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‘Biology doesn’t wait’: Australians overestimate IVF success


Anastasia Tsirtsakis


15/10/2020 3:55:20 PM

Research shows GPs are well-placed to offer preconception advice to people of reproductive age.

Doctor having a discussion with a young couple.
Most people aren’t aware that a woman’s fertility starts to decline from around age 30.

One in six Australian couples of reproductive age will experience difficulties conceiving a child.
 
Australian netballer Liz Ellis is among them.
 
At 38, she struggled with secondary infertility, round after round of IVF and miscarriages for five years, before conceiving her son at 43.
 
‘I really beat myself up for not trying sooner,’ she said. ‘I just didn’t understand the ramifications of putting it off.
 
‘I just assumed we’d try for six to 12 months and if it didn’t work we’d go to IVF, spend the money, and have a child. It’s not until you do a few IVF cycles and it fails that you think “Wow, there is no guarantee”.’
 
Age is the biggest factor affecting fertility.
 
Women younger than 30 have about a 20% chance of getting pregnant each month, dropping to about 5% at age 40. While for children conceived to men in their mid-40s, there is an increased risk of miscarriage and some conditions such as autism.
 
But like Liz, many underestimate when fertility starts to decline.
 
A yet-to-published survey of more than 700 Australians of reproductive age, conducted for Your Fertility, found more than half (58%) believed a woman’s fertility starts to decline from age 35 or older – only 31% knew the decline starts around age 30. Just 14% understood that male fertility declines from about the age of 45.
 
Most respondents also overestimated IVF success rates, estimating more than 20% for a woman in her 40s.
 
Dr Karin Hammarberg is a Senior Research Fellow at Monash University and Senior Research Officer at the Victorian Assisted Reproductive Treatment Authority (VARTA).
 
Having worked in IVF for 20 years, she told newsGP the lack of fertility education is ‘striking’.
 
‘IVF cannot work miracles. The chance of having a baby after one IVF attempt is about 30% for women aged under 35, but it’s only about 10% for women aged 40–44,’ Dr Hammarberg said.
 
‘For women over 45 there’s almost zero chance.’
 
The theme of this year’s Fertility Week (12–18 October) is ‘Age and Fertility – Know the facts’.
 
Dr Hammarberg says the concept of reproductive life planning is important.
 
‘It might sound a bit weird, but if you think of everything you want to do in life, when you ask young people if they want to have children nearly everyone says yes and nearly everyone says they want to have at least two or three,’ she said.
 
‘If you think that your fertility is completely intact until you’re 35 or 40 and you start trying then, you might actually have that first child, but you might miss out on having the second or the third that you thought you might have.
 
‘Age is cruel in that way. So it’s really getting people to be a bit more realistic about what the limitations are in terms of both female and male fertility.’

Karin-Hammarberg-article.jpgDr Karin Hammarberg says the lack of fertility education is ‘striking’.
 
Optimal parental preconception health has been found to benefit reproductive outcomes, yet research shows preconception health promotion is not routinely offered in primary healthcare settings.
 
And when it is, women are often the focus.
 
A survey of 304 GPs in Australia found while two-thirds agreed that it was their role to discuss male fertility, nearly 80% practiced this only occasionally. Most GPs (90%) said they did not feel confident in their knowledge about modifiable factors that affect male fertility.
 
Dr Hammarberg says the Fertility Week campaign aims to bring men along for the conversation.
 
‘Men often say that they’re not ready. But from our point of view, biology doesn’t wait,’ she said.
 
‘It’s important to know what’s actually possible biologically. So if you’re ready or not, you kind of have to get going at some point if having children is really important to you.’
 
Despite the perceived sensitivities around the topic, a population survey of Australian women and men found three in four (74%) would not mind if their GP asked them about their pregnancy intentions.
 
‘GPs often think that “It’s not a question I can bring up. They can bring it up with me, I don’t need to proactively ask”. When in fact, the way it has to be is that GPs ask it as a routine part of a consultation, whether it’s about reproductive health or not,’ she said.
 
Dr Hammarberg acknowledges that GPs are often pressed for time, but says it’s about starting the conversation. 
 
‘GPs are really run off their feet … you have 15 minutes to solve their health problem and then you’re supposed to talk to them about this as well,’ she said.
 
‘But the key is to use simple conversation starters to ascertain intention. It’s not that you need to talk about all this in depth at that conversation, it’s just making sure that you cover it.
 
‘That is the opportunity to say “If you really don’t want children, make sure that you use reliable contraception” or “If you plan to have children, come back and see me before you start trying and we can go through it with your partner – both people should come back – and be aware that there are things you can do to improve [your chances]”.
 
‘This would also then tie in with “If you really want to have children, what age do you think you might be wanting to try?” Weave in this idea that fertility really does have its limitations and it’s not going to be there forever. By 35 you might be starting to struggle.
 
‘Make people think about it and give them the information they need to make good decisions.
 
‘When the intention is there, this is such an important moment where we can do things to make sure that the baby is healthy.
 
‘I can assure you, people are very motivated. If they want to have children they want to do the best they can.’
 
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