tag:theconversation.com,2011:/nz/topics/infertility-198/articlesInfertility – The Conversation2024-02-15T00:00:55Ztag:theconversation.com,2011:article/2202822024-02-15T00:00:55Z2024-02-15T00:00:55ZFeminist narratives are being hijacked to market medical tests not backed by evidence<figure><img src="https://images.theconversation.com/files/575240/original/file-20240213-27-twey75.jpg?ixlib=rb-1.1.0&rect=252%2C97%2C6218%2C4210&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-sitting-on-floor-and-leaning-on-couch-using-laptop-Nv-vx3kUR2A">Thought Catalog/Unsplash</a></span></figcaption></figure><p>Corporations have used feminist language to promote their products for decades. In the 1980s, companies co-opted messaging about female autonomy to encourage women’s consumption of unhealthy commodities, <a href="https://www.mdpi.com/1660-4601/17/21/7902">such as tobacco and alcohol</a>. </p>
<p>Today, feminist narratives around empowerment and women’s rights are being co-opted to market interventions that are not backed by evidence across many areas of women’s health. This includes by commercial companies, industry, mass media and well-intentioned advocacy groups. </p>
<p>Some of these health technologies, tests and treatments are useful in certain situations and can be very beneficial to some women. </p>
<p>However, promoting them to a large group of asymptomatic healthy women that are unlikely to benefit, or without being transparent about the limitations, runs the risk of causing more harm than good. This includes inappropriate medicalisation, overdiagnosis and overtreatment. </p>
<p>In our analysis published today in the <a href="https://www.bmj.com/content/384/bmj-2023-076710">BMJ</a>, we examine this phenomenon in two current examples: the anti-mullerian hormone (AMH) test and breast density notification.</p>
<h2>The AMH test</h2>
<p>The AMH test is a blood test associated with the number of eggs in a woman’s ovaries and is sometimes referred to as the “egg timer” test. </p>
<p>Although often used in fertility treatment, the AMH test cannot reliably predict the <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">likelihood of pregnancy</a>, timing to pregnancy or <a href="https://academic.oup.com/humupd/article/29/3/327/6990969">specific age of menopause</a>. The American College of Obstetricians and Gynaecologists therefore <a href="https://pubmed.ncbi.nlm.nih.gov/30913192/">strongly discourages testing</a> for women not seeking fertility treatment. </p>
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<img alt="Woman sits in a medical waiting room" src="https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The AMH test can’t predict your chance of getting pregnant.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-sitting-on-a-bench-in-a-waiting-area-UssKpGyrBzw">Anastasia Vityukova/Unsplash</a></span>
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<p>Despite this, several <a href="https://bmjopen.bmj.com/content/11/7/e046927.info">fertility clinics</a> and <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808552">online companies</a> market the AMH test to women not even trying to get pregnant. Some use feminist rhetoric promising empowerment, selling the test as a way to gain personalised insights into your fertility. For example, “<a href="https://www.ondemand.labcorp.com/lab-tests/womens-fertility-test">you deserve</a> to know your reproductive potential”, “<a href="https://kinfertility.com.au/fertility-test">be proactive</a> about your fertility” and “<a href="https://monashivf.com/services/early-intervention/amh-blood-test/">knowing your numbers</a> will empower you to make the best decisions when family planning”. </p>
<p>The use of feminist marketing makes these companies appear socially progressive and champions of female health. But they are selling a test that has no proven benefit outside of IVF and cannot inform women about their current or future fertility. </p>
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Read more:
<a href="https://theconversation.com/dont-believe-the-hype-egg-timer-tests-cant-reliably-predict-your-chance-of-conceiving-or-menopause-timing-207008">Don't believe the hype. 'Egg timer' tests can't reliably predict your chance of conceiving or menopause timing</a>
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<p>Our <a href="https://academic.oup.com/humrep/article/38/8/1571/7193900?login=false">recent study</a> found around 30% of women having an AMH test in Australia may be having it for these reasons.</p>
<p>Misleading women to believe that the test can reliably predict fertility can create a false sense of security about delaying pregnancy. It can also create unnecessary anxiety, pressure to freeze eggs, conceive earlier than desired, or start fertility treatment when it may not be needed.</p>
<p>While some companies mention the test’s limitations if you read on, they are glossed over and contradicted by the calls to be proactive and messages of empowerment. </p>
<h2>Breast density notification</h2>
<p>Breast density is one of several independent risk factors for breast cancer. It’s also harder to see cancer on a mammogram image of breasts with high amounts of dense tissue than breasts with a greater proportion of fatty tissue. </p>
<p>While estimates vary, approximately 25–50% of women in the breast screening population <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200066/">have dense breasts</a>.</p>
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<img alt="Young woman has mammogram" src="https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Dense breasts can make it harder to detect cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-taking-mammogram-xray-test-75178006">Tyler Olsen/Shutterstock</a></span>
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<p>Stemming from valid concerns about the increased risk of cancer, advocacy efforts have used feminist language around women’s right to know <a href="https://insightplus.mja.com.au/2022/34/breast-density-we-can-handle-the-truth/#:%7E:text=%E2%80%9CWomen%20can%20handle%20the%20truth,need%20to%20know%20that%20truth.">such as</a> “women need to know the truth” and “women can handle the truth” to argue for widespread breast density notification. </p>
<p>However, this simplistic messaging overlooks that this is a complex issue and that <a href="https://ebm.bmj.com/content/26/6/309">more data is still needed</a> on whether the benefits of notifying and providing additional screening or tests to women with dense breasts outweigh the harms. </p>
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Read more:
<a href="https://theconversation.com/what-causes-breast-cancer-in-women-what-we-know-dont-know-and-suspect-86314">What causes breast cancer in women? What we know, don't know and suspect</a>
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<p>Additional tests (ultrasound or MRI) are now being recommended for women with dense breasts as they have the ability to detect more cancer. Yet, there is no or little mention of the <a href="https://www.nejm.org/doi/full/10.1056/NEJMe1912943">lack of robust evidence</a> showing that it prevents breast cancer deaths. These extra tests also have out-of-pocket costs and high rates of false-positive results. </p>
<p>Large international advocacy groups are also sponsored by companies that will <a href="https://www.volparahealth.com/news/volpara-announces-expanded-sponsorship-of-densebreast-info-org-at-sbi-2023/">financially benefit from women being notified</a>.</p>
<p>While stronger patient autonomy is vital, campaigning for breast density notification without stating the limitations or unclear evidence of benefit may go against the empowerment being sought. </p>
<h2>Ensuring feminism isn’t hijacked</h2>
<p>Increased awareness and advocacy in women’s health are key to overcoming sex inequalities in health care. </p>
<p>But we need to ensure the goals of feminist health advocacy aren’t undermined through commercially driven use of feminist language pushing care that isn’t based on evidence. This includes more transparency about the risks and uncertainties of health technologies, tests and treatments and greater scrutiny of conflicts of interests. </p>
<p>Health professionals and governments must also ensure that easily understood, balanced information based on high quality scientific evidence is available. This will enable women to make more informed decisions about their health.</p>
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Read more:
<a href="https://theconversation.com/young-women-wont-be-told-how-to-behave-but-is-girlboss-just-deportment-by-another-name-132351">Young women won't be told how to behave, but is #girlboss just deportment by another name?</a>
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<img src="https://counter.theconversation.com/content/220282/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brooke Nickel receives fellowship funding from the National Health and Medical Research Council (NHMRC). She is on the Scientific Committee of the Preventing Overdiagnosis Conference.</span></em></p><p class="fine-print"><em><span>Tessa Copp receives fellowship funding from the National Health and Medical Research Council (NHMRC). She is also on the Scientific Committee of the Preventing Overdiagnosis Conference. </span></em></p>Corporate medicine is hijacking feminist narratives around empowerment and women’s rights to market technologies, tests and treatments that aren’t backed by evidence.Brooke Nickel, NHMRC Emerging Leader Research Fellow, University of SydneyTessa Copp, NHMRC Emerging Leader Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190052023-12-14T19:19:48Z2023-12-14T19:19:48ZEggs from men, sperm from women: how stem cell science may change how we reproduce<figure><img src="https://images.theconversation.com/files/564442/original/file-20231208-17-22yb4u.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C748&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/morula-early-stage-embryo-consisting-cells-776035219">nobeastsofierce/Shutterstock</a></span></figcaption></figure><p>It may soon be possible to coax human skin cells into becoming functional eggs and sperm using a technique known as “in vitro gametogenesis”. This involves the creation (genesis) of eggs and sperm (gametes) outside the human body (in vitro). </p>
<p>In theory, a skin cell from a man could be turned into an egg and a skin cell from a woman can become a sperm. Then there’s the possibility of a child having multiple genetically-related parents, or only one.</p>
<p>Some scientists believe human applications of in vitro gametogenesis are a <a href="https://www.statnews.com/2023/10/02/ivg-ivf-replacement-reproductive-technology-hype/">long way off</a>. </p>
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<p>However, scientists who work on human stem cells are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579208/">actively working</a> on overcoming the barriers. <a href="https://www.statnews.com/2023/04/08/ivf-eggs-hormones-gameto-reproductive-fertilo/">New</a> <a href="https://www.technologyreview.com/2021/10/28/1038172/conception-eggs-reproduction-vitro-gametogenesis/">biotechnology</a> <a href="https://www.newyorker.com/magazine/2023/04/24/the-future-of-fertility">start-ups</a> are also seeking to commercialise this technology.</p>
<p>Here’s what we know about the prospect of human in vitro gametogenesis and why we need to start talking about this now.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-are-stem-cells-14391">Explainer: what are stem cells?</a>
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<h2>Is the technology available?</h2>
<p>In vitro gametogenesis begins with “pluripotent stem cells”, a kind of cell that can develop into many different cell types. The aim is to persuade these stem cells to become eggs or sperm.</p>
<p>These techniques could use stem cells taken from early embryos. But scientists have also worked out how to <a href="https://www.eurostemcell.org/stemcellshorts-what-are-induced-pluripotent-stem-cells">revert adult cells</a> to a pluripotent state. This opens up the possibility of creating eggs or sperm that “belong to” an existing human adult.</p>
<p>Animal studies have been promising. In <a href="https://www.nature.com/articles/490146b">2012</a>, scientists created live-born baby mice using eggs that began their life as skin cells on a mouse tail.</p>
<p>More recently, the technique has been used to facilitate same-sex reproduction. Earlier this year, scientists created mouse pups with <a href="https://www.nature.com/articles/d41586-023-00717-7">two genetic fathers</a> after transforming skin cells from male mice into eggs. Mouse pups with <a href="https://www.nature.com/articles/d41586-018-06999-6">two genetic mothers</a> have also been created.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/1ocWjHJgKcc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How scientists bred mice with two fathers.</span></figcaption>
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<p>Scientists have not yet managed to adapt these techniques to create human gametes. Perhaps because the technology is still in its infancy, Australia’s legal and regulatory systems do not address whether and how the technology should be used. </p>
<p>For example, the National Health and Medical Research Council’s <a href="https://www.nhmrc.gov.au/about-us/publications/art">assisted reproduction guidelines</a>, which were updated in 2023, do not include specific guidance for in vitro-derived gametes. These guidelines will need to be updated if in vitro gametogenesis becomes viable in humans.</p>
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Read more:
<a href="https://theconversation.com/the-future-of-stem-cells-tackling-hype-versus-hope-72052">The future of stem cells: tackling hype versus hope</a>
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<h2>The potential</h2>
<p>There are three distinct clinical applications of this technology.</p>
<p>First, in vitro gametogenesis could streamline IVF. Egg retrieval currently involves repeated hormone injections, a minor surgical procedure, and the <a href="https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697">risk</a> of overstimulating the ovaries. In vitro gametogenesis could eliminate these problems.</p>
<p>Second, the technology could circumvent some forms of medical infertility. For example, it could be used to generate eggs for women born without functioning ovaries or following early menopause.</p>
<p>Third, the technology could allow same-sex couples to have children who are genetically related to both parents.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/promising-assisted-reproductive-technologies-come-with-ethical-legal-and-social-challenges-a-developmental-biologist-and-a-bioethicist-discuss-ivf-abortion-and-the-mice-with-two-dads-208276">Promising assisted reproductive technologies come with ethical, legal and social challenges – a developmental biologist and a bioethicist discuss IVF, abortion and the mice with two dads</a>
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<h2>Legal, regulatory and ethical issues</h2>
<p>If the technology becomes viable, in vitro gametogenesis will alter the dynamics of how we create families in unprecedented ways. How we should respond requires careful consideration.</p>
<p><strong>1. Is it safe?</strong></p>
<p>Careful trials, rigorous monitoring, and follow-up of any children born will be essential – as it has been for other <a href="https://theconversation.com/maeves-law-would-let-ivf-parents-access-technology-to-prevent-mitochondrial-disease-heres-what-the-senate-is-debating-176668">reproductive</a> <a href="https://theconversation.com/rest-assured-ivf-babies-grow-into-healthy-adults-23432">technologies</a>, including IVF.</p>
<p><strong>2. Is it equitable?</strong></p>
<p>Other issues relate to access. It might seem unjust if the technology is only available to the wealthy. Public funding could help – but whether this is appropriate depends on whether the state <a href="https://theconversation.com/ideas-for-australia-rethinking-funding-and-priorities-in-ivf-should-the-state-pay-for-people-to-have-babies-57036">ought to support</a> people’s reproductive projects.</p>
<p><strong>3. Should we restrict access?</strong></p>
<p>For instance, pregnancy is rare in older women, largely because egg count and quality <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/age-and-fertility">decline with age</a>. In vitro gametogenesis would theoretically provide “fresh” eggs for women of any age. But helping older women become parents is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566409/">controversial</a>, due to physical, psychological and other factors associated with having babies later in life.</p>
<p><strong>4. We’d still need surrogates</strong></p>
