Scientific breakthroughs in fertility

by Morgan.J / 10 November, 2012
Most Kiwis are already waiting till their thirties before breeding – and scientific breakthroughs are pushing the age out further.
Scientific breakthroughs in fertility - Lyn with Dean and Celine


When Lyn and Ian Mason’s 11-year-old daughter, Kylie, was killed in a car crash along with Lyn’s mother 12 years ago, their world imploded. That Kylie had been born at all was a triumph against the odds – she arrived after seven miscarriages, when Lyn was 38. After 17 years of trying to have a family, the Hamilton couple had given up, and Kylie remained without siblings. Yet remarkably, after losing their precious only child in a car accident, the Masons were able to become parents again in their mid-fifties.

“It was Ian who said one day, ‘Why don’t we have more kids?’” Lyn recalls. “It was something that just rolled off the tongue, really. I thought, ‘My God, where’s that coming from? Do you realise how old we are?’” The couple consulted their GP, who referred them to a specialist. They were originally told they had only a 3% chance of conceiving, but that could be boosted to 30% by using donated eggs. So, at the age of 53, using Ian’s sperm and eggs from a family friend, Lyn used in-vitro fertilisation (IVF) to give birth to son Dean. Two years later she used IVF again to have a daughter, Celine.

Now 63, Lyn says the couple are lucky enough to be financially secure, so will have no problem supporting teenagers in their retirement. And although she wouldn’t necessarily recommend giving birth any older than 55, they have never had any regrets.“You’ve only got one shot at life, haven’t you?” she says. “We would have been pretty sad old sacks if we hadn’t done it, because our whole life’s mission was to have a family.” And she is very proud of her children. “The teachers love them – they’re such lovely, polite children. Wherever we go, people mention that they dress so beautifully.”

Critics claim such cases are selfish, sure to deny children one or both of their parents at a relatively tender age. But as Mason points out, life is a lottery at the best of times. She lost her own father when she was 27. “I’ve seen kids lose their mum and dad younger than we are,” she says. “We’ve done everything we can to remain healthy and it will only be a big stroke of bad luck if we don’t get there in time to get them schooled and on their track to adulthood.”

TECHNOLOGY LENDS A HAND


Thanks to increasingly sophisticated IVF techniques, more and more people are indeed discovering that it is better to be a parent late than never. In the past year alone, several women over 50 have given birth in New Zealand. “A third of all the people we see now are more than 40. It started off at about 10% and has slowly crept up,” says Dr Richard Fisher, co-founder of Fertility Associates, New Zealand’s largest provider of infertility services. Fisher believes the “innate saneness” of Kiwi women has helped prevent the kind of controversy here that has accompanied some of the more extreme cases of older parents sparking debate overseas.

In 2008, despite already having two children and five grandchildren, Indian woman Omkari Panwar used IVF to conceive twins at the age of 70, because she and her 77-year-old husband wanted a male heir. And in 2009, London Mayor Boris Johnson felt compelled to write a long article in the Daily Telegraph defending Britain’s oldest first-time mother, 66-year-old businesswoman Elizabeth Adeney, who went to the Ukraine for IVF treatment. “To criticise her is not only ageist. It is also blatantly sexist,” he argued. Although older parents are sometimes mistaken for their children’s grandparents, there are, of course, many New Zealand children who are being raised by their grandparents anyway – often because their real parents have decided that’s for the best. Nevertheless, debate over “how old is too old” is likely to intensify as more people turn to IVF to help them conceive.

NEW DEVELOPMENTS


Fisher notes the field is developing fast, with further breakthroughs imminent. One promising technique is time-lapse photography, which allows doctors to monitor embryo growth much earlier in the process. Another is better identification of healthy eggs, which is being researched by Victoria University postgraduate student Jozsef Ekart. And yet another has just been introduced in the United States, Australia and Spain and involves what is known as comprehensive chromosome screening. The screening technique, which Fertility Associates is considering introducing here, involves identifying which embryos have genetic abnormalities and are therefore unlikely to be successful. In trials, eliminating these embryos early in the process boosted the chance of a successful pregnancy in 38- to 42-year-olds from 33 to 61%. In other words, a 42-year-old is given the same chances of becoming pregnant as someone 10 years younger.

