ESHRE2011: Avoidable loss of fertility

Stockholm, 5 July 2011

A key note lecture at the 27th Annual Meeting of ESHRE addressed the avoidable loss of fertility with a solution of not delaying pregnancy for too long, since there are no guarantees or evidence that life style changes or medically assisted technologies can help preserve fertility long term.

Professor Bill Ledger, University of New South Wales, Australia

In Europe, the mean age for giving birth for the first time is now aged 30, with many women deferring pregnancy to concentrate on their careers in a climate where employment can be uncertain.

Professor Bill Ledger, however, questioned how advisable this ‘family planning strategy’ truly is, given the failure of evolution of the female reproductive lifespan, which does decrease with age. “Family planning”, he said, “is more than just the use of contraception!”.

And, as part of that planning, he questioned whether well rehearsed methods to delay loss of fertility are truly effective, and consequently cautioned against over-estimating the long term impact of a healthy lifestyle as a viable plan to preserve future fertility.

Avoidance of smoking, reducing alcohol intake, increasing exercise, maintaining a nutritious diet, etc, are all good and well, but there is absolutely no evidence that a healthy life style can counteract deferring pregnancy to later in life.

“For every woman over the age of 40 who has a healthy baby from a spontaneous pregnancy five will be disappointed due to miscarriage, chromosomal abnormalities, birth defects, etc”, said Professor Ledger.

But we have IVF, don’t we?

IVF if often seen as ‘rescuing’ a woman’s fertility if she is too old to conceive naturally, but Professor Ledger did not see this as the answer since it is impossible to stimulate follicles that no longer exist!

“Over the past 20 years we have seen a tremendous increase in the success rates of IVF rising to >31% in a 25-year old. But in 40-year olds the improvement has only gone from an eight percent success rate to 12%”, said Professor Ledger.

He voiced his concern that women may be mis-led about fertility in their 40s when many ‘stars’ appear to succeed in giving birth at a relatively high age. The catch is that most of these stars don’t admit that their successful pregnancies are due to having received donor eggs.

“My message is clear”, concluded Professor Ledger: “Today we have lots of technologies to assist fertility, but the simplest solution is that If you know you want to have children, then don’t delay pregnancy!”