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BRITISH BROADCASTING CORPORATION
RADIO SCIENCE UNIT
CHECK UP
Programme 3. - Fertility
RADIO 4
THURSDAY 07/12/06 1500-1530
PRESENTER:
BARBARA MYERS
CONTRIBUTORS:
GILLIAN LOCKWOOD
PRODUCER:
DEBORAH COHEN
NOT CHECKED AS BROADCAST
MYERS
Hello. There are a number of medical conditions that can compromise your fertility, whether you're a man or a woman. But if you're trying for a baby with no luck so far could it simply be that you've left it a bit late? The number and the quality of a woman's eggs declines rapidly in her 30s, just at the time that she may be feeling ready to start a family and the emotional roller coaster ride that follows has been well documented in the current 大象传媒 television series - A Child Against All Odds. But why does female fertility drop off so dramatically when women are feeling they're in their prime? Is it the same for all women and is there anything that you can do to improve your chances of getting pregnant? If it doesn't happen naturally when do you think about going for treatment? And if you do at what age do you stop - 45, 55? Or like the world's oldest mother at the age of 66 when finally after nine years of IVF treatment she gave birth to a daughter?
Well call us to put your questions to our fertility expert Dr Gillian Lockwood. She's from the Midland Fertility Clinic, where she treats NHS as well as private patients. The number to ring is 08700 100 444 or the e-mail checkup@bbc.co.uk.
Our first caller is on the line from Somerset, she's Dara. Your question for our fertility expert today Dara.
DARA
Yes hello. I'm 38 and I've been trying to get pregnant for just over a year now. I'm aware that it can take a lot longer to conceive at my age, so what I'm wondering really is how long should I wait before going to see my doctor?
MYERS
What an excellent question to start our programme - 38 now, been trying, should you keep on trying, should you start to get some advice.
DARA
Exactly, I'm concerned that if I leave it too long to explore other avenues, for example IVF, which I understand is a two year waiting list and is not available on the NHS to women over 40, it could turn out that myself and my husband are sub-fertile and I've left it too late.
MYERS
Indeed. Well let's see what Gillian has to say.
LOCKWOOD
Good afternoon Dara. Yes it is a very difficult dilemma - wanting to know whether to go straight for treatment or just give mother nature a little bit longer. On average it takes about twice as long to get pregnant over the age of 35 as under 35, so you're quite right - you can expect it to take longer. About 90% of all normally fertile couples will have achieved a pregnancy within a year of trying, so if you've been trying for at least a year now it probably is time to at least have some basic investigations done.
MYERS
Does that mean a trip to the GP or somewhere specialised?
LOCKWOOD
A trip to the GP, in the first instance. The important things to check are that since it takes two to tango that there are some sperm, also that you're ovulating regularly and also that you haven't got any - some of the usual sorts of conditions that can cause problems with fertility like endometriosis or polycystic ovaries. The GP can do all of those tests for you. If they come back clear then you'll probably be advised to just be patient and try a little longer. But if it does throw up any problems you'd be well advised to seek specialist help because 38 seems to be a sort of a watershed year when not only natural fertility starts to decline quite rapidly but also the chance of success even with sophisticated treatments like IVF also starts to decline and of course the miscarriage rate starts to climb as well.
MYERS
So you've given a really important pointer there - at 38, it's like a magic number, is it quite as simple as that?
LOCKWOOD
It does seem to be a true biological watershed, although some women are chronologically 38 but their ovaries still think they're only 35. And unfortunately there are some women who are only 38 who are already getting perilously close to the menopause and it's very important for women to be aware of their own fertility age, as well as their own age.
MYERS
And the fact that we all think we're younger and fitter than we ever were and age just doesn't touch us, that's not true when it comes to the biological clock?
LOCKWOOD
I'm afraid that's right, today's women in their late 30s and early 40s look so young and feel so young that they just can't imagine that their reproductive potential isn't just as good as it was in their 20s. And of course for many women who spend their 20s trying to avoid getting pregnant at all costs it can seem terribly unfair that now they've got into their mid or late 30s and the time is absolutely right to have a baby that mother nature just won't cooperate. But unfortunately only about half of all women in their late 30s who want to get pregnant will actually succeed.
