Women delaying first baby risk age-related infertility

Young women who decide to delay their first baby until their late-30s are running the risk of being left childless because of age-related infertility, scientists have warned.

A woman's fertility declines dramatically after the age of 35 and an increasing number of women are finding that they have to turn to IVF treatment to have any hope of becoming pregnant, experts said.

"Things are really going downhill between the ages of 30 and 40....the best cure of all is for women to have their babies before this clock strikes twelve," said Dr. Sarita Sukhija, a surrogacy and ivf specialist at Eterna IVF and Fertility Clinic.

"They should think of family planning not just in the context of preventing pregnancy but also think of it in the context of having your babies at a time when you still have your reproductive fitness...I would be worried if my own daughter didn't have a child at 35," Dr Sarita said.

The number of women between the ages of 35 and 39 giving birth for the first time has increased from 6.8 per cent in 1986 to 17 per cent in 2008. This has been accompanied by significant increase in the number of women over 40 seeking fertility treatment, many of whom will ultimately fail to become pregnant, the experts said.

Fertility specialists are increasingly concerned about the trend towards having children later in life because, although it can work for some women, it causes problems for many more because female fertility declines so rapidly after 35.

"Family planning has got to include when you are going to have your children as well and what we are seeing over the years is an increase in the age of women seeking fertility treatment," said Dr Sarita.

"We cannot get away from the age-related decline in fertility and I think to put forward the idea of delaying having children is fine for some people but it's not fine for everybody," she said.

"I don't think women understand the risks they run when they reach the older ages....It's better to think about it [in your 20s] and having that thought process inform all possibilities," she told the British Science Festival in Newcastle.

Women are born with a certain number of egg cells in their ovaries and these are gradually lost as they get older, Dr Sarita said.

"Women at the age of menopause have effectively run out of eggs. We do run out of time," she told the meeting.

Dream of motherhood finally real after surrogacy - Eterna IVF and Fertility Clinic

AFTER 17 years, 15 failed IVF attempts and the death of a premature baby, Merri Anderson refused to give up hope that one day she would become a mother.

That courage and unwavering faith will see Merri and partner Peter welcome not one but two little miracles into the world any day now - but not without a little bit of help.

Merri and Peter began their journey to parenthood many years ago and after trying for years to conceive naturally were forced to turn to IVF when they found out one of Merri's tubes was blocked.

That also proved to be a dead end street paved with heartache with four cancelled cycles and 10 unsuccessful cycles before the 11th go when they finally fell pregnant but lost their little girl after she was born premature and lived for just three hours.

"They said I could either adopt or try surrogacy, but the adoption agencies wouldn't approve us because of my lung problem and surrogacy was still illegal," Ms Anderson said.

Their options were dwindling but all that changed when they came for surrogacy in India in Eterna-IVF, the Rockhampton pair was given an email address for Indian woman Usha who had been considering becoming a surrogate for some time.

"We emailed back and forth for a few months getting to know each other," Usha said.

"It was the most nerve-racking day meeting each other after six months," Ms Anderson said.

Usha and her husband Raju have two children, Rani, 16, and Rahul, 13, and said nine months was a small price to pay to make dreams come true.

"Nine months of my life will give them a lifetime of happiness," Usha said.

When the four finally agreed to go ahead with the surrogacy, one attempt failed, the second resulted in a miscarriage and the third resulted in something none of them imagined in their wildest dreams - twins.

Usha is due to give birth to twins, a boy and girl, any day now and says the whole process has forged an incredible bond between the two families.

"They will know that I was the birth mother," she said.

"We'll be aunty and uncle to the twins and see them all the time and they will be like cousins to Rahul and Rani."

Mrs Anderson said she did not know what she would do without the incredible generosity of the whole Raju family.

"She's my life saver," Mrs Anderson said. "I don't know how I was ever going to get through life without kids.

"I've wanted them since I was little and I never ever gave up and I knew one day I would be a mum somehow."

One day is now just around the corner with the twins due on March 27 but doctors have said if they haven't arrived by March 11, they will induce labour.

"She's been so patient the past 17 years but this last two weeks has been crazy for her," Usha said of the mother-to-be.

"She's getting impatient."

Usha said her

family, especially husband Raju, had been incredibly supportive but both exten

ded families had been sceptical when they first told them about the surrogacy plans.

"Both our families were a bit strange at first but they have all gotten used to it," Ms Anderson said. "My family was terrified that she would keep them even though they're biologically ours.

"It's very scary. I had to put all my trust in her."

