uncertainly when you are you looking at raising a child or children having the
support of a peer group who are also all going through the same thing at the same time helps are you
aware of any support groups out there for older parents in the way that there
are for teenage parents or for parents of premature babies or anything like
that. I'm not specifically aware of a support group for older parents There are
the usual ones through Child Youth Health and things but I don't know whether there's anything
specifically for older parents Does anybody else know
chat rooms - internet - But sometimes I think the personal contact is really of benefit
can i just ask about the donor egg program I understand they can't receive financial remuneration
but how do the fertility clinics attract women to become egg donors and what are the
the criteria for an anonymous donor to give their eggs
we've recently had some advertising on Facebook for donors we can't ask patients are
coming through the clinic while they are having treatment to donate but usually they ask people they know
when we talk to people about finding egg donors we say 35 and under and hopefully they completed
their family hopefully they've completed their families but we do have a lot of
women coming through recently I haven't had children because they haven't
started their families yet they choose not to have children So it's very
difficult to advertise A lot of patience we have my advertised in Adelaide's
child magazine You'll often see adds there
but there are three current web-sites Australian Egg Donors, Aussie Egg Donation
and egg donor angels, and theyíre interstate Theyíre all over Australia
and a lot of linking is being done It's almost like a linking website where recipients go and
right a little bit about themselves and women who actually want to donate their
eggs but dont know people to donate too will be on those website and they link
up that way Sorry, Iím not sure if you can hear me very well, but Iím a rural GP
in a country town in South Australia Itís just more of a comment about blended families and how families coming together or two partners
coming together with children previously, the desire to have a shared child together,
and I have experience of a lady who had repeat miscarriages and ended up having a child at about 43 with a new partner and her own child,
who was about 20, had a child at about the same time So thereís those complexities around modern families
that seems to be quite part of the new society weíre in. Just a question regarding IVF treatments
So given that we know that IVF babies are more at risk of Down Syndrome etc,
of having a foetal abnormality and also a pre-term birth,what sort of counselling
are the patients actually given or the clients given prior to actually undertaking IVF cycles
of all these things, these complications that can actually happen?
And does it ever put anybody off? Well first of all, Iíd say that IVF patients arenít at increased
risk of Down syndrome aside from them being older
I guess itís age-related, more than IVF-related About 40% of cycles that we do IVF at the moment
at the clinic I work at, we do pre-implantation genetic testing. So we sort of remove
that effectively out of the equation, Look you are right that there are increased obstetric
risks in fertility patients That is true Increased risk of pre-eclampsia or IUGR,
early delivery etc. But I think we need to get this into perspective,
okay
Thereís an increased risk, but is that sufficient for a couple to say
ìIím not going to have fertility treatmentî? You know, like you say ìLook, thereís an increased risk of foetal abnormalities in IVFî
you know a 30% increase Letís say it goes from 3% to 5%. The couples are made aware of that,
theyíre given written information about that But that doesnít dissuade many people from still
having treatment And I think we donít want to want to scare patients excessively And I
think it's getting that balance right But, look, we do make them aware but we donít
press home the point too much because I think that's coming across as negative
unless thereís a specific issue that they have themselves which would increase that risk further
Just to add into that one, and Iíd perhaps like Bobís opinion on this as well,
but I think if youíve got a woman whoís got a pregnancy that you know has come about through some sort of assisted reproductive technology,
you tend to be a little bit twitchier because theyíve had to jump through more hurdles to get this pregnancy
than a couple thatís conceived naturally
and when things start
to go slightly wrong because in the back of your mind the
effort that this couple who have gone through to get to this point and the
knowledge that they are slightly more risk of things I think it into jump a
little bit earlier
we tend to be a little bit more twitchier, tend to deliver a little bit more early,
tend to be a little bit more aggressive with your intervention, but Iíd certainly
value Bobís opinion on that Thatís just my sort of untutored eye looking
at the practice of my obstetric colleagues. Just a comment ñ you know with your egg timer... what did you call it?
You know, because this is more than just like you were saying, quite rightly, about itís more than just about when they decide Because quite often society plays a big part, which you alluded to And Iíve just finished reading The Wife Drought by Annabelle Crabb,
which is actually quite an interesting book looking at their whole thing about women into the workforce and
men also trying to reduce their hours And I just like to
say working in a large metropolitan hospital here in Adelaide and with a lot
of female doctors I mean some of the pressure that they have on them trying to,
without a wife, you know, continue through their studies So is there anything like that?
Because I mean I think midwifery does tend toÖ you know, a lot of midwives will come back part-time and have that bit of a time, but from what I have observed, you know, women coming back with new babies
who are doctors in training programs, itís really difficult. And so that would, I would imagine,
I donít like to speak for any of my medical colleagues but you know is medicine looking at addressing that
because you know in professional
jobs that are big decision to make
to actually try and squeeze it all in somehow. I guess I can only comment that a lot of
ONG trainees have children when theyíre in the training program,
rather than when they come out in private practice because they are more generous support
for them in terms of maternity care while theyíre a trainee than there is in private practice.
But I guess theyíre all aware of the biological clock ticking
But, you know, itís having that exam that theyíve got at that hurdle to get
over and knowing that itís going to be very hard to study for an exam with a young child
is difficult. I think thereís no one answer to this, thereís lots of things we have to
make it easier to have flexible care, better maternity care, more
half-time jobs when you come back
obviously we can't change the the standard for the exam
That sort of thing is set. Itís a tricky one. I may comment.
