Having babies! It’s a part of so many people’s life plans. But for those who want kids, when is the ideal time to start trying? Our knowledge of fertility (our ability to conceive a pregnancy) and of how age affects fertility has a real impact on our aspirations and plans for family. But how much do we really know? And what could be skewing our knowledge? In this episode we cover some super important fertility research, including a study led by our own Dr Aleena Wojcieszek! Plus, Janine vents about one of her particularly triggering “bug bears” (hint) and Aleena has been staring into the eyes of The King (King Bowie, that is).
Mastering of this episode, intro and outro music, and “What can we learn from David Bowie?” theme music by the ever-talented Dr Adrian Diery.
What do young people know about how age affects fertility? Can their knowledge be improved?
You only have to look around to see that many people are having children later in life. But knowledge around how age impacts on fertility is lacking, especially among young adults. When asked to predict how likely they will be able to conceive a child at different ages, young adults tend to overestimate things. Previous research tells us that women’s fertility starts to decline, on average, as early as age 27, and women’s fertility declines significantly, on average, from age 35. Men’s fertility starts to decline, on average, from age 35.
At the same time, more and more individuals and couples are using reproductive technologies, such as in vitro fertilisation (IVF). For sure these technologies are amazing, but they may lead to a false sense of security among young people: many may think they will be fine conceiving at later ages and, if not, IVF will be a straightforward and effective fix if required. In reality, only 18.1% of assisted reproductive technology (ART) treatment cycles completed in Australia and New Zealand in 2010 resulted in the birth of a live baby. It’s pretty clear that many people may be making uninformed decisions around family planning. And this may lead many to be unable to achieve their family aspirations.
Sister Doctor Squared’s very own Dr Aleena Wojcieszek (#squeal) and awesome collaborator Dr Rachel Thompson were keen to test whether a specific intervention could improve young people’s understanding of how age impacts on fertility and on the effectiveness of IVF. They also wanted to explore what effect such knowledge might have on the age at which people desire to have their own children.
137 female and male university students participated and were each allocated to a control or intervention group. Participants completed an online pre-test survey to establish their existing knowledge around fertility, infertility and IVF effectiveness, in addition to their personal preferences around having children. Participants in the intervention group were then shown an online information brochure with accurate statistics around fertility and IVF. Those in the control group saw a comparable “control” brochure about home ownership.
All participants then completed an online post-test survey containing the same questions as the pre-test survey, as a test of whether their knowledge and/or preferences had changed. Significant shifts were seen for the intervention group after the intervention: their knowledge of age-related fertility decline, and of IVF effectiveness, was significantly better. No shifts were seen in the control group. Participants from the intervention group also reported that they wanted to have both their first and their last child at significantly younger ages after than before reading brochure. Again, there was no shift in the control group.
So we can see that providing accurate information to young adults does improve their awareness of age-related fertility decline AND true effectiveness of IVF. Plus, this information did lead to reassessment of when participants would like to start and stop having children. It’s important to point out that the decision around whether and when to have children is a very big and complicated one; knowledge around fertility is just one thing factoring into these decisions. Society and systemic issues can often mean that many individuals may not be able to conceive at the age of their choosing…
Can a blood test tell women how fertile they are?
Have you heard of the so called “egg timer” or “ovarian reserve” test? This blood test is being heavily marketed to women as a test that can tell them how fertile they are, and therefore when might be the best time to start trying to conceive. But is the test reliable?
The egg timer test measures anti-mullerain hormone (AMH). Anti-mullerian hormone is produced by the ovaries and it decreases as women age. The AMH test gives an indication of how many remaining eggs a woman has in her ovaries. The problem is, the AMH test is not that great at predicting a woman’s chance of conceiving. In fact, there’s evidence that women with low AMH levels have the same chance of conceiving as women with normal AMH levels.
So why do we use this test? The AMH test is used in fertility clinics for women who are going through fertility treatments, like IVF. But outside of this, the test has limited usefulness, and it could actually cause harm…
So who is using this test and why, and where did they find out about it? Researchers Dr Tessa Copp, Dr Rachel Thompson (the very same as in the first paper we covered in this episode!) and others wanted to know the state of play in Australia. They surveyed 1773 women aged 18-55 years either online or by phone to find out.
Of the 1773 women surveyed, 13% had heard of the test and 7% had done the test. Women who had used the test had mostly heard about it from a fertility specialist or their general practitioner (GP), and this was how they accessed the test. This means doctors seem to be the main drivers of use of the test.
Just over half of the women who did the test said they did so as part of fertility treatment. But 19% said they did it because they were thinking about getting pregnant soon and wanted to know their chances of conceiving – exactly what the test can’t tell you. Some of the other reasons for having the test were that women were curious about their fertility, or that they were considering delaying childbearing and wanted to know if this was a good idea. Again, the test can’t tell you that.
These latter findings are concerning because they show that one third of the women took the test thinking it could give them information which it just can’t. There’s clearly some faulty information and advertising that is getting through to women, and this is undermining women’s ability to make informed decisions. Education for the public and for health professionals is clearly needed.
What brought out our inner square?
Janine tells us about her simultaneous feelings of delight and horror while watching Alone Australia. One contestant, Michael, called millipedes “bugs” (this is incorrect; only “true bugs” from the Insect Order Hemiptera are “bugs”, like the amazingly awesome assassin bugs. Millipedes are not event insects! Moving on…).
Said contestant then attempts to eat the millipedes. Janine, whose PhD was on millipedes, wants you all to know this is a big no no. All millipedes are toxic to varying degrees and the Order Janine worked on, the Polydesmida, actually produce hydrogen cyanide – GASP – the same chemical that can stop your cells from performing cellular respiration and keeping you alive and stuff ! Janine found this out “accidentally” while in the animal behaviour lab one day #FunTimes. Hydrogen cyanide made it tough for Janine to do basic stuff with millipede tissue samples in the DNA lab (Janine chats about it in this paper).
Thankfully, Michael tried to eat introduced Portuguese Millipedes, which are from the order Julidae and release quinones – they would taste gross, but aren’t deadly.
PSA: do not eat millipedes. Just leave those funky little critters be 🙂
What can we learn from David Bowie?
Aleena discovered the true origin of David Bowie’s striking, spooky, alien-like eyes. You may think he had two different coloured irises (a condition called heterochromia), but you would be wrong! Take a closer look and you will see David Bowie’s left pupil was much larger than his right – in his case it was permanently dilated. This gives the impression of the left eye being darker, and some pretty hectic “red eye” in photographs. It’s a condition called anisocoria and it helped contribute to Bowie’s otherworldly presence. Read more in this article by Kevin Hunt.
Top image by Rodolfo Barreto Rodolfo Barreto on Unsplash
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