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The part Kenny show on news talk with Marter private network during current restrictions. Don't ignore your health concerns. Our expert team is ready to help. Well, now it's time to talk fragility, and with us is the medical director of the Waterstones Clinic, Dr. John Waterstones. John, good morning and welcome.


Good morning, Pat. Now, let's just talk generally, first of all, before I go into the specific questions from our listeners, fertility problems in the main, is it fair to say that many would be related to age?


That certainly is the case path, and we certainly know that in our clinic, as the years are going by, the women who come to see us, whether they're single women or whether they're in relationships, are becoming older and older. So and if you look at the say, the incidence of egg donation treatment, which reflects, you know, women leaving that too late in their reproductive lives before they start a baby, when you look at the incidence of alienation from the Europe, it's climbing rapidly, alarmingly, you might say, as the years go by.


So there's no doubt in many of the cases of the couples we see the age of the woman concerned is either the fact or is part of the problem.


It's not the case, therefore, that that there are more people who are infertile because of, you know, plastics in the water and things like that. It's just that people are leaving it later to try for a baby and that will bring with it a level of infertility. Absolutely. I mean, men and women are very different. I mean, there certainly is concern in the Western world that male sperm counts and sperm quality are dropping as the years go by.


It seems to be real and not enough and not an illusion, you know, due to testing changing over the years. So it seems to be real, but that's for men. But for women, it's the it's the ruthless elements of biology. You know, Mother Nature is not terribly kind to women. And men are producing new sperms all the time as they get older. But women are not producing new eggs. So if a if a 40 year old man ejaculate, those sperms are only a few weeks old because we're making new ones all the time.


But if a woman who was 40 ovulate, that's a 40 year old egg because the woman has had those eggs in her body since she was born herself. And as the years go by and the eggs age and that means that, A, it's harder for women as they get into their late 30s and in their early 40s, it's hardly harder for them to get pregnant and when they do get pregnant, are more likely to have miscarriages. And it's all related to egg age, which is very unfair, but it's also very real.


Can a man have in his prime, shall we say, in his mid 20s, say, can he have a low sperm count? Can he have low motility in the sperm?


Yeah, of course. Yes. I mean I mean, it isn't all advancing female age that underlies kobolds problems and having babies. Sometimes the problem is obviously with the man and sometimes those men are young. But the other irony of the unfairness of some fertility between the man and the woman is that when men do have problems, then we have XY, which is a kind of IVF, which can really overcome the majority of problems when there is a problem, the man's sperm.


So when a man's got a problem, IVF in the form of he can almost always get around that problem so long as he's got any sperm at all. Whereas if a woman has problems with her fertility generally because she's getting older and her eggs are not so good anymore, unfortunately, IVF doesn't compensate in such a complete way for that, which is unfair.


Now, the questions coming in, I was told my mama was 3.0 and that's a way of counting the eggs, I believe in September. I'm 37 years of age single. I'm considering freezing my eggs in the next few months. Any advice on what preparation I need to do for this? Is it my only option to have a family?


I mean, this is a problem we're seeing increasingly. I mean, over the last 10 years, certainly we're seeing far more women in this situation, women with without a partner who's getting nervous because she's getting into her late 30s. She gets, you know, a name etched on and into the hormone antimalaria and hormone therapy and hate stands for. It's a hormone which is being used increasingly to give a snapshot of what women's egg numbers are like. And so we do get these women increasingly who know their images a bit low, which should really be between, say, about 10 and 20 would be the normal range for women in their 30s.


And if it's three point nine, that indicates that the eggs stores for that woman are certainly low. But if you don't have a partner, what do you do? I mean, the options are really just about two. You can try to get pregnant immediately using donor sperm or this woman is considering you can consider freezing your eggs. And if you can if you consider freezing of eggs, what you would be looking at will be an IVF type process where we try to bring that woman to produce several eggs simultaneously and then collect those eggs and then freeze them.