MYERS
Dara, thank you very much for that question and thanks for the answer Gillian. We'll go to a caller in Chatham now - Mrs Barrett is waiting to talk to us. Mrs Barrett are you there?
BARRETT
Yes.
MYERS
And what's your question please?
BARRETT
It isn't a question, it's just to say that nature isn't always against the older mother. My daughter is 44 on Saturday, she has a daughter of 23, a son of 19 and another daughter who's 14 on Sunday. And she has just given birth, three weeks ago, to a lovely baby son. He was a shock but a very pleasant shock.
MYERS
Well congratulations to her on that. So giving birth at 44. So that does seem to sort of change a little bit what you've been saying Gillian.
LOCKWOOD
Well I think it just goes to show that there's enormous variability in human beings and many congratulations Mrs Barrett on becoming a grandmother again. Yes, women do give birth successfully in their 40s, the oldest lady that I ever delivered giving birth to a child created with her own eggs was in fact 50 and this was a son, after she'd had 11 daughters. So I told the husband it was time they really could stop now. But ...
MYERS
But that really was exceptional wasn't it, which is why you mention it obviously.
LOCKWOOD
Yes, but the problem with getting pregnant at 40 is not just it's harder to get pregnant at 44, it's very difficult to stay pregnant at 44 - the miscarriage rate in the 40s is very nearly 50% and at 45 and older it's as high as 75% and this can be doubly heartbreaking for women who've succeeded against the odds in achieving a positive pregnancy test only to go on and lose the pregnancy because it wasn't quite right.
MYERS
And can I just add in an e-mail from Suzanne who was herself shocked to find herself pregnant at the age of 48. She's already the mother of five, the oldest 28, so it was a shock. However, she eventually miscarried at nine weeks. But what she wanted to say is that she feels her experience does offer some hope to those who are still trying. So what's she's saying is you can be lucky to get pregnant but I guess, to echo your thought Gillian, that you can also be unlucky in terms of your risks of losing the baby.
LOCKWOOD
Yes I'm afraid that's right and that is true whether it's a natural conception or achieved with fertility treatment like IVF. The other thing that seems to influence a woman's change of getting successfully pregnant is whether she's been able to do it before. So a woman who's had a string of successful pregnancies may well go on and have late successful pregnancies. Someone who's found it very difficult to get pregnant at all unfortunately is at a higher risk of miscarriage.
MYERS
I guess we should say that the miscarriage rate must be a reflection of the fact that this pregnancy is not viable and actually the embryo may not be 100% fit, so it's natures way, isn't it, of dealing with perhaps older less quality eggs.
LOCKWOOD
Yes it seems terribly unfair that whereas men can go on making new sperm every morning into their 70s, a little girl is born with every egg she's ever going to have. And so by the time she's 40 those eggs are 40 years old and probably the majority of them have been damaged in some way. So the embryos that they create and the pregnancies that they start may well have chromosomal abnormalities. Mother nature seems to do a particularly ruthless bit of quality control round about the six or seven week into pregnancy and if it's not perfect the pregnancy will stop developing and miscarriage will follow.
MYERS
The advantage though if it's IVF treatment is you are able to sort out the good from the bad eggs I guess.
LOCKWOOD
Not with standard IVF. There is a highly specialist technique called pre-implantation genetic diagnosis which does allow us to check the chromosome structure of the embryo before transferring and this can be very useful if a couple are at risk of passing on something like the cystic fibrosis gene and are very keen to avoid having a pregnancy that's affected like that. But in the vast majority of cases of IVF all we can do is look at the embryos and pick out the ones that look best and transfer those and then really leave it to nature to decide whether or not the pregnancy continues or not.
MYERS
So there are really no guarantees on any level when you go for IVF?
LOCKWOOD
I'm afraid that's right. And again the best guide to the chance of success with IVF is going to be the age of the woman because the younger she is, the younger her eggs will be and the more likely they are to turn into a healthy pregnancy.
