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National Fertility Study 2006

National Fertility Study 2006. Australians’ Experience and Knowledge of Fertility Issues. Dr Anne Clark , MPS, MBChB, FRCOG, FRANZCOG, CREI. Chair, Preservation of Fertility. Why Do This Study?.

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National Fertility Study 2006

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  1. National Fertility Study 2006 Australians’ Experience and Knowledge of Fertility Issues Dr Anne Clark, MPS, MBChB, FRCOG, FRANZCOG, CREI Chair, Preservation of Fertility

  2. 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. • Until there is good quality evidence, programs and practice can only be opinion based. * Fertility Decision Making Project, 2004

  3. 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 400 300 300 700 600 Sample from 2,400 Australians 100

  4. What Makes This Study Unique? • The first time an entire country’s adult • population has been sampled in relation to its knowledge and experienceof fertility issues. • 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.

  5. 30% Total % Who Have Children 25% 20% 15% 10% 5% 0% 18-19 20-29 30-39 40-49 50-59 60+ Results: Ages and Percentage With Children of Those Surveyed

  6. 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)

  7. 400 300 300 700 600 100 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

  8. 20% First Child 18% Second Child 16% Third Child 14% 12% 10% 8% 6% 4% 2% 0% 30-39 year olds 40-49 year olds 50-59 year olds 60+ Is Infertility a Modern Issue? No! Those That Took More Than 12 Months to Conceive a Planned PregnancyShown as a Percentage of Current Age Group • 1 in 6 couples affected consistently from aged 20 onwards. • This represents over 3 million Australians

  9. But … The Time for Couples to Conceive has Significantly Reduced !! • Due to the later timing of events in people’s lives which generally lead to family formation. • Median age of women marrying • 1979 • 2002 • 10 million • 1 million • Number of • eggs available • 100,000 • 1999 • 10,000 • 1,000 • 10 • 20 • 30 • 40 • 50 • Age • 20 years later over 54% of men and 40% of women of the same age were still living at home • MJ Faddy et al, Mol Cell Endocrinol, • 163:43-48, 2000 • Australian Bureau of Statistics data

  10. Survey Results: Percentage of Sample Who Had Their First Child Under the Age of 30 Women 92% Men 75% 27% 20% 1976 2006 1 in 4 unplanned 1 in 2 unplanned

  11. Results: Percentage Who had Unplanned First Children and Treatments for STI 46% 28% 26% 26% 22% Age 20-29 30-39 40-49 50-59 60+ 7% 5% 5% 2% 2% STI 8% of IVF cycles in 2003 for tubal disease cf 28% in 1994

  12. M = 26% M = 19% F = 34% F = 38% Barriers to Conception:Pre-requisites for Having Children Rated as Very Relevant Stable relationship Good income Partner not ever wanting children Your age Owning a home Own career You not wanting children ever Partner's career Your partner's age 0% 10% 20% 30% 40% 50% 60% 70% 80% • Two, then three was the most preferred family size

  13. Male partner make a good parent • 3 • 2 • Partner make a good parent • 1 • 3 Barriers to Conception:Pre-requisites for Having Children Fertility Decision Making Project, 2004 • Men Women • Rank • Rank • Afford to support child • 1 • 1 • Having someone to love • 4 • 7 • Male partner’s job security • 5 • 4 • Female partner’s age • 6 • 5 • Add purpose/meaning to life • 8 • 11 • Male partner’s age • 9 • 9 • Male partner established in job • 10 • 13 • Giving child(ren) a brother/sister • 11 • 13 • Female partner’s job security • 14 • 12 • Child would be good for relationship • 15 • 19 • Ability to buy/renovate/move home • 15 • 17 • Female partner established in career • 19 • 13 • Two, then three was the most preferred family size

  14. Barriers to Conception:Pre-requisites for Having Children • 1 in 3 women in their late 20’s and 30’s have no partner … Sydney Morning Herald, 2002

  15. Barriers to Conception:Lack of understanding of the effects of age on a woman’s fertility Dunson et al, Hum Reproduction 2002: 17: 1399-4033 • 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

