9th May 2005
Demography is a difficult discipline, human beings being an unpredictable bunch. After attending a session of the European Chapter of the International Medical Parliamentarians Organisation held recently in Seanad Éireann on the topic of infertility in Europe, I can see we have a challenge on our hands in both Old and New Europe.
"Fertility is low throughout Europe. It is lower than ever before and lower than elsewhere in the world and the current trends are stable at low levels", said Dr. Karl Nygren of Sweden, who is Chairman of the European IVF Monitoring Consortium. Looking at the fertility rates over the last forty years in Europe, what he says is definitely so.
In 1960 Albania had the highest fertility rate in Europe, 6.57. The most recent figure I have for that country is 1995 when it was 2.62. We were quite near the top in 1960 with 3.78 but by 2002 we were down to 2.00, not even replacement rate. We have improved on 1995 when it was 1.84. Italy is one of the countries with the most serious problem, 2.41 in 1960, it must have been so bad in 2002 no one will admit to the figure but in 1995 it was 1.26, going down to 1.21 in 2001, one of the lowest figures I can find anywhere. They should be welcoming those Albanians who try to cross the Adriatic with open arms, not deporting them.
Interestingly Scandinavia, which is predominantly Protestant, is holding up better than the southern European countries which are mainly Roman Catholic. And going from east to west across Europe, Belarus was at 2.80 in 1960 to 1.22 in 2002, and the abortion rate there has been halved in recent years I am told. Iceland was 4.17 in 1960 and is 1.93 in 2002.
What interested me very much was Dr. Nygren's explanations for this trend - he did not, as I expected, point to the greater availability of family planning or even to abortion in those countries where it is legal but said the reasons for low fertility rates in Europe were socio economic. Even medical factors which lead to infertility such as sexually transmitted diseases, especially the big increase in infection with Chlamydia, (although he stressed prevention of these problems is much better than cure), and women being older now when embarking on pregnancy, were less important than socio economic factors. When we look around us in Ireland one can see how the change in lifestyle has made this so.
We still have the same situation where boy meets girl, but now when boy and girl get together, having a house of their own and a car, holidays and a good lifestyle would appear to come well ahead of having a baby. The house and car require a huge amount of borrowing. The Celtic Tiger has been referred to by some as the Celtic Tigress, it being dependent for its very existence on the involvement of many young women in the workforce outside the home. The mortgage on the house and the loan on the car require a double income, so both must keep their noses to the grindstone and I have even heard it suggested, (by a Frenchman in WHO!), that sex becomes less fun when one has these sort of problems.
The stress of her life affects the woman so that she does not ovulate regularly. We can all be relieved to hear that sperm decline is marginal, if at all, in stressed out men. Then if the woman is driven to smoking by the stress she will ovulate even less. She begins to eat too much and hasn't time for exercise, her BMI goes up and she becomes less fertile. She is so anxious she cannot eat at all, her BMI goes down and the same applies. And longer working hours, combined with commuting, mean that the Frenchman might be right and they are both just too tired for sex. What a scenario all over Europe!
There is help at hand, however, especially if one has money, and that is where IVF comes to the rescue. Dr. Nygren and the other speakers in this session of the seminar were all involved in IVF treatment and their interest in the plight of so many couples was apparent. One in six couples in Europe have problems in conceiving. It is not a topic they like to discuss with family or even close friends and so delay coming for treatment until they have been trying for a child for several years.
The message these doctors put forward was that the state as well as the couple involved had a stake in helping them achieve their reproductive goals. Availability and cost of IVF treatment varies greatly across Europe.
Europe is in the lead for infertility treatments, about 60% of all IVF activities occur here. However, there are large differences in clinical practice and availability of services from public resources. The allocation of public resources depends on politicians and they are influenced by the culture of each country and societal reactions to treatment of infertility.
Diagnostic skills are good all over Europe, the cause of infertility being diagnosed in 80% of cases, but availability of treatment depends very much on funding for the couples involved. If the cost is high fewer couples can avail of it, they seek treatment later in life and they try to maximise the likelihood of pregnancy per treatment. A high pregnancy rate is associated with a high multiple pregnancy rate, which is not desirable. The more embryos that are replaced the more likely is a multiple pregnancy with a greater likelihood of premature delivery and all the problems associated with that.
If, as Professor Arne Sunde of Norway suggested the state paid for all infertility treatment, those giving the treatment would be in a position to encourage the couple to concentrate on best medical practice rather than on what they could afford. This, he said, would be what is best for the couple and best for society, too.
We have a very high standard of IVF in this country and while the very expensive drugs involved are paid for in the main by the State it is still an expensive exercise for couples. One in six couples are affected and despite the fact that helping such numbers would be a large expense for the state to undertake without action in this area, and our attitude to immigration being ambivalent we, like the rest of Europe, may have a lonely old age ahead of us.
Senator Mary Henry, MD
