A WOMAN’S fertility future has long been the great unknown, reports Elisa Black
First you’re not even sure you want kids then, when you finally decide it’s time, you have no idea how long it might take to fall pregnant.
You could be one of those fortunate women who falls pregnant the first time they try, it might take a few months before you strike it lucky or, years down the track, you might be wondering why you’re still not pregnant.
Unlike men, who have famously become fathers into their dotage and beyond, women’s ovaries are a little more capricious.
We are born with all the eggs we are ever going to have.
And every year, their numbers dwindle, from our fabulously fecund 20s, to our thriftier 30s, before our ovaries finally shut up shop in our 40s. But women’s bodies are complicated things and, for any number of reasons or no reason at all, some women find it hard to have a baby much earlier on.
And this is even worse news when that woman has put off children until later in life due to career, or not meeting the right partner, or it just not feeling like the right time.
But more and more Australian women are deciding to try to remove the mystery surrounding their their fertility with a local test that assesses the number of eggs they have left.
The Egg Timer Test, pioneered by Adelaide IVF clinic Repromed, estimates the number of eggs left within the ovaries and gives women an opportunity to make a more informed decision about when to start a family.
While the test isn’t new, the amount of women interested in it is increasing and it has been implemented in about a dozen clinics around the country in the last 18 months because of demand.
The Egg Timer involves a single blood test and a pelvic ultrasound between days three to five of a woman’s menstrual cycle.
Hormone levels are combined with the scan results to give an estimate of ovarian reserves.
Dr Kelton Tremellen, Repromed deputy medical director and Associate Professor at the University of South Australia, who is the inventor of the Egg Timer test, said while the test was originally designed to help predict patients’ response to IVF stimulation treatment, it soon became apparent the test could be useful for women who were debating the best time to start trying to get pregnant.
“It gives an accurate assessment of how many eggs you have for your age, relative to your peers,” he said.
“By this, I mean it identifies women who have significantly fewer eggs left within their ovaries compared to other women of the same age.
“But the results are quantitative rather than qualitative. If you get a bad result it doesn’t mean you can’t fall pregnant or that your eggs are low quality.
“Rather, it indicates that you are likely to have an early decline in fertility and go through the menopause earlier than average. For this reason, women found to have low ovarian reserve should not further delay conception if possible.”
While many women are considering pregnancy later and later in life, Dr Tremellen said the ideal candidate for the test was a woman in a relationship in her early 30s.
“The typical woman who has been requesting the test, a woman in her 40s, is not the ideal patient. We already know that there is diminished egg quality at that age,” he said.
“A woman in her early 30s, who’s in a relationship, is the ideal candidate for the Egg Timer test because, if results are bad, she can bring forward the decision to have a child.
“It’s a contentious area for a patient who is not in a relationship. A bad test result puts them in a quandary. It’s a more difficult situation when you are considering egg-freezing or sperm donation and being a single mother.”
But the test has its critics.
Professor Robert Norman, fertility specialist and director of the Robinson Institute at Adelaide University, said he would not encourage women to have the test unless they were already having trouble conceiving.
“The results have zero correlation with women’s fertility,” he said.
“A woman could be 30 and have low egg reserves and still be normally fertile as the test tells you nothing about egg quality.
“With inadequate counselling the test can cause enormous stress.
“I have had many women coming to me who have panicked after receiving bad results and thinking they would need IVF and I think it is often used to scare people into inappropriate fertility treatment when they didn’t need it. Practically, if someone chooses to have the test and it galvanises them to not delay having a child, that’s it.
“But the best predictor of fertility potential is still age.”
There is often more to consider on the road to having a baby than just the biological.
Centacare relationships counsellor Pauline Connelly said that life was meant to be unpredictable and it was healthy to not always have control.
“The right time to have a baby is when you feel ready for it and when your relationship is ready for it,” she said.
“To be reliant on a scientific test can make us really vulnerable to situations or needs or urges that may cause us to make decisions that may not be the best for us at that time in our lives.”
Danielle James had a five year plan.
At almost 35, the police officer knew exactly where she wanted to be with her career by her 40th birthday but, single after her marriage dissolved four years earlier, she hadn’t given much thought to children.
It was only when her GP suggested she think about whether children might be a part of her future that she decided to take the Egg Timer test.
And the extremely fit avid surfer, who didn’t smoke, drink or take drugs, who ate well and took care of herself, was told that her egg reserves were extremely low and that she had just a three per cent chance of conceiving with IVF.
“You’re sold the dream from childhood,” she said.
“That you’ll meet the prince, buy the house with the white picket fence, and have children, but for so many women it doesn’t happen in that order.
“I’ve always been a woman who takes control of their life.
“I just immediately thought I need to take control of the situation. I became as educated as I could so I could make my own choices.
“It wasn’t my choice to become single at 31, but it was my choice what I did from there.”
Danielle decided immediately to start trying for a baby and, with the aid of a sperm donor, underwent IVF for two years.
The results were not good.
“The first time there were hardly any eggs and they were so expired that even if they had been able to be fertilised they wouldn’t have lasted,” she said.
“I had another go but at that point was told that IVF with my own eggs was virtually impossible.”
Thinking the only option was to buy a donor egg from America, Danielle accepted a security job in Iraq to try to raise the $60,000 needed. But before she left for the Middle East, she managed to convince her doctors to let her give IVF one more try.
“That last shot was my son,” she said of Flynn, who was born in 2008.
“I’m so glad I took the test because I didn’t expect that result, you just don’t know.
“I’ve explored the option of more children and I’d love to have them but, realistically, if my eggs were that bad at that age it doesn’t look good now.
“I could not imagine my life without Flynn and there’s no place I’d rather be than with him.
“I’m very lucky, he brings so much joy to my life.”