The surrogacy has cost approximate 9700 GBP but that's only a portion of what the pair have spent on IVF and related

expenses over the years.

Why Infertility Happens | Your Guide to Female Infertility

Infertility is the inability to get pregnant after a year of unprotected intercourse. 

About 10% of couples in only United States are affected by infertility. Both men and women can be infertile. According to the Centers for Disease Control, 1/3 of the time the diagnosis is due to female infertility, 1/3 of the time it is linked to male infertility, and the remaining cases of infertility are due to a combination of factors from both partners. For approximately 20% of couples, the cause cannot be determined.

How Does Age Affect Fertility?

Women are born with a finite number of eggs. Thus, as the reproductive years progress, the number and quality of the eggs diminish. The chances of having a baby decrease by 3% to 5% per year after the age of 30. This reduction in fertility is noted to a much greater extent after age 40.

What Causes Female Infertility?

Female infertility can be also be caused by a number of factors, including the following:

• Damage to the fallopian tubes (which carry the eggs from the ovaries to the uterus) can prevent contact between the egg and sperm. Pelvic infections, endometriosis, and pelvic surgeries may lead to scar formation and fallopian tube damage.
• Some women have problems with ovulation. Synchronized hormonal changes leading to the release of an egg from the ovary and the thickening of the endometrium (lining of the uterus) in preparation for the fertilized egg do not occur. These problems may be detected using basal body temperature charts, ovulation predictor kits, and blood tests to detect hormone levels.
• A small group of women may have a cervical condition in which the sperm cannot pass through the cervical canal. Whether due to abnormal mucus production or a prior cervical surgical procedure, this problem may be treated with intrauterine inseminations.
• Abnormal anatomy of the uterus; the presence of polyps and fibroids.
• The cause of infertility in approximately 20% of couples will not be determined using the currently available methods of investigation.

How Is the Cause of Infertility Determined?

If male infertility is suspected, a semen analysis is performed. This test will evaluate the number and health of his sperm. A blood test can also be performed to check his level of testosterone and other male hormones.

If female infertility is suspected, your doctor may order several tests, including:

• A blood test to check hormone levels
• An endometrial biopsy to check the lining of the uterus
• Two diagnostic tests that may be helpful in detecting scar tissue and tubal obstruction are hysterosalpingography and laparoscopy.
•  This procedure involves either ultrasound or X-rays taken of the reproductive organs. Either dye or saline and air are injected into the cervix and travel up through the fallopian tubes. This enables the ultrasound or X-ray to reveal if the fallopian tubes are open or blocked.
•  In this procedure, a laparoscope (a slender tube fitted with a fiberoptic camera) is inserted into the abdomen through a small incision near the belly button. The laparoscope enables the doctor to view the outside of the uterus, ovaries, and fallopian tubes to detect abnormal growths, as in endometriosis. The doctor can also check to see if the fallopian tubes are open at the same time.

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What to Expect During IVF | Eterna IVF & Fertility Clinic

1. The intake interview.

If initial fertility treatments such as fertility drugs or surgery fail and you decide to move forward with IVF, your ob/gyn will refer you to a reproductive endocrinologist. During your initial meeting with the doctor, you'll discuss your medical and fertility history, and that of your partner, to determine which treatment protocols will work best for you, as well as what you can do to improve the odds of a healthy birth.

2. Preliminary tests and talks.

You'll undergo ultrasound and blood tests to determine the number and quality of your eggs. You'll also meet with a nurse to learn how to self administer fertility drugs, a financial counselor to work out payment, and a psychologist to discuss coping with any stress that might arise.

3. Drugs to induce egg growth.

To stimulate your follicles to grow as many eggs as possible during your cycle, for about two weeks you'll give yourself one to three daily injections of fertility medications (such as GonalF, a folliclestimulating hormone, and Repronex, a luteinizing hormone) in your thigh or stomach. Either before your cycle or midway through, you'll also inject a gonadotropinreleasing hormone (GnRH) drug such as Lupron, which prevents you from ovulating too early. Around day 12, you'll inject the drug human chorionic gonadotropin (hCG) to stimulate ovulation and precisely time the final burst of egg growth. During these two weeks, you'll visit the clinic about five times for blood and ultrasound tests to monitor your progress.

