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There are many variables which influence the success
of infertility treatment and many infertile couples are aware of the
importance of healthy eggs , sperm, uterus and tubes in making a baby.
They factor these into their calculations, but one of the most important
variables in baby making is one which many infertile couples ( and their
doctors) often overlook - and this variable is time . Infertility
specialists , on the other hand, are acutely aware of a woman’s
biological clock, and the impact of reproductive aging on reproductive
efficiency is a key concept of infertility treatment today.
However this is often something many patients and
doctors overlook This is why they often end up treating a 40 year old
woman exactly the way they would treat 25 year old woman . However this
is not good medical practice .
Younger women have the luxury of time they can
afford to experiment and try and this treatment options even those with
lower pregnancy rates or experimental treatment protocols because they
can afford the luxury of doing so
However for the older woman , time is at a premium ,
and they cannot afford to fritter away their precious time on treatments
with low pregnancy rates or untried treatments. They need to focus their
energies on treatments which will maximize the chances of getting
pregnant.
This is what I am always upset when I see 40 year
old women being treated with options such as intrauterine insemination,
which were designed for much younger women Remember that whether you're
dealing with fertility or fitness, age does play a role. Whether
you feel like you're 15 or 50, whether you look your age or not,
your body knows how old you are, and your ovaries do too. As regards
your fertility, it’s not your calendar age which is important, it’s the
age of your eggs, or your “ovarian age “!
Another important concept is that of "trying time" ,
or how long you have been trying to have a baby. If you have been trying
to conceive for over 3 years and have failed to do so , the chances of
your succeeding on your own without medical treatment are very slim.
For women, optimum
fertility occurs at the age of 18. It stays pretty constant in the early
part of the 20s and then begins a gradual downward turn from 30 onwards.
By the time you turn 35, the process has accelerated and when you
approach 40, the slide becomes even more dramatic. One third of women
over 35 have difficulty conceiving, and this increases to two thirds
when they are over 40. The live birth rate in women more than 44, is
less than 1%. As usual, Mother Nature is very unfair, and men have it
much easier . Their fertility generally remains constant throughout
their 40s. It does begin to decline after the age of 60, but at a much
slower pace than for females.
Unfortunately many infertile couples waste a lot of
time. They get paralysed into inactivity ( “paralysis by analysis” )
because they are confused by their treatment options, and they don’t
know how to proceed . This often means they end up doing nothing , which
is the worst possible treatment option of all. Many will hang on to the
unrealistic hope of having a “natural “pregnancy ; while others will
change doctors at the drop of a hat . Neither of these are constructive
strategies – you need to retain focus on your end-goal, which is having
a baby.
Unfortunately many doctors also waste their
patient’s time . This is true specially for gynecologists rather than
infertility specialists , who contribute to this inefficient use of
their patients’ precious time. Common examples of time wasting treatment
include using danazol to treat patients with mild endometriosis; or
using antibiotics to treat pus cells in the semen . Others will insist
on repeating a laparoscopy – “to see for themselves”; or repeat the same
treatment which the previous doctor has given This often means that
patients get fed up and frustrated and lose confidence in themselves and
in their doctors.
Studies presented by Dr Leridon at ESHRE in July
2004 have shown that under natural conditions, 75% of women starting to
try to conceive at the age of 30 will start a successful pregnancy
within one year. This falls to 66% for those who start at 35 and drops
to 44% for women starting at age 40. Unfortunately, assisted
reproductive techniques will make up for only half of the births lost by
postponing a first attempt at pregnancy from age 30 to 35 and fewer than
30% after postponing from 35 to 40 years. Referring to women 35 or
older, Dr Leridon has found that even ART "will not fully compensate you
for the years, and the chances of conceiving, that you have lost."
When trying to make sense of these figures, remember
that human reproduction is a very inefficient process at any age.
Ultimately, you are the only statistic that counts when you're
trying to conceive. Again, the statistics provide probable outcomes, not
facts – they apply to populations, not individuals, and you are unique !
Everything in life comes back , except for time. “
For all sad words of tongue and pen, the saddest are those 'It might
have been.'" But kicking yourself later doesn’t help . You need to
factor in time as an important variable when formulating your treatment
plan, so you have peace of mind you did your best. You need to know when
it’s time to move on – on to the next stage of treatment, or the next
stage of resolution.
Infertile couples need to take a proactive approach
in their treatment, and have a treatment plan in their mind , so that
they can maximize their return on investment. This is why IVF is such a
useful option– it maximizes your chances of conceiving in a short span
of time, and by magnifying your fertility, it telescopes time, allowing
us to accomplish in one month what Nature would ordinarily take 3-6
months to do !
Time management for infertile couples is important,
not only to maximize your chances of conceiving, but also to maximise
the pleasure you get from
parenting ! After all, the time and energy you
can devote to your child when you are 35, is far more than when you are
45 !
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