For a group of teenagers, Lauren, Fazana, Flora and Mackenzie are remarkably knowledgeable about fertility. Sitting in the library at St Marylebone school in central London, they’re explaining what they’ve learned. These year 10 girls know how common infertility is, how female fertility declines with age and they understand that IVF doesn’t always work. The discussion ranges from egg donation and surrogacy through to the dilemmas they know they may face later in life trying to balance careers with the desire for a family; “There’s never a time that’s exactly the right time to have a baby,” they explain.
It’s something every girl at St Marylebone will cover in their religious studies lessons, where the curriculum covers religious attitudes to family, relationships and family planning, as well as the ethics of fertility treatments. But in some other schools this highly topical issue barely gets a mention. IVF may be covered as a technological advance in science, but infertility isn’t part of the sex education curriculum, where the focus is on preventing pregnancy and sexually transmitted infections. This may seem sensible when dealing with young people, but the reality is that pupils are far more likely to have a fertility problem in the future than they are to get pregnant while they’re still at school. The teenage pregnancy rates for England and Wales are the lowest they’ve been since the 1960s, but infertility rates are rising; one in six of the population will experience problems getting pregnant – that’s about five pupils in each class of 30.
Prof Michael Reiss, of the Institute of Education, who founded the journal Sex Education, says infertility isn’t covered because it hasn’t been seen as a priority. “It’s not wilful, but these things are determined by the previous generation’s issues. The situation was always portrayed as if everyone wanted to be a parent at 15 or 16, and as if the major job was to stop them doing so or being infected with an STI and that has dominated the discourse. It’s just that people don’t think about infertility.”
Jane Knight is a fertility nurse specialist who has been invited in to schools to talk to teenagers about fertility awareness, but her lessons are usually one-off sessions, squeezed in wherever a school feels they may fit. “There is no cohesion when it comes to fertility education in schools, nothing joined up,” she says. “I try to give teenagers information in a way that is relevant to them and I talk about protecting fertility. They have learned about IVF, but it’s so far removed from where they are at that it’s almost irrelevant.”
Of course, it isn’t easy to get teenagers to think years ahead, but there is clearly room for improvement when it comes to fertility awareness. When the sexual health charity FPA investigated young people’s knowledge about sex and reproduction, they found widespread confusion, as Rebecca Findlay, of FPA, explains. “Our research revealed many very basic misunderstandings about fertility. It showed that sex and relationships education is letting young people down, and that they are aware of that – just 4% rated the sex education they’d received as excellent.”
When it comes to fertility, it isn’t just young people who are confused. Despite what can seem like a constant stream of media messages about the impact of age and lifestyle on fertility, many people still don’t really appreciate that a woman’s fertility begins to decline rapidly at 35, or that obesity, eating disorders, smoking and drugs can all affect your chances of having a family. A recent study of undergraduates in the US found that most thought female fertility declined far later than it does and that they overestimated both the chances of getting pregnant after unprotected intercourse and the likelihood of success after fertility treatment. Attempting to redress this balance is something they are taking seriously in Scotland, where plans for a Fertility Education Project are under way, with funding for two part-time workers who will help to raise awareness of infertility among students and the wider community.
For those elsewhere in the UK, knowledge about infertility looks set to remain patchy. This has led fertility specialists to call for a change to the school curriculum, as Dr Allan Pacey, senior lecturer at Sheffield University and chair of the British Fertility Society, explains. “I don’t think we do sex education well enough in schools. We don’t give people the skills they need for fertility planning. I understand that from the point of view of teenage pregnancy it is essential to focus on contraception, but that is only one side of the coin. We could do so much more for young people – most are very naive when it comes to fertility. I would package it as fertility advice rather than infertility advice, but I do think it should be part of the sex education curriculum.”
It is in fertility clinics that our failure to get the message across is really felt by those who discover that their chances of getting pregnant are not as good as they had hoped. Clare Lewis-Jones, chief executive of the charity Infertility Network UK, sees at first hand the distress this can cause. “It is vital that we get information out there so that people make informed choices at the right time in their lives and avoid the heartache infertility can cause,” she says. “Of course, not all fertility problems are caused by lifestyle choices, but we do hear from those who would have done things differently if they had known more about how lifestyle choices would affect their chances of having a family.”
There are sensitivities surrounding the idea of teaching young people that getting pregnant isn’t always easy, perhaps due to anxieties that this could water down messages about teenage pregnancy prevention, but Sarah Swan, assistant head at St Marylebone, believes it is important to give their girls the full picture. “You’ve got to give young people the facts and educate them about the realities to help them make the right decisions. You can’t decide not to give them information because you are worried that it might lead to problems.”
Far from leading to problems, Reiss suggests that giving young people all the facts could bring benefits. “Teaching about infertility in schools wouldn’t increase teenage pregnancy rates. In fact, if it was part of a coherent, high-quality sex education programme, I would expect it to lower teenage pregnancy rates.”
With ever-increasing numbers seeking medical help to conceive, and warnings that infertility rates may rise yet higher, it seems that ensuring our teenagers are properly educated about fertility might not only help to prevent future problems, but could be beneficial in the present.
