Sunday, June 2, 2013

“No time to wait” – The western fertility crisis

by Carla O’Hara

One in six couples in the west is said to have trouble conceiving. That’s a pretty staggering figure, considering that there’s probably someone you know who has received some form of fertility treatment. But what does this mean for the average Australian who many want to have children in the future? Nationalist Alternative explores the issues of the western fertility crisis.
 In January 2011, the Federal government introduced a tax payer funded 18 week paid maternity leave scheme in the hopes of boosting Australia’s birth rate. Currently, 280,000 babies are born in Australia each year, and each Australian woman on average is having 1.9 children.
Bernard Salt, a leading demographer noted in regards to the paid maternity leave scheme “As significant as this event will be, it will not in the same magnitude as a baby boom. At best it will be a baby blip“. And he is right. Australia’s birth rate is still below population replacement levels, and with the average cost of raising a child to 18 estimated at over $1 million, it’s not surprising that fewer westerners are choosing to have children, and those that are, are having them later in life. The average age for a woman to have her first child is 30, whilst for a man it is closer to 33.
Australia, like many western nations is heavily reliant on tertiary education for job security. Invariably, women will postpone their child-rearing years to pursue an education and career, and for the average educated woman, she will have one less child for each degree she holds. In the ten years from 1995 to 2005, the proportion of women who had their first baby at 35 years of age or older doubled to 10%. However, as the percentage of women postponing their first child increases, so too does the number of childless families.
The Australian Institute of Health and Welfare’s biennial welfare report released in 2009 notes that while couple families with dependent children had long been the most common family type “their proportion has gradually declined from 45% of all families in 1986 to 37% in 2006. Coinciding with this decline has been an increase in the proportion of couple-only families, increasing from 30% to 37%,” the AIHW report finds. “This increase is partly due to population ageing, with more empty-nesters (older couples whose children have grown up and left home), but also reflects younger couples delaying having children or not having children at all (Double Income no Kids)”. Whilst no statistics are available for the reasons behind these younger childless couples, some are simply the result of waiting too long, referred herein as ‘Socially-induced Infertility’.
Director of Monash IVF, Professor Gab Kovacs suggested that women should be settling for “Mr Not-Too-Bad”, rather than waiting for “Mr Right”. However, as with many other IVF specialists, Professor Kovacs fails to comment on the western societal norm where women attempt to establish careers prior to starting their families, often with dire consequences.
Fertility peaks between 18 and 25 years of age for women and naturally declines with age, with a sharp decrease after 35. Celebrities are partly to blame for giving a false impression of extended natural female fertility and the use of IVF as an insurance policy for the over 35. Dr Randy Morris, M.D an infertility specialist in Illinois, commented on this phenomenon “Marcia Cross [is] the most honest celebrity in Hollywood. She admits she used egg donation”. Dr Morris also encourages women to start their families at a younger age, as “The success rates for fertility treatments also decreases with age. This is true even with “high tech” treatments such as IVF.” Most notably, Nicole Kidman and Sarah Jessica Parker, both over 40 resorted to the use of surrogates after multiple failed IVF attempts.
The elephant in the room is that older women who use IVF to achieve a pregnancy often do so using donor eggs, and in extreme cases surrogates. However, some doctors believe that there are options for women in the west who do wish to delay having children.
Many fertility clinics are starting to spruik egg freezing to women in their 20s and 30s. A Queensland-based IVF specialist, Dr Ashley Stevenson believes it is time for GPs to start talking to young women about fertility and informing them of egg freezing when they do not have the right social circumstances for it to happen naturally. ”For young women, I think it’s a perfectly valid and sensible thing to do,” he said. However, the director of Monash IVF, Professor Gab Kovacs, said women should not be conned into thinking it offered a ”guaranteed family in the fridge”.
Egg freezing for social reasons is not covered by Medicare, and costs between $10,000 and $14,000 per cycle. The egg retrieval procedure carries about a one-in-1000 risk of significant complications, such as bleeding or infection, and depending on the woman, one cycle will retrieve about 10 eggs each time. With a success rate of 27% per embryo transfer for a woman over 35, and even poorer success rates with egg freezing, it is not surprising that egg freezing for social reasons is limited to the uber-wealthy.
A less invasive, and cost effective method is the use of fertility testing which can be determined using a simple blood test at specific times during the menstrual cycle by your family GP. The blood test is used to measure FSH (Follicle Stimulating Hormone), LH (Luteinizing Hormone) Progesterone, Prolactin and Androgen levels. However, these tests need to be performed yearly, as the results are not static, and should continue until a couple is ready to begin their family, as fertility declines with age and exponentially declines after 35.
These fertility tests should become as common as a yearly pap smear for women over 25, as prime fertility continues to decline in the west due to an over exposure of chemicals.
Endocrine Disrupting Chemicals (EDC) are prolific in the west (ranging from herbicides, pesticides and polycyclic aromatic hydrocarbons/ petrochemicals), with acute exposure to these chemicals linked to a rise in the incidence of Premature Ovarian Failure (POF). Whilst little is openly published about the links of EDCs and POF, there has been significant research into the effects of EDC exposure, which includes transgenerational epigenetic damage of the eggs (oocytes) contained within the ovaries. Transgenerational effects can be put into a simple explanation as follows; A woman is born with all the eggs she will need for her lifetime. The eggs therefore, contained within a woman were created whilst she was still within her mother’s womb, subject to her mother’s genetics and her mother’s environmental conditions. Her mother’s eggs (which would eventually become the woman herself) were also created whilst in the womb of the grandmother, subject to the environmental conditions of the grandmother. Thus, the quality of the woman’s eggs will predate her own creation, but will date back to the environmental and genetic conditions her grandmother experienced.
Currently, it is estimated that Premature Ovarian Failure affects 1-4% of the population, and it is expected that this figure will rise with the increase in transgenerational epigenetic effects of Endocrine Disrupting Chemicals. In girls and young women with POF, something has happened to the supply of eggs in the ovaries at a young age. It could be a loss of eggs, a dysfunction of the eggs or the removal of the ovaries at a young age, but unlike menopause, this is not a natural occurrence, although it is still considered as a premature menopause.
Premature Ovarian Failure usually occurs in women under the age of 40 and can happen as early as the teen years. Premature ovarian failure is also called primary ovarian insufficiency (POI), premature menopause, and hypergonadotropic amenorrhea. Whatever it’s called, the consequences of Premature Ovarian Failure can be devastating to a young couple trying to conceive, and what is more alarming, is that POF can display minimal symptoms, whereby an individual may not even know that they have the disease.
When it comes to reminding women of child rearing age in the West that there literally is “No Time To Wait, that there really is no better time than the present to conceive, it can be a difficult topic for a woman to hear. However, arming ourselves with relevant information about fertility and fertility testing can help defend against the unfortunate results of Socially-induced infertility.
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