The number of women in Canada having children in their 40s has tripled in the past 30 years, The Globe's Jennifer MacMillan writes in Tuesday's paper. Many have turned to in-vitro fertilization to facilitate the process using their own eggs, but the practice has a low success rate since the quality of women's ova deteriorates quickly after the age of 35.
Through donor eggs, rare cases of women giving birth well into their 50s and even 60s have made headlines, sparking debate over just how old is too old to be a mother. Last month an expert panel recommended that Ontario's health-care plan cover the cost of IVF for anyone unable to conceive on their own, including same-sex couples and people who want to be single parents. But not for women over 42.
The panel members say it's a cost-benefit decision based on the very low chances of a woman over 42 getting pregnant through IVF, not a judgment on the ideal age for parenting. Indeed, if the recommendations are implemented by the Ontario government - they're currently under review - women over 42 will still be able to get fertility treatments provided they pay for them.
Still, the controversy remains: Should there be a cut-off age for such procedures? Sylvia and Mike Braithwaite, an Ontario couple who went into debt to attempt in-vitro fertilization outside Canada, took your questions about the challenges of conceiving over 40. Fertility specialists Dr. Arthur Leader and Dr. Marjorie Dixon joined the coversation to talk about their roles on Ontario's expert panel on infertility and adoption.
What follows is a transcript of the discussion. Use the Cover It Live player below to replay the event as it happened.
Dr. Art Leader: Thanks for joining our online discussion on in-vitro fertilization. We'll get underway with some reader questions answered by Art Leader, a fertility specialist based in Ottawa and a member of Ontario's expert panel on infertility and adoption.
Dr. Art Leader: A question from Susan: I'd like to know about the long-range health implications for multiple trials of IVF? How do the drugs and hormones that are used impact a woman's health?
Dr. Art Leader: Egg retrieval has no long-term adverse effects on a woman's health. In countries like France and Israel where multiple cycles of IVF are funded menopause does not come earlier in women who have IVF multiple times (compared to those who have never had IVF. The fertility drugs used for IVF have been associated with long-term health risks: clomiphene citrate tablets used more than 12 times in a lifetime is associated with an increased ovarian cancer risk; injectable gonadotropin use is associated with a slightly increased risk of breast cancer, but no increased risk of uterine or ovarian cancer.
If too much of the drug is used to hyperstimulate a woman's ovaries during an IVF treatment, there is a risk of ovarian hyperstimulation syndrome, cyst formation or ovarian twisting or torsion.
Dr. Art Leader: Question from reader: How much of your practice involves treating men with fertility issues vs. women with fertility issues? Do you think there is less awareness among men about their declining fertility as they age?
Dr. Art Leader: Probably 50% of the time, the cause of infertility can be traced to a male factor. About 60% of all IVF done in Ontario is for male factor infertility. The general public is less aware that not only does men fertility decline with age >40 but also that paternal age >40 increases the risk of miscarriage, still birth rates and fetal abnormalities. Myths are continued by older men who father children with younger women.
Dr. Art Leader: When the panel was drafting these recommendations, did they consider how age caps are applied to other publicly funded medical procedures? What sort of precedence exists for age caps?
Comment From Guest: Were Sylvia and Mike successful?
Globe and Mail: From Sylvia: Although we were not able to have a child biologically together, we are close to finishing the adoption process and hope to have our child soon.
Globe and Mail: A question from John-David: My question is in regards to male infertility. In my case I have a blocked vas deferens on the right side and no vas on the right. It is my understanding that women in Ontario with blocked fallopian tubes are currently covered for IVF. Why the difference between male and female? Is it not the same condition? Also, do you think that this is a discriminatory practice and should be taken up with the Ontario Human Rights Commission?