat­u­ral de­cline in fer­til­ity (un­less a do­nated egg is used). Given th­ese sober­ing facts, I was re­luc­tant to make the con­sid­er­able phys­i­cal, emo­tional and fi­nan­cial in­vest­ment that would be re­quired. How­ever, in or­der to sat­isfy our­selves that we had ex­plored ev­ery av­enue, we pro­ceeded with treat­ment soon af­ter my 42nd birth­day.

Much to our dis­ap­point­ment, only two eggs were col­lected in the first cy­cle. We were there­fore sur­prised to learn that both eggs fer­tilised nor­mally and even more shocked to dis­cover, some 14 days later, that I was preg­nant. We were thrilled, but con­scious that at my age there was a 50 per cent risk of mis­car­riage, and a 1 in 39 chance that the baby would have a chro­mo­so­mal ab­nor­mal­ity.

At seven weeks we had our first ul­tra­sound to check the vi­a­bil­ity of the preg­nancy. We came away with more than we bar­gained for. I was car­ry­ing iden­ti­cal twins! We were in­formed that the risk of mis­car­riage was even higher with twins but, with the ba­bies’ heart beats re­ported as good, we were still con­fi­dent.

By the time I pre­sented for the 12-week ul­tra­sound that screens for ge­netic ab­nor­mal­i­ties, the risk of mis­car­riage was down to 2 per cent. Imag­ine my hor­ror then, when the ul­tra­sound re­vealed that the twins no longer had a heart­beat.

The med­i­cal staff couldn’t have been more un­der­stand­ing, but this did lit­tle to al­le­vi­ate my grief. It wasn’t un­til the mis­car­riage that I re­alised how much I had wanted a baby. To dis­cover, al­most too late, that I had been mis­taken in my be­lief that I didn’t want chil­dren only in­ten­si­fied my sense of loss.

More bad news was to come. Ge­netic anal­y­sis re­vealed the mis­car­riage was caused by Down syn­drome. One of my worst fears had been re­alised, and any re­main­ing il­lu­sions re­gard­ing my re­pro­duc­tive age had been well and truly dis­pelled.

With time now rapidly run­ning out, we re­vis­ited the fer­til­ity spe­cial­ist. He was less op­ti­mistic about our prospects, but in­di­cated that there was still a chance of suc­cess un­til I turned 43. Af­ter this, he said ‘‘ na­ture could do a bet­ter job’’ than he could. Based on this ad­vice we re­solved to squeeze in as many IVF cy­cles as pos­si­ble.

Af­ter wait­ing im­pa­tiently for my body to re­turn to its pre-preg­nancy state, we fi­nally com­menced our next IVF cy­cle two months later. Once again the treat­ment yielded just two eggs and two em­bryos, but this time we had no joy. Two fur­ther IVF cy­cles fol­lowed, with the Medi­care-man­dated month off in be­tween. The first failed. The sec­ond re­sulted in a preg­nancy, but my hor­mone lev­els soon fell and it was over al­most be­fore it be­gan.

De­spite min­i­mal hopes of suc­cess, we had one last at­tempt at IVF be­fore I reached my 43rd birth­day. To be fac­ing de­feat, af­ter so much hope and en­ergy had been ex­pended, was es­pe­cially dif­fi­cult for a cou­ple who, like many high achiev­ers, were ac­cus­tomed to achiev­ing their goals.

As it turned out, we un­ex­pect­edly beat the odds on our fi­nal IVF cy­cle and are now the proud par­ents of a healthy baby girl. While enor­mously grate­ful for our good for­tune, we are acutely aware that 90 per cent of cou­ples in our po­si­tion would not have been so lucky.

If noth­ing else, the ex­pe­ri­ence has taught us that there are lim­its be­yond which mod­ern medicine can­not (yet) push the hu­man re­pro­duc­tive sys­tem. It also served as a timely re­minder that while it is cer­tainly pos­si­ble to de­liver a healthy baby at 40, 42 or even 44, it is not likely — even for fer­tile cou­ples.

So, to those of child­bear­ing age, give your­self the time and op­por­tu­nity to se­ri­ously con­sider whether you want chil­dren. Un­der­stand­ing why you hold this view may avoid re­grets. Con­sult­ing a coun­sel­lor can help achieve clar­ity.

For those who ar­rive at a firm com­mit­ment to have chil­dren, take stock of your pri­or­i­ties and, if nec­es­sary, ad­just your life so that you can act be­fore the win­dow of op­por­tu­nity closes. It may be smaller than you think. Anne Fox — not her real name— is a 43-yearold Syd­ney pro­fes­sional. Her healthy baby daugh­ter was born last month.

Long­ing: Cou­ples wait­ing too long some­times find IVF isn’t sim­ple

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