Fisher’s only reservation about the technique is that it is relatively expensive – $3000-4000 for a single cycle of treatment. In New Zealand, women up to the age of 40 can have publicly funded IVF treatment, but beyond that they need to pay for themselves. Clients also need to understand it could mean many, or possibly all, of their embryos might be eliminated – leaving them no better off than when they started, says Fisher. “I think the ethics around it are making sure that people are not doing treatment that has no chance of success. The difficulty is everyone has a different idea of what a reasonable chance is. If you say to someone, ‘Look, you have a 5% chance of success’, there are a lot of people who would say, ‘That’s fantastic – that’s 5% better than I’ve got myself.’”

OLDER AND OLDER


Although infertility often has a medical cause, some people have simply waited too long to have children. In the 1960s the median age of a New Zealand mother was around 26. In the early 1970s it dropped below 25, then climbed to 30, where it has sat for the past decade. New Zealand women now have fewer children and have them later in their lives, and more remain childless. According to Families Commission publication The Kiwi Nest, one of the reasons is that more women are waiting until they are financially settled. They are also spending longer in higher education. Dr Lynsey Cree, a senior lecturer in reproductive science at Auckland University, who works with Fertility Associates, recognises these pressures both in patients and work colleagues. “I certainly see it happening in science – by the time you’ve done your degree, your PhD and post-doctorate, and get your first academic position, you’re in your mid-thirties and you may not even have thought about starting a family,” she says.

Marc and Renee Rutherford and family


Cree contends there isn’t a “best time” to start trying to conceive, because lifestyle often dictates when is best. “If you waited till the ideal time in your life, I don’t think anyone would ever get pregnant,” she says. But biologically, trying in your twenties increases your chances. Women who are 25 have a 20-25% chance of conceiving each month. At 35, those chances are halved, and by 39 they halve again. For men, fertility doesn’t begin to markedly deteriorate until they hit 55. Experts attending a fertility conference in Auckland this week noted that many people still appear to be unaware of these biological facts. “Our lifestyles are shifting, but unfortunately menopause isn’t moving. It’s been averaging 50-51 years of age for a very long time,” says Cree. “Essentially once you get to 45, the chance of conceiving with IVF with your own eggs is only 2%. It’s quite a dramatic decline.”

Of course, there are always exceptions to the rule – like the Melbourne mother of 12 who naturally conceived quintuplets at the age of 48; four of the five babies survived when she gave birth in September, taking her brood to 16. And TV3 entertainment reporter Kate Rodger, who unexpectedly fell pregnant with her first child at the age of 44 despite having only one functioning fallopian tube. She is due to give birth next month. For some women, it’s a shock to discover they have left it too late. Dee (not her real name) was 39 when she came off contraception and could not get pregnant. She is among the 1% of New Zealand women who go through premature menopause before the age of 40. She and her husband had concentrated on building up their cattle-breeding business, and when they began trying to conceive, with no luck, tests revealed Dee was no longer producing eggs.

“We had talked about having a baby for three years, but we put it off under the financial pressure of getting our business set up. We didn’t see a gap in the traffic, and then the road was closed,” she says. “People find it hard to understand your grief. If someone has a miscarriage, it’s something very tangible. But with premature menopause, you lose all the babies you never had.”

COST OF LIVING


For those lucky enough to conceive in their late thirties, or even early forties, parenthood can indeed be a blessing. As well as being better-off financially, older parents are often more secure in their careers. Many have already travelled and are less resentful of the kind of compromises that parenthood requires. But as more couples, or even singles, delay such responsibilities, some are starting to question whether being an older parent is really so wise. One issue is that it is slowly dawning on older parents that their nests may not be empty until they hit retirement. And if the current generation continues to give birth so late, then grandparents could eventually become a rarity.

