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A recruitment drive aimed at gay men has contributed to a significant reduction in the waiting times for Australian women seeking a sperm donor in their bid to have a baby, according to a leading IVF specialist. But women who delay reproduction are more likely than ever to encounter difficulties, experts say. IVF Australia spokesman Professor Michael Chapman said Australian women were waiting up to 18 months for donor sperm about a year ago
The waiting time was now about eight weeks, thanks largely to imrproved supply from overseas clinics and to a local donor drive that targeted gay men. Professor Chapman said improved adherence by US sperm banks to Australia’s strict legal requirements had helped to slash times. Donors must give consent so any child resulting from the donation can make contact once they turn 18. Similarly, a recent advertising campaign by IVF Australia in the gay media had resulted in an increase in inquiries and, subsequently, much-needed donors, he said. However, the demand in Australia for donors has steadily risen as women who put off having children suddenly find themselves emotionally or financially ready, yet unable to fall pregnant as easily as hoped - if at all.
Perils of putting it off
According to a recent study of 1010 women aged 18-44 years, more of them know someone in their circle trying to fall pregnant — and failing — than don’t. More surprisingly, these women of childbearing age remained ambivalent about - or oblivious to - their own decreasing chances of conceiving, the survey by pregnancy test maker Clearblue found. Figures from the Australian Bureau of Statistics confirm that women are delaying pregnancy, with the average age at which women fall pregnant for the first time rising from 27.5 years in 1990 to 28.9 years in 2010. Since 2005, more women aged 35-39 years have given birth than have women aged 20-24 years, the ABS figures show. IVF experts concur that both the number and the average age of women seeking help from fertility clinics has increased. Dr David Molloy of the Queensland Fertility Group said while the age of women seeking help getting pregnant at his Brisbane clinic had steadily risen, success rates had struggled to keep pace. "There’s a misconception that infertility clinics can cure you getting older. We can’t," he said. "Pregnancy rates drop quite dramatically once you hit 39-40, and start to reduce from 35. Certainly we can help patients get pregnant in those age groups, but the success rates are lower and there’s no major cure."
Research published over the weekend suggests that babies conceived using commonly available fertility treatments are almost 50 per cent more likely to have a birth defect than those conceived naturally. In the most comprehensive study of its kind in the world, researchers from the University of Adelaide's Robinson Institute compared the risk of major birth defects for each of the reproductive therapies commonly available internationally, including IVF, intracytoplasmic sperm injection (ICSI) and ovulation induction. "The unadjusted risk of any birth defect in pregnancies involving assisted conception was 8.3 per cent, compared with 5.8 per cent for pregnancies not involving assisted conception," said Associate Professor Michael Davies, the lead author of the study published on Saturday in the New England Journal of Medicine. The risk of birth defects for IVF was 7.2 per cent, while the rate for ICSI - a procedure used to overcome male infertility in which a sperm is injected into an egg - was even higher at 9.9 per cent (139 defects).
No substitute for good planning
Dr Molloy said Queensland had led the country in pioneering such recent technology such as oocyte (egg) freezing and AMH (Anti-Mullerian Hormone) testing - "a measure of how many eggs you have left" - but they were no substitute for good planning and prioritisation. "It doesn’t get around the problem of reproductive ageing completely," he said. "What you don’t want to be is 39 with 39-year-old DNA in your eggs and not many eggs left. "And you don’t want to be 31 and thinking you can delay getting pregnant. At 31 you have lovely DNA but if your egg stocks are very poor it’s still going to be harder to get pregnant and you mightn’t be able to fit your two children in. "The DNA ageing that goes on between 35 and 45 still happens, but if you’ve got fewer eggs then you’ve got a double whammy and your back to the wall." Professor Chapman said the average age of the patients seeking help at his New South Wales fertility clinic was "now 37 years of age, so half of them are over 37". He said while the news that more than half of women trying to have a baby were now aged over 30 was alarming enough from a scientific perspective, "more importantly, the percentage of women over 35 trying to have babies has climbed quite dramatically". "More women are putting off faster than science is able to reverse it. The sad part is that we don’t know how to reverse the inexorable decline in egg quality over time. That’s the conundrum," he said. "The truth is, even with multiple attempts, with all the technology that we have, less than 50 per cent of women over 40 will end up having a baby."