MYERS
Well we got a long way from Mrs Barrett's question but thanks for that and telling us about your daughter. But let's go to Ruth - Ruth Kirby - who's thinking about having another child, what are your circumstances Ruth?
KIRBY
Hi. I'm turning 42 on Monday. I had my first child at 35 and she was conceived very easily, sort of on the first attempt. I have got a slightly unusual situation. The first thing is I've had a Merina coil for two years, I don't know if that'll influence it, but also I now only have one ovary - I had one ovary removed because I had an ovarian cyst. And I was just wondering if that would - what would my chances be.
MYERS
And you'd like to have a go would you - is that the point yes?
KIRBY
Yes I'm considering having a second one now, yes.
MYERS
What are the chances, that's the question for Gillian Lockwood our fertility expert here on Check Up today?
LOCKWOOD
Well obviously the coil's going to have to come out. It can sometimes take a little while for your normal ovulatory pattern to settle down when you've had a coil like the Merina that's impregnated with hormones but hopefully your cycles will start up again quite promptly. Even though you've only got one ovary that's not such a problem because instead of the ovaries taking it in turns to ovulate, which is what normally happens, if you've only got one ovary then that ovary will ovulate every month, so you still get as many chances. The problem of course at 42 is that the eggs that you're ovulating are almost 43 years old and probably about half of them will have some minor genetic fault, which could interfere with a healthy pregnancy developing. So it's going to take longer to get pregnant than the first time you tried, and the risk of miscarriage unfortunately is quite high at about 40% but very best of luck to you.
KIRBY
Thank you.
MYERS
It is past the age which if you were listening earlier the 38, which I've now firmly got in my mind as a sort of magic number. And although obviously Ruth has been successful with an earlier pregnancy, the fact that was before she was 38, she's now 42, can it make that big a difference, you know you might very easily get pregnant at 38 if all goes well, although you would get pregnant more quickly if you were 35, as you said earlier, but at 42?
LOCKWOOD
Yes, this is something that we see - that for fortunately a lot of women they are able to conceive in their mid to late 30s without too much difficulty or delay and that tends to make them think well that was easy and these fertility doctors don't really know that much and then they decide three or four, or as in this case, seven years later that it's time for baby number two and they can be really quite distressed by the fact that it doesn't happen as quickly as it did the first time around. And then of course time starts to tick on and they get into a terrible dilemma about whether just giving it a little more time to try naturally or whether they really ought to go for high tech fertility treatment before the chance of even that working starts to disappear. And many women who have had one successful pregnancy actually report that the pain and distress of not being able to get pregnant a second time is even worse than what they felt when they couldn't get pregnant the first time - the so-called secondary infertility is something that we're seeing a lot of now and an awful lot of families end up having just one child, where ideally they would have liked to have had two.
MYERS
And of course perhaps for onlookers, when they see parents with one child, they feel well at least they have their child and perhaps they've been unlucky themselves and have no children. But you're suggesting that you certainly see women where having a second child is as important to them as having that first child.
LOCKWOOD
Yes we certainly have many couples who say if only I could have just one healthy baby I'd think that we'd been doubly blessed and I'd never want for anything else again. And then they've hardly finished breast feeding and they're back for baby number two. Partly because they've experienced the joy of new parenthood and also quite reasonably they think it would be very nice for their child to have a little brother or sister.
MYERS
Let me throw in an e-mail which I've just seen which - Melanie, is asking I think a really tough question here. She said: What do you think of a 53 year old trying to have a baby? Perhaps she's got in mind the woman from Romania, that I mentioned earlier, the 66 year old who was successful in having a daughter. She says that she has tried three IVF and embryo transfers, she's wondering if she should try one more time. She's obviously spent a lot of money, a lot of time, invested a great deal of emotion in this, this is a tough one though isn't it.