Compared with what it was when I had my first child I have to say the College of Obs and Gyn at least have
improved significantly
I canít talk about other colleges, but I can say that it is not uncommon nowadays, at least for our trainees,
for the possibility to have a good amount of maternity leave without putting so much pressure on
and be able to come back to work and even have a part-time job, which I can tell you when
I had my first child was not an option
And theyíve also brought forward the stage when you can do the exams.
I think second year or somethingÖ So lots of things have changed for good, but thereís a long way to go I just wanted to ask a question, something that was touched on just briefly
at the very beginning, about women freezing eggs as a possibility when theyíre younger. Is that something that could be advocated for more in society for younger women? I mean, what is the viability of an egg thatís popped on ice at 30 to be used when youíre 40? Is it a bit of false hope?
It's a tricky one
It does work. Vitrification or rapid egg freezing rapidly increasing now is is quite an now is quite an effective
technology where five years ago the technology wasnít very good at all.
So itís basically ballpark at 30, youíve got a 10% chance of having a live birth
per frozen egg.
So if you do an IVF cycle at 30 and you get a dozen eggs, youíve got a
youíve got a reasonable chance I guess the problem is that (a) it costs money;
(b) itís placing a patient at risk of some complication of the
procedure and (c) it can give a false sense of security.
So you have, you know, a dozen eggs frozen away and some people will think I can have kids at 45 and what happens if
the IVF unit burns down and the eggs are lost or, you know, they donít result in pregnancy.
Itís then too late to go back. I mean, Iíd like to see more social egg freezing,
and the way I see it, if people donít need those eggs themselves, they conceive naturally,
then that would be a fantastic pool of eggs to use for the donor,
for older women who havenít had that opportunity
So I mean thatís something Iíd like to see, but I canít see it happening any time soon.
Iím in the midwifery group practice
and Iíve had a few women that have gone through IVF. We, at Flinders, are a low risk group practice.
We donít have high risk as the Womenís and Childrenís do. And I think there has been a question whether an IVF
pregnancy is high risk or not high risk. Listening to you tonight, Iím thinking
where are we going with that because the ones I have had are between 35 and 40.
They are what we call fit and healthy, at low risk pregnancy, but they were on the IVF program.
These women are very keen to give themselves every opportunity for a vaginal birth. Some people will indicate that they donít
think they probably should go through the group practice, that they are
classed as a high risk pregnancy. Iím just interested to know what you think about that?
Do you think that in our model of care, being low risk, that they should come through us
because, you know, it is talked about a lot. And I think the women I have had, whilst they
appreciate the fact that it has been a special pregnancy, itís been tough and
all the rest of it, that but I still are extremely keen to go through this model of care
So do you class them then as a high risk pregnancy? Should they be going through this model of care? I guess Iíll give my response first.
I mean, a lot of women feel a little bit ripped off that theyíve had to use medical
technology to conceive. Something that should be natural and fun, theyíve had to pay money
for and it isnít fun at all. And so they do want to get some of that back and a lot of them
would like to have a normal
delivery rather than a caesarean. A lot of IVF conception ladies are very
anxious in pregnancy; very, very anxious.
And they just simply want an elective caesarean for that reason.
In terms of should they all be considered high risk I mean, I donít practice obstetrics any longer,
so Iím probably not the right person.
But I donít personally think theyíre massive risks. I donít think we should be looking at them as
being time bombs ready to explode at any moment and surely even if
you just see them more frequently and if you pick up there's an issue and then are
happy to move them onto the high risk service, that should be enough. I don't
think we should be labelling them as problematic patients or high risk
The principle reasons that the midwifery group practice at Flinders is
restricted to low risk patients is to reduced transfers out.
And the principle reason for transfers out is caesarean section and epidural
Theyíre the principle reason for transfer to medical care.
Women who have IVF pregnancies, to me, the principle dangerous risk for those
pregnancies is theyíre at significantly increased risk of preterm birth. And that
would be another reason for transfer out. I think they're on the borderline really
of whether they can can stay with a low risk unit or or go to a high risk unit
they certainly are at increased risk of transfer out compared with women who had
a naturally conceived pregnancy Just touching on the freezing eggs question that we had a minute ago,
I just wanted to ask are you talking about freezing eggs or freezing embryos because my understanding was
freezing eggs generally youíll get a fairly poor result. Iím talking about freezing eggs, that is unfertilised eggs.
Traditionally, embryo freezing has been a lot more successful, but it is getting better,
the egg freezing.
And I think 10% pregnancy rate, live birth rate, per frozen egg is pretty reasonable.
I mean, obviously, if you start freezing embryos in a woman of a young age, then youíre locking
her in to having a child with that partner. And, you know,
look, that necessarily isnít going to work, especially if theyíre very young.
So we like to keep their options open and we would normally only create embryos in a married couple
or a couple who have been together for quite a period of time.
It would be very rare we would do that sort of thing and store them unless there was like an oncology situation,
like breast cancer, and we were creating embryos for later use.
In the single woman who hasnít got a partner or an unstable relationship, itís always eggs that we freeze.
Well Iím going to thank all the presenters.
It has been excellent. Thank you.