<p>If we took skin cells from each male partner and created an embryo, that embryo would still need a surrogate to carry the pregnancy. Unfortunately, Australia has a shortfall of surrogates. International surrogacy provides an alternative, but carries <a href="https://theconversation.com/its-hard-to-find-a-surrogate-in-australia-but-heading-overseas-comes-with-risks-206182">legal, ethical and practical difficulties</a>. Unless access to surrogacy is improved domestically, benefits to male couples will be limited. </p>
<p><strong>5. Who are the legal parents?</strong></p>
<p>In vitro gametogenesis also raises questions about who are the future child’s legal parents. We already see related legal debates surrounding non-traditional families formed through surrogacy, egg donation and sperm donation. </p>
<p>In vitro gametogenesis could theoretically also be used to create children with more than two genetic parents, or with only one. These possibilities likewise require us to update our current understandings of parenthood.</p>
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Read more:
<a href="https://theconversation.com/we-may-one-day-grow-babies-outside-the-womb-but-there-are-many-things-to-consider-first-125709">We may one day grow babies outside the womb, but there are many things to consider first</a>
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<h2>How far is too far?</h2>
<p>Of the potential uses already mentioned, same-sex reproduction is the most controversial. The reproductive limitations imposed by being in a same-sex relationship are sometimes seen as a “social” form of infertility the medical profession is not obligated to fix.</p>
<p>The moral stakes, however, are virtually identical regardless of whether in vitro gametogenesis is used by same-sex or opposite-sex couples. Both uses of the technology fulfil exactly the same goal: helping couples fulfil their desire to have a child genetically related to both parents. It would be unjust to deny access to only one of these groups.</p>
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<a href="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Same-sex female couple cooking in kitchen, one feeding the other fruit" src="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Who should have access to this technology? How about same-sex couples?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lesbian-couple-cooking-kitchen-together-1071305168">Rawpixel.com/Shutterstock</a></span>
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<p>But same-sex reproduction is only the tip of the iceberg. In vitro gametogenesis could theoretically facilitate “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973109/">solo reproduction</a>” by deriving both eggs and sperm from the same individual. Interestingly, a child created this way would not be a clone of its parent, since the process of gamete formation would shuffle the parent’s genetic material and create a genetically distinct individual.</p>
<p>Or people could engage in “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215291/">multiplex parenting</a>” combining genetic material from more than two individuals. Imagine, for example, that two couples create embryos via IVF. In vitro gametogenesis could then be used to derive eggs and sperm from each of these two separate embryos, which could subsequently be used to conceive a single child that is genetically related to all four adults.</p>
<p>Finally, in vitro gametogenesis could revolutionise prenatal genetic selection. We’d have <a href="https://rmanetwork.com/blog/number-of-eggs-good-ivf-in-vitro-fertilization/">many more embryos</a> than available during regular IVF to screen for genetic diseases and traits.</p>
<p>So it would be urgent to discuss “designer babies”, eugenics, and whether we have a <a href="https://bioedge.org/bioethics-d75/savulescu-interviewed-on-procreative-beneficence/">moral obligation</a> to conceive children with the best chance of a good life.</p>
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Read more:
<a href="https://theconversation.com/worlds-first-synthetic-embryo-why-this-research-is-more-important-than-you-think-188217">World's first 'synthetic embryo': why this research is more important than you think</a>
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<h2>We need to start talking about this now</h2>
<p>Both law and ethics can lag behind new technologies, particularly when their implications are as profound and far-reaching as the implications of in vitro gametogenesis.</p>
<p>We need to discuss how this technology should be regulated before it is rolled out. Given how rapidly the science is developing, we should begin this discussion now. </p>
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<p><em>Laura Smith, a masters student from Monash University, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/219005/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Koplin receives research funding from Ferring Pharmaceuticals for an unrelated project.</span></em></p><p class="fine-print"><em><span>Neera Bhatia receives funding from UKRI Arts and Humanities Research Council for an unrelated project.</span></em></p>The technology may be here sooner than we think. But we have so much to discuss first.Julian Koplin, Lecturer in Bioethics, Monash University & Honorary fellow, Melbourne Law School, Monash UniversityNeera Bhatia, Associate Professor in Law, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2173222023-11-30T14:22:54Z2023-11-30T14:22:54ZBeing child-free has been deemed ‘selfish’ for decades – the history of this misconception explained<figure><img src="https://images.theconversation.com/files/562173/original/file-20231128-18-m2by5b.jpg?ixlib=rb-1.1.0&rect=3%2C17%2C1260%2C943&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Waiting By The Window by Carl Holsøe.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Waiting_By_The_Window.jpg">Wiki Commons</a></span></figcaption></figure><p>Choosing to be child-free is <a href="https://www.pewresearch.org/short-reads/2021/11/19/growing-share-of-childless-adults-in-u-s-dont-expect-to-ever-have-children/">more common than ever before</a> in some countries, including the US. Many people see not having children an <a href="https://www.theguardian.com/world/2018/jun/20/give-up-having-children-couples-save-planet-climate-crisis">ethical and ecological choice</a>, made to protect the environment, people and other species. Being child-free is about being “green”. Consequently, more positive discourses around childlessness are emerging.</p>
<p>But this was not always the case. In societies that encourage an increased birthrate, motherhood is <a href="https://www.proquest.com/docview/232581954">often presented</a> as natural and caring. Meanwhile, women without children are often described as <a href="https://psycnet.apa.org/record/2022-00837-001">biological failures, or as deviant</a>. For example, when visible in popular culture – they are often not represented at all – women without children are either presented as animal-lovers like the “crazy cat lady” or animal-killers, like Cruella de Vil. In these examples, the focus on animal represents their supposed inability to care for humans (their species), their “unnaturalness”. </p>
<p>In the 19th century, women without children were already being described as selfish and unnatural. The natural world was conversely used to describe fertile women, who were often compared to flowers in bloom in literature.</p>
<hr>
<p><em><a href="https://theconversation.com/uk/topics/should-i-have-children-148388?utm_source=TCUK&utm_medium=InArticleTop&utm_campaign=Parenting2023">Should I have children?</a> The pieces in this series will help you answer this tough question – exploring fertility, climate change, the cost of living and social pressure.</em>
<em>We’ll keep the discussion going at a live event in London on November 30. <a href="https://www.waterstones.com/events/the-conversation-should-i-have-children/london-tottenham-court-road">Click here</a> for more information and tickets.</em></p>
<hr>
<p>The association of women with plants and fertility is an ancient one, found particularly in agricultural pagan figures. Demeter, the ancient Greek goddess of the harvest, for example, was the goddess of grains, but also of marriage and fertility. </p>
<p>Many expressions still link women’s reproductive systems and flowers. In French, the flower is a metaphor for a virgin sexual organ. To <em>avoir ses fleurs</em> (have your flowers) is an expression for having periods, and being <em>une jeune fille en fleur</em> (a young woman in flower) means that the young woman is ready for marriage – and therefore reproduction. </p>