LOCKWOOD
Yes, the only way to get pregnant at 53 is obviously using donor eggs and since it's the age of the egg donor that determines the health of the pregnancy there is no risk or certainly no increased risk of miscarriage associated with being pregnant at 53. In a big series of egg donation pregnancies of women in their 50s and even 60s the most important factor was the health of the woman at the point that she achieved the pregnancy. So if you're fit and healthy at 53 you have a pretty good chance of having a perfectly healthy normal pregnancy. Obviously if somebody has got high blood pressure or kidney problems with diabetes then they certainly shouldn't be considering embarking on pregnancy, especially using donor eggs. But today's women at 53 have a much longer life expectancy than the previous generations did, even 10 years younger, and it does seem to look a little bit ageist and sexist to think that it's perfectly fine for a chap to father a pregnancy at 53 but there's somehow something dreadful about a woman who's been desperate to be a mother, maybe for several decades, wanting to become a mum at 53, particularly since she's probably got another 30 years of healthy life ahead of her. Don't forget women's life expectancy is longer than men's.
MYERS
And in this case of course it's about having a donated egg clearly and it's about the age of the egg, so that's what's different isn't it.
LOCKWOOD
Oh yes, yes, we would expect a perfectly healthy pregnancy using donated eggs, however old the woman was.
MYERS
Let's go to another caller. Catherine, I think, is waiting to speak to us, Catherine.
CATHERINE
Oh hello. I've got a question that my grandmother stopped her periods when she was 40 and I'm just wondering, because I'm quite similar to her, would that mean my fertility declines earlier than perhaps another person's would?
MYERS
And did you say how old you are now?
CATHERINE
I'm 30.
MYERS
You're 30, right yes.
LOCKWOOD
Yes, reproductive potential runs very strongly through the female line, so if you come from a long line of women who've had babies in their 40s without even trying you'll be able to do the same, if you've got a strong family history of relatively early menopause you may well be heading in the same direction. The average age of menopause for healthy women in the UK is 51 but before that there's a decade we call the perimenopausal transition, which is the time when it becomes increasingly difficult to get pregnant. Now if you were destined genetically to have your menopause at 41 then your perimenopausal decade is going to start in your very early 30s and if having a baby is a very important part of your life plan or maybe having a second child is then you really shouldn't consider waiting. There are some tests available that would give you a better idea if you were likely to follow in your grandmother's and mother's footsteps and have a relatively early menopause and you may want to consider having some of those to help you make your decision about when to try for a baby.
MYERS
Thanks for that Catherine. We've had a question from Rebecca about testing kits. She's wondering about home testing kits. Are they worth buying? She's been trying for some time now and she's wondering whether she should go to her GP or what is the next step - would a home testing kit be helpful? And what are these kits and what would it prove?
LOCKWOOD
I'm not really in favour of home testing kits because there are so many other factors that can influence the chance of a woman conceiving. The home testing kits are measuring hormones and you can have the best hormones in the world but if you've got blocked or damaged fallopian tubes or your partner's not producing very good sperm then you're not going to achieve a pregnancy without help. Your GP can do a simple test called the FSH test, for follicle stimulating hormone test, which will immediately tell you whether you are entering the perimenopause or whether you're ovulating normally. And there are some more sophisticated hormone tests which may give an even better guide. But if you're worried about your fertility and particularly if you've been trying for more than about a year a trip to the GP, just to get those basic tests I talked about at the beginning done would be the best thing to do. Home testing can be very misleading, it can give false negatives and also you need - if the news is bad you really need the counselling and support and advice of a doctor or a specialist to help you cope with the news.
MYERS
We were talking a minute ago to Catherine about the menopause and how an early menopause may or may not affect her chances and how long the window remains open, as it were, we've had another e-mail - someone who doesn't want to be known by her name - but she's wondering about the onset of early menstruation. In her case she was 10 when she started her periods, does that affect fertility, should she get cracking because she's been, as it were, able to produce children for 20 years, she's now 30 years old?
