National Fertility National Fertility Study 2006Study 2006

Dr Anne Clark, MPS, MBChB, FRCOG, FRANZCOG, CREI

Dr Anne Clark, MPS, MBChB, FRCOG, FRANZCOG, CREI

Chair, Preservation of FertilityChair, Preservation of Fertility

Australians’ Experience and Australians’ Experience and Knowledge of Fertility IssuesKnowledge of Fertility Issues

Why Do This Study?

Australia’s fertility rate (1.81 babies per woman) is below population replacement level (2.1) but “it’s not for lack of wanting kids” *

Therefore very important that couples have access to information that enables them to have children quickly and easily when they are ready.

* Fertility Decision Making Project, 2004

Until there is good quality evidence, programs and practice can only be opinion based.

Methodology• 2400 Australians aged 18 and over

• Omnibus survey carried out with equal numbers of men and women

• Call backs and appointments used to ensure people who spend a lot of time away from home were included

• Results weighted to Australian Bureau of Statistics data on age, gender, locality and level of schooling

600

700

400300300

100Sample from 2,400 Australians

What Makes This Study Unique?

The other major Australian study on fertility issues, the Fertility Decision Making Project 2004 (FDMP), commissioned by the Office for Women, published by the Australian Institute of Family Studies surveyed over 3,200 respondents (men and women) but only between the ages of 20 to 39 years about parenting choices and barriers.

The first time an entire country’s adult population has been sampled in relation to its knowledge and experience of fertility issues.

Results:

Ages and Percentage With Children of Those Surveyed

0%

5%

10%

15%

20%

25%

30%

18-19 20-29 30-39 40-49 50-59 60+

Total% Who Have Children

Results:Of the 68% that had children,4 out of 5 did not want any more(81% of men and 31% of women)

Of the 32% that had no children, 1 in 2 never wanted children (21% of men and 14% of women)

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Results:

There were no significant differences in results between different states or rural and urban areas.

Presentation of results will only be split by age and gender when a difference occurs

1 in 6 couples affected consistently from aged 20 onwards.This represents over 3 million Australians

Those That Took More Than 12 Months to Conceive a Planned Pregnancy Shown as a Percentage of Current Age Group

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

30-39 year olds 40-49 year olds 50-59 year olds 60+

First Child

Second Child

Third Child

Is Infertility a Modern Issue? No!

But … The Time for Couples to Conceive has Significantly Reduced !!

20 years later over 54% of men and 40% of women of the same age were still living at

home

Due to the later timing of events in people’s lives which generally lead to family formation.

Australian Bureau of Statistics data

10 million

10 20 30 40 50

1979

2002

MJ Faddy et al, Mol Cell Endocrinol,

163:43-48, 2000

Number of eggs available

Age

Median age of women

marrying

1 million

100,000

10,000

1,000

1999

Survey Results:Percentage of Sample Who Had Their First Child

Under the Age of 30

92% 75

%

27% 20

%

1976

2006

WomenMen

1 in 4 unplanned

1 in 2 unplanned

Results: Percentage Who had Unplanned First

Children and Treatments for STI46

%

60+

22%

28%

26%

26%

50-5940-4930-3920-29Age

STI 2%2%5%5%7%8% of IVF cycles in 2003 for tubal disease cf 28% in

1994

Barriers to Conception:

Pre-requisites for Having Children

Rated as Very Relevant

0% 10% 20% 30% 40% 50% 60% 70% 80%

Your partner's age

Partner's career

You not wanting children ever

Own career

Owning a home

Your age

Partner not ever wanting children

Good income

Stable relationship

Two, then three was the most preferred family size

M = 26%F =

38%

M = 19%F =

34%

Barriers to Conception:

Pre-requisites for Having Children Fertility Decision Making Project, 2004

Men Women

Rank

Rank1 1Afford to support child

9 9Male partner’s age

19 13Female partner established in career

1 3Partner make a good parent

5 4Male partner’s job security 6 5Female partner’s age

14 12Female partner’s job security

4 7Having someone to love

8 11Add purpose/meaning to life

10 13Male partner established in job11 13Giving child(ren) a brother/sister

3 2Male partner make a good parent

15 19Child would be good for relationship15 17Ability to buy/renovate/move home

Two, then three was the most preferred family size

1 in 3 women in their late 20’s and 30’s have no partner …

Barriers to Conception:

Pre-requisites for Having Children

Sydney Morning Herald, 2002

Barriers to Conception: Lack of understanding of the effects of age on a

woman’s fertility

51% of childless women aged 30-49 years thought they could still conceive whenever they wanted to. Despite, 95% also believing their fertility declined with age

Dunson et al, Hum Reproduction 2002: 17: 1399-4033

Barriers to Conception:

Marked lack of understanding of the effects of age on a man’s fertility

Only 2% thought male factor was a reason to have IVF

Actually the single largest reason for Australian couples to have IVF

24% of treatment cycles for male factor alone*

Not one person in the study thought a man’s age was a factor

in requiring to do IVF

34% of IVF cycles are for men over the age of 40*

*AIHW National Perinatal Statistics Unit Data 2003

Barriers to Conception:

Lack of understanding of the effects of age on a man’s fertility

Dunson et al, Hum Reproduction 2002: 17: 1399-4033

Impact of male age on chance of natural conception

Only 4 out of 100 women believed their partner’s fertility could affect their chance of conceiving

Only 20% of women have a younger partner - ABS

Barriers to Conception:

Men

94%83%88%81%63%38%

79%

Women

94%84%57%43%NANA

62%

Age

18-1920-2930-3940-4950-5960+

Total:

Think they would be able to have a child without any problems

But, only 18% of women and 7% of men didn’t understand that their fertility declines

with age

How Has Medicine Invested In Research on the Impact of Ageing on Fertility Rates ?

Impact of increasing female age on fertility

981

1st paper published circa 1952

Impact of increasing male age on fertility

10

1st paper published 1982

(30 years later)

Publications found on literature search

Barriers to Conception:

Lack of knowledge of lifestyle effects - Smoking

Active and passive smoking harms sexual and reproductive health throughout reproductive life in both men and women, compromising the ability to have children. Smoking more and for longer increases the risk.“Smoking and reproductive life” British Medical Association, 2004

A child born to a male smoker is 4 times more likely to develop

cancer in childhood

Barriers to Conception:

Lack of knowledge of lifestyle effects - Smoking

0%

10%

20%

30%

40%

50%

60%

70%

Under 20 20-29 30-39 40-49 50-59 60+

Men

Women

Despite all of this - • 39% of women and 36% of men experiencing fertility problems also

smoked. • The impact of passive smoking is not included.

• The DNA damage smoking induces in sperm and its abhorrent repair in the fertilised egg can result in embryo mutations that induce miscarriage or impair the health and fertility of the child. J Aitken et al, MJA: 185: 8: 2006

Percentage of smokers by age

Barriers to Conception:

Lack of knowledge of lifestyle effects - Alcohol

Moderate alcohol intake (1 to 5 drinks per week) increases the risk of:- Fertility problems and miscarriage in women- Fertility problems and sperm DNA fragmentation in men

Survey shows that 30% of men and 19% of women affected by fertility problems reported they drank more than two alcoholic drinks per day (14+ drinks per week)

Barriers to Conception:Lack of knowledge of lifestyle effects:Perceptions of Being Overweight

100

90

80

70

60

50

40

30

20

10

018-19 25-29 35-39 45-49 55-59 75-7965-59

20-24 30-34 40-44 50-54 60-64 80+70-74

Men

Women

Age Group in Years

% w

ith B

MI >

25

Donath, S.M., MJA 2000; 172: 375-377 – ABS Data

Only half the expected number of men surveyed in all age groups reported they were overweight.

Usual Age at Conception

People underestimate their “overweight” compared to medical definitions

Barriers to Conception:

Lack of knowledge of lifestyle effects – Increased Weight

Overweight women have an of fertility problems (2 to 5 fold increase)

of miscarriage rate (2 to 3 fold increase)

success with fertility treatment

Weight loss of 5% to 10% dramatically improves pregnancy and outcome rates.Overweight men have an of fertility problems (2 fold increase) and erectile dysfunction (3 fold increase)

9 kilo weight is sufficient to lower fertility rates

42% of men and 52% of women surveyed with fertility problems said they were

overweight.