As for finances, an Inland Revenue calculation in 2009 put the cost of a child at around $250,000 – about $14,000 a year until they’re 18. But that formula includes only basic expenses like food and clothes, not childcare or dental treatment. “If you analysed it, you wouldn’t have children. That’s the brutal truth,” says financial adviser Susanna Stuart. Stuart has noticed many parents are also factoring in the cost of education these days. “Private education is now a priority for a lot of people,” she says. “There’s a smaller window of time now to do the major things in life, like buying a home and having a family, and parents are adding paying for their children’s education to the list.”

She is frequently asked how much children cost. “It’s an endless bucket. It isn’t just the cost of raising the children, it’s the opportunity costs – parents taking time out of work, dropping down to a single income.” If asked, Stuart advises clients to have children early. “It’s all loaded at the other end, where you have your retirement to sort out, and your parents to care for,” she says. It’s all about avoiding becoming part of the “sandwich generation”, a term coined by American social worker Dorothy Miller to describe women squeezed between responsibilities to their kids, their employers, and their elderly parents. Twenty-fi ve years on, the sandwiching is even tighter – between the “boomerang kids” (children staying at home longer), and baby boomer grandparents who are living longer.

“The only proviso if you want to start early is to make sure you are covered by insurance. You won’t have built up the financial backing you need to raise kids,” Stuart says. Few people in New Zealand know more about that subject than Paula Bennett. As Social Development Minister, Bennett holds the purse strings for thousands of parents – from single women on the DPB to those claiming Working for Families. At 17, she was a single mother herself. “It was 1987, and things were very different then; there was still a stigma against young single mums,” she says. “I wasn’t allowed to see my scan, because even though I was clear that I was not going to adopt, they were concerned about me bonding with my unborn baby and not looking at [adoption] as an option.”

But she says the emotional advantages of being a teenage mum to daughter Ana were many. “I never had anything, so I never felt a loss of income or freedom. I was energetic and took most things in my stride; I didn’t ever feel things had to be perfect, so I didn’t stress the small stuff,” she says. “The disadvantages were that I was so young and immature. I was still a teen and had that rebellious streak, which didn’t magically disappear when I had a baby.”

YOUNGER IS BETTER


Writer and broadcaster Wendyl Nissen has experienced motherhood from both sides of the fence – she had her first child, Daniel, at 24, and her fourth child, Pearl, at 35. She is advising her daughters to start their own families early – although not too early. “I was quite ready to have Daniel. I had a good strong career, and I knew what I was doing in my life. But it was very uncool in the 80s to get pregnant young. It was a very lonely time,” she says. Few of the women she worked with at that time had children, and she recalls feeling resentful that she was unable to do an OE.

“With Pearl, I was much more relaxed, more in control; I didn’t have to worry about how we were going to pay the mortgage,” she recalls. She and second husband Paul Little could also afford to pay for a night nanny to watch over the baby (Nissen had earlier lost a daughter, Virginia, to cot death). But she’s glad she wasn’t any older. “I’ve seen so many of my friends leave it till later and then struggle to get pregnant. And then when they have a baby, there’s so much on that poor child’s head.”

According to research by Macquarie University psychology professor Catherine McMahon, older first-time mothers tend to be more anxious about the health and safety of their baby, and many do not have close support. Plunket clinical adviser Allison Jamieson has also noticed that women with well-established careers can find new motherhood particularly difficult. “They have maybe been part of a corporation, managing people, and then they have this tiny slip of humanity throw their lives into complete disarray,” she says. “The younger ones often just accept what is and get on with it. They might not have the resources the older mums do, but they haven’t got the hang-ups.”

