Health

Is a Cambridge president right in warning her students against putting off pregnancy?

When I was 14, I had a baby. All the girls in my year had one. They weren’t real, of course. They were robotic dolls – given to us at school to teach us, I presume, why we shouldn’t rush off and get pregnant in a hurry.

The wretched doll let out sporadic, deafening shrieks 12 times a day. This would stop only if you touched a toy bottle to its mouth or put a toy nappy on its bottom.

A computer inside its plastic belly monitored the number of times you ‘soothed’ it. The greater the score, the more likely you were to pass the task and, presumably, be a good mother.

About five hours into my three-day parental stint, I gave up. I had important things to do, like go to the cinema and try to wangle someone’s older sister’s driving licence, so I could buy alcopops from the newsagent. I’m afraid that a baby didn’t fit in.

So I shoved it into a plastic bag. And then the boot of my mother’s car. And, eventually, into the garage. Unsurprisingly, I failed the task, as did most of the pupils. One friend actually managed to break the doll, leaving it in permanent cry mode.

And judging by the number of girls at my school who had babies in their teens, it didn’t put them off.

I thought of this last week when I read that students at Cambridge may soon be offered lessons in fertility. Dorothy Byrne, the new president of all-female Murray Edwards College, plans to introduce seminars to warn Britain’s brightest young women about the perils of ‘leaving it too late’.

Eve Simmons, pictured while in school, second right, was handed a robot baby at the age of 14 along with her friends with the intention of teaching them the constant demands of having a baby

Eve, pictured, has just turned 30 and feels as if she is being constantly reminded of her ticking biological clock

Eve, pictured, has just turned 30 and feels as if she is being constantly reminded of her ticking biological clock

Dorothy Byrne, pictured, the new president of all-female Murray Edwards College, plans to introduce seminars to warn Britain¿s brightest young women about the perils of ¿leaving it too late¿

Dorothy Byrne, pictured, the new president of all-female Murray Edwards College, plans to introduce seminars to warn Britain’s brightest young women about the perils of ‘leaving it too late’

The former head of news at Channel 4 thinks they need warning, early on in life, that the chances of conceiving begin to drop ‘significantly’ after the age of 35.

It struck a chord with me. Aged 30, I feel like I am constantly being reminded of my biological clock – be it by pushy relatives who ask if my fiance and I are ‘thinking about starting a family soon’ or by television programmes. And to be honest, robot babies aside, I feel like I’ve grown up with these sorts of messages: in Friends and Sex And The City, episodes seemed to revolve around the female characters, all in their late 20s or mid-30s, obsessing about how they needed to get married so they could get pregnant.

And on the flipside, women who don’t have children – both in real life and portrayed in pop culture – are seen as slightly sad, even selfish or freakish.

I’m just not convinced the proposed Cambridge lessons are needed, or particularly useful for young women taking the first steps in what may become a career.

To find out more, we invited Dorothy Byrne to argue her case on The Mail on Sunday’s Medical Minefield. ‘Young women know their fertility declines significantly at the age of 35, but in my experience, they don’t know the specific facts,’ she told me.

Interestingly, Dorothy had her first child at 44, after fertility treatment. She said: ‘I wish I’d known that there’d be such a huge difference between trying to get pregnant at the age of 38, and then 40, and then after.’

Fair enough. But is university the right time for such a discussion?

‘I absolutely think it is,’ she said. ‘You need to give people information quite a bit before they will actually need it – so that they’re armed with it, ready.’

Dorothy Byrne isn’t alone in becoming concerned about women ‘missing out’. Last month, reproductive medicine expert and chairman of the Fertility Education Initiative, Professor Adam Balen, suggested putting warnings on contraception, alerting women to the risks of ‘leaving it too late’.

‘With cigarettes, you have health warnings about the adverse effects of smoking. You could have that on contraception, whether it’s a pack of condoms you get from the pub or the contraceptive pill,’ he said.

