Below is my feature on fertility from Saturday’s Irish Times. Contrast it with Mary Kenny’s article in the Irish Independent on the same day.
One in six couples are now seeking medical help to achieve their dream of a baby. The visibility of older celebrity mums could be lulling women into a false sense of security, writes Feebee
Holly Hunter did it at 47, Geena Davis did it at 48, Marcia Cross has just done it at 44. So what’s wrong with waiting until your forties to have your first child? I’ve lost count of the number of times I’ve heard someone in their thirties say that they want kids but just not now, that they’re planning on trying at some stage in the future, and look at Madonna/Brooke Shields/Miriam O’Callaghan, didn’t they have children at forty-something? Are these celebrity success stories part of a wider demographic, or are they simply lulling women into a false sense of security? Despite the visibility of older celebrity mums, age remains the biggest factor in fertility problems, according to Dr Tony Walsh of the Sims Fertility Clinic in Dublin. A woman’s fertility starts to decline in her late twenties and goes downhill rapidly after the age of 35. After 40, the success rates are very low – 50 to 60 per cent of women trying for the first time will never have a baby with their own eggs. The hard truth is that it doesn’t matter how much you take care of yourself or how good you look for your age, your eggs have an expiry date.
And yet, the average age at which women in Ireland had their first child rose to 28.7 in 2006, according to the Central Statistics Office – that’s up by almost four years in the past 30 years. Likewise, the number of couples seeking fertility treatment continues to rise, with that figure now standing at one in six. So why is our sociological view of reproduction so at odds with the biological reality?
Dr Walsh suggests that the reasons are twofold. Firstly, our increased life expectancy has changed where we see ourselves in the ageing process, but the evolution of our reproductive tracts has not kept pace. He explains that the conflict between the genetic process within us and the healthcare advances that are helping us to live longer has not yet emerged into our psyche.
Secondly, the increase in women in the workplace, without the development of structures to support childrearing, has forced women into a situation where they will voluntarily defer pregnancy during their most fertile years.
It is not enough, however, to point the finger at women who have “waited”. What did they wait for? The right man? Financial security? A roof over their heads? Helen Quinn of the Irish Infertility Support Forums points out that nowadays many women do not meet their partners until they are in their thirties. With the added pressure of getting on the property ladder, simply telling women that they should be having babies in their twenties is not an adequate solution. Helen feels that fertility education should take place in schools, so that women are armed with as much information as they need, once they are in a position to use it.
Educating the young is key. As debate rages around fertility and the older woman, it is easy to ignore the fact that infertility is a medical condition that can affect anyone at any age. The under 35s make up 20-25 per cent of Dr Walsh’s patients. And what about the men in the equation? Male factor infertility accounts for at least 40 per cent of all cases, yet we rarely hear about it. As Dr Walsh puts it, “Infertility is not a woman’s problem, it’s a couple’s problem.”
Many couples choose to keep their infertility secret for various reasons – the unwillingness of others to talk about it, the lack of understanding of the subject, or simply because they don’t want to court pity. So it is easy to see why those in the public eye may be less than eager to speak out. However, those that have chosen to go public have received tremendous support and understanding from the media.
David Arquette and Courtney Cox-Arquette reportedly suffered from recurrent miscarriage and needed several IVF (in vitro fertilisation) cycles to conceive their daughter, Coco. By most accounts, Brooke Shields did seven IVFs before having her first daughter. Desperate Housewife Marcia Cross has also made no secret to the media of the fact that she needed IVF to conceive her newborn twin girls, and has also spoken positively about the use of donor eggs.
So are these happy endings indicative of how far fertility medicine has come? Marcia Cross is quick to point out in interviews that she is one of the lucky ones, and that IVF does not work for everyone. Statistics from the Sims Clinic in Dublin show the real picture. For women under 35, success rates are good at 55 per cent; at 35-39 this drops to 34 per cent. By 43, only 9 per cent of IVF cycles are successful.
At the thin end of the wedge are those celebrities who are prepared to share their stories of IVF failure. Emma Thompson has spoken openly to the media about her failure to provide a sibling for her daughter, despite repeated IVF attempts, and Claire Grogan of pop band Altered Images reportedly endured 12 agonising years of infertility before adopting her daughter.
However, there is one way to beat the statistics and that is by using donated eggs. Success rates for IVF with donor eggs stand at 70 per cent across all ages. That is because the chance of success depends on the age of the donor and not the recipient. In fact, there is no real reason why a woman in her forties wouldn’t conceive with the help of donor eggs.
Ciara (not her real name) and her husband battled for a baby for six years before they received the devastating news that they would need donor eggs if they were to keep trying. An ectopic pregnancy, two failed IUIs (intrauterine inseminations), and three failed IVFs had left them with no other option. However, with the help of counselling, they realised that this was a positive way by which they could make their family.
Ciara met her donor at a barbecue. After a few glasses of wine, she found herself chatting about her situation; before the weekend was out, someone had offered to donate. Her son was born last year. “He is all I ever wanted and all I ever dreamed of. I can give him my heart and soul, I just wasn’t able to give him the genetics,” she says.
Ciara feels that there is a huge need for people to talk more openly about infertility, not only to raise awareness of what couples go through, but also to allow those couples to seek support from those around them. She credits the support of her own family and friends for helping her survive the past seven years.
“I felt really special because this was an extraordinary pregnancy as far as I was concerned, and the more people that understood that, the better I felt about it. I loved the fact that people knew I had worked really hard at this, that I had battled against all of the odds and I had won. I felt like a champion.
“We have decided to keep the subject of egg donation private for our son’s sake. It’s not a secret, it’s just that I am guardian of the information until he is old enough to make up his own mind as to who he tells.”
