(Please note: I use this image ironically.)
Yesterday, Professor William Ledger wrote an opinion peice in The Age on fertility and the problem of an aging population. Ledger is head of UNSW Medicine’s School of Women’s and Children’s Health and professor of obstetrics and gynaecology. You can read the opinion piece here:
I also attended Ledger’s lecture last night, entitled, “The Ticking Clock: Demographic Change and Future Families” presented with social researcher Mark McCrindle at UNSW. I appreciated how Ledger’s discussion of IVF in older women was preceded by McCrindle’s thoughtful analysis of demographics in Australia and how they have changed. There were moments, particularly at the end of Ledger’s question time, when he seemed to be suggesting that it was a simple thing for women to choose to have their families earlier, that they should be prioritising finding their partners and ‘settling down’ over career or other goals. I found this uncomfortable on a number of levels, not the least of which was the suggestion that women should settle with a partner they might not otherwise have wanted children with, just because they feel the pressure of their ‘ticking clock’. McCrindle’s demonstration was a welcome relief to this simplistic idea of young women’s lives. McCrindle argued that society is changing, and that the pressures of housing and income make the fairytale of ‘a house and kids’ less available to most young people.
Of course I am not ignoring the fact that while our generation can expect to have a longer lifespan than any before it, and therefore to spread out our life experiences, a woman’s window for fertility does not change. Certainly, I am taking what I consider Ledger’s most helpful piece of advice to dinner conversations with friends: if you are over 30, and not sure when you plan to have kids, get your AMH tested so that you have some idea of how many fertile years you have left. The AMH test is a simple blood test, and should cost less than $100. For giving yourself some indicator of when menopause will happen, this seems like a good investment. If you find out that you are one of the unlucky ones who will run out of eggs sooner rather than later, then you have the option to freeze some eggs, and keep them in the bank for later.
The thing that surprised me the most about sitting in this lecture was watching the audience’s reactions. I had not realised how few people understood that IVF does very little to fix the age of eggs. In fact, women in their 40s usually have the same chance of conceiving naturally as they do with IVF. So long as there are no ovulation or fertilisation issues, which there usually aren’t, IVF cannot yet do anything to solve the fundamental problem in getting pregnant at this age: that a woman’s eggs are not as chromosomally capable as they once were. This means that the egg is unable to develop an embryo, which needs all of the power of the egg to combine the DNA from egg and sperm into a new baby’s individual DNA.
Ledger mentioned some emerging research looking at how to help older eggs repair DNA more efficiently, which may reduce the aging process, but is still in the early stage of development and a long way from clinical applications. It was all too clear listening to Ledger that the research needs more funding also, and the research that is being done is primarily directed at this ‘older egg’ problem, rather than younger women’s fertility issues such as Polycystic Ovaries and Endometriosis. While I wholeheartedly agree with the fundamental premise that women and men need more education about fertility, I am also wary that pressuring young women to think about their fertility may cause unnecessary anxiety, particularly in women who are likely to have no problem conceiving once they decide that that is a life course they want to take. Ledger mentioned that, to date, the overwhelming majority of eggs frozen by young women have not been used, suggesting that these women did not need the procedure in the first place. One cannot help but be curious what advantage it is to the business model of IVF clinics to be able to extend their market into the entire demographic of women in their 20s and 30s, not just women who have been unsuccessfully trying to conceive. Perhaps I am synical, but how many more patients and cycles can be marketed and invoiced if this huge new population of women were enticed into the market?
Ledger’s one piece of advice that he would give to a woman in her 30s right now, if she wasn’t in a relationship, would be to freeze her eggs. While I think this suggestion is rather extreme, I would suggest that if you are in your 30s, and definitely know that you want a child, but don’t know how or when that will happen, at least get your AMH test done. It’s quick, it’s simple, and will more than likely let you know that you have another decade of reproductive years ahead of you. If that test tells you that you would be better off to freeze some eggs, then at least you have that option, and those frozen eggs will be ready for whenever you and your uterus are ready to use them.