DR BILL WATKINS: It was partly by chance. My dad started the TasIVF clinic (in Hobart) back in 1983 and then I went into obstetrics and gynecology training and had an opportunity in Melbourne to get a sub-specialty training job just in infertility for a year. I thought I’d do it for a year and then get into general O and G, but I absolutely loved it, so I continued the training program in Melbourne.

In 1996, my wife and I returned to Hobart and I moved into the TasIVF practice, and, basically, for the last 25 years, all I’ve been doing is fertility work.

CD: How long has the Launceston clinic been open?

BW: We’ve been here almost two years. Patients, in the past, had to travel to Hobart for everything. We have a lot of patients coming to the Launceston clinic now and not having to travel to Hobart, and North-West and North-East patients come here as well. Some of the treatments we can’t do here but we hope to expand the services up here.

CD: Have you seen the need for fertility treatment increase a lot over the decades?

BW: Yes, a lot. When I first came back to Hobart, they were doing about 150 cycles of treatment a year and now we’re doing about 700 cycles a year.

CD: Is it mainly the age issue, or are there other factors causing infertility?

BW: We normally say, a third is female factors, a third is male factors, and a third is a combination of the two. The two big avoidable factors are maternal age, which is not always avoidable because people have careers and things, and the second one is obesity. 

There’s a test called an AMH - anti mullerian hormone, which is a blood test you can do to give you an idea of your ovarian reserve and so the way I see it, we’ve got a generation now who are delaying pregnancies and then finding out late that their ovarian reserve is not very good. The generation before had babies in their 20s and a few in their 30s. Now it’s sort of 30s and a few in their 40s.

The next young generation coming through will hopefully have access to this test and we can work out who’s running out of eggs and freeze eggs for them. 

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CD: You mentioned obesity, which is something that’s increased in Tasmania in the past few decades. What recommendations do you have in relation to the foods we eat and the lifestyles we lead?

BW: Yeah, it’s an issue across Western countries. You’ve got to eat a healthy diet. I think we all know what a healthy diet is but most people like to eat too much food that’s unhealthy. It’s a fast food problem. We don’t need fast food outlets. We don’t need fizzy drinks. Fertility increases quite significantly with a relatively small amount of weight loss.

CD: Back to the age factor - what age does it start to become a potential problem?

BW: Women reach their peak fertility at 25 and it is downhill from there up to 35, where, for most women, there’s not much of a decline. There are some women who do decline faster than others but if you’re looking at a population, up to about 35, we’re pretty happy we can help them and get pregnancies for them. Over the age of 40, there’s a very significant decline in fertility. The chances of a spontaneous pregnancy after the age of 40, your lifetime chance beyond that is only 50 per cent. That’s in the best circumstances. And what we see between 35 and 40 is a great difference from woman to woman. Some will remain fertile up to 40 quite well but others, it declines very rapidly from 35 onward.

CD: Where can women get the AMH test done?

BW: Just about anywhere - their local doctor can do it. We get a few people coming along wanting to talk about their fertility and we do that test for them as part of that.

CD: We’ve spoken quite a lot about women. What about men - what issues do you see with male infertility?

BW: The main thing we see is low sperm count. That is often probably genetic and there’s not a lot we can do to actually improve their sperm count. We obviously get them to improve their lifestyle. Obesity is a factor for men as well. Smoking is a significant factor – it’s very bad for your sperm, and smoking marijuana is particularly bad for your sperm.

Often with male factor infertility, it’s not an absolute thing. You don’t look at a sperm count and say, ‘you can’t have children’, but they’ve got a reduced chance per year. An average sperm count is 60 million sperm per millilitre. We see quite a number of men a year with an average sperm count of less than 1 million sperm per millilitre. 

CD: The technology has changed a lot over the years. Where is it now and where’s it headed?

BW: Medications have changed, but the technique of retrieving eggs has pretty much stayed the same over those 25 years. Our practices have improved and our laboratories are much better, so we’re producing better quality embryos for patients. What that has allowed us to do is reduce the multiple pregnancy risk. In the past, it used to be standard to have 20 to 25 per cent multiple pregnancy rate. That’s because the embryos weren’t of such good quality, so you’d put two in. Nowadays, we’d rarely put two embryos in - only when people really haven’t succeeded for quite some time. 

There’s now also the opportunity to biopsy embryos, so you can create an embryo. You grow it through to day five and take some cells off that embryo and have them genetically tested. So if people are known to carry a certain genetic disorder, you can say, ‘well we won’t transfer an embryo that’s genetically abnormal’ because it may just lead to an early pregnancy loss or a child with significant disabilities.

Going forward in the future, you never know where it’s going to go, but there’s talk now of being able to take certain genetic disorders and manipulate that to eliminate it at the embryo level, which should be very interesting. At some point, I think we will develop a technique using cloning technology to grow eggs or sperm for women or men who don’t have eggs or sperm. So if we could take blood cells and convert those into egg cells, or convert them into sperm cells.

CD: Is technology the way forward now. As you said, infertility has increased over the decades - is it continuing to increase?

BW: I think it’s just not getting better. We should be getting better. Everybody knows that age is a critical factor but we still see this slow increase in the average age of patients we see. The average age of a woman we see nowadays would be about 36. These are social changes not medical changes – social situations so that women can have careers and have babies at a younger age. That would be a bigger development than anything we’re likely to see on the science side over the next five to 10 years.

CD: Is part of it finance - people might have a career, they want to buy a house, maybe get married and then by that stage, they find themselves in their late 30s?

BW: I often say to people, they’re planning a renovation for their house - they want to put in a new kitchen, a new bathroom, that sort of thing, and they can’t afford to have treatment now, can’t afford to have a baby now. I say, ‘look, if you just project forward 10 years, if you stop now and have a baby, you can do your renovation anytime. If you stop now and do your renovation and don’t have a baby, you may not be able to have a baby when finally you’re ready’. And nobody’s ever ready. There’s never a perfect time to stop and have a baby - there’s always a reason to put it off.

CD: Are there other treatments available besides IVF?

BW: We always focus on IVF and the technology involved in IVF, but I think the real skill now is to try to help people avoid IVF. It is partly having babies earlier but also, seeing which patients are suitable for treatments that don’t need the high-tech involvement. The majority of our patients don’t have IVF. There are a lot of people out there practicing fertility care that just put patients through IVF. The most common thing we see is people not ovulating, and if you can get that right, the majority of people won’t need IVF. They’ll just need good management of their ovulation.

CD: What is the success rate now in Tasmania?

BW: It’s very much age-dependent. Of patients that walk through the door wanting to get a pregnancy, at least 80 per cent will get at least one baby. If you then look at pregnancy rates per cycle of IVF, if you’re in our young age group of 35 and under, one in three every time they try to succeed, but numbers are very difficult. If you’re 40, you can’t apply those numbers because you’re much older and the success rates aren’t as good.

CD: When IVF is successful, it must be pretty nice for you as a fertility doctor?

BW: It’s the best part of the job. The worst bit of the job is when you don’t succeed. Everybody looks for the positives, but it’s the negatives that are worse than the positives are good in some ways.