HELEN AND ANTHONY QUINN
Helen Quinn started her journey when she got married at 28. Little did she know then that over the next 10 years she would be diagnosed with PCOS (polycystic ovarian syndrome), she would discover her husband Anthony had sperm problems, and between them they would undergo one failed fertility treatment after another.
When the couple’s first IVF cycle failed, they were devastated. Friends kept telling them that they could just try again. Helen says, “I couldn’t understand why they were saying that, and it was only when they saw the documentary that they realised what ‘trying again’ meant.”
Helen and Anthony participated in RTÉ’s Making Babies documentary in 2004; it was their third IVF, again unsuccessful. Following the programme’s broadcast, they received unprecedented support, and not just from friends and family. Helen says: “You could be out shopping and someone would come up to you and say, thank you for doing that, for showing people what it’s really like”. It was important that the programme showed the reality of unsuccessful treatment, adds Anthony. “You don’t tend to hear about failed IVFs, so people just assume you will be successful.”
In 2005 the couple underwent their fourth and final IVF. Their daughter Rowena was born last year.
After Rowena’s birth, Helen set up the Irish Infertility Support Forums, the first Irish website exclusively devoted to infertility. It’s a support network for those who wish to discuss their problems with others in the same boat. “You can be anyone you want to be, you can say as much or as little as you want,” says Helen, who feels it is a release for many of the members. “People who don’t understand infertility can say very cruel things and you want to lash out, but you just take it on the chin, even though it really hurts. The beauty of the website is that you can come along and vent your spleen.”
Would such a site work for men? Anthony feels it would certainly help men if they discussed infertility. “I’m sure there are men out there who feel they don’t have anyone who would listen without making fun of them.” However, he points out that as women endure most of the medical procedures, regardless of the cause of infertility, they are the ones more likely to talk about it. “If men were going through it, I’m sure they’d be telling the world,” he concedes. “Everyone would know all about it, how painful it was and how long it took!”
JOANNA DONNELLY AND HARM LUIJKX
Joanna Donnelly conceived her daughter at the age of 32 “without a thought”. When she decided to try again, she had no reason to believe it would be any different. Two and a half years, and several fertility treatments and early losses later, she is pregnant again by IVF.
Joanna and her husband, Harm Luijkx, suffer from secondary infertility, the inability to conceive despite having conceived a child naturally in the past. Furthermore, their secondary infertility is “unexplained”, the medical profession’s way of saying that they just haven’t worked it out yet.
Having had no success with fertility drugs or with IUI, the couple reluctantly moved on to IVF. “IVF is not getting your teeth polished,” says Joanna. “It was absolutely terrifying – the injections, the waiting, the anguish. I had to have 256 injections, 500 pills, 100 pessaries, not to mention the scans and procedures, and paid €5,000 for the pleasure. I did yoga, aromatherapy, reflexology, acupuncture and I took six weeks off work. Why should I have to go through all of that for something that other people get by having sex?”
How has infertility affected Joanna’s life? “It has made me so sad. I have a beautiful new house, a gorgeous husband that I love to bits and a fabulous daughter that I worship, and yet I have been utterly miserable for two and a half years.” Why? “It’s because 75 per cent of your brain is working at trying to get pregnant and the other 25 per cent is thinking about it. When you want a baby, there is nothing else.”
Irish Infertility Support Forums is at www.irishinfertilitysupportforums.ie
And Mary Kenny’s article from the Irish Independent, also on Saturday 11 August:
There are some things you can’t change and some you shouldn’t. A failure to conceive may be one of them
IVF has been hyped up out of all proportion. It is being promoted by a competitive strain of medics who see both pioneering possibilities and ‘loadsamoney’ growth from the frantic desires of women who have, in most cases, left it too late to beget children in the manner that nature intended. If you want to educate people about fertility, teach them basic facts: nature wants women to reproduce young. The best age at which to have a baby is 23. But the IVF establishment doesn’t teach that. Quite the contrary. They are talking about extending, indefinitely, the time in which assisted conception may occur — 40, 50, 60 years of age. Borrowed eggs, fabricated sperm, and now, the latest horror — spare-part babies. That is, babies conceived so as to provide bone, marrow or tissue for other babies.
Infertility has always been a source of sorrow — it’s in the Bible, it’s in folk tales and sagas — so biologists want to fix it. Sometimes they are able to. Then the issue gets into the hands of the consumerists, on one side, and the “equality” merchants, on the other. Howls go up throughout the land if IVF isn’t “equally” available to all — young, old, straight, gay, sick, well, poor, prosperous, married, single, separated, divorced, whatever. But why should it be “equally” available to all? Is it in the best interests of the possible child? Is it advisable that so many children are now being conceived through IVF? Questions remain about the long-term health of babies born through such assisted reproduction.
Parenthood is wonderful, but it is a gift, not a right. Not everyone is destined to be a parent and people can live happy and fulfilled lives without bowing before what is now a fertility cult of primitive dimensions. “We must have adoption for all!” “We must have IVF for all!” “We must go to any lengths to ensure that anyone who chooses to have a child, has the right to one!”
In my view, no we mustn’t. And we certainly mustn’t allow assisted-fertility fanatics to frogmarch civilisation towards the horrors of mixing and matching eggs, embryos, sperm (combining animal and human sperm is the latest wheeze) and all the rest of the ghastly experiments they have in mind.
The Elders should teach the wisdom — which exists in all the great traditions — of acceptance. There are some things you cannot change, and there are some things you should not change. A failure to conceive may be one of them.
Thankfully, in Ireland, enough young people are becoming parents in the way that nature intended. We should celebrate the population increase that has just occurred, without recourse to laboratory invasiveness.