For centuries Māori women have undertaken rituals and ceremony to help with conception. From visiting tōhunga and wearing hei tiki, to standing over the whenua of a newborn child. Today, alongside our traditional therapies, there is an ever-developing series of medical treatments to help families conceive.
While treatment varies for everyone, scientific advances in technology have increased chances for couples to get pregnant.
According to Dr Guy Gudex, Medical Director for Repromed NZ, infertility in Aotearoa has become more prevalent in the past 20 years. Attributed to a combination of growing male and female reproductive problems, alongside a delay in couples starting families, there are more people seeking treatment than ever before.
"The average age we are seeing women for treatment is 37," says Dr Gudex. "But fertility decreases with age and is significantly reduced between 35 and 39."
While Māori women typically have children younger, and therefore have better fertility rates overall compared to non-Māori, there is a noticeable shift in more Māori women having their first baby after age 30. Dr Gudex has also noticed Māori are accessing services a third less than the other ethnic groups.
"There are general barriers to accessing health but I think whakamā and being unaware of all the services available plays a big part in the decision making."
Dr Olivia Stuart (Ngāpuhi, Ngāti Kahungunu) of Fertility Associates adds: "Less than five per cent of those we see for a fertility consultation, and that undergo fertility treatment at Fertility Associates, identify as Māori. This is an underrepresentation compared to the general population."
Infertility is defined as not falling pregnant after one year of trying to conceive naturally. Recent data suggests one in four people experience infertility in their lifetime.
In Aotearoa there are a number of government-funded treatments to help couples start their family. However, this funding is limited.
For In Vitro Fertilisation (IVF) the Ministry of Health funds patients whose eligibility is determined by clinical priority assessment criteria: a female must be under 40 years old at the time of referral. The couple must also have New Zealand residency (or a two year work permit) and have either not fallen pregnant after one year trying, or present with a known male or female fertility issue such as very low sperm count, blocked tubes or a genetic or hormonal condition.
You must also be a non-smoker and have a body mass index (BMI) of less than 32.
"You are able to come in for a consultation if your BMI is more than 32," clarifies Dr Gudex. "But if you want to receive funded treatment, that rule does apply."
The weight rule, he feels, is unfair to Māori and Pasifika women. The mean BMI for an adult Māori woman is 30.6.
"In our industry we wonder if this weight criteria is one of the reasons we see fewer Māori and Pasifika women come forward through the public system. New research doesn't justify excluding these women from treatment. There are conversations happening about whether it is time to change this rule."
In the past two decades there have been many breakthroughs and developments in the fertility space. These have seen procedures where a single sperm can be injected directly into an egg, treating the common sperm problems males face. Cycles of IVF have routinely become shorter with less injections and side effects, and specialists are now able to genetically test embryos to check chromosomes, leading to fewer miscarriages.
For those who do not qualify for funded treatment, the personal financial cost could be anywhere between a few hundred dollars, to tens of thousands, depending on treatment options. And with treatment ranging from oral medications through to IVF, sperm and egg donation and, surrogacy, there are lots of avenues available.
"The best thing you can do is see a specialist early," urges Dr Gudex.
Article continues in issue 134