Infertility is a global issue with one in five couples worldwide struggling to conceive. In Ireland that figure is thought to be one in four. When infertility occurs it can be a very painful experience for women or couples that really want a child.
Globally, couples are waiting longer to start a family, which has meant a steady rise in infertility rates. According to experts, every year, the number of people accessing assisted reproductive treatments increases by 5- 10 per cent. In addition to heterosexual couples, there are same-sex couples and single women who need fertility services to create their families.
In 30 per cent of couples the cause is attributed to male factor infertility, 30 per cent are female factors, 30 per cent will have a combination of male and female factors and in 10 per cent of cases no cause will be found, which is called unexplained infertility.
Dr Bart Kuczera, of Beacon Care Fertility, says roughly 2 per cent of women in the 20-44 age bracket will be infertile if they never use contraception, or have never delivered a baby. Of those who have had one child and wish to have another, the figure for secondary infertility will be about 10 per cent for the same age group.
The scale of the problem is significant, Dr John Waterstone, of Waterstone Clinic in Cork, says. In the Western world, women are steadily waiting later in life to become mothers. According to Eurostat figures, 52 per cent of first-time mothers in Ireland are between 30 and 39. “Alongside Italians, Irish women are the oldest mothers in Europe,” he says.
Complicated
“This trend looks set to continue, and we know that age will limit women’s ability to conceive. The rates may be complicated further by a drop in male fertility as studies are showing that sperm counts are falling in men in Western countries,” he adds.
The older a woman is, the more her egg quantity decreases, while the chance of miscarriage unfortunately increases, group head of nursing at Sims IVF and Rotunda Deirdre Gorman says.
“Those suffering from PCOS (polycystic ovarian syndrome) and endometriosis can also play a huge part in female infertility. Male factor infertility is also a major factor. Lifestyle choices such as smoking and drinking can affect sperm quality too.”
For those that are experiencing problems conceiving, the rule of thumb is: under the age of 35 and trying to conceive for a year or more, get tested. Those over 35 and trying for six months with no luck should see a doctor. The good news is there are now lots of options available to help women get pregnant.
In heterosexual relationships there is timed sexual intercourse and artificial insemination that can be beneficial for younger women.
“We have IVF or ICSI, which is a more sophisticated version of IVF. One single sperm is selected to fertilise the egg. If egg or sperm quality is the issue then we have donor programmes available. PGS is another procedure, whereby after the embryos have been created they can be tested for any abnormalities. This is especially useful for those experiencing recurrent miscarriage,” Gorman says.
“If you are a single woman, we have a robust sperm donor programme, artificial insemination or IVF would be options too. Same-sex female couples will need sperm donors but we also have a fantastic programme called ‘Shared Motherhood’ Reciprocal Donation,” she adds.
This is where the eggs of one partner are used in an IVF cycle to create embryos that are then transferred into the other partner, with the effect that one partner is the birth mother and the other partner is the genetic mother.
Meanwhile, periodic sexual and fertility health checks for both men and women will let them know where they stand in terms of fertility and can help them plan for the future.
“During a fertility check , we use blood tests to explore various hormone levels, one of which is the anti-mullerian hormone (AMH) level. Along with your menstrual history and a transvaginal ultrasound, we count the number of antral follicles in the ovaries and explore the general health of your uterus and pelvis. These explorations help us to build a picture of your overall fertility health and give an insight into your ovarian reserve. At the end of the check, you’ll know if you have more or fewer eggs than average for someone of your age, and have our recommendations. You can then use the results to inform your decision making,” Dr Waterstone says.
After a fertility test, women might consider preserving their fertility through egg freezing, or pursuing fertility treatment with a partner or donor. IVF remains the most common treatment plan for women who cannot conceive, with 80 per cent in Sims IVF and Rotunda undergoing the treatment.
Treatment
However, simple procedures are tried first – the philosophy at Waterstone Clinic is to minimise intervention while maximising patients’ chances of creating a family. They often use ovulation induction (OII) treatment or intrauterine insemination (IUI) treatment first.
So what happens during IVF? “A woman produces many immature eggs each month. One or two mature eggs become dominant and the rest are then discarded. In fertility treatment, we use drugs to stimulate those immature eggs and help them mature. The woman will have to undergo a series of injections and undergo ultrasound scans to see how the eggs are developing. This usually takes 10-14 days. After this, she will undergo an egg collection. Her eggs will then be fertilised in the lab by her partner’s or donor’s sperm. The embryos are then usually grown out to five days. Either they will be frozen or transferred after those five days,” Gorman says.
There is also the option of freezing embryos when exploring IVF. This means it is possible to have one round of IVF treatment and create an entire family from that one cycle over the course of a few years.
Sims IVF and Rotunda's most recent clinical pregnancy rates sees 48.7 per cent under 35, 49.8 per cent between 35 and 37, 41.8 per cent between 38 and 39 and 30.6 per cent for women 40 getting pregnant and a foetal heartbeat is found at a scan between 8-12 weeks gestation.
At Waterstone Clinic, for women aged between 38 and 39 they have a live birth rate of 30 per cent (meaning a baby born full term) while women aged between 40 and 42 can expect a live birth rate of 22 per cent.
While each cycle of IVF is expensive, ranging anywhere from €4,500 to €8,500 with an average cost of about €6,000 – there is also a physical and psychological cost too.
“Physically it is well managed, but psychologically the toll is much higher. For patients who have had two failed cycles, this can be similar to a loss in your family. This is a degree of stress that often involves counselling and it’s one of the reasons why they have a link with professional counsellors if they are struggling and this is a part of the patient’s management,” Dr Kuczera says.
“Fertility doesn’t last forever, and at some point infertility is natural – every couple will be infertile eventually, so the sooner you start diagnostics the better the outcome,” he adds.