Eve Simmons was handed a robot baby aged 14 along with all other girls in her year to teach them how demanding a baby could be. She abandoned the experiment within five hours of the three-day stint

Eve Simmons was handed a robot baby aged 14 along with all other girls in her year to teach them how demanding a baby could be. She abandoned the experiment within five hours of the three-day stint

His comments come as official figures show the UK birth rate has dropped to historically low levels – 1.58 babies per woman.

But is the answer to tell students to get on with it?

No, says London-based gynaecologist, Dr Jess McMicking. ‘There’s a long gap between coming out of school aged 19 or 20 and the stage in life most women have kids. As a young student, you’re at a vulnerable age, surrounded by huge pressures in terms of exams, career prospects and social life. I don’t think it’s the right time to be flogging this information.’

But what about the dreaded biological clock? Well, there is truth to it. But the idea that a woman’s fertility falls off a cliff in her mid-30s is simply not true.

Of course, the number of eggs women have reduces over time.

By the age of 30, she has about 13 per cent of the two million eggs she had at birth. Those not released during ovulation either die or are reabsorbed into body. But that’s still about 150,000 eggs. After 30, that number continues to fall, and the quality of eggs declines, meaning a higher risk of the baby developing genetic problems such as Down’s syndrome.

Studies show there’s a one in three chance a woman will get pregnant at each cycle in her 20s, compared with a one in five chance in her 30s.

Over a year, roughly 82 per cent of women trying to get pregnant will succeed when the mother is aged up to 39, according to a 2004 French study.

By the age of 41, the statistics are less favourable – but women still have a 40-50 per cent chance of natural conception, according to Dr Nick Raine-Fenning, consultant gynaecologist at the University of Nottingham.

‘There is no cliff at all, it’s more of a very gradual decline,’ he said. ‘If you’re 36, for instance, it might just take you a bit longer to get pregnant than if you were in your late 20s – but it doesn’t mean you won’t.’

Experts say the myths about a sudden drop in a woman’s fertility after 35 are rooted in old research that used data going back to the 1700s, when women were in poorer health, and also the outcomes of IVF.

Couples undergo IVF because they can’t conceive naturally, for myriad reasons that may well not be related to age. A 38-year-old woman has a 20 per cent chance of getting pregnant with the treatment.

‘It’s after the age of about 42 that the success rate for IVF drops off dramatically if women are using their own eggs,’ says Dr Raine-Fenning.

But it’s not right to look at these figures and apply them to every woman. A recent study, drawing on success rates from 10,000 Dutch couples trying to conceive naturally, suggested that, even at 41, couples may have a 75 per cent chance of succeeding at least once.

If you do need to undergo IVF, it’s no quick fix. It can also be expensive. Recent figures show only 20 per cent of local NHS trusts fund the recommended three cycles, and private treatment can cost from £3,000 a go. But medical advances mean it is more successful than ever – if women do struggle in their mid-late 30s. Statistics from the Human Fertilisation and Embryology Authority last year showed success rates have tripled since the 1990s.

By the age of 30, she has about 13 per cent of the two million eggs she had at birth. Those not released during ovulation either die or are reabsorbed into body. But that¿s still about 150,000 eggs. After 30, that number continues to fall, and the quality of eggs declines, meaning a higher risk of the baby developing genetic problems such as Down¿s syndrome

By the age of 30, she has about 13 per cent of the two million eggs she had at birth. Those not released during ovulation either die or are reabsorbed into body. But that’s still about 150,000 eggs. After 30, that number continues to fall, and the quality of eggs declines, meaning a higher risk of the baby developing genetic problems such as Down’s syndrome

‘If women are in their early 40s and struggling, there is generally something we can try to help them have children,’ says Dr Virginia Beckett, a consultant gynaecologist at Bradford Teaching Hospitals.

