Posted on Apr 04, 2014 by Ruth Loftus
The Chief Medical Officer to the UK has spoken out about the “worrying issue” of increasing levels of childlessness among British women in their thirties and forties. Speaking at an event in January, organised by the Wellbeing of Women charity, Prof Dame Sally Davies addressed the issue and stressed the fact that women who postpone motherhood until 35 years old and beyond must understand that fertility declines after this point.
Medical discussions about fertility, pregnancy and birth at such an event are not uncommon. In June 2009, Royal College of Obstetricians and Gynaecologists (RCOG) issued a statement about the complexities of later maternal age. That statement included statistics about the optimum period of fertility between age 20- 35 years old with the likelihood of 75% of women aged 30 and 66% of women aged 35 conceiving naturally within one year. This must be compared with statistics for women over the age of 35 who often find it increasingly difficult to fall pregnant and face additional pregnancy complications as the chance of miscarriage increases.
Since that RCOG statement, fertility and motherhood has continued to receive regular attention in the media over the last 4.5 years. Today, the average age of woman giving birth for the first time is thirty years old which is an average of two years later than all other industrialised countries. In December 2013, the Office for National Statistics published statistics about how the number of childless women at the age of 30 has increased across the last three generations of women living in England and Wales. There was a slight increase in the number of women without children at age 30 between the first two generations (women born in 1927 and women born in 1955), and then a dramatic increase between the second generation and the third (those women born in 1982), so that in 2012, 45% of women celebrating their 30th birthday that year had not yet entered motherhood.
This discussion about delaying motherhood is complicated further as it brings together a number of different opinions from the Department of Health, Department of Education and the Department for Work and Pensions. Prof Dame Sally Davies has previously raised the issue of how to get more women into senior professional positions in the NHS and clinical academia. Davies’ has been quotaed as saying: “It's not for me to tell [women] what to do”. Regardless, her comments have sparked another national debate about women needing to be aware of the impact that age has on fertility.
As the chances of conceiving naturally start to decrease after a woman has reached 35, women and couples have the option to explore other techniques if they experience fertility problems. In vitro fertilisation (IVF) is one of these and is available and paid for by the NHS. However, what is not always understood is that IVF availability also depends on the woman’s age as the success of IVF is reduced when a woman reaches 35 years old. In 2010, the success rate for IVF treatment for women under 35 was 32.2%. This dropped to below 15% success for women aged 40-42 (with 13.6% of treatments resulting in a live birth).
Clearly, the success statistics for women over 40 are quite low. These success rates can often be confused by the celebrity cases and miracle births which make it to the newspaper headlines. Stories about Madonna, Uma Thurman and Halle Berry all having children in their forties promote an unrealistic impression of how easy it is to delay pregnancy. It is highly likely that these celebrity mothers attend private fertility clinics to receive specialist (and expensive) treatment. The reality about treatment available to women aged over 40 in England and Wales is quite different: according to NHS guidelines, women aged 40 to 42 can receive one cycle of IVF. After this, women would have to receive additional treatments at a private clinic where one cycle of IVF costs about £5000.
Perhaps Dame Sally Davies wanted to use her discussion time to send a message to the increasing number of families who are deferring childbearing until women are relatively old to make it clear that while she fully encourages women to focus on higher education, career goals and financial stability, waiting doesn’t always allow the same fertility possibilities. Following Davies’ comments, Patrick O’Brien, spokesman consultant in obstetrics and gynaecology at University College London Hospitals said: “Quite often we will see businesswomen of 42 or 43 who will think that with IVF they can easily have a baby, whereas really success rates are very low for women using their own eggs”.
On the other hand, Natika Halil, made a statement on behalf of the Family Planning Association, trying to take focus away from the age debate and reminded us that “There are a myriad of reasons why women can’t conceive, it’s not always linked to age.” As a result, the best advice is for women to seek medical advice before they reach their thirties so that they can get information and if necessary, advice about their own fertility.