Calls for more support for those struggling to get pregnant

Thursday 16 February 2023

A local fertility charity and the former head of Assisted Reproduction are calling for more support for those struggling to get pregnant - as the Jersey Health Profile continues to show a downward trend in the island's fertility rate.

Dr Neil Machlachlan, a Jersey-based Gynaecology consultant and former head of the Jersey Assisted Reproduction Unit, believes that the problem requires a two-fold response from both health providers and local employers.

He said: "Women need urgent access to an Assisted Reproduction programme that is equitably funded and an employer who is sensitive to the need of the one-in-six women who will need assistance to conceive, with sensitivity and time off for clinic appointments and when things go wrong in pregnancy.

"Our society must not ignore those suffering in silence."

Chloe Fosse, the founder of Tiny Seeds - a charity that offers support for women seeking fertility treatment - agreed with Dr Machlachlan that employers could be more sensitive to the needs of people who require assistance in getting pregnant.

She said: "I think what most people are worried about is not knowing how their employers will react, not knowing if they will be able to get the time off or how it will affect their careers.

"So, the best thing employers can do is just saying and making people aware that they are a fertility friendly workplace, and making that clear, because its quite a private thing to disclose." 

Pictured: Women in Jersey are having less children, and are waiting longer to have them.

The latest Jersey Health profile, which presents details of various health indicators between 2016-2021, estimated that the number of children a woman would have over her lifetime is now 1.2 for Jersey.

This is equal to the 6th lowest in the world and is similar to countries such as South Korea, Hong Kong, Spain and Ukraine which are all countries struggling with the impact of an ageing population. 

Dr Machlachlan explained a Total Fertility Rate of 2.1 is required to generally maintain a population.

"A decreasing trend would suggest Jersey will have to rely more and more on immigration to support the ageing demographics," he said.

Not only are people having less children, but people are choosing to have them far later, with the 2021 Health Profile confirming that the average age of mothers in Jersey is increasing.

In 2021, 40% of mothers were aged between 30-34 with the average age of mothers increasing from 30 years old in 1995, to 33 years old in 2021.

The number of births to mothers aged under 20 has been declining steadily and, in 2021, there were more births to mothers aged over 40 than to those aged under 25. 

This trend seems to be fuelling the fire for Jersey's dwindling birth rate.

Dr Machlachlan said: "At the age of 35 years some 50% of a woman’s eggs are chromosomally abnormal, and this may lead to problems with subfertility and miscarriage.

"For those women who do become pregnant [at an older age], there are higher rates of pregnancy complications such as high blood pressure, diabetes and problems in pregnancy that often requires surgical intervention by caesarean section."

Pictured: The proportion of women giving birth by c section increases with age. 

Indeed the Health reports states that during the period 2019-2021, 38% of all deliveries in Jersey were by C-section section, an increase over the last two decades, up from 27% in 2000-2002.

Tellingly, the proportion of C-section deliveries in Jersey during period 2019-2021 increased with the age of the mother. 

Dr Machlachlan explained that he believes many people delay having children due to economic reasons.

He previously told Express: "There could be several factors, but it is my belief that most of these relate to affordability and employment. The steep cost of living in the island means Jersey has high numbers of households that are reliant on double incomes, childcare costs are high, there is a shortage of affordable accommodation.”

The experience of Chloe at Tiny Seeds also corroborates the Health Profile's findings: "The majority of people we see are in their mid to late 30s which supports what the data is showing. I think the high cost of living is pushing people to start their families later."

Pictured: "There could be several factors, but it is my belief that most of these relate to affordability and employment."

Chloe also said that more funding is required to support those people who need fertility treatment to conceive.

With most of the high-level fertility treatment unavailable on island, she said: "The most beneficial thing to do, would be to support people getting fertility treatment off island." 

The Jersey Assisted Reproduction Unit offers assistance and support to public and private patients who need fertility treatment.

Between 2015 and 2020, the service has seen an average of 428 patients a year. For IVF, the ARU will cover the treatment cost for the medication requires for the first three cycles. 

The medication for each cycle costs is upwards of £1000.

Pictured: The Jersey Assisted Reproduction Unit will see between 400 and 500 couples a year. 

However, Chloe argued that the existing provision is insufficient as the medication costs only scratches the surface. She stated that if a sperm injection is required during then IVF process, a common occurrence, then this will incur and extra £800 – £1,250 a time depending on the clinic. 

Genetic testing, which may be used to detect chromosomal anomalies, can cost up to £500 per embryo. An average of ten to 20 eggs are usually retrieved for IVF. 

"It adds up very quickly," said Chloe.

Moreover, Chloe believes the income threshold to be too low as a couple would not qualify for support unless they have a combined income of less than £34,000.

"We're not aware of anyone that's qualified for it in seven years," she admitted.

Likewise, single mothers are not eligible for full IVF funding - although are able to have their scans paid for. 

Dr Enda Mcveigh, who currently heads the Assisted Reproduction Unit and is an experienced Oxford Professor of Reproductive Medicine, argued that Assisted Reproduction is not just about IVF.

While the Assisted Reproduction unit will see around 400-500 new couples a year, it would like only see around 100 IVF cycles.

The service offers a number of other treatment options, like providing information on the menstrual cycle, dietary and lifestyle information, testing for and helping to stimulate ovulation, testing and helping to mitigate sperm quality, and other treatment options that aim to help couples get pregnant without resorting to IVF. 

Pictured: Only a select few States in Europe offer to pay for the medication for 3 full cycles of IVF. 

He said: "Couples don't want to have to go through IVF. It's a hassle and it's expensive...we don't want to rush them into it. "

When it comes to IVF, Dr McVeigh argues that Jersey is ahead of the game: "Jersey is very good. Only one in 3 States in Europe will fund IVF for for three cycles." 

Dr McVeigh also mentioned that, as well as funding treatment, the Government provides sick notes to those undergoing IVF treatment off-island to ensure they are able to get the time off work.

Unlike in the UK, there is no funding cut-off in Jersey for factors such as having a high BMI or smoking.

The island also funds other innovative treatment options: couples who could pass on an inheritable genetic condition can have their IVF treatment paid for by the Government to allow for genetic selection of embryos.

In cases of sterilising cancer treatment, such as radiotherapy, the Government will also pay to freeze the patient's eggs.

For children undergoing potentially sterilising treatment, Dr McVeigh described how they have been able to surgically remove and freeze the uterus, to be implanted back later on once the treatment is over. 

"I'm always lobbying the Minister for more funding for IVF," he said. "Of course, you always want more, but the best way to get more is to thank people for what you've got already and move forward from there."