<p>Women themselves are also compared to flowers: in English, both “pretty flower” and “English rose” describe attractive young women. Reducing women to flowers, through these comparisons, is not only misogynistic, but reinforces the social pressure to produce children “on time”. Timing is important in these comparisons, as flowers fade quickly.</p>
<h2>Being child-free in the 19th century</h2>
<p>But what about women without children, those flowers that will not produce seeds? <a href="https://library.oapen.org/bitstream/handle/20.500.12657/25269/1004825.pdf?sequence=1&isAllowed=y**">My research</a> into literature and paintings from the second half of the 19th century has shown that they were often represented as monstrous horticultural hybrids. </p>
<p>At the time, “hybrid flowers” – which were often sterile – became the preferred metaphor to describe sexually active women who were either unable or refused to bear children. In France, having and raising children was seen as a woman’s <a href="https://www.cambridge.org/core/books/debating-the-woman-question-in-the-french-third-republic-18701920/A1E670D26BDB0203197A734E856855C1#:%7E:text=Book%20description,neighbors%20from%201870%20to%201920.">natural and civic duty</a> for the nation. Conversely, women who were sexually active but without children were often seen as <a href="https://books.google.co.uk/books/about/Figures_of_Ill_Repute.html?id=jaSPKb2kJ5wC&redir_esc=y#:%7E:text=Ubiquitous%20in%20the%20streets%20and,%2C%20class%2C%20and%20the%20body.">unnatural and dangerous</a>.</p>
<p>Comparisons that described women as flowers were historically about fertility. How was it then that flowers became a metaphor for sterility at the end of the 19th century? </p>
<figure class="align-center ">
<img alt="Painting of a woman smelling roses" src="https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fertile, childbearing women were compared to more classic flowers such as roses. Girl And Roses by Auguste Toulmouche (1879).</span>
<span class="attribution"><a class="source" href="https://www.artsy.net/artwork/auguste-toulmouche-woman-and-roses">Clark Art Institute</a></span>
</figcaption>
</figure>
<p>The emphasis on flowers as sexual organs and as a metaphor for women’s sexuality appears to have been used more often after the Swedish botanist Carl Linnaeus <a href="https://ucmp.berkeley.edu/history/linnaeus.html#:%7E:text=Biography%20of%20Linnaeus,from%20a%20very%20early%20age">openly discussed</a> the sexuality of plants with anthropomorphic language at the end of the 18th century.</p>
<p>It is important to note that, for a long time, if men knew at all that flowers were sexual organs, they believed they were unisexual and feminine. They did not believe that both male and female organs were involved in the production of fruits. </p>
<p>Once the sexual nature of plants had been established, the nature of the floral metaphor changed and the innocence of the flower was lost. Flowers progressively became the symbol of a young lady with an emerging sexuality or who was waiting to “bear fruit”.</p>
<h2>Horticultural hybrids</h2>
<p>During the second empire in France (1852-1870) and the beginning of the <a href="https://www.britannica.com/topic/Third-Republic-French-history">Third Republic</a> (1870-1840), horticultural hybrids were extremely popular. </p>
<p>Horticulturists developed large plants and flowers such as <a href="https://www.britannica.com/plant/cattleya">cattleya</a>, <a href="https://www.rhs.org.uk/plants/hibiscus/growing-guide">hibiscus</a>, <a href="https://www.britannica.com/plant/Nidularium">nidularium</a> which often looked like enlarged genitals (natural plants are often a lot smaller and less colourful). These hybrids made the sexual analogy even more obvious. </p>
<p>By the end of the 19th century, the artificial hybrids became used for describing, indirectly, near-pornographic scenes. Here is an example from <a href="https://global.oup.com/ukhe/product/the-kill-9780199536924?cc=gb&lang=en&">The Kill</a> (1895), a famous novel by <a href="https://www.britannica.com/biography/Emile-Zola">Émile Zola</a>. Instead of describing the characters making love, he describes the plants:</p>
<blockquote>
<p>As their glances penetrated into the corners of the hothouse, the darkness became filled with a more furious debauch of leaves and stalks; they could not distinguish on the terraces between the marantas, soft as velvet, the gloxinias, purple-belled, the dracoenas, like blades of old lacquer; it was a great dance of living plants pursuing one another with unsatisfied fervour.</p>
</blockquote>
<p>Many of the hybrids being created at this time were sterile. They therefore became a metaphor for “unproductive” sexuality. Because they were man-made, they could be seen as a perversion of the laws of nature. Comparing women to those hybrids was a way to criticise what was deemed the artificiality of their infertility, or decision not to have children. </p>
<p>Fertile, childbearing women were frequently compared to natural, more classic flowers such as roses or lilies.</p>
<p>At the time, France was obsessed with its low birth rate. Many politicians believed it explained why France had lost the war against Prussia (1870-1871). Childless women were therefore also seen as bad citizens.</p>
<p>Through their comparisons with hybrid, infertile flowers, women who could not or choose not to reproduce were deemed un-French, undesirable and, in some ways, monstruous. </p>
<p>Understanding how women are associated with nature and very often compared to flowers is essential to understanding how being childless continues to be demonised in contemporary society. As contemporary art, culture and the very language we use demonstrates, child-free women are still often described as “unnatural” or biologically deviant.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>Looking for something good? Cut through the noise with a carefully curated selection of the latest releases, live events and exhibitions, straight to your inbox every fortnight, on Fridays. <a href="https://theconversation.com/uk/newsletters/something-good-156">Sign up here</a>.</em></p>
<hr><img src="https://counter.theconversation.com/content/217322/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aude Campmas is affiliated with:
I am a volunteer for Portsmouth Abuse and Rape Counselling Service.</span></em></p>Hybrid flowers became a metaphor for sterility at the end of the 19th century.Aude Campmas, Lecturer in French Studies, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2177262023-11-28T16:52:45Z2023-11-28T16:52:45ZWhy you should talk about fertility, even if you don’t want children – and what you should discuss<figure><img src="https://images.theconversation.com/files/561557/original/file-20231124-23-k697g6.jpg?ixlib=rb-1.1.0&rect=0%2C152%2C7551%2C4975&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/diverse-male-female-hipsters-having-positive-1746193439">GaudiLab/Shutterstock</a></span></figcaption></figure><p>Women (and men) are having their first child at older ages. As a result, couples are sometimes unable to conceive or require medical intervention in their pursuit of parenthood. Others may face a <a href="https://ifstudies.org/blog/the-global-fertility-gap#:%7E:text=While%20fertility%20ideals%20around%20the,children%20is%20a%20serious%20problem">“fertility gap”</a> between the number of children they anticipate having and those they actually have.</p>
<p>Young people often <a href="https://www.tandfonline.com/doi/abs/10.1080/14647273.2020.1798516">overestimate</a> womens’ capacity to become pregnant as they age, and the extent to which technology like IVF can help them conceive.</p>
<p>Despite these issues, conversations about fertility and childbearing remain taboo. <a href="https://www.emerald.com/insight/publication/doi/10.1108/9781787564831">I have found</a> that women in particular feel uncomfortable bringing it up in new relationships, fearing that discussing a desire for motherhood may “put off” potential romantic partners or make them appear “desperate” for a baby.</p>
<hr>
<p><em><a href="https://theconversation.com/uk/topics/should-i-have-children-148388?utm_source=TCUK&utm_medium=InArticleTop&utm_campaign=Parenting2023">Should I have children?</a> The pieces in this series will help you answer this tough question – exploring fertility, climate change, the cost of living and social pressure.</em></p>
<p><em>We’ll keep the discussion going at a live event in London on November 30. <a href="https://www.waterstones.com/events/the-conversation-should-i-have-children/london-tottenham-court-road">Click here</a> for more information and tickets.</em></p>