It takes time
Professor Chapman said a large number of women failed to realise that falling pregnant often took time, the very thing hindering the chances of a woman over the age of 37 conceiving. "What we haven’t been able to get through to people is that getting pregnant doesn’t happen the day you want to be pregnant," he said. "The human body at its peak in the mid-20s produces a pregnancy rate of only around 15 to 20 per cent a month. To actually have a good chance of getting pregnant, you have to keep going for a number of months - 12 months - before you maximize your chance of falling pregnant naturally. "In women who are older, that natural cycle rate drops. At 35, it’s probably more like 10-12 per cent and by 40, that rate per cycle of falling naturally is probably around 5 per cent. "Cumulatively, a rate of 5 per cent over 12 months gives you a better than 50-50 chance of getting pregnant at 40, but if you’re the 50 per cent that hasn’t gotten pregnant, another year has gone by - another year of decline in the quality of your eggs and the number of eggs has occurred."
Why women struggle with fertility
Professor Chapman said the most common reason he saw for women not getting pregnant after 38 was the quality of their eggs. As a result, he said, more people were using fertility treatment. Despite the repeated warnings from experts, the Clearblue survey found that only 4 per cent of women currently in their best childbearing years saw having a baby as a top priority in their lives. Job security and income was the main concern of 48 per cent of those surveyed, with only 5 per cent admitting to significant stress at the thought of not being able to conceive. Yet nearly half of Australian women have experienced difficulty in falling pregnant — and there are more than twice as many women (450,000) trying to conceive as are pregnant (190,000), according to the study. And seven out of 10 women admit to wanting to have children in their life — when the time is right. Ninety per cent of women could see the benefits in having kids early, however the sentiment was outweighed by the reasons for delaying motherhood.
Of those surveyed:
•74 per cent felt the need to be financially secure;
•50 per cent wanted to be in a loving relationship; and
•51 per cent wanted time to travel and fulfil life experiences free of children.
White-collar women's expectations
Professor Chapman said that an overwhelming majority of women who sought help at his clinic were "white-collar professionals" whose driven nature and high expectations of themselves extended in the realm of reproduction. "When they get to us, they are the desperate ones, and therefore emotion gets in the way of reality. I can tell a woman that she’s got a less-than 1 per cent chance of success with IVF and she says 'I still want to go through with it'," Prof Chapman said. "They don’t want to be in a situation in 10 years' time looking back and saying 'I never tried'. They wouldn’t get to the point of coming to a clinic and then being confronted with some pretty harsh facts and [not] keep on going." He added: "Their expectation will be that they will have a baby." Dr Molloy said that apart from the career women and couples who put off child-bearing, he increasingly treated women who had simply failed to secure a commitment from partners in time. "You see an awful lot of women who invest 10 years in a live-in relationship and they say in their mid-30s 'we need to get moving' and the guy is out the door. All of a sudden they’re trapped," he said. "It takes a while to re-establish a baby-making relationship. That’s a big commitment. The interview process for that could be a couple of years. So these women do get time trapped in these relationships. In a way there’s a shame that there isn’t a higher level of commitment - marriage, home and a commitment to children. "I bet you know people like that."
Sperm donor option
Dr Molloy said sperm donation was one option for women in this situation and in the face of shortages in recent years, Queensland clinics had actively targeted the gay community as a source of sperm donation for several years. "We've had the gay population coming from NSW and particularly Victoria, where the laws are draconian - you have to have a police check before you can go to an IVF clinic and donate sperm," he said. "We were the second unit in the country to import US sperm - started doing it 7 years ago." Queensland Fertility Group had also led the country in "reproductive insurance", namely egg-freezing, he said. "We've had more pregnancies from egg freezing than all the other IVF units in the country combined," he said.
Advertising representative Scott McKeown is among those gay men who would willingly donate sperm to a fertility clinic for use by women - "straight, lesbian or bisexual” – wanting to start a family. While Mr McKeown cannot himself donate for medical reasons, he said gay men were prime and willing candidates for sperm donation, as they were unlikely to be deterred by laws requiring a donor to agree to being contacted by the child once the child turns 18. “The difference between gay guys and straight men in wanting to be a sperm donor is, we are not going to create a complication for ourselves or a future partner and kids, more often than not," he said. “We’re not going to have to deal with a future wife or husband, and those kids, and then someone knocking on the door or making a phone call years later, because it’s less likely that we’re going to have that kind of lifestyle.” He added that for many gay men – just as it was with heterosexual brethren – “it would kind of be nice - as you get older to actually see someone, possibly see yourself in their face and actually say, well the surname may not pass on but maybe my genes will live on”. “It’s the basic human driver for both men and women - why we live, and how we came about anyway. What a nice thing to leave,” he said.
Article: 8th May 2012 www.brisbanetimes.com.au