The hard facts about older women and fertility — but are the Irish listening?

CHILD psychologist Patricia Rashbrook was 62 when she had a baby in 2006.

The hard facts about older women and fertility — but are the Irish listening?

Briton Susan Tollefsen became a first-time mum aged 57, after IVF, in 2008. The world’s oldest IVF mum gave birth in 2009, in India, aged 70.

Do breakthroughs in science mean we are too old to have a baby? “With assisted reproduction, there are no limits — you can get pregnant through egg donation [eggs donated by a younger woman] at any age, once the womb is there,” says Dr David Walsh, medical director at Sims IVF clinic.

Because you can do something doesn’t mean you should. “Our job in the clinic is to simulate what may happen in the natural world. There have been recorded pregnancies in the 50s, but they’re few and far between.” (From 2000 to 2010 inclusive, 33 live births in Ireland were to women aged 50 or older — ESRI).

The age trajectory of natural female fertility takes no prisoners. It’s over 10 years before menopause — and women are menopausal by age 51. If you start trying to get pregnant at 30, you’ve got a 90% chance of succeeding. If you wait until you’re 40, you’ve a 40% chance of not getting pregnant.

By 45, your chance of becoming pregnant naturally is 1.5%.

These are the hard facts of age-related, declining female fertility, but Irish women aren’t listening, say experts. “For most women, fertility’s coming to an end at 41 or 42. We all know women who conceive at 44 or 45, but they’re the exception. It’s massively difficult to get this message across in Ireland,” says Anita O’Neill, fertility midwife specialist and manager of the London-based Zita West Group, which runs monthly fertility clinics in Dublin and Cork.

Women in Ireland are “not realistic” about their chances, says consultant gynaecologist and medical director of Clane Fertility Clinic, Peter Brinsden. “In the UK, national figures come out every year — you can easily look up your chances of getting pregnant using assisted fertility. In Ireland, women tend not to be so well-informed.”

The latest report from the European Society of Human Reproduction and Embryology, published in 2012, shows that 1,768 IVF cycles were carried out in six Irish fertility clinics in 2007. More than 20% of the women were aged 40 or more. It’s estimated that 3,000 IVF cycles are carried out annually across the country’s seven fertility clinics and women are increasingly presenting in their 40s.

The existence of IVF can lull women into a false sense of security, says Mary Wingfield, gynaecologist in Holles Street Hospital and medical director of Merrion Fertility Clinic. But IVF can’t regenerate female fertility. “One-third of women under 35 will get pregnant with one IVF treatment. A woman aged 40-42 has a 15% chance with one treatment,” says Wingfield.

IVF can reverse the natural drop in fertility by about 50% but not by 100%, says Walsh. “At 40, and into the early 40s, the full deficit is probably only reduced by 30%.”

Media headlines about celebrity mums giving birth for the first time in their 40s send a flawed message — that as long as you look young, getting pregnant in your 40s can be as straightforward as conceiving in your 20s or 30s. “It’s a real bugbear of mine — women see celebrities having babies at 48 and think ‘that could be me, too’. Any woman can have a baby at that age if she’s using the eggs of a younger woman,” says Anita O’Neill, who says the Zita West Clinic has not had any 45-year-old woman become pregnant using IVF and her own eggs within a year of treatment.

Egg donation has revolutionised fertility for older women.

The process stimulates the donor with fertility drugs, retrieving her eggs, using IVF to fertilise them with the recipient’s partner’s sperm and transferring the embryos to the recipient’s womb. “Using donor eggs is the most likely, and most widely used, IVF technology to help older women get pregnant,” says senior clinical embryologist, Declan Keane. He runs ReproMed.ie, which works with selected health professionals, complementary therapists and licensed clinics, in Ireland and worldwide, in diagnosing and treating male and female sub-fertility.

“Egg donation is super-successful. There’s a 50% to 75% success rate when you use an egg from a younger woman,” says Keane, who says the cut-off age range in European clinics is 48 to 50. “They don’t routinely do older — only in exceptional circumstances will they go over 50.”

The majority of Irish clinics don’t process donor eggs here. Sourcing of donors, collection of eggs, and conduction of IVF are all done abroad — in the majority of cases, embryos are transferred to the recipient female abroad.

In Dublin, the Sims clinic will bring eggs back to Ireland — generally from the Ukraine — and complete the process here. “With egg donation, more than half of patients will achieve pregnancy, almost regardless of age. If the man and woman are over 45, their chances are blunted slightly,” says Walsh.

When women get pregnant over the age of 40, they have a one in three risk of miscarriage compared to one in four for younger women. At 40, risk of having a baby with Down’s Syndrome is one in 100; at 45, it’s one in 20 — it’s one in 1,000 for a 30-year-old. Using donor eggs from a younger woman can cut these risks, says Dr Mary McCaffrey, consultant obstetrician and gynaecologist at the Scotia Clinic, Tralee.

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