Precious Time – Dr Aisha Alzouebi on how to time check your body

Precious Time

WORDS: AMY SESSIONS

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& Gynaecology at Mediclinic Parkview Hospital on how to time check your body so you can plan ahead, and which outdated myths you should ignore

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.

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.

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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smoking is key, exercising, losing weight if overweight and reducing stress where possible. What is the approach to egg freezing at different ages and at what stage would you advise to do this? The ideal time is between 30-35 years old. Ideally book an appointment with a recognized fertility centre. The success rates are between 5-10%. Approximately thirty eggs need to be retrieved and stored to have a good chance of achieving success. The cost of this can vary but is usually around the Dhs75,000 mark. If your older than 35, and wish to perform egg freezing, it is still possible, but the chances are reduced, and I would suggest instead to plan to start a family more immediately. At what stage is egg freezing no longer the most viable route and what should be the course of action in this case? Egg freezing isn’t viable if very few eggs are retrieved

“Social egg freezing is a false reassurance to all career women who believe that there is a way to ‘pause’ their biological clock when there isn’t.”

during egg collection. Or having a very low AMH level. At this stage your fertility Doctor may advise if you plan on having a child, to consider egg donation. What are the most outdated myths you’ve heard surrounding this subject? The most outdated myths: the main one is that women lose hope after 40. This should not be the case. The rate of IVF pregnancies increases with age, however it’s not impossible at all. Also, the hype surrounding social egg freezing is a false reassurance to all career women who believe that there is a way to “pause” their biological clock when there isn’t. How important is it for a woman or couple to get an unbiased opinion? An unbiased opinion is very important especially if there is a difference in the ages of the couple, and when each believes that they will be ready to start trying for a family. Men and women are led to believe that it’s very easy to get pregnant – so many years of contraception is factored in life to avoid unwanted pregnancy so that many couples believe that once no contraception is used, they will conceive immediately. In reality the process can take years, and those are crucial years for a woman’s egg reserves to decline. For anyone who would like more information on this subject what is the first step? I would suggest looking at: www.nhs.uk/conditions/infertility www.nice.org.uk/guidance/CG156/ifp/ chapter/Unexplained-infertility The Lister London Clinic patient leaflet – listerfertility.co.uk/treatments/fertilitypreservation-program/egg-freezing. This is The Finer Things Issue – how do you implement the finer details into your life/ work? The truth is that most women with a career are not spending enough time on focusing on themselves, or on their health or relationships. Therefore, by the time they come up for air, we have reached 40 and can’t believe where the time has gone. The only way of helping those that are younger than us, or the younger generation, is not by promising egg freezing as guarantee.