<hr>
<p>But these conversations can be crucial in preventing future relationship breakdown, and preparing for age-related fertility decline. No matter your situation – single, coupled-up, or childfree by choice – you might benefit from talking earlier and more often about your plans. </p>
<p>Here’s what to talk about depending on your situation.</p>
<h2>I want to have a child, but not yet</h2>
<p>Many factors are leading women and couples to delay having children. Women are participating more in the labour force, there are more reliable forms of contraception available, and it’s more accepted to have multiple relationships before getting married or having a child.</p>
<p>The growing gap between wages and the cost of living means it is harder to achieve the <a href="https://theconversation.com/more-young-people-in-the-uk-are-living-with-parents-and-grandparents-heres-what-you-need-to-know-if-youre-considering-it-216280">standard of living</a> that many deem necessary to become parents. </p>
<p>Whatever the reason, technology like egg or embryo freezing may offer the opportunity to preserve reproductive material for future use. </p>
<p>Egg freezing sees women undergo the same ovarian stimulation and retrieval process as IVF patients. A number of her eggs are then frozen and stored for future use. Used most often by women who do not yet have a partner, egg freezing <a href="https://theconversation.com/six-things-you-should-know-if-you-are-considering-freezing-your-eggs-94039">at any age</a> cannot guarantee a live birth. </p>
<p>Previously, the law only permitted eggs to be frozen for up to 10 years. This meant a woman who froze her eggs at 30 would have to use them by the time she was 40 or risk them being destroyed. A <a href="https://www.legislation.gov.uk/ukpga/2022/31/schedule/17/enacted">legal change</a> in 2021 means women in England and Wales are now able to freeze their eggs for up to 55 years, making this a more viable form of “fertility extension”.</p>
<p>The <a href="https://www.londoneggbank.com/news/blog/what-is-the-best-age-to-freeze-my-eggs/#:%7E:text=Indeed%2C%20more%20than%20any%20other,smaller%20number%20over%20age%2035.">optimum time</a> to undertake egg freezing is before the steepest decline in a woman’s fertility in her late 30s. The best results are generally from women who froze their eggs by the time they were 35.</p>
<figure class="align-center ">
<img alt="Close up of a woman looking solemnly at a pregnancy test" src="https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People are delaying pregnancy for a number of health and social reasons.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-pregnancy-test-hands-427218448">Pressmaster/Shutterstock</a></span>
</figcaption>
</figure>
<p>Embryo freezing – where eggs are fertilised and stored for later use – offers a greater chance of a live birth and can be achieved as part of a relationship, or with donor sperm. </p>
<p>Embryos created by a couple can lead to complications if the relationship breaks down. One party may want the genetic material destroyed against the other’s wishes. Embryo freezing may be an option for stable couples who need to delay parenthood due to issues like illness or overseas deployments. However, it is unlikely to be of use to those who aren’t ready to have a child due to the cost of living or who are trying to save for their first home. The cost of the procedure, like egg freezing, can often be between £3,000-£4,000 or more, plus annual storage fees. </p>
<h2>I’m not sure, and I’m getting older</h2>
<p>Fertility monitoring can provide some insights into reproductive health for both <a href="https://www.createfertility.co.uk/blog/whats-a-fertility-mot-and-why-are-experts-recommending-it-to-women#:%7E:text=What%20does%20a%20Fertility%20MOT,time%20in%20the%20menstrual%20cycle.">women</a> and <a href="https://www.londonivfandgenetics.co.uk/fertility-mot/male-mot/">men</a>.</p>
<p>Fertility “MOTs” are offered by clinics and as <a href="https://hertilityhealth.com/?tw_source=google&tw_adid=681259505447&tw_campaign=19778466649&gad_source=1&gclid=CjwKCAiAjfyqBhAsEiwA-UdzJP0C3Wl-suGdFy73atjNWo656QCKLzylw2_zjbzOmRqIosPmubgjaRoCBSsQAvD_BwE">at-home tests</a>. They can reveal sperm quantity and motility, give an indication of ovarian reserve and help identify factors which could inhibit conception. </p>
<p>However they cannot reliably be used to calculate how many “fertile years” a woman has, or provide detailed quantitative insights in to a woman’s ovarian reserve. They are also not provided on the NHS and clinics often charge in excess of £500 for such tests.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/at-home-fertility-tests-heres-what-they-can-actually-tell-you-198639">At-home fertility tests: here's what they can actually tell you</a>
</strong>
</em>
</p>
<hr>
<p>Like those in heterosexual relationships, LGBTQ+ couples can also access technologies like egg or embryo freezing through the use of donated gametes (egg and sperm) and can build their families with the help of a <a href="//www.sciencedirect.com/science/article/pii/S1472648313001806">surrogate</a>. Like most fertility treatment, these procedures are rarely fully funded by the NHS and can cost tens of thousands of pounds. </p>
<h2>I don’t want children – but what if I change my mind?</h2>
<p>Without question, technology has created more opportunities for people to have children later in life, even if they just want to keep their options open. But egg freezing and fertility monitoring have financial, physical and emotional costs, and are not a guarantee. </p>
<p>For many, the best form of preparation is a conversation. </p>
<p>If you are a young woman unsure about having children, this may mean speaking to immediate female family members about the age they experienced menopause and any fertility issues within the family. Even if you are not planning to have children, these conversations can be helpful for learning about other medical issues that may affect you in ways beyond fertility, such as endometriosis or PCOS.</p>
<p>Evidence has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717046/">also shown</a> that both women and men can improve their fertility chances by paying attention to issues such as their weight, stress levels, alcohol consumption and exercise patterns. These are all things that can benefit general health, regardless of your plans for children.</p>
<p>Talking more openly about fertility and the choice to have children or not can help break the stigma around these topics. Just as people (women especially) may face criticism for <a href="https://theconversation.com/women-still-face-unfair-pressure-about-having-children-heres-what-to-expect-if-you-dont-have-kids-when-youre-young-217135">delaying parenthood</a>, there are social taboos around deciding not to have children. The conversations you have now may help you, and future generations, make more informed decisions about their reproductive choices.</p><img src="https://counter.theconversation.com/content/217726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Baldwin receives funding from The Foundation for Sociology of Health and Illness</span></em></p>Talking about plans for childbearing is still seen as a taboo.Kylie Baldwin, Senior Lecturer, De Montfort UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2038292023-11-01T12:36:19Z2023-11-01T12:36:19ZEndometriosis afflicts millions of women, but few people feel comfortable talking about it<figure><img src="https://images.theconversation.com/files/555396/original/file-20231023-21-48765g.jpg?ixlib=rb-1.1.0&rect=38%2C0%2C5046%2C3369&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Endometriosis pain can be so severe that it impairs a person's ability to keep up with school, succeed at work or have a satisfying sex life.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/stomach-pain-royalty-free-image/1463546435?phrase=pain&adppopup=true">Kinga Krzeminska/Moment via Getty Images</a></span></figcaption></figure><p><a href="https://www.who.int/news-room/fact-sheets/detail/endometriosis#">Endometriosis</a> causes physical, sexual and emotional pain. About <a href="https://www.ox.ac.uk/news/2023-03-14-global-study-shows-experience-endometriosis-rooted-genetics">190 million people around the globe</a> have endometriosis, <a href="https://gonzalez-colon.house.gov/media/press-releases/house-approves-push-finkenauer-and-endometriosis-caucus-double-research">including one in 10 American women</a>, but there has historically been <a href="https://doi.org/10.1007/s00404-023-07205-3">a deafening silence</a> about the disease and the pervasive impact it can have on a person’s life. </p>
