As people start trying to have children ever later in life, the number of those having difficulties conceiving naturally is on the rise. And so growing numbers are turning to fertility clinic services, for treatments such as IVF.
The latest annual report (for 2022) from the clinic regulator, the Human Fertilisation and Embryology Authority (HFEA), out last week, confirms this trend.
But would-be parents face a maelstrom of misinformation about fertility, experts have warned. Here, i takes a close look at eight of the myths in this area.
Women are waiting too long to start IVF
The average age that women begin IVF has now crept up to just over 35, according to the latest figures. Success rates for IVF decline with age – just like chances of a natural pregnancy – so this has led to headlines blaming women for “leaving it too late”.
Such judgement is unfair, as many women may have wanted to start fertility treatment sooner, said Clare Ettinghausen of the HFEA.
In NHS services, there can be long waits to get a fertility clinic appointment, and for those going private, rising costs of living could have affected their ability to pay – IVF typically costs several thousand pounds per cycle. “A lot would have wanted to start earlier,” said Ms Ettinghausen.
Only women need to consider their biological clock
Most people are aware that women need to start trying for children before their fertility wanes. A woman’s chance of getting pregnant each month is more or less steady until her early 30s. After that age, the pregnancy rate declines each year, becoming markedly lower by her late 30s.
But men’s fertility also reduces as they get older, starting to tail off noticeably from their mid-40s, although the fall is less steep than in women.
Older men also have more chance of their partners’ pregnancies ending in miscarriage. “It’s pretty unusual that people would be aware of the link between male age and pregnancy outcomes,” said Professor Tim Child at the University of Oxford.
“They’re nearly always aware of the link between female age and infertility.”
Infertility is usually due to problems on the woman’s side
In fact, a couple’s fertility issues are just as likely to be caused by medical problems in the man as the woman. If a couple have medical tests because they are taking a long time to conceive, fertility problems in the woman can be found about a third of the time.
In another third, the man has a low sperm count or his sperm may not function properly, like being poor swimmers. The rest of the time, a cause for infertility cannot be found.
“Often when patients in heterosexual couples are going to clinics, it’s assumed that it’s the female who will be getting the tests,” said Ms Ettinghausen. “The male plays a big part in this as well.”
Egg freezing isn’t worth it
Having some eggs removed and frozen for later use in IVF has long been offered to women having cancer treatment. But egg freezing is increasingly being done for personal reasons, for example, if a woman does not yet have a partner.
Until recently, doctors warned this was a gamble, as the success rate for using those eggs was thought to be relatively low.
But a study out last week has found the success rate with IVF after egg freezing is now nearly as high as after standard IVF, when the eggs are used immediately.
After egg freezing, 26 per cent of embryos transferred led to a live birth, compared with 31 per cent for standard IVF. Previous lower estimates of success were based on doctors using older egg freezing techniques, said the researcher, Professor Nick Macklon, at the London Women’s Clinic. “The technique has moved on,” he said.
Miscarriages are rare and caused by something you’ve done
Miscarriages, when a pregnancy is lost in the first 24 weeks, used to be seen as uncommon. This may have been partly because people talked about them less and also because early miscarriages can happen without women being aware they were pregnant.
Since urine tests for pregnancy became more widely used, it emerged that miscarriages are more common than was realised with about one in four pregnancies ending this way.
Many myths surround the causes of miscarriage, with women sometimes wrongly blaming themselves, for being too physically active or having an unhealthy lifestyle, for instance.
In reality, more than two thirds of early miscarriages happen because of genetic errors in the fetus, a study found last year. The researchers believe that many of the other third are caused by genetic errors that are less easy to spot.
Infertility is caused by stress
Women trying to conceive are often advised to avoid stress. In fact, there is little evidence that stress causes infertility in people trying to conceive naturally.
And a review of 14 studies of women having IVF found that success rates did not seem influenced by their stress levels.
But mental health can impact pregnancy chances if people find the IVF process so stressful they abandon it, warned Prof Child. “The worst outcome is you have a couple where there’s a chance of getting pregnant but the stress aspect is so bad that they stop trying,” he said.
You need to time sex for the ‘fertile window’
Messages abound that for the best chance of conceiving, you need hormone tests and fertility-tracking apps, or at least a calendar. The aim is to time sex for the few days that comprise the woman’s “fertile window”, when she is about to release an egg. This can be detected using urine tests for a biochemical called luteinising hormone.
Unfortunately, most trials that compared pregnancy rates in couples using this strategy with rates in those just having sex regularly haven’t seen a benefit from the urine tests, according to a review of all the research last year.
One trial did find using the tests led to a modestly higher pregnancy rate, but it was funded and written up by a test manufacturer, so it might have been biased, said Prof Child, who debunks fertility misinformation on his Instagram account, drtimchild.
The risk with the urine test strategy is that people fail to spot hormone levels rising, perhaps through badly timing the tests, and then miss out on that month’s opportunity to conceive. The careful planning can also make things more stressful, said Prof Child. He advises people to just have sex two or three times a week without worrying about precise timing.
IVF needs pricey extra medical procedures
IVF involves fertilising a woman’s eggs with sperm in a lab, allowing the embryos to grow for a few days in a dish and then transferring one or more into the woman’s womb.
On top of this basic process, clinics may offer extra procedures known as “add-ons”, claimed to boost success rates.
These include injecting sperm directly into the egg or making a scratch inside the womb to encourage the embryo to implant. But there is debate about whether add-ons make any difference to pregnancy rates for most people, although they typically cost hundreds of pounds per procedure.
“For the most common add-ons, none of these is going to increase your chance of a live birth,” said Ms Ettinghausen. “You would be better spending your money on another cycle of treatment.”