YOUR HEALTH:There is no perfect time to have a baby, so take the advice of the experts and don't delay, writes RONAN McGREEVY
IT HAS been known for a long time that women who leave it late to have children run the risk of increased infertility, but rarely have the dangers been put in such stark terms as it was recently by the Royal College of Obstetricians and Gynaecologists (RCOG) in the UK.
The RCOG commissioned a study group to examine the impact of later motherhood, a phenomenon that is present in nearly every western country including Ireland where the average age of first-time mothers is now 31 and 33 for women who are married.
The college’s conclusion that it would be better for women to have children between the ages of 20 and 35 was not new.
However, it says in emphatic terms that women are still not sufficiently aware of the dangers of leaving it into their late 30s and 40s to have children, although the issues seem to have been well documented in the mass media.
“There is an urgent need for better public information on the issues surrounding later maternity. Women should be supported, rather than constrained, in their life choices,” the RCOG says.
“However, both women and society need to be aware of the possible problems that older mothers may encounter. There may also be factors facing the child which need to be addressed,” it concludes.
The RCOG identified two separate problems. Three-quarters of women who try to become pregnant will do so at the age of 30. That figure falls to two-thirds by the age of 35 and continues to decline until the menopause.
The chances of conception through IVF is one in three under the age of 35, but by the time a woman reaches the age of 42, it has declined to one in 20.
The RCOG also warns that, for older mothers who do become pregnant, the chances of complications and interventions dramatically increase – a trend borne out by studies carried out here.
Researchers at the National Maternity Hospital in Holles Street and the Rotunda Hospital in Dublin found that twice as many older mothers were admitted to the special care baby unit.
Dr Melanie Davies, a spokeswoman for the RCOG, says the warnings were well known, but not sufficiently well heeded, and a lot of women believe that infertility will not happen to them.
“My experience is that even women who are very well educated and leading fulfilled lives with good jobs do not know about the biology of conception.
“I often have people coming in to say, ‘I have left it too late, I wish I’d known’,” she says.
Dr Cathy Allen, a consultant gynaecologist at the Merrion Fertility Clinic and at the National Maternity Hospital in Holles Street, says a recent study of 17,500 women across the developed world, including Ireland, showed that many women did not have a basic knowledge of fertility.
“There is no general public awareness. To me, it is confined to women’s magazines and daytime television,” she says.
“Those of us who work in fertility are surprised by the lack of information. As a nation I don’t feel we prioritise fertility, perhaps, because in the past we didn’t need to.”
Dr Allen says there are many reasons for delayed parenthood, and the biggest impediment is finding the right partner.
“My advice to couples is that once the relationship is stable and the possibility of having children becomes a reality, do not delay.
“I would say to people there is no perfect time to have children, but the longer you leave it, the more difficult it becomes,” she says.
Prof Bill Ledger, a professor of Obstetrics and Gynaecology at Sheffield University and a member of the influential Human Fertilisation and Embryology Authority (HFEA) in the UK, goes further than the RCOG warning.
He recommends that childless women, aged 30, should go firstly for a blood test and if that shows abnormalities, an ultrasound test.
The total cost of both would be significantly less than fertility treatment later in life, he believes.
Dr David Walsh, from the Sims Clinic, one of the Republic’s biggest fertility clinics, says there is merit in Prof Ledger’s comments, and a test for the Anti-Mullerian Hormone (AMH), an indicator of fertility, taken at the age of 30 could be a relatively reliable indicator for the future.
Dr Walsh says the experience of American colleges which ran fertility campaigns and were widely derided for hectoring women, shows that the issue is as much a political one as a health one.
“As health professionals, you want to be part of the solution and not part of the problem,” he says.
“It is not fair to hit people over the head about the issue, but a test might turn the dynamic in a positive way. Screening would be useful and would indicate problems early when there is time to deal with them.”
Dr Shirley McQuade, the medical director of the Well Woman Centre in Dublin, says the concept of a fertility test does not necessarily work.
“There is more to fertility assessment than the result of a single blood test,” she says.
“Usually couples are not referred for fertility assessment until they have been trying unsuccessfully to become pregnant for at least one year.
“It is not unheard of for couples to conceive, whose test results suggest that they are highly unlikely to get pregnant. Equally, couples who seem to have completely normal fertility tests may find themselves childless,” she says.
She believes late motherhood is not as a result of ignorance, but complex changes in today’s society.
“The delay in having children is due more to how society views women who take time out to have children and the childcare arrangements that are available in the early years.
“Many women wait until they are established in their careers – which gives a level of job security and flexibility – before deciding to have a family.”
Helen Browne, one of the founders of the National Infertility Support and Information Group (NISIG) which provides help for infertile couples, says women are unfairly blamed for the delays and are often made to carry the guilt of leaving it too late.
“We find in many cases that the woman is ready to have children, but their partner is not,” she says.
“A lot of men say they are not ready. It is not just women who need to be educated about delayed parenthood.”
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