The risks of pregnancy complications that come with older age should not to be dismissed. In the spring, experts in Scotland raised the alarm about a record number of annual caesarean section births – 39 per cent of all babies – which they blamed on older mothers bringing age-related complications. Emergency caesarean sections are almost twice as likely in women over 40.

‘We are seeing more older women having babies, and it is associated with an increased frequency of complications during childbirth,’ says Dr McMicking.

‘But these births can be perfectly safe. Often it’s just about staff being prepared and taking the right precautions. The increase of conditions like Down’s Syndrome is a lot higher over the age of 40, but when you compare 30 to 35-year-old mothers with those aged 35-40, there’s not a huge difference.’

There are others in this story who are all too often neglected: men. ‘The chaps are rarely included in this conversation – and yet a third of fertility problems are male related,’ says Dr Raine-Fenning. Dr Beckett says that for half the couples she sees seeking fertility treatment, the sperm is the problem.

Doctors at Hull Royal Infirmary followed more than 2,000 couples over a year and found that when a man was 45, the couple took five times longer to conceive – regardless of the woman’s age. One reason posed by experts is the increased likelihood of erectile dysfunction as men get older – between 40 and 50 per cent of men over 40 are thought to suffer from it.

Other US studies have shown that babies born to fathers aged over 45 are more likely to be born prematurely, be stillborn and have birth defects such as congenital heart disease, no matter how old the mother.

Although the number of sperm produced is plentiful in a man’s 40s, the quality of cells is thought to drop dramatically. Specifically, a greater proportion of cells become irregular in shape and structure, increasing the likelihood of foetal abnormalities.

‘We’re seeing more men than ever who are making lifestyle choices that affect their fertility,’ says Dr Beckett. ‘The use of anabolic steroids or protein powders, which men use to gain muscle, can affect sperm production, as can sexually transmitted diseases, which are on the rise.

‘These are all massive issues affecting male fertility which require urgent discussion.’

Over the past few years, experts have voiced concerns over an increasing decline in sperm counts of British men. One study examining sperm samples at an Aberdeen fertility clinic over more than a decade found that sperm counts have dropped by an average of a third since 2004.

Elsewhere, some fertility experts say that they are treating nearly twice as many men now compared with a decade ago.

Dorothy Byrne admits that she was ‘lucky’ because she had the financial security to have a baby without a partner, using a sperm donor.

For most women I know, this is not a viable option – nor is it their first choice. It’s all very well telling women to hurry up and have kids, but, for most, it’s not exactly a one-woman job.

‘There’s always a risk with these discussions that you push women to rush into trying for a baby when they’re in an unhealthy relationship,’ Dr Raine-Fenning says.

Studies show there¿s a one in three chance a woman will get pregnant at each cycle in her 20s, compared with a one in five chance in her 30s

Studies show there’s a one in three chance a woman will get pregnant at each cycle in her 20s, compared with a one in five chance in her 30s

Dr McMicking agrees: ‘You have to be careful when talking to young, impressionable women that you’re not pushing them into a situation they’re not ready for.’

And not being ready for a child is as risky as ever – for both mother and baby.

Only half of pregnancies in the UK every year are planned, with the rest either pleasant surprises or unwanted, according to studies. Unplanned or ‘ambivalent’ pregnancies are associated with subsequent mental health problems for mothers including post-natal depression, as well as obstetric complications.

I have a better suggestion. Instead of trying to frighten, sorry, remind young women – or men – about their fertility prospects, schools and universities could offer advice on how to better manage money.

A recent study of 177,000 young parents by the charity Action For Children found that nearly half of parents in their mid-twenties couldn’t cope financially.

We have ‘life lessons’ about having babies and being a mother rammed down our throats from an early age, but are told almost nothing about how to afford it.

How about lectures on how important it is to open a savings account, or find a decent pension plan – something I wish I’d known about far earlier – or on how to apply for a mortgage, or invest in the stock market?

Those are lessons I’d back in a heartbeat.


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