Breastfeeding also seems to come more naturally to younger mothers, Jamieson believes, and they are more comfortable with the baby being minded by other family members. “They’re also pretty good at asking for help. They’re into Facebook and Twitter, so they will ask questions online, or ring Plunketline, because of the anonymity,” she says. Renée Rutherford is one of those techsavvy young mums. The 27-year-old and her husband Marc, 29, had their first daughter, Stella, four-and-a-half years ago. They’ve since had another daughter, and another is about to arrive. “Things can change through the generations, and when I want an opinion outside my mum’s, I go to websites and forums to see whether what I’m doing is okay,” Rutherford says. “But I still speak to my nana every day; even if she can’t fi x a problem, she gives me support.”

PLEASANT SURPRISE


Rutherford, who has a bachelor of health science in psychology, didn’t plan to become a parent quite so young. As a teenager, she was diagnosed with polycystic ovarian syndrome and was told it could compromise her fertility. “But along came our little surprise. We could have stopped at one child, but we chose to have two more. I don’t regret it, and I don’t think we’ve missed out on a thing, even though our life is certainly different than if we didn’t have kids. We took a six-week holiday in South Africa last year, but obviously we couldn’t go backpacking with two toddlers.”

Rutherford’s parents are in their forties and work full-time, but Stella and her twoyear- old sister, Alexa, get to spend time with their great-grandparents, who are in their eighties. “I feel lucky to be able to give my kids my time,” Rutherford says. “I hope to eventually go back to work, but Marc and I are both committed to having someone at home till they’re five.” She admits she sometimes looks at her friends who don’t have children and wonders what she might be giving up. “But then they say to us, ‘Do you realise how many of us would love to be in your position?’ That’s been an eye-opener.”

Age matters


A major study finds surprises in the way we’re having families.

Susan Morton


Dr Susan Morton, a mother of three adult children, is finding her latest baby babbling out plenty of surprises. Her “baby” is Growing Up in New Zealand, the University of Auckland’s longitudinal study of almost 7000 children and their parents. The children are now two years old. The mums – aged between 15 and 46 – replicate the age distribution for all births in New Zealand. Five per cent were under 20 when they had their children, 40% were aged 20-29 and 55% were over 30. The fathers in the study are aged between 16 and 64. Morton is discovering that age is an important variable in the well-being of both parent and child.

Forty per cent of the pregnancies were unplanned; although some of the parents under 25 had planned to have their child, three-quarters of the under-twenties had not. The young mothers are more likely to have less education, or have not finished their studies, and are less financially secure, often living with extended family. They are most likely to have a change in relationship status in a short time, even during the pregnancy. Women under 30 were more likely to be among the 11% of mothers who suffered symptoms of depression after the babies were born. “The many challenges of being a young mum can cause stress, which sometimes manifests itself as poor mental health. Our older mums tend to have greater levels of family support around them, with more established relationships within their family and more support systems outside too,” Morton says.

The older mothers had found it harder to get pregnant; some had been trying for more than 10 years to have a baby. “They are much more likely to be in a stable relationship with a partner they’ve been with for some time. It’s very rare for mums 35 and over to have no formal qualifications. They’ve established themselves in careers, have resources behind them and are more likely to be in a home of their own.” Yet just under half of the families in the study were working towards or owned their own homes. “That’s a big surprise. The impression is that most people who have children have or are moving into their own home.”

In the period from pregnancy to nine months, most household incomes dropped significantly, especially in the $100-150,000 bracket. One in four families moved house during that time. Morton says her generation had children once in a stable relationship and in their own home, where they remained to raise their family. “It’s a different way for children being born in New Zealand today,” she says. Almost all the families – regardless of age or financial status – found the first year had been challenging. Half reported at least one experience of hardship, such as not being able to afford fruit and vegetables, or to take a child to a doctor. Morton found that regardless of age, ethnicity or income, 99% felt they would be very good or excellent parents. “That’s a great way to start,” she says. Morton classes herself as a young mum, having had children at 23, 25 and 31. “They are adults now, and I’m glad I’m young enough and well enough to watch them make their mark on the world,” she says. She hopes this “baby” will also make its mark with future generations of New Zealand families.

Once more with feeling


With a child at 78, Peter Bromhead could be New Zealand’s oldest new dad.

