Fertile ground

Fertile ground

For a fertility feature we ran in the paper a couple of weeks ago, I spoke to leading Cork fertility expert, Dr John Waterstone, about the hows, whys, and whos of fertility treatment.

The interview reveals some interesting things. You can read it here... I wonder if anybody else will come up with the same queries and misgivings I had in relation to some of those statistics.

Dr John Waterstone is probably Cork’s best-known fertility expert.
Co-founder and Medical Director of the Cork Fertility Centre, his interest in helping couples conceive arose when he worked with the now world-famous fertility doctor and television personality Robert Winston, now Baron Winston, in London. He currently works as a Consultant in Obstetrics and Gynaecology at CUMH, and as a gynaecologist at the Bons Secours, as well as his work at the Cork Fertility Centre.
An energetic, fast talker, Dr Waterstone is clearly passionate about his subject. Fertility treatment, he says, is “magic” when it works, but when it doesn’t work it can be heart-wrenching.

Changing profile

Although the clinic only opened in 2002, there have been major changes in both Irish society and its operations, in its short life.
While the clinic originally dealt only with couples, and Dr Waterstone was “uncertain” how staff would feel about dealing with single women or lesbian couples, an increase in approaches from these groups led to a change in policy.
In the past 18 months, about 50 per cent of the couples seen at the clinic have been lesbian couples, a dramatic change to the previous dynamic. This is despite the lack of a legal framework for gay parents. Single women are also a huge group.
“It’s striking, we see so many single women who are heterosexual, very personable, good looking, with good jobs, it makes you wonder what’s wrong with Irish men, and why these women haven’t been snapped up,” he says, sounding genuinely baffled for a moment.
The clinic’s typical clients are couples who have been trying to get pregnant for a year or more, have seen their GP with concerns, and have been referred on.
“We tend to see older women rather than younger, often the women are in their late 30s or older,” explains Dr Waterstone.
“The average age for IVF treatment would be about 37. It’s unusual to see women in their 20s, and we sometimes don’t see people if they are too old; we would have a cut off age of 45.”
The clinic doesn’t recommend IVF treatment for women over 45.
“If women are over this age they often go abroad, where they can get egg donation as old as 49 or even 50. Where they want to use their own eggs [here in Cork] the cut off would be the conventional age, 45.”

When should I worry?

But when, or how, should women go about investigating their fertility, and how do they know when to start worrying?
Age is incredibly important, says Dr Waterstone.
“How old are they? If the woman is young, in her 20s or early 30s, there is no mad rush. I would be concerned if the woman was in her late 30s or 40s, because that’s when you have to move fast as the time is limited, and she could miss the boat.
“Speed is important depending on how old the woman is. The perception of this very basic issue really varies, some women waltz in at 42 and can’t understand what the problem is, while you get some in their early 30s who are very worried.
“Women can be blissfully unaware that this is such an important issue.
This is not necessarily covered in biology classes, and people just don’t get it,” he adds.
Other issues include a basic lack of knowledge about when conception is most likely to occur, he says.
“A lot of women don’t know that ovulation happens in the middle of the month,” he says, “so trying just before ovulation is the best time. Sometimes you’ll get people trying every day for a year but not realising that there is a best time.”

Men’s problems
Of course, there are problems on the men’s side too.
“There can be problems with men, but you don’t know that until the sperm analysis.
“Once you get to the GP, that is one of the first tests done, so before they come to us we already know, immediately, if that’s the issue.
“Quite a chunk of the couples we see have this problem, maybe a quarter have problems with semen quality,” explains Dr Waterstone.

Legalities
Apart from regular IVF treatment, the clinic is one of only two in Ireland to offer egg donation treatment. Because of the lack of legislation in the area the clinic only offers this to women who already have a donor. However, if women don’t have a donor and need to go abroad, the Cork Fertility Centre can offer a support service for that.
The lack of legislation covering IVF is worrying, says Dr Waterstone.
“The biggest stress factor regarding legislation is uncertainty regarding donor sperm or eggs. Who are the legal parents of the child, that can have a bearing on inheritance, and other things.
If you speak to lawyers working in the area, they will tell you it’s quite complicated to introduce legislation, but there is certainly a need for it.”
In the UK, legislation deems that the woman who bears the child is the legal mother, but here, although there has never been a test case, it could be quite different.


It’s not an easy job.
“It’s fantastic when it works, when you treat a couple who’ve been trying for ten years, and bingo, there’s a baby! But it doesn’t always work. When it does, it’s magic.”