What the fertility doctors wished you knew

No one expects to have fertility challenges when they think about falling pregnant, but for some women it’s a long and difficult process. Here’s what the fertility experts think you should know, according to Julia Boltt WE ALL ASSUME that childbearing is just something that’s going to happen naturally, but this isn’t always the case. “The most common fertility concerns are decreased egg quality in women between the ages of 37 to 45 years,” says Dr Paul le Roux, a specialist in reproductive medicine at the Cape Fertility Clinic. “There are also many couples with a male factor problem and sperm counts seem to be decreasing on a global level, possibly due to toxins in the environment. In younger women, the common problems are polycystic ovary syndrome (POS), fallopian tube blockages and endometriosis,” he says.

AGE DOES MATTER

“A female of the age of 20 has a 25 percent chance to conceive every month. A woman of the age of 40 and above has less than a five percent chance to conceive monthly. Not only does the chance of a pregnancy decrease, but also the risks of a miscarriage increase, due to an increased risk of chromosomal abnormalities in the foetus,” says specialist gynaecologist and fertility expert Dr Chris Venter of Vitalab. As you get older, there’s a decrease in both the quantity (ovarian reserve) and quality (age related) of your eggs. In his opinion, “Women get a false reassurance that they’ll be able to fall pregnant in their late 30s. To conceive naturally at 40 within a few months is the exception to the rule,” he says. “After age 37, one in three women will need fertility treatment,” cautions Dr le Roux. “Women should not delay childbearing until it’s too late. In addition, they need to ask their gynaecologist to refer them to a reputable fertility clinic early (or refer themselves) if they’re battling to conceive, to maximise their chances of conception,” he advises. “There are more women in developed countries that have children in their 30s compared to their 20s now. Although this is accepted in society now to allow women time to develop their careers and settle in with the right partner, it carries a harsh price of increased numbers of women having fertility problems. Unfortunately, there is a time limit on fertility, which doesn’t fit in with the changing social environment,” he says.

IVF ISN’T A MAGIC BULLET FOR INFERTILITY

“This is a misguided notion. IVF can certainly increase the fertility chances, but if the egg quality is poor, it won’t be successful and the couple will need to use an egg donor. Egg quality decreases with age, and in modern fertility clinics up to 30 percent of all patients need an egg donor to have a baby,” cautions Dr le Roux.

YOU CAN RUN OUT OF EGGS

“Ovarian reserve refers to the number and quality of the eggs in the ovary. Both decline with age. It’s not possible to reverse the worsening genetic abnormalities that occur in women’s eggs due to age, but it helps if there are higher egg numbers when starting fertility treatment,” explains Dr le Roux. “We measure the egg numbers by doing two important tests – a transvaginal scan to count the number of resting eggs in the ovary (antral follicles) – antral follicle count (AFC), and we measure a chemical in the blood which the eggs produce, called AMH,” he says. Dr Venter says the aim is to create awareness about ovarian reserve among patients to know their reproductive status, and not to create anxiety. A lot of patients have said, “If only we knew this earlier, we would have started our family earlier.” However, he reassures that 90 percent of tested patients will fall within the normal range.

DON’T WAIT TO SEEK HELP

“Women should go to a fertility clinic if there is no pregnancy after one year of unprotected intercourse; or, after six months if they’re older than 37 years, or the woman has irregular periods,” recommends Dr le Roux.

CONSIDER FREEZING YOUR EGGS

“The technology to freeze eggs has dramatically improved over the years. It’s now a very successful procedure, and it’s better to do it as young as possible to get the strongest eggs frozen. This will hopefully bring hope to many women who are ready to have children, and need a back-up plan,” says Dr le Roux. “Social fertility preservation by egg freezing is now a common request, because many people don’t have a partner ready to have a baby and need to store eggs before they get too old,” he adds. “It’s not about the age of a woman’s uterus, but all about the age and quality of her eggs,” says Dr Venter. YP