Peter and Carolyn Bromhead


As Peter Bromhead has crept into old age, he’s discovered a greater confidence in his reprised role of father. “I have no problem walking up the road singing Thomas the Tank Engine songs with my children, where I would have thought that was below my dignity 30 years ago. I suspect as I go into my dotage, I’m getting closer to childhood myself,” says Bromhead, 79, and purportedly New Zealand’s oldest new dad. He’s made his apologies to the two sons from his second marriage – now in their late twenties and early thirties – for not giving them enough of his time. And now, without guilt, he pours his love and attention into his latest progeny – Oscar, who has seven, and Felix, who has just turned one.

The average age of New Zealand fathers of newborns today is 32; one in 100 children have dads aged 50 or older. Bromhead reckons it was tougher becoming a dad at 21 than at 78. “At 21, I was just married and we stumbled into having a child by haphazard accident. We didn’t set out to have one. I had no money, and coming to New Zealand, I had no job, nothing. It wasn’t an easy road,” the cartoonist and designer says. “There’s a psychological difference to having children young. At 21, mothers looked after the children. Fathers took the kids along to the park on Saturday morning and played footy with them. That attitude wasn’t just bred into me; it was how it was for everybody. You weren’t engaged very much in the day-to-day process of raising children as you are today.”

Fifty-eight years on, Bromhead takes Oscar to school and Felix to daycare, makes their lunches, listens to their problems and cuddles them in the night when they wake. “I had to go and pick up Oscar from holiday programme because he’d had a fall and was in tears. I had to deal with his problems when I was halfway through a cartoon. In the old days, no one would have disturbed me when I was working on a project with a deadline. Now you have to wait because my kid’s fallen over. I’ve changed my priorities,” he says. The result is he has a better understanding of his young sons’ feelings than he did with his four other children. “With the children from my second marriage, I was contaminated by the fact that I was too busy making money and running a business here and internationally,” he says.

He occasionally visits his daughter from his first marriage, a theatre producer in Frankfurt. “But the relationship is remote, in the sense that if you don’t have that early bond, it doesn’t come back. Although you have the blood relationship, you’re psychologically remote.” Still drawing, still running Bromhead Design with wife Carolyn, he admits he runs on two of four cylinders some days if Oscar has been up in the night. “But I feel very privileged to have children late in life. People say, ‘You aren’t going to be around forever’, but I say at least I have given them the gift of life. I lost my father in the early days of World War II, when I was six, and I survived. One does survive,” Bromhead says. “Obviously I would like to be around. I’d be happy to pay school fees till I’m 96.”

Incidentally, that’s the age of the world’s oldest “new dad” – Indian pensioner Ramjeet Raghav, who welcomed his second son into the world this year. Bromhead’s main concern is if illness strikes and he becomes a burden to Carolyn, who’s 37. At this stage, he’s still blessed with good health. He’s well aware of studies linking a father’s age to mutations in their offspring. The latest, a study of families in Iceland, showed that men starting families in their forties and beyond could be increasing their children’s chances of developing autism and schizophrenia. Although women are born with their full complement of eggs, men are continually making sperm and creating new genetic mutations.

“The older we are as fathers, the more likely we will pass on our mutations,” Kári Stefánsson, chief executive of deCODE Genetics in Reykjavik, told international science journal Nature. “The more mutations we pass on, the more likely that one of them is going to be deleterious.” By all accounts, Bromhead says, his young sons are both bright, happy and healthy. “I’m not in a position to say what the best age to have children is. But I’m more comfortable at this stage – no mortgages, less work stress running a successful business,” he says. “It has changed my life, though. My beautiful bachelor flat in Parnell, designed purely to entertain young women, is highly unsuitable for young children. My life is now in turmoil looking for new houses; my sports cars have been replaced by family station wagons. But actually, I am very happy.”

Happy, and puckish, in his second childhood. “When people ask me if I would do anything different, I say, yes, if I had my time again, I would have had ‘school fees’ tattooed on my dick.”
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