Life has changed so much in the past few generations that evolution has not had time to keep up. Our little fingers, which were apparently shrinking due to their total obsoleteness, have, with the advent of the typing generation, experienced a resurrection in usefulness - but haven't had the chance to grow back up to size yet. Our skin has not yet developed a natural protection against UV. Our lungs can't filter out pollution. And women are still most fertile in their early 20s.
Seeing as 20-something women (and men) are busy getting educated, building careers, travelling the world, finding The One, enjoying gender equality and generally getting the most out of their lives, the window of ‘optimum fertility' doesn't quite match up with the window of ‘wanting to settle down'. In fact, at age 35, when most women will have achieved a lot of their dreams and found a partner they can stand for longer than one evening, women are six times more likely to suffer from fertility problems than they were at 25. When you add lifestyle elements to the issue - such as higher rates of obesity leading to higher rates of polycystic ovary syndrome, smoking, drinking and stress (all of which are known risk factors for infertility) - it becomes clear that the number of people needing medical help to conceive is probably going to keep rising. Luckily for mankind, we have options.
In 1978, the godfathers of IVF, Patrick Steptoe and Professor Robert Edwards, aided the conception of the world's first IVF baby, Louise Brown. Two years later, they opened the first IVF clinic, Bourn Hall Clinic in London. Since then, the Bourn Hall name has become synonymous with quality, cutting-edge technology and strong ethics. In addition to their clinics across the UK and India, in February 2012 they will open a clinic here in the UAE. Dr Peter Brinsden, medical director for Bourn Hall in the UK and President of the British Fertility Association, says, "We're not just IVF - we're fertility and assisted conception. People can get advice about how to conceive naturally and what steps to take if it doesn't happen. There's a lot of bad advice out there - a lot of folklore and hocus pocus - and people don't want, or need, to be pushed into IVF prematurely. Get advice from someone who can help you get all the basic, easy tests done quickly, so that you have a diagnosis and know the options available." Read on for a discussion of some of the options.
Freezing eggs: Stop the clock
Dr David Robertson, a consultant in reproductive medicine and the medical director of Bourn Hall Dubai, says "Freezing eggs is a much newer technique than freezing sperm or embryos, and it's not yet routinely available - mainly because a lot of clinics have had poor rates from thawed frozen eggs. However, techniques and success rates are improving. There's a lot of talk in the press about women freezing eggs for lifestyle reasons, while they pursue a career, or find the right partner, but it's not as simple as that as there are no guarantees it will work out - and there's just no getting away from the fact that after the age of 35, your fertility rates really are lower."
Good for: For women who are worried that their fertility may decline before they are ready to have a family, or who are going to be undergoing medical treatment, such as chemotherapy, that may interfere with their fertility, the freezing of their eggs can offer them the chance to press pause.
What happens? Fertility drugs are used to stimulate the ovaries in order to produce lots of egg follicles. Then, when the eggs are ready, they are removed from the ovaries (this is done under sedation or under general anaesthetic), and they are frozen. The eggs can then be stored for up to ten years.
The success rate: This is a relatively new procedure still and eggs don't seem to respond well to the freezing and thawing process. According to the British government's Human Fertilisation and Embryology Authority (HFEA), out of 6,388 eggs frozen before the end of 2008, so far 88 embryos have been created. These embryos resulted in three births. Dr Robertson says, "Rates have improved since then, and many babies have been born from frozen eggs. However, I would say that the chances of getting pregnant from frozen eggs are still lower than that of getting pregnant from fresh eggs - I'd say approximately 10 to 15 per cent of IVF cases using frozen eggs end in pregnancy. But this number will increase over time."
Freezing sperm: Boosting chances
Dr Brinsden says, "In half of the cases we see, the issue lies with the man. A sperm test is quick and easy - much quicker and easier than tests for women. In the past it has been quite difficult to get men involved in the fertility process, but that is starting to change now."
Good for: The HFEA recommends sperm freezing for men who are suffering from a medical condition that may affect their fertility, or where treatment (such as chemotherapy) may affect fertility; for men who are opting for a vasectomy; for men with a low sperm count, or whose sperm is deteriorating in quality over time; or for men whose wives are undergoing fertility treatment, and who struggle to produce a sample on the day of the treatment.
What happens? Sperm samples are frozen and stored, normally for ten years, but they can be stored for up to 55 years.
The success rate: According to the HFEA, the IVF success rate when using frozen and thawed sperm stands at 19 per cent for women below the age of 35; 15 per cent for women aged 35 to 39; and 7 per cent for women aged 40 to 42.