<p>While endometriosis is a chronic gynecological illness that can affect anyone with a uterus – women, transgender men and nonbinary individuals – it often goes undiagnosed because its symptoms can be attributed to other physical or psychological concerns. Patients presenting with this pain are often told it is “all in your head.” </p>
<p>However, endometriosis is becoming a more visible illness, thanks in part to celebrities such as Lena Dunham, Chrissy Teigen, Amy Schumer, Whoopi Goldberg and others who have <a href="https://www.everydayhealth.com/endometriosis/living-with/celebrities-who-speak-endometriosis/">begun sharing their stories publicly</a>. After going undiagnosed for 23 years, Padma Lakshmi, a popular cookbook author, actress and host of the TV show “Top Chef,” founded <a href="https://www.endofound.org/">EndoFund, previously Endometriosis Foundation of America</a>, in 2009 so that others do not have to go through what she did.</p>
<p>I am a <a href="https://www.adler.edu/programs/kristina-s-brown/">couple and family therapy professor, clinician</a> and <a href="https://scholar.google.com/citations?user=ZeuvLPoAAAAJ&hl">researcher</a>. My own endometriosis diagnosis at the age of 19 has inspired my work exploring how this illness affects others beyond the physical symptoms.</p>
<p>To better understand the impact of endometriosis on relationships, I interviewed 10 couples about their experiences of diagnosis, treatment and living with this disease. Through their stories of how endometriosis-related pain can affect every aspect of daily life, including their intimate relationships, I provide some specific recommendations. The quotes I have included in this article <a href="https://surface.syr.edu/mft_etd/14/">are from my doctoral dissertation research</a>. </p>
<h2>The basics of endometriosis</h2>
<p>When a person has endometriosis, the endometrial cells that line their uterus “implant” in places outside the uterus, such as the ovaries, fallopian tubes and the lining of the abdomen — called the <a href="https://teachmeanatomy.info/abdomen/areas/peritoneum/">peritoneum</a>. At the end of each menstrual cycle, the uterus sheds its lining, which exits the body via the cervix and vagina. The “misplanted” endometrial cells also shed, but they have no place to go – resulting in internal bleeding, inflammation and pain. </p>
<p>An endometriosis diagnosis is described in stages related to the visual presence of the disease, from minimal, or Stage 1, to severe, or Stage 4. However, there is no connection between the stage and the experience of pain. </p>
<p>One symptom of endometriosis is <a href="https://doi.org/10.1080/10410236.2018.1440504">intense pain during the menstrual cycle</a>. Another is pain with sex. Because pain with menses or sex can be attributed to “normal” pain, a history of sexual abuse or psychiatric reasons such as a dislike of sex, some people with endometriosis wait an average of seven years for diagnosis, which can <a href="https://doi.org/10.1016/j.advms.2022.02.003">be visually confirmed only through</a> a procedure called <a href="https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/laparoscopy">laparoscopy</a>. </p>
<p>In addition to these and other types of severe pain, endometriosis <a href="https://doi.org/10.1111/jocn.16145">can also cause infertility</a>, and patients who want to have children must often undergo <a href="https://doi.org/10.3389/fsurg.2022.1049119">medical or surgical interventions</a> to conceive.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/uu0EKzRBvg4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dr. Megan Wasson of the Mayo Clinic explains what endometriosis is and how it can be treated.</span></figcaption>
</figure>
<h2>Impacts on school, work and sex</h2>
<p>Physical pain from endometriosis can be debilitating. Adolescents with endometriosis <a href="https://theconversation.com/endometriosis-can-end-womens-careers-and-stall-their-education-thats-everyones-business-179846">may struggle to keep up</a> with their classes, friends, homework or extracurricular activities when the pain becomes too severe. They may <a href="https://doi.org/10.1016/j.jpag.2021.01.021">shift to home-schooling or virtual learning</a> <a href="https://www.yalemedicine.org/news/teens-endometriosis">to complete their studies</a>.</p>
<p>The pain can also deeply <a href="https://theconversation.com/endometriosis-can-end-womens-careers-and-stall-their-education-thats-everyones-business-179846">affect a career trajectory</a>. “I almost lost my job because of time off,” one interviewee told me. “In fact, when I had to get my hysterectomy, I walked in to tell my manager and he goes, ‘Well, I hope you’re not going to tell me that you have to have a hysterectomy and have to be out for six weeks!’ And I just broke down in tears.” </p>
<p>All of my participants shared experiences where doctors <a href="https://doi.org/10.3390/ijerph20043362">dismissed complaints</a> of sexual pain – called <a href="https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967">dyspareunia</a> – from endometriosis. This can delay diagnosis and treatment.</p>
<p>Sex and intimacy often become nonexistent, while some couples shared that they have come to accept that <a href="https://hdl.handle.net/2123/22345">pain is part of sex</a>. One woman shared with me: “I don’t want to be touched or have my naked body seen because I feel bloated and ugly and I’m in horrible pain!” </p>
<p>Partners can also be affected emotionally. “I just feel horrible,” one told me. “There are times when we are having sex that I actually feel guilty that I know that I am hurting her and I know she is going to be in pain and it makes me unhappy.”</p>
<p>These experiences of pain, of not being believed by doctors and professionals, of negative effects on education and career and of intimacy destroyed create a heavy emotional burden on individuals and relationships. </p>
<h2>Breaking the silence around endometriosis</h2>
<p>When I was diagnosed with endometriosis, it changed the course of my life. My partner and I learned to expand our definition of intimacy and to redistribute household responsibilities when I was incapacitated. As the risk of infertility only increases without intervention, we started conversations about having children earlier than anticipated. My diagnosis also led me to focus my professional identity as a medical family therapist to help others deal with endometriosis and chronic illnesses.</p>
<p>Based on this experience, here are some ways to break this silence:</p>
<ul>
<li><p>Learn about endometriosis. It directly helps when one’s support systems are educated.</p></li>
<li><p>Separate the person from the disease. When the pain you are experiencing from endometriosis is debilitating, help those around you who are also affected to understand that it is because of your endometriosis and it is not personal. </p></li>
<li><p>Speak from your own experience, saying, “I …” rather than “You …” When we do this, it decreases the other person’s defenses and opens up the communication, making space for connection.</p></li>
</ul>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KZBTYViDPlQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Social work researcher Brené Brown describes how to create a genuine empathetic connection with another person.</span></figcaption>
</figure>
<h2>Recommendations from people living it</h2>
<p>My research participants shared their own recommendations with me, especially the importance of <a href="https://doi.org/10.12968/bjon.2005.14.9.18073">believing that their pain is real</a>; accept that what they are sharing is their very real experience, and let them know that they are believed. </p>
<p>Bestselling author and social work researcher <a href="https://www.youtube.com/watch?v=KZBTYViDPlQ&ab_channel=DianaSimonPsihoterapeut">Brené Brown has said</a>, “Empathy fuels connection, sympathy drives disconnection.” Approaching someone with endometriosis from a position of empathy sends a message that you <a href="https://doi.org/10.5301/JE.2011.8906">want to work with them collaboratively</a>. </p>