She doesn't even make it if she's saying what preparation does she need to know? Great preparation, really. So it's really a question of making the decision as to whether she wants to go down that road or not. It's kind of fairly new technology. Freezing eggs on fertilised human eggs is relatively difficult to do technically. So it's something which is kind of just starting and becoming more and more common as the years go by. And women have to realise, obviously, if they do consider freezing the rate that it's not it doesn't guarantee that a baby will come out of those frozen eggs in years to come.


But certainly by freezing her eggs, a woman in that situation is doing all that you can do to to kind of optimise our fertility chances as the years go by. What can I do to build my lining?


I've had two failed cycles due to poor lining below seven. The third cycle cancelled due to lightning not even getting to six. I'm losing hope and wondering should I be looking to surrogacy? My treatment plan has included all the relevant endometrium building medication. I've just started acupuncture also due to have another transfer in April. My periods have also stopped since before Christmas. My clinic has me on Provera for this and we have two frozen embryos.


It's a little bit difficult for me to comment here, because without knowing more of the kind of background details, it's we are increasingly using frozen embryos, you know, as part of the IVF process. It's remarkable, actually, that the last 10 years of the last 10 years, how many babies are now being produced from frozen embryos in IVF programmes last year and are in our clinic and 42 percent of all of the IVF, 60 babies came from frozen embryos rather than fresh embryos.


And 10 years ago would have been maybe five percent of our babies would have been coming from frozen embryos. So it is an interesting change. I don't know. It's it's unusual that the lining of the womb would be sort of so poor that it can't sustain a pregnancy unless something has happened to damage in the past. And the typical things which might damage the lining of the womb would be miscarriages or sometimes problems after somebody had a baby. But we don't often come across lining's, which are so thin and so poor that we can't go ahead and put frozen embryos back is a little bit difficult for me to comment further on this.


Sure. The lady, if she really has a damaged endometrium, then she might want to consider surrogacy. But surrogacy is a terribly complicated and expensive treatment option. And you wouldn't want to be going down the road for surrogacy unless you really, really sure that the lining isn't your own line isn't good enough. You just know that the embryos, you know, could be put back into it. But it's difficult for me to to comment on the situation.


It's obviously a complicated one.


Next question. I'm 42. I have a four year old. We'd love to have another baby, but I've had three miscarriages in the last three years. The last was a late trimester miscarriage. I'm taking Letrozole for fertility. But if it doesn't work, the next step is IVF. Is IVF very tough? I really don't think I can face it since nothing is certain.


And obviously, I think this baby's scenario probably reflects the passage of time because they say she had a successful pregnancy with the four year old and she's since had three unsuccessful pregnancies, probably relating to the fact that her quality is diminishing because you're getting into her 40s. Very, very sad, but something that we would come across all the time, that was all. But she's been taking something like Plummer did something to make you ovulate. If you're not ovulating already.


I'm not sure that would be what I would recommend for a woman in her situation. IVF is obviously the most successful thing that she could do to boost her chances of having that second baby that she so much wants. I wouldn't say that IVF is tough. It's expensive, and it's very disappointing when it doesn't work. But sometimes I think that it's hyped up to be more sort of more traumatic. The process is to be more dramatic than what it really is.


And what goes on with regard to what the woman has to do is not that complicated. She has to take injections in the scans. You need an egg collection. The very complicated stuff takes place in the laboratory, obviously. But in terms of, you know, feeling that IVF is very daunting, I wouldn't have that concern.


Well, the texture was just John just popped up. I'm 37. I am going through IVF. It's one of the most stressful and heartbreaking things I've ever done to the point where I've lost my self-worth and everything revolves around IVF. I didn't consider myself old until I started this. Is there any kind of education being given to young adults on this issue?


Well, it is a major sort of public health issue isn't as telling women, making sure that women understand that the passage of time is so important for women while it isn't for men. I don't know what point that sort of process should take place. Schools too early, maybe college is a better time. But even then, I suppose I mean, your 20s are kind of for you to be having fun, to try to think of when you should be having babies.


So when you hit 30, then you should be if you want to have children that you should be considering. But how do we get that public health message across? I don't know. It's probably maybe radio shows like yours, which might play an important role, but it certainly is an issue.


