Wednesday, 5 May 2010
. Dr. Cathy Allen, Gynecologist and Obstetrician, National Maternity Hospital
. Joan Hamilton - Couseller, HARI unit, Rotunda Hospital
. Marion Bernard - NSIG & Case Study
Dr. Cathy Allen
What are the causes of fertility problems?
Reasons for fertility is one third of the time due to a male problem, a third a female problem, and a third a couples factor (both couples with fertility issues).
What are the main biological factors that lead to common fertility problems?
Low Sperm count
Problem with mobility of sperm.
Common Female reasons
Fibroids - Obstruction in the fallopian tubes
Can male fertility issues be treated?
If there is a cause identified then treating the cause will either sort the problem, or make it easier to decide on what to do next. Its important for a doctor to get a full profile of the person. Causes could be for example diabetes, injury due to previous accident, thyroid problems.
General health is important, but weight and smoking are two lifestyle factors that have an effect on male fertility.
Approx 10 - 15% of women have endometriosis. It is treatable but everyone is different. Similar to problems such as fibroids in the fallopian tubes, often the only treatment is surgery, which in the long term can prove more harmful, as surgery is so invasive. If a woman has ovulation problems it means that her menstrual cycle will be affected, for example irregular or absent periods.
If someone is aware that they have a low sperm count, endometriosis etc before trying for a baby, should they go to a doctor before even trying?
A GP is your first port of call, but often if only one partner has a problem, the other may often be fertile enough (the woman) to compensate, and natural conception is still quite likely, especially if she is young.
So when should you see a doctor?
The recommended time for seeing a doctor about fertility issues is if you have been trying for a year. With women who are in their mid thirties and starting to try, we still recommend they try to conceive naturally for the first year, unless there is any history of infertility, or if they suspect already (as above) that they may have an underlying condition.
When do couples seek IVF treatment?
Partners seek treatment when they have already investigated with their GP - who can sort a lot of fertility issues without ever having to refer to a clinic - and they have gone through the other treatments or decided with their doctor that there is no other treatment suitable.
What is the procedure?
The IVF cycle lasts for six weeks. It is an outpatient procedure. The male produces a semen sample and the female partner injects hormones daily to stimulate the ovaries.
It is a controlled ovulation and regular scans are taking to and also control ovulation, so that lab can control when the eggs are ready to be collected. They are then removed from the body and but 'in vitro' with the sperm. After that there is a waiting period of two weeks, which can prove to be the most difficult time for couples.
What if the male has a low sperm count?
Whether the male has mobility problems or low sperm count, it doesn't make a difference because even if there is some sperm it is those that will be chosen for the fertilization, and injected into the eggs.
If there is no sperm produced in the ejaculation, there is a procedure called ICSI that can remove the sperm from the testes. This is a relatively new procedure and a revolution in the 1990's in fertility treatments.
Do people reject the idea that women are leaving it too late to have children?
From a sociological point of view it is unfair, however it is a biological fact. I always say there is never a perfect time to have a baby, but I also say not to delay it, because as much as we'd like to change it, it is a reality.
Women over the age of 35 do not produce as many fertile eggs as they would have before, and therefore their chances are lowered. Any age up to this they should have no problems (unless there are underlying issues). By the age of 42 women only have a 5% chance of conceiving, either naturally or with IVF. However with figures like 1% of babies in Ireland being born through IVF, obviously it is a trend for women to try later in life.
Do men have a cut off point?
At the age of forty the chances of conceiving are reduced for men, so they do have to be aware.
What about celebrities that we hear about having children in their forties, Nicole Kidman, Celine Dion, Emma Thompson.
Well I can't say what treatment they have had, but women's uterus doesn't age as quickly as the ovaries do, so they are still able to carry and give birth to a baby.
In this case they would need a donor egg, which is fertilized with the father's sperm, and placed in the mother's uterus. She then carries the baby which has a huge psychological affect. However this can be tricky and counseling needed, because it can be difficult for the mother to accept that the baby's genes and DNA are not the same as the mums.
Joan Hamilton Cousellor, Hari Unit
Why do people need counseling while going through IVF?
Some people do and some people don't, so to normalize it, we make it compulsory.
It is useful to look at issues that may arise, as these things do come up - money, jobs, family etc. In counseling we discuss how to be at the optimum health in your life to cope with IVF.
We talk about lifestyle, limitations and pressure. We are also here to help people take in the information that they are given, as doctors appointments are quick and they don't get to discuss options and ideas. We are also at the other end of the phone or email if people have quick questions, if they are feeling sick and think it will have an effect on the IVF etc.
What do you say to someone who's IVF treatment hasn't worked out?
We go through options, not advising them on what they are medically, but to talk about the implications i.e. implications on work, family, jobs, do they have a good lifestyle etc and also to talk about results that they have been given by the doctor, as often they don't discuss this with the doctor.
What do you say to someone when they find out they have little chance of chance of becoming pregnant after a failed IVF?
At this stage it is a case of grief, and they need someone to listen to them and restore calm, breathing exercises because they are in shock.
It's like being given bad news, women can be distraught when told that their treatment hasn't worked as they will have to come to terms with never having a baby, so it is pure grief or feel like they are in a black hole.
Saying that, some people don't talk about their feelings, take the news and think, 'what now?'
What effect does this have on a couples relationship?
Some couples get closer. They only speak to each other about it because they tend not to tell their friends, so they are there to support each other. It can be hard for both parties because the husband often feels 'helpless' while the woman is constantly thinking and talking about it.
I don't know when they leave if the couples stay together, but if they are not together supporting each other at the start, they won't be by the end. We try to get couples in counseling to tell each other there and then how they feel. Women tend to feel lonely, and all men see are them getting angry or sad, but they don't realize how they are feeling, and vice versa.
What advice would you give to couples?
If you are going through IVF or having problems with fertility, decide on a period of time, a day or a certain hour that you will think about it or talk about it, but do other things during that period that makes you happy e.g. cinema, go out walking etc. If women talk about it constantly, men find themselves deviating from it, and then they get resentful.
With one percent of Irish children being born with IVF.