Mother of all dilemmas

WOMEN can have it all.

Or so we’ve been told. We’ve encouraged our daughters to pursue a career, and to enjoy life before they marry or have children.

They’ve listened. In 2010, the last year for which figures are available, the average age of first-time mothers was 29.4. At an overall average of 31.7, Irish mothers are the oldest in the EU.

With an increasing number of women using fertility treatment, should society change its message? Should we be talking to our 20something daughters about the risk of leaving pregnancy too late?

Dr David Walsh, who founded the SIMS fertility clinic, says that we should. He says women often have a disordered view of their fertility.

“We’ve had a couple of women in their 20s who were thinking of donating their eggs to other women. And when we check their ovarian reserve, we find they have hardly enough eggs for themselves. We’ve said, ‘you’ll have to think about your own fertility’,” he says.

Dr Walsh says that women should be offered the AMH egg count, and preferably before they are 30.

“Then, they’ll know if they have more eggs than normal, or less,” he says. Dr Walsh says the test should be offered routinely, and for free.

“I would love to see this happen,” he says. “Women are bound to be influenced by that. And that doesn’t mean they will rush off and freeze their eggs, or grab the first man they see and have a baby. But I can’t believe it wouldn’t make them more likely to consider starting a family earlier.”

The six current patients at SIMS who filled in a questionnaire wished they had been offered the AMH test in their 20s.

All of them would have taken it. Some had approached their GPs asking to be tested, but had been fobbed off. One woman, who at 36 has discovered she is infertile due to diminished ovarian reserve, had asked to be tested when she was 32.

“I went to my GP, telling him I planned to put off starting a family until I was 35,” she says. “I asked for the test, and the doctor laughed at me and told me to go home and relax. I was brushed off and made to feel like a silly little girl. I wish now that I had insisted.”

Dr Walsh says parents should discuss fertility with their offspring. He says he will discuss with his twin daughters, now 21, when they are in their mid-20s. The Cork-based homeopath Sarah Leather, though, wonders whether women that age will listen.

“I think women are aware that their fertility decreases at 35,” she says. “But they tell themselves they can have it all. Women coming to me in their late 30s and 40s say that things just kept happening. Or they hadn’t met their partner. But, in hindsight, they do have regrets.

“One lady put off starting trying from 35 to 37, because she was going to be a bridesmaid for her sister. She regretted it at 41, when she was still trying to have a baby after several miscarriages.”

For all that, Sarah doesn’t like to panic women.

“Plenty of women in their late 30s become pregnant quickly. But it can be more challenging, and it probably is a good idea to broach fertility with younger women. But you have to be careful not to come across as preaching,” she says.

Claire Hennessy, writer, and director of www.bigsmokewritingfactory.com, is 26. She has discussed fertility with her mother, but it was to say that she doesn’t want children.

“I’ve known it since I was 15,” Claire says. “I’ve always seen having children as an option and not a default. I think a lot of women assume they will have children and think there’s something wrong with you if you don’t want them.

“I like children. I do a lot of teaching with them, and it’s the classroom setting I’m most comfortable with. But when you become a mother you have to put someone’s needs ahead of your own. I don’t think I’m capable of doing that without feeling great resentment. I don’t think I’d find it fulfilling.

“I have to establish a potential boyfriend’s policy on having children before I start something up. It doesn’t put them off. But I was discussing the issue with a male friend recently, and he asked if people treated me as if I won’t be fulfilling my potential as a women. No one says that. But they never believe me,” she says.

“It’s tempting to be certain that I will never, ever want a child. But there is, I suppose, a possibility I could change my mind. Nobody knows what will happen in life.”

Sinead, (name changed) knew that her mother had difficulty conceiving. She’d had miscarriages and a stillborn child. Sinead, while still aged in her 20s, discussed her own potential problems with her GP. But he said that could be investigated when she wanted a family.

Sinead was in her late 20s when she met her husband. They started trying for a baby when she was 31. Seven years later, they are still trying. “I had four miscarriages in the first three years, and since then I’ve been unable to get pregnant,” says Sinead.

She’s attended the Rotunda, where she was seen by the infertility clinic and the recurrent miscarriage clinic, and she tried hormone medication at a clinic in the west. She recently had her first, failed, try at IVF.

The couple have tried adoption. They’ve applied for fostering. But they were unable to proceed, because they didn’t want to give up on the struggle to have their own children.

And they won’t give up now.

“When you want children, you will do anything. You’d stand on your head in a bucket of water and try and breathe through your toes,” she says.

Gráinne dislikes the perception that women deliberately wait to have children. “It wasn’t that I left it too late,” she says. “I didn’t meet the person I wanted to have children with until I was 38.”

It wasn’t her age that sent the couple for IVF treatments, either. Her partner, who’d been married, had a vasectomy.

“I was brought up a practising Catholic. I believed you couldn’t have children outside marriage. I met a guy at 21. We were together for seven years. We were engaged, but I knew I didn’t want his children,” she says.

Gráinne’s 30s were hectic with activity. She was busy working, and buying a house. So it wasn’t until she met her partner that the time for children felt right.

The couple have been through three IVF cycles at a cost of €7,500 a cycle. She’s had treatment for an overactive thyroid. Gráinne’s partner has had his vasectomy reversed. Gráinne is now in her 40s.

“But I have an absolute belief that I will have children,” Gráinne says. “My grandmother had her one, and only, child at 44. I have a lot of friends whose mothers had them in their late 40s. It will happen.”