Ivf Australia Fertility Forum – Lynam, Queensland

Brian Pridmore Perinatal Forum 2015 Professor K Tremellen

So tonight I've been asked to speak on thetopic of the older the better and, of course, as a fertility specialist, I'll be talkingmore from the fertility perspective. I'll just acknowledge that I'm representing bothRepromed and Flinders Fertility and the Flinders University tonight. Now, I'm going to dividemy talk into two parts. The first five or so slides I'm going to give a bit of backgroundon why fertility diminishes as you get older and then I'm going to address the issuesthat Maria faces. So, look, this trend of having children laterand later in life has really been existing for a number of years now. Ever since theearly 70s throughout the Western world, there's

been an advance in the average age of women.When I was a baby, the average age of a mother was 23 and it's now approaching 31 years.And interestingly, within the professional class, so the women who have tertiary education,one in four women will still not have had a child by the time they're 45 years ofage. Now, half of that is because they elect not to have children. Not everyone wants achild. But in the other half, it is an involuntary choice. Now, why are couples or women delayinghaving kids later and later in life? I think this is probably pretty obvious. There'san element of a career. I mean, certainly having children can stymie the career a littlebit and women are wanting to advance their

career, which is entirely natural. There'san element of, you know, having a double income, no kids, high disposal income. That's fun.You get to travel a lot and children certainly can be timeconsuming – I know that, havingfour of them. I have a lot of women say to me “Oh look, I can't get my husband ormy partner to commit.� Commitment phobia seems to be quite prevalent amongst the malepopulation. And then finally we have Lisa Curry and others who, you know, front pageof the New Idea, “My IVF Baby a 51�. It gives this perception – there's a perceptionout there of you can leave it until very late and if it doesn't happen naturally, wellyou've always got that parachute called

IVF. And I guess that's true if you'rewilling to go to donated eggs. But it isn't true that you're going to have success at51 using your own eggs. And that's where the majority of these stories… they don'tpoint out that it's donor egg. So when does fertility decline naturally? It's actuallyquite a difficult question to answer from a scientific perspective because there arelots of variables here. I mean there's obviously the male factor, whether she's got opentubes, ovulates and also simple things like coital frequency. You know, the older a womangets, the longer the relationship, the reduction in coital frequency. So this particular studyfrom the New England Journal looked at getting

rid of those confounding factors. It was astudy from France where they looked at donor insemination. So all the men had no sperm,the husbands had no sperm. They used top quality donor sperm and all these women were knownto have open tubes and to ovulate. And you can see that fertility is pretty good up until30, but from then on, it starts to decline. So the evidence suggests that fertility ispretty good up until 30 and then it starts to spiral downwards. Another way of lookingat this natural fertility is a population called the Hutterites. These are a religioussect that lives in northwestern United States in Canada and they're interesting becausethey get married very early, they never use

contraception and they live in a communalsetting where everyone's cared for equally. So there's no financial disincentive tohave kids. So they're a good natural model of fertility. And the average Hutterite womanhas ten kids. Sounds like fun. And the incidence of infertility is very low – 1.8%. You know,in our community it's 15%. So very few women can't have kids in this population. Andyou'll see from the graph on the right that looking at this, the fertility starts to dropeven from the mid20s. So, you know, we're not meant to be reproducing in our 40s. That'snot the natural process. What's also interesting is that average age of a Hutterite woman,who has been previously fertile, to have her

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