LOCKWOOD
That's a very interesting question. The age at which girls are starting their periods is getting progressively younger and younger, it seems to be a reflection of the excellent nutrition. Only a few generations ago it was very rare for a girl to start her periods much before 16 or 17 and now it's quite common for girls to start their periods as young as 11 or 12. Girls who start their periods early tend to go on longer, so it's probably a reflection of having been born with a very good store of eggs and it's certainly not the case that more times you ovulate the earlier you're going to have your menopause, you don't use up the eggs in that way. Otherwise someone who was on the pill for all their life would never have a menopause and we know that isn't the case. Women who have very early periods, particularly if they're heavy and never go on the pill, are at increased risk of developing endometriosis, so that's something that you might want to consider.
MYERS
We'll go to Lisa next, she's in Bristol. Hello Lisa, your question please for our expert today.
LISA
Hello. This is a very simple question - my daughter-in-law is French, she's been trying to conceive for about three years now, she found out that her husband's got a rare disease and she just would like to know in France it seems that after 35 you can't get an IVF, it's far too difficult, and she's been trying to call several countries and she'd like to know what's the legal age limit to get an IVF in England or in Scotland.
LOCKWOOD
There isn't a legal age limit as such in the UK. For NHS funded treatment women are rarely offered it above the age of 40. For couples paying for private treatment then they can be considerably older than that but most clinics would say that once a woman was 43 or 44 then her only realistic chance of achieving a healthy pregnancy would lie with using donor eggs. I think in France that again in the private sector there isn't a strictly upper age limit, it may well be for state funded IVF that there is an age limit.
LISA
Well thank you very much.
MYERS
Thanks for your call, good luck with that and I think we may be on to our last caller from West Sussex, Louise is waiting to speak to us. Question please.
LOUISE
Well it's not really a question, I just wanted to make a point again about the sort of cut off age of 40 because I've been told I wouldn't get an offer of IVF, having reached the age of 43 this year. I mean - which is a shame because one feels that one would make a very good mother and there is no reason I've been told from the basic tests that - I'm still ovulating and you know I'm not menopausal that there's no reason why I can't sort of conceive really except that they don't - I've been told - because of two laparotomies I had because I suffer from endometriosis that they wouldn't want to do anymore sort of scope work with scopes and can't actually identify the reason why I can't - why the two aren't meeting.
MYERS
Let me get Gillian to pick up on that insofar as you can, it's obviously quite a complicated history, is there some general point that you perhaps could make?
LOCKWOOD
Yes I - hello Louise - I do sympathise very much with your plight, it does seem very arbitrary and unfair that the rules seem to be that whereas one could be a perfect parent up to the age of 39 and 11 months that something mysterious happens on the day of your 40th birthday that means you're no longer entitled to have a chance of motherhood. Endometriosis is a difficult gynaecological problem for fertility, about one in five women have endometriosis to some extent and it does significantly reduce the chance of getting pregnant naturally and obviously if it's been a severe form of endometriosis requiring the sort of surgery that you've had it does often mean that the tubes do get blocked or damaged and that's probably why you've not been able to conceive naturally. At 43 the chance even of IVF producing a healthy live birth is unfortunately very low, again because of the age of the eggs. And as we've said although a woman may well go on ovulating, may well go on having perfectly regular periods into her early 50s her chance of conceiving is very, very low.
MYERS
Can I just conclude really by getting you just to say very briefly - I think we've touched on a really interesting and important subject and I think perhaps we don't understand the whole story - but your advice to sort of women now in their 30s thinking about getting pregnant. Is it really get on with it - is that realistic to say?
LOCKWOOD
I think it probably is realistic to say. What I tend to believe is that if a woman knows that being a biological mum is a very important part of her life plan then even though it may seem tempting just to pay off a bit more of the mortgage or go one more rung up the career ladder it's going to be terribly difficult to regain that lost time. It's always possible to do the career step later but you can never regain lost time when it comes to starting a family.
MYERS
Wise words. And we'll leave it there, thank you very much indeed. Thanks to Gillian Lockwood and thank you to all of you for your questions and your comments. You can listen to the programme again on our website, you can get more information by going to our helpline 0800 044 044. And join me again if you will next Thursday at the same time for your questions on the not unrelated topic of the menopause.
Ends
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