<p>By practicing these important relationship skills, we can break the silence around endometriosis.</p><img src="https://counter.theconversation.com/content/203829/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I continue to be grateful to the ten couples who shared their experiences of painful sex with endometriosis for my dissertation research.</span></em></p>Health care providers often dismiss endometriosis pain as ‘all in your head’ − which can delay a correct diagnosis and treatment for years.Kristina S. Brown, Professor and Chair of Couple and Family Therapy, Adler UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2083152023-09-07T15:18:16Z2023-09-07T15:18:16ZWhen IVF fails it can be devastating – so why do clinics offer so little in the way of support?<p>Four in every ten people who start IVF treatment in the UK end it without having their child, according to <a href="https://doi.org/10.1136/bmj.i5735">data</a> from the UK fertility regulator, the <a href="https://www.hfea.gov.uk/">Human Fertilisation and Embryology Authority</a>. </p>
<p>Fertility clinics’ websites are prone to promoting their success rates or enthusing about the <a href="https://www.sciencedirect.com/science/article/pii/S1472648320303928">latest technology</a> that will revolutionise treatment. But <a href="https://bmjopen.bmj.com/content/7/1/e012218">research has found</a> these websites often report on the clinic’s pregnancy or live birth rates without relevant information on how these figures were calculated, or how many patients were involved. </p>
<p>It has also been shown that some clinics <a href="https://bmjopen.bmj.com/content/6/11/e013940">make claims</a> about treatment benefits without including supporting evidence.</p>
<p>But what is less talked about is the effect that unsuccessful treatment has on patients.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<h2>The reality of failed IVF</h2>
<p>Ending treatment unsuccessfully can be <a href="https://edition.cnn.com/2022/11/19/health/ivf-women-jennifer-aniston-wellness-cec/index.html">devastating for patients</a>, throwing them into deep sadness, grief and loss. Those who go through this experience lose their sense of purpose and struggle to make sense of a new reality that denies a so desired family and parenting role. </p>
<p>Patients talk about feeling isolated from the “fertile world” and alone in their grief, with its constant pain making it hard to be with friends who have children. Indeed, the end of unsuccessful treatment is such a challenging experience that it takes on average <a href="https://doi.org/10.1002/j.1556-6676.2001.tb01991.x">two years</a> for patients to come to terms with their loss, recover their sense of balance and renew their hope for the future. </p>
<p>Research shows that <a href="https://academic.oup.com/humupd/article/23/3/322/2970305">mental health and wellbeing are significantly impaired</a> during this process and that <a href="https://doi.org/10.1093/humrep/dew131">around one in ten people never fully recover</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Going through a failed IVF cycle can be tough on couples.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/upset-black-couple-sitting-apart-at-home-5700169/">pexels/alex green</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Research has also found that <a href="https://academic.oup.com/humupd/article/23/3/322/2970305">many of these patients</a> that are unsuccessful in their treatments say they feel abandoned by their fertility clinics when they most need support – which can lead them to become angry and frustrated. Indeed, as it currently stands there aren’t any support interventions <a href="https://bmjopen.bmj.com/content/5/1/e006592.short">available to infertile patients</a>, that are tailored to support them when treatment ends unsuccessfully. </p>
<p>The lack of evidence-based support for parents in this position is so striking that it prompted me and my colleagues to develop <a href="https://myjourney.pt/">MyJourney</a>, a free self-guided app that provides step-by-step support to ease the acceptance of an unfulfilled wish for children. <a href="https://doi.org/10.1093/humrep/deac168">Our research shows</a> that using MyJourney is linked to improvements in wellbeing within ten weeks – and that these improvements seem to last for at least six months.</p>
<h2>Support and care</h2>
<p>I believe that clinics need to do more to forewarn patients of the reality of IVF failure. Not only would this mean people go into the process properly informed, but it would also offer patients the opportunity to discuss and prepare for grief and sadness if it does happen. </p>
<p>Fertility staff also need to give patients a realistic view of treatment that does not soften its well-known challenges. Patients want to know what to expect and how to prepare for it. They want to have the “bigger picture” view of what the treatment entails so they can make informed decisions. <a href="https://doi.org/10.1093/humrep/dead096">Patients agree</a> these are difficult conversations to have but the research shows that most think the pros outweigh the cons. </p>
<p>Essentially the fertility industry needs to provide the best care for those who take a chance on IVF. And all patients should be able to access support during and after treatment, irrespective of its outcome.</p><img src="https://counter.theconversation.com/content/208315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Gameiro works for Cardiff University. She reports consultancy fees from TMRW Life Sciences
and Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International
and Gedeon Richter, grants from Merck Serono Ltd, an affiliate of Merck KgaA, Darmstadt, Germany.</span></em></p>IVF doesn’t always work, but clinics often don’t make that clear to patients.Sofia Gameiro, Reader at the School of Psychology, Cardiff University, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2103542023-08-23T09:01:57Z2023-08-23T09:01:57ZFertility is becoming a workplace issue but employer support can create winners and losers<figure><img src="https://images.theconversation.com/files/542291/original/file-20230811-23-ftk7sw.jpg?ixlib=rb-1.1.0&rect=43%2C34%2C5708%2C3199&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">kj-create/Shutterstock</span></span></figcaption></figure><iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/fertility-is-becoming-a-workplace-issue-but-employer-support-can-create-winners-and-losers-210354&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p>Since the world’s first human baby was born by in vitro fertilisation (IVF) in the UK in 1978, over 10 million IVF babies have been <a href="http://www.eshre.eu/Press-Room/Resources">born globally</a>. Assisted reproductive technologies (ART) have also <a href="https://www.wiley.com/en-gb/Clinical+Reproductive+Science-p-9781118975954">become even more sophisticated</a>, now including egg-freezing and intracytoplasmic sperm injection (ICSI).</p>
<p>But alongside these new fertility possibilities, the technology has also brought challenges. Access to publicly funded fertility treatment is not universal, and success rates are limited. This means many people globally are forced to pay privately – if they can afford it – often for multiple cycles of treatment. This can equate to <a href="https://www.fertilityclinicsabroad.com/ivf-costs/">tens of thousands of pounds</a>. </p>
<p>For some, it might also mean travel overseas. Inequalities in access and care in the UK have been linked to factors such as patient <a href="http://eprints.lse.ac.uk/90977/1/Smietana_Introduction-making-and-breaking.pdf">sexual orientation</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/32760816/">ethnicity</a>, age and weight.</p>
<p>Infertility is a disease of the reproductive system affecting one in six people, or around <a href="https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility#:%7E:text=Large%20numbers%20of%20people%20are,care%20for%20those%20in%20need.">17.5% of the global adult population</a>, according to the World Health Organization. </p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<p>As well as medical issues, sexual orientation or lack of a partner can affect the ability to conceive. But despite its prevalence among the working age population, and the considerable <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383794/">psychological and social tolls</a> it can bring, discussion of infertility has historically been silenced in public discourse and in the workplace. </p>
<p>Until recently, employers’ attention to reproductive journeys has been limited to mainly maternity provisions. This has been mandated by employment legislation in many countries for some time. </p>
