Precious Time WORDS: AMY SESSIONS
How long have you been practicing medicine and how have you seen approaches to this subject change since you started? I have been practicing since 2005. We were taught at medical school by the famous Professor Bill Ledger; he recommended that if we wanted to have children, we needed to start planning it right away. That was when I was 21 years old looking forward to an intensive medical career. The reality is that the best time for a woman to have a child is in her twentys. The approach has changed more over the last 20 years as more women have become the main bread winner for the households, more time away from the family home due to work travel, as well as meeting a partner later on in life. In the last ten years as more companies offer to pay for women to “preserve their fertility by using assisted reproductive techniques” it has created a false reassurance to women that delaying childbearing to whenever one is ready, is very easy, do-able and has a guaranteed outcome of pregnancy. I see many women who are in the late 30s to 40s who are pregnant with their first child. Ten years ago, this was far less common. The trend is that advanced maternal age pregnancies are very common in the Western world.
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How do you check the fertility of a woman and how accurate is it? Checking fertility is based on what causes infertility. There are five main reasons for infertility: 1. One is that a woman may have blocked fallopian tubes, this may be due to adhesions from previous surgeries, pelvic infections or previous pelvic infections. This can be tested by a Hysterosalpingogram or by Hysterosalpingo Contrast Sonography (HyCoSy). This is very accurate. 2. Anovulation, (for example PCOS) or low egg count – this is more difficult to monitor however ensuring that one has regular periods, and hormones which can be tested are AMH (antimuellerian hormone, FSH, LH, testosterone) 3. Endometriosis – this is diagnosed based on clinical symptoms and if there are ovarian cysts – can also be detected during a transvaginal ultrasound 4. Male factor – poor quality semen 5. Unexplained – all the tests are normal, but no pregnancy is achieved These tests are fairly accurate however they are a snapshot in time. Even if a woman undergoes these tests one year prior to attempting to conceive, this does not imply that she will be able to conceive when she wishes.
WELLNESS
What is the average age of women you work with and does this differ depending on nationality? My patient population is very mixed, 60% European and 40% from the Levant area. My European populations are mainly late 30s into 40s and the Levant are usually early to mid 30s. Middle Eastern culture is more driven towards earlier marriage and starting a family at a younger age, with European culture, usually my women have met their partners at a later stage in their lives. What are the risks of having a family later on in life? There are several and these can include an increased risk of miscarriage or stillbirth, diabetes, hypertension, deep vein thrombosis, pre-eclampsia and for the baby: chromosomal and genetic disorders. What are the main areas of lifestyle that impact a woman’s fertility and how should we be supporting living a healthy lifestyle? Stopping
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With so many women leaving it later in life to start a family, we spoke to Dr Aisha Alzouebi, Consultants Obstetrics & Gynaecology at Mediclinic Parkview Hospital on how to time check your body so you can plan ahead, and which outdated myths you should ignore
