STI: When science can't hatch a baby

May 24, 2004

When science can't hatch a baby

HER fertility doctor gave her drugs to stimulate ovulation but she ended up bleeding non-stop for a year.

'I became very weak. I couldn't do anything to stop it,' says the 33-year-old civil servant of her six-year ordeal to get pregnant.

She and her husband, a marketing executive, spent over $100,000 on fertility treatments.

The scary part is that when she started trying for a baby, she wasn't even old enough to fret about her biological clock.

What is even more frightening is the fact that many more women and men believe age poses no barrier to a couple's ability to have children. Science has all the solutions, they believe.

A new Community Development and Sports finding shows that over six in 10 believe that fertility can be turned on like a tap at any age thanks to medical technology.

Insight's interviews with young women in their late 20s bear out this perception. A 26-year-old executive's answer that she will only think of having babies when she is in her 30s is typical: 'I'm not worried. When I hear about other people's suffering, I think, it is their story, not mine.'

Singapore's in-vitro fertilisation or IVF programme which started in 1982 to help childless couples, has made groundbreaking advances in the field that have appeared in reputable medical journals. But paradoxically, the advances may have had an unintended consequence of lulling Singaporeans into a false sense of security.

The survey finding only adds to the complex web of issues the procreation policy committee has to tackle before it delivers its recommendations in August.

How to persuade couples that delaying parenthood could mean not ever having children? How to make them recognise the risks involved in taking the petri-dish route?

For a start, the facts should make them sit up. The harshest one first: Doctors warn for women aged 40 and above, fertility might well be an exercise in futility. Fertility levels start dropping around the age of 30, slides down dramatically at 35 and then again after 40.

The second reality check: While IVF treatments are said to be more effective in helping couples who have difficulty conceiving, it is not so with age-related fertility problems.

Hence, doctors say couples should turn to medicine as a last resort and not in their frontline.

One fertility expert, Professor Ariff Bongso, notes that because of poor egg quality, the pregnancy rates for women after 40 years of age go down to as low as 10 per cent.

'It is very difficult to make an old egg younger even through research,' he says.

Other experts say that as women age, they are more likely to have gynaecological problems such as endometriosis and fibroids which also reduce fertility.

Some eggs will be blighted and even a fertilised egg might fail to attach itself to the uterus. When pregnancies occur, miscarriages are more likely.

A Danish study in 2001 of 600,000 women found that at age 22, a pregnant woman faces an 8-per-cent chance of having a miscarriage. But, from age 45, that possibility jumps to 75 per cent.

There are other risks. At 25, a woman has a 1 in 1,250 chance of having a baby with Down's Syndrome, a combination of mental retardation and physical abnormality. At age 45, she has a 1 in 26 chance of giving birth to such a child.

Infertility is not just women's problem but men's as well. The quality of men's sperm 'Maybe the nurses do this job everyday and become insensitive. But, I didn't want to be treated like some zoo animal.'

He and others in their late 30s to 40s interviewed agreed that they should have paid more attention to what one American academic calls 'the creeping non-choice factor'.

Academic Judy Friedlander used the phrase to describe how women believe they can have both career and baby but end up losing out on the baby part because they ignored their biological clocks.

Singaporeans' confidence that science can beat that clock is widely shared among Americans too.

In the United States, similar sentiments have been documented by Ms Sylvia Ann Hewlett, an economist and author of Creating A Life.

In her 2001 nationwide survey of the top 10 per cent of high-earning American women, she found that childlessness haunts their executive suites and many lived with regret for not finding a way to have children.

For many, the fertility industry lulled them into a false sense of security that they can get pregnant, deep into middle age.

Among the women aged 28 to 40 she surveyed, almost 9 in 10 believed that they would be able to get pregnant into their 40s.

However, the older corporate females aged 41 to 55 found that while they wanted to have children, their preoccupation with their careers meant that by the time they were ready to have a baby, their bodies had given up on them.

Among this age group, only 1 per cent had a first child after age 39.

Highly-hyped Hollywood pregnancies, Ms Hewlett adds, have also sent a dangerously misleading message that women can wait to have children because science will be there to save them.

But she points that for every 52-year-old woman who make the headlines, thousands more waste an inordinate amount of time, energy and money.

Fertility experts and family counsellors say it is time for Singapore's young adults and couples to know fully the risks of having babies late. They are not in it for the campaign to boost Singapore's baby numbers, they add.

Rather, they want to spare couples the deep physical and emotional pain and anguish they have seen in their clinics and counselling rooms that can drive some couples into depression and even divorce.

Young couples should realise the limits of medical advances, which can improve their chances if they are infertile but cannot guarantee them babies.

Yes, there are new areas of research opening up, says Prof Bongso, but these are still in their early stages.

One such attempt is to store eggs through freezing, he says, adding: 'In this way couples can postpone having babies.'

Member of Parliament Lily Neo, who is a medical doctor, feels strongly that messages about fertility need to be factual with people being told about the risks and dangers of having a baby late in life.

'But we need to be careful because any form of public education can result in a backlash, especially for the young who do not like being told what to do,' she says.

If Singapore women are to learn from their American peers, they need to look at how they are paying the price of motherhood because of their chase of high-altitude careers.

Ms Hewlett, who discusses the empty promise of high-tech reproduction, urges women to figure out early what they want their lives to look like at age 45.

Stressing that the choice lies with the individual, she urges them to choose a career that will give them time to also have a family.

Other experts suggest that women have their babies early and return to the career track when the children get into school.

Will Singapore women listen? What about Singapore men? Too little has been done to focus on them, whether it is their emotions in dealing with childlessness, or how their own decisions in their careers affect their wives' choices.

Whatever the answers, with the latest survey findings, the procreation committee's work just got more difficult.  --  Additional reporting by Azrin Asmani