4. Egg harvesting.

In a carefully targeted window of time — shortly before doctors calculate that your eggs will be released through the fallopian tubes during ovulation — you'll be heavily sedated and, using ultrasound as a guide, your doctor will pull eggs out of your ovaries with a hollow needle inserted through the wall of the vagina. In the meantime, your partner, in a nearby room, will ejaculate into a cup to obtain sperm, which the lab will then quickly process to extract the most robust ones. The sperm and eggs are then mixed together in an incubator so insemination can occur. If necessary — for instance, when sperm count is low or the sperm are having difficulty penetrating the egg — the lab embryologist might also perform intracytoplasmic sperm injection (ICSI), a procedure in which sperm are injected directly into an egg. If you are over 40 or a previous IVF attempt failed, he might also puncture the outer shell of a resulting embryo shortly before transferring it into the uterus so it can implant itself more easily, a process called assisted hatching.

5. Embryo transfer.

Three days after harvesting your eggs, your doctor will use a thin catheter to insert two or three embryos into your uterus via the vagina. "This is a painless procedure that feels like a Pap smear," explains Sarita Sukhija, medical director at Eterna IVF in Delhi. If genetic diseases are a concern, this step might occur on day five, after lab biopsies have been performed to select the healthiest embryos.

6. The outcome.

Your partner (or a friend or a family member) will give you daily injections of progesterone, a hormone that aids implantation, in the buttocks. In two weeks, you'll take a pregnancy test at the clinic; someone there will call to give you the results.

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Infertility and Men | Eterna IVF and Fertility Clinic

Although some people still think of fertility as a "woman's problem," a third of all cases of infertility involve problems solely with the male partner. Infertility in a man may be the sole reason that a couple can't conceive, or it may simply add to the difficulties caused by infertility in his partner.

So it's crucial that men get tested for fertility as well as women. It's also important that men do it early. Though some guys may want to put off being tested -- possibly to avoid embarrassment -- early testing can spare their partners a great deal of unnecessary discomfort and expense. It's also a good way to quickly narrow down potential problems.

Getting Tested for Infertility

The first thing to do for fertility issues is to go to the doctor, typically a urologist. After a physical exam, your doctor will probably order a semen analysis, which will check the quality and quantity of the sperm in the semen. And yes, your doctor will want you to give the sample there, or at least someplace nearby, because it's important that the analysis take place quickly. Just remember, as sheepish as you might feel, a semen analysis is a common test, and the results could save you months of worry and stress.

If the first semen analysis is normal, your doctor may order a second test to confirm the results. Two normal tests usually are interpreted to mean that the man doesn't have any significant infertility problems. If something in the results looks irregular, your doctor might order further tests to pinpoint the problem. At this point, if you aren't already seeing a urologist, you should considering seeing a specialist.

What a Semen Analysis Can Detect

Azoospermia. No sperm are produced, or the sperm aren't appearing in the semen.

• Oligospermia. Few sperm are produced.
• Problems with sperm motility. If sperm aren't moving normally, they are less likely to be capable of fertilizing an egg.
• Problems with sperm morphology. Problems with the form and structure -- or morphology -- of the sperm may cause infertility.

But while these conditions may be the direct reason that you can't conceive, they themselves may be caused by an underlying medical condition. Your doctor will probably want to investigate the issue further by ordering blood and urine tests or other procedures.

Reasons for Male Infertility

There are a wide number of reasons for male infertility. Some are caused by physical problems that prevent the sperm from being ejaculated normally in semen. Others affect the quality and production of the sperm itself.

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Myths and Facts about Men's Infertility | Eterna IVF and Fertility Clinic

When a couple is diagnosed infertile, first thoughts often run to the woman. She's barren. She can't conceive. She's not a "complete" woman because she can't get pregnant. As nature would have it, problems with infertility are equally due to male and female conditions.

Infertility is the inability to get pregnant after one year of unprotected sexual intercourse. Statistics suggest that 35 to 40 percent of the problems are caused by male conditions, another 35 to 40 percent by female conditions, and the last 20 to 30 percent a combination of the two, plus a small percentage of unknown causes.

Men's part in fertilization is quite amazing. About 200 million sperm are mixed with semen to form ejaculate. In most men, 15 to 45 million of these sperm are healthy enough to fertilize an egg, although only 400 survive after a man ejaculates. Only 40 of those 400 reach the vicinity of the egg, surviving the toxic environment of the semen and the hostile environment of the vagina. After another process called capacitation (an explosion that allows the remaining sperm to drill a hole through the tough outer layer of the egg), only one lone sperm reaches the egg for fertilization and conception.

Top Causes of Male Infertility

• Low sperm count
• Slow sperm motility (movement)
• Abnormal morphology (shape and size of sperm)
• Problems with semen

Even though specialists know the causes of male infertility, what's not always known is the cause behind the cause. There are many factors -- lifestyle, genetics, physiology -- that might explain low sperm count, slow sperm mobility, abnormal sperm shape, and so on.

