Presentation on theme: "National Fertility Study 2006 Dr Anne Clark, MPS, MBChB, FRCOG, FRANZCOG, CREI Dr Anne Clark, MPS, MBChB, FRCOG, FRANZCOG, CREI Chair, Preservation of."— Presentation transcript:
National Fertility Study 2006 Dr Anne Clark, MPS, MBChB, FRCOG, FRANZCOG, CREI Dr Anne Clark, MPS, MBChB, FRCOG, FRANZCOG, CREI Chair, Preservation of Fertility Australians’ Experience and Knowledge 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.
The Fertility Society of Australia’s aim is to promote and improve Australasian reproductive health. Therefore, it wishes to ensure that all couples have access to information that enables them to have children as quickly and easily as possible when the time comes. All research funds for 2006 were committed to this project. Why Do This Study ?
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 600 700 400 300 100 Sample 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% 18-1920-2930-3940-4950-5960+ 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)
600 700 400 300 100 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 olds40-49 year olds50-59 year olds60+ 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 1020304050 19792002 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% 19762006 Women Men 1 in 4 unplanned1 in 2 unplanned
Results: Percentage Who had Unplanned First Children and Treatments for STI 46% 60+ 22% 28% 26% 50-5940-4930-3920-29 Age STI 2% 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 11Afford to support child 99Male partner’s age 1913Female partner established in career 13Partner make a good parent 54Male partner’s job security 65Female partner’s age 1412Female partner’s job security 47Having someone to love 811Add purpose/meaning to life 1013Male partner established in job 1113Giving child(ren) a brother/sister 32Male partner make a good parent 1519Child would be good for relationship 1517Ability 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% NA 62% Age 18-19 20-29 30-39 40-49 50-59 60+ 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 1 st paper published circa 1952 Impact of increasing male age on fertility 10 1 st 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: Major reproductive health effects and age groups affected by smoking “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 0-11520304050607080 Age affected - years Infant health Childhood health Impotence Cervical cancer Early menopause Menopausal systems Fertility Pregnancy Men Women
Barriers to Conception: Lack of knowledge of lifestyle effects - Smoking 0% 10% 20% 30% 40% 50% 60% 70% Under 2020-2930-3940-4950-59 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 0 18-1925-2935-3945-4955-5975-7965-59 20-2430-3440-4450-5460-6480+70-74 Men Women Age Group in Years % with BMI > 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 Ovaries Polycystic ovaries is a medical condition that affects 1 in 5 women. It has health implications throughout a woman’s life. DiagnosisInfertility Endometrial Cancer Diabetes Ovarian cancer Hypertension Cardiovascular Disease 203040506070Age in Years Lobo R; MJA, Vol. 174, June 2001, p554 Family 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 of Endometriosis Diagnosed Endometriosis 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 MenWomen 54% 44% 34% 14% 59% 65% 61% 48% 10% 74% But 59% of those with fertility problems have never consulted a doctor!
600 700 400 300 100 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
600 700 400 300 100 Finally: Australians badly need more information to make the right choices. They also need a National Fertility Policy to 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 18 th 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
600 700 400 300 100 1000 Acknowledgements Fertility Society of Australia Preservation of Fertility Team Anne Clark - Chair Adrianne Pope Sandra Dill Devora Lieberman Michael Chapman Nicole Phillips Labett Research