Fertility expert who has seen it all

  • Deborah Condon

Conception, pregnancy and birth are topics that mean so many things to so many people. And from couples who struggle to conceive to women who choose to have Caesarean sections for 'nonsensical reasons', international fertility expert, Dr Louis Keith, has seen it all.

Dr Keith is professor emeritus of obstetrics and gynecology and former director of the section of undergraduate education and medical student affairs at Northwestern University's department of obstetrics and gynecology in Chicago. He has been working as an obstetrician and gynaecologist since the 1960s. and was recently in Ireland to discuss the many issues surrounding pregnancy and fertility.

One of the most pertinent issues facing women today is that of waiting to have a child. Whether a woman wants to focus on her career, ensure she is with the right partner or is simply not sure if she wants children, her decision to wait can have a direct effect on her ability to conceive.

"From Sri Lanka to Ireland to the US, age is a worldwide issue. The longer you wait, the more likely you will require help to have a baby," Dr Keith explained.

He insisted that despite the problems associated with waiting to have children, 'it is a woman's right to decide when she is ready'. However, he emphasised that women who are 35 or older will face more problems, as their ability to ovulate and the number of eggs they have naturally decline.

"At this age, time is running out and it will become more difficult to conceive naturally," he warned before noting that the situation was 'very different' 20 years ago, when women were more likely to have babies at a younger age.

While many cases of infertility are unexplained, the most common fertility problems seen in women today are:
-Endometriosis - a condition in which the lining of the womb (the endometrium) grows outside the womb. It can be intensely painful and symptoms include unusually heavy periods and difficulty getting pregnant. It affects around 10% of women
-An inability to ovulate regularly due to ovarian dysfunction
-Other problems with the endometrium.

In men, the most common problems are:
-Low sperm count
-Abnormal forms of sperm
-Poor motility (movement) of sperm.

Dr Keith explained that in men, these problems can all occur at the same time in the same patient or a man may only be affected by one of them.

He also noted that while there are no specific risks associated with men who wait to have children, ‘as men age, their ability and desire to have sex may decline', which could affect the chances of conception.

While there are many different types of fertility treatment people can opt for, IVF (in vitro fertilisation) probably continues to be the most well known.

With IVF, a woman's eggs are fertilised with sperm outside the body in a test tube and the resulting embryo is placed back inside her womb. The first IVF baby was born in the UK in 1978 and since then, more than four million children have been conceived worldwide using this treatment.

There is no doubt that fertility treatment is now a growth industry, with specialist clinics all over the world, including a number here in Ireland. However, one consequence of this is an increase in the number of twins and other multiple pregnancies.

This is often because when an embryo is being transferred back into a woman during the IVF process, a decision may be taken to transfer more than one at a time. In the past, it was felt that this could optimise a woman's chances of at least one embryo progressing.

However, according to Dr Keith, 'study after study' has shown that transferring one good embryo offers as much chance of success as transferring two or more.

But more importantly, transferring one embryo 'diminishes the risk of a multiple pregnancy'.

"When we see a photograph in the newspaper of a woman with quadruplets, everyone is clapping and it is a happy picture, but the reality behind this is that multiple pregnancies produce enormous risks to both the mother and children," he insisted.

Dr Keith has carried out extensive research on the topic of twins and he pointed out that while there can be a number of risks involved, the biggest risks in relation to twin births are a pre-term (premature) birth and low birth weight.

He noted that while a full-term baby is usually born at around 40 weeks, most twins are born at 37 weeks, most triplets are born at 33 weeks and most quadruplets are born at 31 weeks. Being born too early can have a huge impact on the health of a child, particularly if their lungs are not yet mature.

When it comes to the actual birth of a child, caesarean sections have in recent years become an increasingly popular method of delivery.

According to the latest available figures for Ireland, the overall caesarean rate here was 27% in 2011. In other words, at least one in four births here are via caesarean.

Dr Keith acknowledged that the reasons some women opt for a caesarean range ‘from the medically recommended to the nonsensical', as it may simply fit in with their schedule better.

However, he still believes that women should have the choice of opting for a caesarean, as long as the pregnancy has reached 37 weeks, the baby's lungs are mature ‘and the woman consults with her doctor and has a reasonable reason'.

Finally, for anyone who is hoping to become pregnant, Dr Keith noted that aside from obvious lifestyle changes, such as stopping smoking, people should consider multivitamin supplements in the months before conception.

The benefits among women of taking folic acid in the 12 weeks before and first trimester of a pregnancy are already well recognised.

Folic acid reduces the risk of having a baby with an NTD (neural tube defect), such as spina bifida.

"However it has recently been shown in men that the addition of folic acid and zinc increases the number and motility of sperm and decreases abnormal forms of sperm, so men should consider taking a multivitamin supplement as well," he said.

Dr Keith was in Ireland recently for Pregnacare to discuss the many issues surrounding pregnancy and fertility.


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