Barriers to Conception:Inadequate diagnosis of medical problems that

affect fertility: Polycystic OvariesPolycystic ovaries is a medical condition that affects 1 in 5 women.

It has health implications throughout a woman’s life.

Diagnosis Infertility

Endometrial CancerEndometrial Cancer

DiabetesDiabetes

Ovarian cancerOvarian cancer

HypertensionHypertension

Cardiovascular DiseaseCardiovascular Disease

20 30 40 50 60 70Age in Years

Lobo R; MJA, Vol. 174, June 2001, p554Family members are also at increased risk

Barriers to Conception

Inadequate diagnosis of medical problems that affect fertility:

Polycystic Ovaries

Australian research has shown it takes 48 months on average for a woman to be diagnosed with

polycystic ovaries and its complications from the time of first presentation to a medical practitioner

20%

5%

Incidence of PCO

Diagnosed PCO

Barriers to Conception

Inadequate diagnosis of medical problems that affect fertility: Endometriosis

Genes that effect inheritance have been identified. Other women in the family effected could also miss early diagnosis. Diagnosis takes

8 to 11 years on average.

Endometriosis is a condition associated with pain, infertility and menstrual problems in which the cells that line the uterus grow

outside it.

Incidence ofEndometriosis

DiagnosedEndometriosis

30-40%

12%

Incidence of Endometriosis in

fertility patients

Diagnosed fertility patients

7%

10-15%

What Proportion of Those Surveyed Indicated a Concern About Fertility

Preservation?

86% of women surveyed had or wished to have children

but

Only 9% expressed concern about fertility preservation, principally women

in their 30’s and 40’s

How Has Medicine Invested in Research on Reproductive

Education

45% related to STD’s, 23% post cancer and

other medical conditions

Patient education

Fertility preservation

Patient education

Contraception

13,596 148

99:1 Ratio

Publications found on literature search

If People Have Fertility Problems,Who do They ask for Advice ?

Family

Friends

Natural therapist

Won’t see a Doctor

Change lifestyle

Men Women

54%

44%

34%

14%

59%

65%

61%

48%

10%

74%

But 59% of those with fertility problems have never consulted a doctor!

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Conclusions:

Fertility problems are common,affecting 1 in 6 couples

They affect over 3 million Australians

Fertility problems also impact on the couple’s extended family

Fertility problems are associated with long term health issues

Conclusions:

‘It takes two to tango’

Fertility is a couple issue

not a woman’s issue

Socially – Medically - Personally

Conclusions:Societal changes have impacted

significantly on couples.

Lifetime events are happening later so a couple might not be able to have children until the time

their fertility has already started to decline

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Finally:Australians badly need more information to make the

right choices.

They also need a

National Fertility Policyto enable all interested groups including government to

coordinate their efforts and resources

• Fertility Society of Australia• ACCESS Australia• Australian Medical Association• Andrology Australia• Australian Reproductive Health Alliance• Indigenous Australians Sexual Health Committee • Jean Hailes Foundation • Polycystic Ovarian Syndrome Association of Australia• Royal Australian College of General Practitioners • Royal Australian & NZ College of Obstetricians &

Gynaecologists• Sexual Health and Family Planning Australia

Moving towards a National Fertility Policy

Action to date:• Community survey commissioned August 2006• GP survey commissioned September 2006• FSA presentation to Parliamentary Support Group on Fertility Preservation & partners 11th

October 2006• FSA presentation to bipartisan Parliamentary Group on Population & Development 18th

October 2006• FSA meeting with RACGP National Standing

Committee for Quality Care In 2 weeks• FSA to host Fertility Information Day with

Parliamentarians and partners, Canberra 28th Nov 2006

• Prepare program for Government Funding February 2007• FSA Conference - Fertility Preservation September 2007

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Acknowledgements

• Fertility Society of Australia

• Preservation of Fertility Team• Anne Clark - Chair• Adrianne Pope• Sandra Dill • Devora Lieberman• Michael Chapman• Nicole Phillips

• Labett Research