  16. 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

  17. Barriers to Conception:Lack of understanding of the effects of age on a man’s fertility Impact of male age on chance of natural conception Dunson et al, Hum Reproduction 2002: 17: 1399-4033 Only 20% of women have a younger partner - ABS Only 4 out of 100 women believed their partner’s fertility could affect their chance of conceiving

  18. Barriers to Conception: • Think they would be able to have a child without any problems • Age • 18-19 • 20-29 • 30-39 • 40-49 • 50-59 • 60+ • Total: • Women • 94% • 84% • 57% • 43% • NA • NA • 62% • Men • 94% • 83% • 88% • 81% • 63% • 38% • 79% • But, only 18% of women and 7% of men didn’t understand that their fertility declines with age

  19. How Has Medicine Invested In Research on the Impact of Ageing on Fertility Rates ? • Publications found on literature search • Impact of increasing male age on fertility • 10 • 1st paper published 1982 (30 years later) • Impact of increasing female age on fertility • 981 • 1st paper published circa 1952

  20. 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

  21. 70% 60% Men 50% 40% Women 30% 20% 10% 0% Under 20 20-29 30-39 40-49 50-59 60+ Barriers to Conception:Lack of knowledge of lifestyle effects - Smoking • 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

  22. 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 menSurvey 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)

  23. Barriers to Conception:Lack of knowledge of lifestyle effects:Perceptions of Being Overweight Usual Age at Conception 100 90 80 70 60 50 40 30 20 10 0 Only half the expected number of men surveyed in all age groups reported they were overweight. % with BMI > 25 Men Women 18-19 25-29 35-39 45-49 55-59 65-59 75-79 20-24 30-34 40-44 50-54 60-64 70-74 80+ Age Group in Years Donath, S.M., MJA 2000; 172: 375-377 – ABS Data People underestimate their “overweight” compared to medical definitions

  24. Barriers to Conception:Lack of knowledge of lifestyle effects – Increased Weight Overweight women have an Çof fertility problems (2 to 5 fold increase) Çof miscarriage rate (2 to 3 fold increase) Èsuccess with fertility treatment Weight loss of 5% to 10% dramatically improves pregnancy and outcome rates. Overweight men have an Çof fertility problems (2 fold increase) and Ç erectile dysfunction (3 fold increase) 9 kilo weight Ç is sufficient to lower fertility rates 42% of men and 52% of women surveyed with fertility problems said they were overweight.

  25. 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. Age in Years 20 30 40 50 60 70 Diagnosis Infertility Endometrial Cancer Diabetes Ovarian cancer Hypertension Cardiovascular Disease Family members are also at increased risk Lobo R; MJA, Vol. 174, June 2001, p554

  26. Barriers to Conception Inadequate diagnosis of medical problems that affect fertility: Polycystic Ovaries 20% Incidence of PCO 5% Diagnosed PCO 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

  27. Incidence of Endometriosis 10-15% Diagnosed Endometriosis 7% Incidence of Endometriosis in fertility patients 30-40% 12% Diagnosed fertility patients 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.

  28. 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

  29. How Has Medicine Invested in Research on Reproductive Education Publications found on literature search 99:1 Ratio Patient education Contraception Patient education Fertility preservation 148 13,596 45% related to STD’s, 23% post cancer and other medical conditions

  30. If People Have Fertility Problems, Who do They ask for Advice ? Men Women Family Friends Natural therapist Won’t see a Doctor Change lifestyle 54% 44% 34% 14% 59% 65% 61% 48% 10% 74% But 59% of those with fertility problems have never consulted a doctor!

  31. 400 300 300 700 600 100 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

  32. Conclusions: ‘It takes two to tango’ Fertility is a couple issue not a woman’s issue Socially – Medically - Personally

  33. 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

  34. Finally: 400 300 300 700 600 100 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

  35. 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

  36. 400 300 300 700 600 1000 100 Acknowledgements • Fertility Society of Australia • Preservation of Fertility Team • Anne Clark - Chair • Adrianne Pope • Sandra Dill • Devora Lieberman • Michael Chapman • Nicole Phillips • Labett Research

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