Via The Guardian
Olivia Tullo was 28 when she and her husband decided to start a family. They’d bought a house; they had a puppy. They were ready.
“We started trying, and several months went by. I just had a feeling,” Tullo said. “I just knew something wasn’t right.”
Her OB-GYN recommended a fertility specialist, who eventually recommended surgery for what was determined to be endometriosis. After that, there was more trying, more tests and the discovery that she had premature ovarian failure.
“My ovaries were shutting down,” Tullo said. “And I was only 29.”
Age is one of the main factors that can drive up a woman’s risk of infertility, which affects approximately 10 percent of women between the ages of 15 to 44. By 40, a woman’s chances of becoming pregnant drop from 90 to 67 percent; at 45, a woman has just a 15 percent shot.
But the Centers for Disease Control and Prevention estimates that in 2002, the most recent year for which data is available, 11 percent of married women under 29 also experienced infertility. In that age group, infertility is defined as one year of trying and failing to conceive.
“You are really still in your fertility peak until 31 or 32,” said Dr. Pasquale Patrizio, director of the Yale Fertility Center. Most healthy young women in their 20s can rightly expect that they will be able to conceive, he said. Which can make it all the more shocking for women who cannot.
“I never thought our 20s would be so consumed and obsessed with dealing with these treatments,” said Mary Roberts, now 27, who has been trying to have a baby for almost four years. “No one says their vows — ‘through sickness and health’ — and thinks that right after you say them you’ll test that.”
Roberts is now in the very early stages of her second round of in vitro fertilization. Her first round was successful, but she miscarried at four weeks. She has been told that an autoimmune disorder is at the root of her infertility.
“It drives me insane,” Roberts said. “When did it happen? How did it happen? I don’t have answers. I just know that infertility is a symptom.”
There are many diagnoses offered to women like Roberts to explain their infertility: diminished ovarian reserve; ovulatory dysfunction; pelvic inflammatory disease; endometriosis (when the tissue that normally lines the inside of a woman’s uterus grows outside of it and can prevent an egg and sperm from uniting). Polycystic ovarian syndrome is the most common cause of female infertility, resulting from a hormone imbalance that can disrupt normal ovulation.
“Usually in that young age group, a common factor is a tubal disease, like the fallopian tubes are blocked,” said Dr. George Attia, director of the Reproductive and Fertility Center at The University of Miami Miller School of Medicine. “The other cause is the partner may have a low sperm count, or poor sperm motility.” (According to Resolve: The National Infertility Association, one third of infertility is a result of male factors.)
Some studies have focused on the role that environmental exposures, like pesticides and heavy metals, as well as behaviors such as drinking and smoking, can play in declining sperm counts, largely because those effects are easier to see and track in men.
Although many women may be labeled infertile without a clear reason behind it, one bright spot for women experiencing infertility in their 20s is that they may be more likely to get an answer to that wrenching question: “Why?”
“With younger patients, there’s usually a cause rather than ‘unexplained fertility,'” said Dr. James Grifo, director of the New York University Fertility Center.
But their treatment options are largely the same as those available to women who are no longer in their 20s.
Women are often prescribed drugs to promote ovulation, or they try artificial insemination or IVF. Artificial insemination is significantly cheaper (at an average of $865, according to Resolve) than the $8,000-plus per cycle paid by women doing IVF. Yet some young women do take the more expensive option.
According to the Society For Assisted Reproductive Technology, women under 35 underwent nearly 40,000 cycles of IVF using fresh embryos from non-donors in 2010, up slightly from years past.
Several fertility experts said they had never heard of a young woman being turned away from IVF or denied coverage because of their age, as is reportedly the case with a 24-year-old woman in the U.K. who says she was denied coverage for it until she turns 30. But they do say they are likely to be more conservative with younger patients.
“We might be less aggressive,” Dr. Attia said. That could include taking time to work on weight loss if they think obesity is hampering ovulation, he said, or spreading each treatment out a little longer.
Occasionally, however, a woman’s young age can work against her.
“The very first doctor we saw said ‘come back in a year,’ and he excused us out of his office without doing one single test,'” Roberts said. At that point she and her husband had already been trying for at least that long.
“I had a lot of people say, ‘Well you’re lucky, because you’re so young,'” said Katie Schaber, 27, who started trying when she was 23. “It upset me because in the end, it didn’t work. I was young and it still didn’t happen.”
After four artificial inseminations and continued cysts and other health issues, she and her husband stopped pursuing treatment and put themselves on adoption lists. Schaber blogs about her experience and says the Internet can be a key resource for women seeking comfort and understanding at a time when so many of their friends are settling down and having babies.
Isolation was a real problem for Tullo, who said she lost touch with many of her friends who just couldn’t connect to her experience. She and her husband have a two-month-old daughter through adoption. They stopped pursuing fertility treatments after she miscarried with identical twins last fall.
Tullo said she would like to see more frank, honest information out there for young women to help them make informed family planning decisions. But you can’t force it, she said. Women have to wait until they are ready.
After all, even the best laid plans can go awry.
“Infertility at any age is difficult, but I do hold a special weakness in my heart for people in their 20s,” Tullo said. “That’s true infertility, when your body fails you at an age when you should be able to get pregnant.”
Via Huffington Post