Dr Kate Van Harselaar Obstetrician and Gynaecologist Fertility Associates Dunedin 8:40-9:00 Modern Fertility - Social Changes Impacting Fertility
Modern Fertility Social Changes Impacting Fertility Dr Kate van Harselaar Reproductive Medicine, Obstetrician, Gynaecologist FRANZCOG, PGDipOMG, MBChB, MSc (Distinction)
Latest NZ Research 1 in 4 experience infertility 1,037 couples, Dunedin 1 in 4 people experienced infertility Result entering parenthood later no or incomplete family
Career Starting a family comes after financial stability no time is the right time.. Too late decrease chance having a child completing family
Financial Both couples having to work Working 2 jobs 7 children 1970-4+ children 2018-2.4
Education Less educated women have more children Contraception Too good accessible, reliable and effective Need to plan
Lifestyle factors.. Smoking Decr sperm quality, bld flow to uterus, incr MC IVF halves success, decr quality/number eggs Weight (BMI) <19 and >32 (men and women) Alcohol >2units/day Incr RR Infertility 60% Coffee >250mg/d Decr fecundability 45%
Men they re never too old? 73 67 67 68 68 68 But only need one
But. Sperm quality in men declining Older men Increased risk autism and schizophrenia Abnormal sperm Increase DNA fragmentation Decreases IVF pregnancy rate Increases rate of miscarriage Normal sperm No effect
Sperm Health Normal BMI Diets high in fruit, vegetables, fish and wholegrains Low alcohol No cigarettes Menevit Frequent ejaculation
Fertility Treatment
More opportunities Better technology - egg freezing Greater acceptance Learn history Education Sperm donors Egg donors Surrogate
Realization more is not better
IVF and age number eggs? How many eggs required per baby (for a 70% chance) 25-34 required 10 oocytes 35-37 required 14 oocytes 38-40 required 25 oocytes 41-42 required?50 oocytes
Sperm Donor Same sex couples Abnormal sperm Single women (increasing) Financially stable, educated Late 30s Have not met Mr Right Biological Clock is ticking
Sperm Donor - waitlist 2 years?! Requires advanced planning. Long wait list Changes in laws mean men reluctant to donate
Egg Donor Social media womens own eggs at 45yo? Growing need for egg donors women having children later Realistic option
Fertility preservation egg freezing Career Social Cancer No sperm at IVF Rapid reduction of ovarian reserve
Where are we at? Better health cares services earlier detection disease Eg PID, endometriosis Less complications Social media - Greater acceptance Inconceivable program Education Greater advances in technology, increased awareness of fertility options egg freezing, egg donor/sperm donor, surrogacy More chances of a baby
What do we need to work on? Disparity between supply vs demand of IVF/ICSI with public treatment Start early Meet criteria Requires >2 cycles Fertility treatment costly Only accessible to the few Education Social Media Understand fertility window Know limitations (BMI, smoking) Lifestyle (diet exercise) Criteria public funding
Fertility.. The future? Thinking about starting a family Early means. Time to try Time to act Maximise chance accessing pubic funding Time find egg donor/sperm donor/ surrogate Time to complete family