Fertility Treatment in Asia
Majority of Asian Women and Men agree that it is very important for them to have children. Unfortunately, many Asian couples face challenge trying to conceive naturally or using fertility treatment. The decline in natural fertility and the lower success of IUI and IVF in Asian women is documented in The US, UK, China, Japan, Korea and other Asian countries.
Fertility in Asian countries has declined to the population replacement rate 2.1 or lower. Many factors contribute to decline in natural fertility in Asian women;
Ovarian Reserve in Asian Women
When compared to Caucasian women, Asian women undergoing IVF significantly produce less eggs at all Anti-Mullerian hormone (AMH) levels, even in women with high AMH. AMH is the most accurate marker for ovarian reserve.
Gynecologic and medical disorders that impairs fertility: PCOS, endometriosis and Systemic lupus (SLE) are more common in Asian women.
Vaginismus : may interfere with regular intercourse in some Asian women.
Environmental Factors: increase exposure to methyl Mercury, vitamin D deficiency has been suggested.
Culture : surveys of Asian women and men indicate that Asian women are less likely to consent to be contacted for fertility research, are fatalistic about failure to conceive, less informed about fertility issues, only 36 percent knew that chances of getting pregnant declined with age, and are less likely to suspect a male factor. Asian women are commonly late at seeking care for infertility and overestimate the chance for getting pregnant.
Genetics : Many genes are likely involved. FMR1 is a gene on X chromosome responsible for Fragile X syndrome and its variants. High repeats at this gene may reduce ovarian reserve.
Fertility in Asia countries has declined to the population replacement rate 2.1 or lower. Many factors contribute to decline in natural fertility in Asian women;
Fertility Treatment Outcomes in Asian Couples
1. Pregnancy and delivery rates are lower in Asian women following ovarian stimulation and IUI compared to white women
2. IVF: when compared to white women in the US, 31 per cent of the Asian women gave birth successfully compared to 48 per cent of the white women. Asian women were also less likely to become pregnant; 43 per cent against 59 per cent even after control for many fertility factors. Enodmetrial lining was thinner in Asian women compared to Caucasian women.
Asian women should be aware that fertility-treatments may be less successful and seek care of a reproductive endocrinologist and fertility specialist as early as possible.
By
DR. AMR AZIM
Amr Azim, MD, FACOG is a reproductive endocrinologist and a fertility specialist with special training in treating simple and complex fertility problems. His areas of expertise are assisted reproduction and preservation of fertility.