And another question, John. Can you get pregnant naturally if your partner has a low sperm count, 12 million 12am anyway?


Yeah. Or do you have to have IVF? Yes, an interesting question.


The normal sperm counts just for for listeners is 15 million per mile or more. So 12 is a little bit low, but it's not disastrously low. So we would have lots of couples where the man sperm count is that low or even lower, down to five million per mile rather than the 15 million per mile it should be. And still, pregnancies are achieved naturally. I suppose you'd have to look at how long have the couple have been trying? If they've only been trying a short time, you'd be still hopeful that they would be able to get pregnant without resorting to IVF if they've been at.


So it's it's low, but not really low.


Next one. I'm 37. I have an implant in my arm for contraception, but I'm looking into getting it removed so I can get fertility tested and have my eggs frozen. How long should I wait from the time I get it removed before I get the fertility tests. And how far away is the science for male contraception? Separate question, really, but that business of, you know, being contraceptive through an implant and then how long before you can actually get a fertility test?


So, I mean, the implant is going to be releasing some progesterone constantly. And so there's no point having the fertility hormones tested while you have that in. So once it's removed, it would be the progesterone that release. It will be out of your system, you know, pretty quickly. So if you had to removed and you had your you probably get your your fertility hormone test done when your next period comes after that device has been removed. So should be more than a few weeks.


You don't need to wait any longer than that. In terms of male contraception, there isn't really any great progress on that front. I think women still, I'm afraid, after relying on themselves for effective contraception these days. I suppose also, you know, a man says, yes, of course, I'm on the pill.


Do you believe that's the question, that you might be able to control it yourself?


Now, this one I conceived my first baby via IUPUI after three years trying in 2019, thanks to you and your team, unexplained infertility. But our baby is now nine months old and we want to try again. How long would you recommend trying to conceive before recommencing fertility checks?


What I don't know, of course, is this lady's age. I mean, if she's in her early 30s, I'd say I mean, her situation is unexplained. In other words, there is a possibility still that she will get pregnant even though it took away to produce a baby that they have. So it depends if she's in the early stages of it. Takes a lot of weight, doesn't it? At least six months, nine months, even a year.


If she's young enough, if she's older, if you're getting into her late 30s, then you're back to the biological clock ticking. And therefore, she shouldn't leave too long before she comes back to us. And I suppose from a commonsense point of view, if you might produce a baby for them before I let you try again, if you're going to do anything, the question of age limits for IVF or other fertility treatments.


Are there upper age limits that have been imposed by, you know, ethical procedures at the ethical guidelines or indeed by the Department of Health?


Well, it's a very interesting question because I was just thinking it's almost exactly three years, you know, there's no at this time there's no comprehensive legislation in Ireland to control assisted reproduction. But there is a bill, the Human Assisted Reproductive Bill, 2017 and three years ago, almost exactly, I remember with the middle of the snow and the ice was in the this joint health committee, which was starting to consider the whole area.


And look at that bill and just look at the detail. One of the details was proposing an upper limit for the woman, for any sort of fertility treatment of 47, which is a little bit early because sometimes women have babies naturally at age 49 or 50 even. And there was no in the bill. As it stands, there's no upper age limit for men at all, which seemed a little bit harsh. In other words, this legislation, if it were to go through unaltered, would mean that a very unfit man in his 60s would be allowed to undergo fertility treatment, whereas his partner, who might be very fit for the eight year old in great health, wouldn't be allowed to access fertility treatments.


That was one of the points that we took issue with when we were discussing it. Unfortunately, the whole of legislation has been a setback and a setback. First of all, by and with this vocal controversy and the controversy, then there was the termination of pregnancy issue, which kind of took over centre stage. And most recently, obviously, we've had the covid-19 outbreak, which just put it back again. But at some point and that bill needs to be debated.


And it certainly is a very important issue. And people need to be aware that there will be a debate going on and people should be encouraged to get involved with that debate because it's a very, very far reaching.


We have to leave it there, John. Thank you very much for joining us. Run out of time. Loads of questions, but my thanks to Dr John Waterston, medical director of the Water Stone Clinic and.