40: A new golden age to start a family

She doesn’t want to be named (as with other clients mentioned, her name is changed).But four years with her triplets have convinced her anyone above 40 can have a baby, and there’s technology to help achieve the dream of starting a family.She was above 50 when she discovered her husband’s condition meant they couldn’t start […]

She doesn’t want to be named (as with other clients mentioned, her name is changed).
But four years with her triplets have convinced her anyone above 40 can have a baby, and there’s technology to help achieve the dream of starting a family.
She was above 50 when she discovered her husband’s condition meant they couldn’t start a family. She was open to in-vitro fertilization, unlike her husband. The couple separated, and she went on alone for IVF, using a donor.
Today, she’s become part of a Fertility Awareness Advocacy Initiative—a group of couples above 40 who have had babies through assisted reproduction—keen to put out the message that options exist to start a family above age 40.
More and more women are delaying having babies for several reasons: academics, work and career; the right partner; others have been trying for a while until the big 4-0 came calling and some are not aware of the implication of time and age on their capacity for reproduction.
An online survey of 289 people found insufficient knowledge on issues around fertility: whether sex positions increase the likelihood of conception, monthly chance of conception, causes of infertility and the gender most affected, fertile period.
In fact, up to 41% still thought an infection of staphylococcus was a leading cause of infertility—“and there is a big industry building around staphylococcus in Nigeria,” says Dr Abayomi Ajayi, consultant obstetrician and gynaecologist, a fertility specialist at Nordica Fertility Centre, Lagos.
Some 43% of those who took part in the survey thought women experience infertility more, compared with 11% who said men did.
Awareness about fertility, or infertility, and technology that’s increasingly becoming available to help is inadequate.
“Nobody wants to be seen associated with infertility. It is like a stigma. It is so hush-hush, that’s why there is quackery,” says Dr Ajayi.
In 2012, the number of first-time mothers above 40 outnumbered teenage mothers for the first time.
A woman’s reproductive age spans 15 to 44, and the best age for a woman to reproduce is 20-34 years. Anything before and after that age bracket poses risks to both mother and child, experts say, hence the need to start families early. Many “unexplained infertility”, in which all tests show everything is ok, might be age related.
 Understanding the egg
A woman’s eggs are as old as she exactly is—and she needs around 400 throughout her reproductive age.
A female is born with all the eggs she will need in her lifetime, an estimated 2 million. They fall to 400,000 by puberty. At age 37, only around 25,000 remain.
She loses around 13,000 each year, and the bad thing is that the best eggs disappear first.
At 43, she’s at the end of her egg supply and old poor quality ones remain, hence fertility declines alongside supply and quality.
At this age, men are usually okay with sperm count, but sperm quality decreases with age, and older sperm has been linked with Down’s Syndrome (as found for children born to older women) and schizophrenia.
The chances for natural pregnancy after 40 are low, but it is possible, say experts. Success rates for intrauterine insemination—when sperm is placed inside a woman’s uterus to fertilise her eggs—is abysmally low and a waste of time, says Dr Ajayi.
Achieving fertilization outside the body before transferring the embryo into a woman is an option, but the big question is whether or not to use a woman’s own eggs, considering success rate falls to around 10% for a woman in her early 40’s.
As age increases, the cycles of IVF needed for success also increase—for a woman using her own eggs. But an expert has to determine whether a woman’s eggs are viable—and would most likely suggest donor eggs from a younger person, which increase success chances to 50%.
Say, ovulation and fertilization occur ordinarily, implantation—where the embryo “hatches” and attaches itself to the wall of the uterus—is still tricky business. (Much fertilization occur, but only when an embryo successfully implants itself can pregnancy take. In fact, prolife and prochoice groups still debate whether life begins at fertilization or implantation).
In laser-assisted hatching, a laser is used to weaken the egg covering, allowing the embryo to implant itself.
 Better ways
Freezing technology has improved in the last decade, pushing up chances of success from 30 to 90% than was possible five years ago.
Embryos can also be screened before implantation in a procedure known as Pre-Implantation Genetic Diagnosis—used to screen for almost anything from HIV and sickle cell to abnormalities in chromosomes, ensuring only the best is selected for transfer. This leaves a tiny window of opportunity for would-be parents to even pre-select sex and preferences for a baby.
Choice aside, a successful embryo grafted into a woman still needs the body to accept this graft, doctors warn. The procedures might be expensive, but money spent out of pocket for assisted reproduction in Nigeria cannot push the technologies to deliver the impossible.
A woman without a uterus, who can’t carry a pregnancy for medical or social reasons might opt for surrogacy. Traditional surrogacy uses a surrogate’s egg. In gestational surrogacy, a woman uses her own eggs.
Or she could harvest and keep her own eggs from a young age (in cryopreservation) for future use. It is handy for women before they go into chemotherapy. It also comes in handy when she’s over 40, successful, wanting to start a family but still single and without a partner.
 Knowledge that empowers
“Whom we need to empower are the people themselves,” says Dr Ajayi.
The over-40 group is at the vanguard of assisted reproduction. If at 40, you are still waiting, says Dr Ajayi, “This is not the time to go to the gym or a gynaecologist. Report to a fertility specialist.”
But the pressure to have babies in African families means many who need the help of technology are praying in church, not talking about their problems, or simply horrified of the cost implications.
“If I can borrow to buy a tokunbo car (second hand), why can’t I borrow to have a child who I can send to get me water?” asks a lawyer, Makinde, who had his first baby on his 50th birthday after 16 years of marriage.
“It gets to the point where you have to be selfish. IVF is a cycle; you plan toward it. It is not too much to invest to get a child of your own, so long as it is legal.”
He’s head of the fertility awareness group, a support network for couples who have gone through the procedure and giving hope to women like Lami—in her 40s, with two fibroids removed, a third on the way but still wanting to conceive.
 “Don’t look at it as a problem. People will talk, but you have to make up your mind,” says, Soetan, an engineer. He and his 49-year-old wife had their first baby after being childless for 19 years.
He remembers people visiting ostensibly to see whether his wife was breastfeeding a “real baby”.
“You are married and have 10, 15 cars, they will still ask ‘where is your child?’ If I have 20 babbar riga without a child, who is it for? We are Africans, not Americans.”