Fertility education: educating young people that fertility isn’t a guarantee

Mr Tim Bracewell-Milnes is a consultant gynaecologist and subspecialist in reproductive medicine and surgery at the Lister Fertility Clinic. He is dedicated to delivering personalised care in all areas of reproductive medicine, including recurrent implantation failure, recurrent miscarriage, reproductive immunology and endocrinology, and the management of patients with a low ovarian reserve. Here Tim talks about the importance of younger people understanding their own fertility.

Women are born with the eggs that they will use in their lifetime. Women cannot produce new eggs, and the quality of eggs decreases as women get older, with this decrease accelerating after the age of 35 years. But why is this? 

Humans are made up of 2 sets of 23 chromosomes. Before an egg gets released at ovulation it divides its genetic material from 2 sets to 1 set of chromosomes. As humans, our genetic code is very complicated, so mistakes can be made in this genetic division, and the egg can sometimes have too many or too few of some of these chromosomes. If this happens then when the egg gets fertilised with sperm it will make an embryo with the incorrect number of chromosomes. The older the egg, the more often mistakes will be made when dividing its chromosomes. Embryos with the wrong number of chromosomes will not result in a viable pregnancy.

This is why it is more difficult to get pregnant for a woman as she gets older. At 30 years of age 80% of women will conceive within one year of trying. However, the reality for women in their forties trying to conceive is that the majority will not be able to, with 40% of women able to conceive naturally age 40 years, and only 10% age 45 years. 

Unfortunately, fertility treatments, such as IVF, are not able to bypass the issue of female age and egg quality. From the most recent Human Fertilisation and Embryology Authority (HFEA) data, the chance of having a baby per embryo transferred is 33% when aged 18-34 years, 9% when aged 40-42 years, and 4% when aged 43-50 years. Therefore, women in their forties will often have to use donor eggs (eggs donated from women aged 35 years and under) to successfully conceive.

There is currently a significant trend in media attention embracing celebrity pregnancies at an advanced age. However, bearing the above statistics in mind women should be aware that the vast majority of them will have conceived with IVF by either using their own eggs they froze when they were younger, or a donor egg from a younger woman to conceive. Of course, it is the celebrity’s right to not disclose the nature of their conception. However, the media attention these celebrity pregnancies are giving to the general public is currently giving a false message that could, at least partially, be contributing to them delaying having children. Many women are currently being indirectly falsely reassured about how easily they could conceive when they’re older.

Fertility education for women should be significantly reformed in two key areas. Firstly, at school, educational curriculum should include information about the limited reproductive window women have. Secondly, family planning clinics are currently fully focused on preventing pregnancy. This should of course be the focus as the women who attend these clinics are definitively not wanting a pregnancy at that time in their lives. However, many of them may well want to have children in the future and it is an ideal time for healthcare professionals to briefly provide women with information regarding the limited female reproductive window. By providing women with vital information at these two key time points, women could be much better informed about their reproductive options, allowing them to be far better educated and enabling them to make more informed reproductive choices, and most significantly of all, reducing the chances of women suffering from involuntary childlessness when they are older.

If you’d like to discuss your fertility preservation option with Mr Bracewell-Milnes then please email the team at info@lfclinic.com.