Transcript Document

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?
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
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
300
300
400
700
Sample from 2,400 Australians
600
100
What Makes This Study Unique?
The first time an entire country’s adult
population has been sampled in relation to its
knowledge and experience of 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.
Results:
Ages and Percentage With Children of Those Surveyed
30%
Total
% Who Have Children
25%
20%
15%
10%
5%
0%
18-19
20-29
30-39
40-49
50-59
60+
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)
Results:
There were no significant differences in
results between different states or rural
and urban areas.
400
300
300 will only be split by
Presentation
of results
age and gender when a difference occurs
700
600
100
Is Infertility a Modern Issue? No!
Those That Took More Than 12 Months to Conceive a Planned Pregnancy
Shown as a Percentage of Current Age Group
20%
18%
16%
14%
First Child
Second Child
Third Child
12%
10%
8%
6%
4%
2%
0%
30-39 year olds
40-49 year olds
50-59 year olds
60+
1 in 6 couples affected consistently from aged 20 onwards.
This represents over 3 million Australians
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.
10 million
Median age of
women marrying
1979
2002
1 million
Number of
eggs available
100,000
1999
10,000
1,000
10
20
30
40
20 years later over 54% of men and 40% of women of
the same age were still living at home
50
Age
MJ Faddy et al, Mol Cell Endocrinol,
163:43-48, 2000
Australian Bureau of Statistics data
Survey Results:
Percentage of Sample Who Had Their First Child
Under the Age of 30
Women
Men
92%
75%
27%
20%
1976
2006
1 in 4 unplanned
1 in 2 unplanned
Results:
Percentage Who had Unplanned First Children
and Treatments for STI
46%
22%
28%
26%
26%
Age
20-29
30-39
40-49
50-59
60+
STI
7%
5%
5%
2%
2%
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
Stable relationship
Good income
Partner not ever wanting children
M = 26%
Your age
F = 38%
Owning a home
Own career
You not wanting children ever
M = 19%
Partner's career
F = 34%
Your partner's age
0%
10%
20%
30%
40%
50%
60%
70%
Two, then three was the most preferred family size
80%
Barriers to Conception:
Pre-requisites for Having Children
Fertility Decision Making Project, 2004
Men Women
Rank Rank
Afford to support child
Partner make a good parent
Male partner make a good parent
Having someone to love
Male partner’s job security
Female partner’s age
Add purpose/meaning to life
Male partner’s age
Male partner established in job
Giving child(ren) a brother/sister
Female partner’s job security
Child would be good for relationship
Ability to buy/renovate/move home
Female partner established in career
1
1
3
4
5
6
8
9
10
11
14
15
15
19
1
3
2
7
4
5
11
9
13
13
12
19
17
13
Two, then three was the most preferred family size
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
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
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
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
Barriers to Conception:
Think they would be able to have a
child without any problems
Age
Women
Men
18-19
20-29
30-39
40-49
50-59
60+
94%
84%
57%
43%
NA
NA
94%
83%
88%
81%
63%
38%
Total:
62%
79%
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 ?
Publications found on literature search
Impact of increasing
female age on fertility
Impact of increasing
male age on fertility
981
10
1st paper published circa
1952
1st paper published 1982
(30 years later)
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:
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
70%
60%
Men
50%
40%
Women
30%
20%
10%
0%
Percentage of smokers by age
Under 20
20-29
30-39
40-49
50-59
60+
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
Usual Age at Conception
100
90
Only half
the
expected
number
of men
surveyed
in all age
groups
reported
they were
overweight.
% with BMI > 25
80
70
60
50
40
30
Men
20
Women
10
0
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
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.
Age in Years
Diagnosis
20
30
40
50
60
70
Infertility
Endometrial Cancer
Diabetes
Ovarian cancer
Hypertension
Cardiovascular Disease
Family members are also at increased risk
Lobo R; MJA, Vol. 174, June 2001, p554
Barriers to Conception
Inadequate diagnosis of medical problems
that affect fertility: Polycystic Ovaries
20%
Incidence of PCO
Diagnosed PCO
5%
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
Barriers to Conception
Inadequate diagnosis of medical problems that
affect fertility: Endometriosis
Incidence of
Endometriosis
Diagnosed
Endometriosis
10-15%
7%
Incidence of
Endometriosis in
fertility patients
Diagnosed fertility
patients
30-40%
12%
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.
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
Publications found on literature search
99:1 Ratio
Patient education
Patient education
Contraception
Fertility preservation
13,596
148
45% related to STD’s,
23% post cancer and
other medical conditions
If People Have Fertility Problems,
Who do They ask for Advice ?
Men
Women
Family
54%
65%
Friends
44%
61%
Natural therapist
34%
48%
Won’t see a Doctor
14%
10%
Change lifestyle
59%
74%
But 59% of those with fertility problems have
never consulted a doctor!
Conclusions:
Fertility problems are common,
affecting 1 in 6 couples
They affect over 3 million Australians
400
300
300
Fertility problems also impact on the
couple’s extended family
700
Fertility problems are associated
600
with long term health issues
100
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
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
400
300 of Australia 300
• Fertility Society
• ACCESS Australia
• Australian Medical Association
• Andrology Australia
700
• Australian Reproductive Health Alliance
• Indigenous Australians Sexual Health Committee
• Jean Hailes Foundation
600
• Polycystic Ovarian Syndrome Association of Australia
• Royal Australian College of General Practitioners
100
• 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
• GP survey commissioned
• FSA presentation to Parliamentary Support
Group on Fertility Preservation & partners
• FSA presentation to bipartisan Parliamentary
Group on Population & Development
• FSA meeting with RACGP National Standing
Committee for Quality Care
• FSA to host Fertility Information Day with
Parliamentarians and partners, Canberra
• Prepare program for Government Funding
• FSA Conference - Fertility Preservation
August 2006
September 2006
11th October 2006
18th October 2006
In 2 weeks
28th Nov 2006
February 2007
September 2007
Acknowledgements
• Fertility Society of Australia
• Preservation of Fertility Team
• Anne Clark - Chair400
300Pope
300
• Adrianne
• Sandra Dill
• Devora Lieberman 700
• Michael Chapman
600
• Nicole Phillips
• Labett Research
100
1000