Recent developments in treatment have made fertility possible for many men. But before undergoing any complicated procedures, there are some simple lifestyle changes that can better the odds of a successful conception. (These tips are helpful for any couple trying to conceive, whether or not infertility has been diagnosed.)

Stop smoking cigarettes or marijuana. Smoking tobacco has been linked to low sperm counts and sluggish motility. Long-term use of marijuana can result in low sperm count and abnormally developed sperm.

• Decrease your drinking. Alcohol can reduce the production of normally formed sperm needed for a successful pregnancy.
• Watch your weight. Both overweight and underweight men can have fertility problems. With too much weight, there can be hormonal disturbances, and when a man's too lean, he can have decreased sperm count and functionality.
• Exercise in moderation. Excessive exercise could lower your sperm count indirectly by lowering the amount of testosterone in your body. And as you might have guessed, stay off the steroids -- they can cause testicular shrinkage, resulting in infertility.
• Value your vitamins. Low levels of vitamin C and zinc can cause sperm to clump together, so keep your numbers up. Vitamin E can counteract excess free-oxygen radicals, which can also affect sperm quality.
• Turn your back on toxins. Landscapers, contractors, manufacturing workers, and men who have regular contact with environmental toxins or poisons (pesticides, insecticides, lead, radiation, or heavy metals) are all at risk of infertility.

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How to Choose a Fertility Clinic | Eterna IVF and Fertility Clinic

Before you take the next step in your journey to become pregnant, it's worth seeking out a good fertility clinic.

Let's say you've been getting advice from your gynecologist, who's run a blood test for hormones or had you record your basal body temperature for a couple of months. At the same time, your husband has had his plumbing checked out by a urologist. When it comes time to diagnose where the problem may be and suggest solutions, you may wish there were a single doctor you both could see. That's where the infertility specialist comes in, providing big-picture advice. Women over age 35 or who have a history of three or more miscarriages; men with a poor semen analysis; and couples who have tried for at least two years to get pregnant, should plan on seeing a specialist, recommends Resolve, an infertility support group. 

However, you need to do some homework first. Before you step foot into the fertility clinic, find out what kind of invasive tests or procedures might lie in wait for you. And give some thought ahead of time to how far you're willing to go with this process. Advanced reproductive technology can cost many thousands of dollars, can involve strong drugs or hormones, and can be an emotional roller coaster. Knowing your limits will keep you from being talked into some nifty new procedure that you really don't want and can't afford.

When it comes to choosing a clinic, do thorough research ahead of time. One useful resource is a federal database kept by the national Centers for Disease Control and Prevention that contains the success rates of fertility centers around the country. The statistics are updated every few years, so check the date. Keep in mind that some fertility centers that looked great several years ago may have had high staff turnover and declined in quality. But the numbers give you a place to start. Also, ask a lot of questions of every fertility clinic you're considering.

"You shouldn't look at the report and say 'Center A has the highest success rate, I'm going there,'" says Arthur Gautam Chhabra, GM, an infertility specialist in Delhi, India., and author. "Just be sure they have a success rate that's at least above the national average."

We've all heard the scary stories about embryos ending up in the wrong womb or ugly legal disputes over someone's frozen eggs. To be sure you don't become the next reproductive-technology headline, check that the clinic has good quality control and strong ethics.

Questions to Ask of a Fertility Clinic

How long has the fertility clinic's medical director been there?

• How long have the doctors and technicians been there? High staff turnover can be a sign of bad management and can contribute to mistakes.
• Which procedures do you do, and how often? Be sure the clinic has a wide range of infertility remedies available and is familiar with the latest technology, such as something called blastocyst transfer.
• Do you have age limits for treatment? If so, it's a good sign that the clinic is concerned about ethical issues.
• When you do an advanced procedure that involves fertilizing the eggs outside the woman and then planting them inside her, who decides how many eggs go back in -- the doctor or patient? Gautam recommends steering away from a clinic that gives complete control to the doctor. This is important because the more eggs planted, the greater the chance for multiple births.
• How many cycles per year do you do? Gautam notes that some clinics handle so many patients -- each of whom may be treated for multiple menstrual cycles -- that patients end up feeling like a number.
• What does treatment cost? While you don't want to choose strictly on price, it's good to know costs ahead of time so you know what you're getting into. Beware of clinics that offer a money-back guarantee if you don't get pregnant -- the doctor may have a financial incentive to treat you more aggressively than you want.

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