Freezing embryos: Make it easier next time
When a woman has IVF, she may end up with eight fertilised eggs, which are called embryos. Of these, the best one or two will be implanted into her uterus. Although in other countries this procedure has been used for decades, it was outlawed here in the UAE in 2008, resulting in thousands of embryos being destroyed. Now the laws on freezing embryos have changed again, meaning that unused embryos can be frozen to be used at a later date. Dr Robertson explains: "Where the results of egg fertilisation might be supernumerary, and a patient ends up with seven or eight embryos, one or two can go into the womb and any good-quality embryos can be frozen for a later date." This means that if the couple comes back for another round of IVF - either because the first round hasn't been successful, or because it was successful and they want to try for a second baby - the process will be much cheaper, quicker and easier on the female than it would be if they were starting from scratch. "There is no known biological limit for duration of freezing, but many countries set limits of ten years," says Dr Robertson, "Patients with frozen embryos are usually back within a few months if it hasn't worked, and within a few years if it has."
What happens? For IVF treatment, a woman is given hormone drugs (normally a daily injection for two weeks) to suppress her normal monthly cycle, then given different drugs to stimulate egg production (a daily injection for about two weeks). The eggs are harvested and mixed with her husband's sperm. Less than a day later, the eggs are checked and ones that have fertilised to become embryos are transferred to an incubator. A few days later, the strongest embryos are chosen for transfer to the womb.
The success rate: Dr Robertson says, "It's widely accepted that the transfer rate for frozen embryos is less than for fresh embryos. There's a number of issues, firstly you'll lose about 30 per cent in the freezing and thawing process... and then the pregnancy is more difficult, too. So, you are probably looking at about 50 per cent the success rate of using fresh embryos." According to the HFEA, success rates of IVF with fresh embryos starts at about 30 per cent for women under 35, going down to 3.4 per cent for women aged 43 to 44. A
What steps should I be taking now?
Dr Peter Brinsden, medical director for Bourn Hall in the UK and President of the British Fertility Association, says, "Women are waiting longer and longer to have children, sometimes past their mid-30s. The problem is that after this point, fertility declines. People often ask us how long they should keep trying before they seek help. I would say that if you're in your 20s, you can wait a year or more, providing you don't have any medical conditions that may prevent you from conceiving. However, if you're over 30, don't wait more than six months - a year maximum. People need to remember that the process can be quite lengthy. Doing different tests to find out where the issue lies, 35 can quickly become 36. Also, it may take two or three goes before it happens.
"Another piece of advice is, if you think you need help, see an expert - if you leave it to your GP or your gynaecologist, they wait some time before referring you to a specialist. Whereas fertility experts might be able to see what's wrong with you instantly. For example, I can spot a case of PCOS [polcystic ovary syndrome] coming through the door. There are very high rates of PCOS here - in the UK approximately 40 per cent of women suffer from PCOS, but amongst Arab and Asian communities, the rates can be as high as 60 per cent. PCOS can impact your chances of falling pregnant, but it's a simple problem that can be easily solved with good advice. The fact is that a lot of the women we see don't even need IVF. They may not even need high-tech treatment.
"My advice would be to see someone who knows all of the options, so you can get your basic tests done, get a thorough diagnosis of the situation and an explanation of your options, before you make any decisions."
A healthier lifestyle for a healthier fertility
Bourn Hall experts offer the following tips to boost your chances of conceiving naturally.
Get the timing right Find out exactly when you are ovulating by using an ovulation kit, which you can buy from your local pharmacy.
Detox Smoking and drinking alcohol can dramatically impact fertility for both sexes.
Lose weight Women need to have a Body Mass Index of between 19 and 30 to be eligible for IVF, according to international guidelines.
Eat healthily Having a balanced and nutritious diet can improve your chances of conceiving. Include green leafy vegetables, eggs, dairy, nuts and seeds and citrus fruits in your diet.
Quit the coffee Drinking too much caffeine can impact the fertility of both genders.
Get moving Exercise boosts fertility in men, but women trying to conceive should avoid intense exercise and opt for relaxing cardiovascular activities, like swimming, walking and yoga instead.
Catch some zzzs Eight hours of sleep a night, for you and your partner, will keep hormone levels balanced and keep you de-stressed.
Bourn Hall Clinic Dubai is due to open in February 2012 with cutting-edge facilities in the Shaikh Hamdan Centre, Jumeirah. It will offer Sharia-compliant fertility support/procedures for couples struggling to conceive, plus fertility advice and consultations. Visit www.bournhall-clinic.ae or call 04-3862000.