<p>But changing social attitudes, advances in technology and business pressures have increased the attention being paid to fertility treatment by many employers in the developed world. This is often driven by business logic: supporting staff through IVF and the like will help with recruitment, performance, retention and engagement.</p>
<h2>Supporting different fertility journeys</h2>
<p>Indeed, employer interest in fertility treatment appears to have originated in Silicon Valley in the US. Apple and Facebook introduced fertility benefits (paid IVF and egg freezing) in 2014 as a weapon in the “war for talent”. This was controverisal, however, with companies accused of essentially trying to bribe women into <a href="https://www.theguardian.com/society/commentisfree/2017/apr/26/its-not-a-perk-when-big-employers-offer-egg-freezing-its-a-bogus-bribe#:%7E:text=5%20years%20old-,It">delayed childbearing</a>. </p>
<p>In the UK, the focus is generally on wellbeing. Workplace benefits often centre on fertility policies and time off, flexibility and workplace adjustments. But only 3% of employers said they offer such provisions to a significant extent in a <a href="https://www.cipd.org/globalassets/media/comms/news/ahealth-wellbeing-work-report-2022_tcm18-108440.pdf">2022 survey</a>. This puts fertility, alongside menstruation, bottom of the list of wellbeing supports aimed at certain employee groups.</p>
<p>Arguably, the emergence of <a href="https://journals.sagepub.com/doi/10.1177/09500170231155752">employer interest</a> in assisted fertility technology has furthered “reproductive stratification”. <a href="https://www.researchgate.net/publication/227872369_Conceiving_the_New_World_Order_The_Global_Politics_of_Reproduction">Research on this issue</a> defines this as when “some categories of people are empowered to nurture and reproduce, while others are disempowered” </p>
<p>Among the minority of employers that offer fertility-related policies and support, it tends to be aimed at permanent, highly valued staff in countries in the global north such as the US, UK and Japan. And so, large proportions of the world’s workforce are missing out. </p>
<p>Migrants and workers in precarious employment also miss out on other things that help with reproductive journeys. This can include job security, protection from dismissal, decent wages, access to sick leave, access to maternity and paternity provisions, and well-trained and supported line managers.</p>
<figure class="align-center ">
<img alt="Pad on desk showing handwritten egg freezing calculations, beside glasses, a pen and some other notebooks." src="https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Calculating the costs of IVF.</span>
<span class="attribution"><span class="source">Linaimages/Shutterstock</span></span>
</figcaption>
</figure>
<p>When policies are in place, they are not always inclusive of all employees and all fertility journeys. Our <a href="https://www.mmu.ac.uk/sites/default/files/2022-06/ComplexFertilityJourneysResearchProjectReport.pdf">research</a> shows policies often neglect partners and non-normative families (same-sex couples and those pursuing motherhood alone). They often focus on a set number of days off for treatment cycle(s). This may not be sufficient and also fails to consider the needs of staff where treatment is unsuccessful.</p>
<p>And even when employees can access fertility treatments via progressive employment provisions, they often end up being penalised via discrimination or <a href="https://onlinelibrary.wiley.com/doi/10.1111/gwao.12953">negative career consequences</a>. We found this during a study in which participants reported having to go part-time, switch career focus, leave jobs, or were just generally disadvantaged at work after embarking on a fertility journey. </p>
<p>Similar findings have been reported in international studies and surveys by campaign groups such as <a href="https://fertilitymattersatwork.com/fertility-struggles-the-impact-to-careers/">Fertility Matters at Work</a> and <a href="https://pregnantthenscrewed.com/one-in-four-women-undergoing-fertility-treatment-experience-unfair-treatment-at-work/#:%7E:text=As%20the%20new%20report%20shows,unfair%20treatment%20as%20a%20result.">Pregnant then Screwed</a>. Since women are most likely to experience these negative career consequences, this means increased take-up of fertility treatment could further existing gendered inequalities in the workplace.</p>
<h2>A more equitable future</h2>
<p>To fully optimise the hope created by ARTs, governments around the world should expand publicly funded provisions as much as possible (bearing in mind other healthcare commitments) and ensure equitable access and care. Employment legislation should also protect workers from discrimination on the grounds of accessing ARTs and allow suitable time off. </p>
<p>There is some hope. The UK parliament is currently considering a <a href="https://bills.parliament.uk/bills/3235">private members’ bill</a> to allow people to take time off work for appointments and treatment, but unfortunately it hasn’t made much progress to date.</p>
<p>A few other countries have <a href="https://ub-deposit.fernuni-hagen.de/servlets/MCRFileNodeServlet/mir_derivate_00002197/Koslowski_et_al_Leave_Policies_2021.pdf">already taken action</a>, however. Malta legislates for 100 hours’ paid IVF leave (per cycle, up to three cycles) split between the “receiving person” and their partner. Korea provides three days’ leave per year (one paid) and protection from discrimination. Japan has also introduced provisions for public workers.</p>
<p>Other recent UK developments include workplace <a href="https://www.cipd.org/uk/knowledge/guides/fertility-challenges/">guides</a> from professional body The Chartered Institute of Personnel and Development (CIPD) and <a href="https://healthcareandprotection.com/sixteen-organisations-share-1-97m-fund-for-womens-reproductive-health-at-work/">government funding</a> for charities to develop resources aimed at small and medium-sized enterprises (SMEs). These are welcome. </p>
<p>But until the government can step up to provide universal cover, organisations should not think of fertility benefits strictly in terms of a cost-benefit calculation. Employers must take a compassionate and fully inclusive approach to supporting their employees’ fertility journeys.</p><img src="https://counter.theconversation.com/content/210354/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Krystal was PI on an empirical research project connected to this article, which was funded by The Leverhulme Trust (Research Project Grant)
Krystal is a member of advisory boards for the charities Working Families and Tommy's. She has also contributed to resources (book chapters, surveys and guides) for the CIPD and is a CIPD member
</span></em></p><p class="fine-print"><em><span>Clare Mumford and Michael Carroll do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The landscape has been shifting when it comes to employer interest in employee fertility journeys.Krystal Wilkinson, Reader (Associate Professor) in Human Resource Management, Manchester Metropolitan UniversityClare Mumford, Research Associate, University of Central LancashireMichael Carroll, Reader / Associate Professor in Reproductive Science, Manchester Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047512023-07-04T20:07:54Z2023-07-04T20:07:54Z‘I gave birth but did not bring a child to life’: for millenia, women expressed their pain through a belief in demonic, female monsters<figure><img src="https://images.theconversation.com/files/534238/original/file-20230627-15-7mwt03.jpg?ixlib=rb-1.1.0&rect=49%2C32%2C2643%2C2680&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An incantation bowl with an Aramaic inscription around a demon from Nippur, Mesopotamia.</span> <span class="attribution"><span class="source">Wikimedia Commons</span></span></figcaption></figure><p>Sarah Clegg’s <a href="https://www.goodreads.com/book/show/75367019-woman-s-lore">Woman’s Lore: 4,000 Years of Sirens, Serpents and Succubi</a> is about ancient demonic figures, expressly the infamous child-killing monsters of the Near East and Mediterranean. Intimately tied to childbirth and infant and child mortality, such monsters were female in form. </p>
<p>Often, they were negatively connected to female sexuality. Chronicled over centuries, monsters such as the Mesopotamian <a href="https://www.britannica.com/topic/Lamashtu">Lamashtu</a>, the Greek <a href="https://www.theoi.com/Ther/Lamia.html">Lamia</a>, and the Hebrew (and Mesopotamian) <a href="https://jwa.org/encyclopedia/article/lilith">Lilith</a> are, in Clegg’s thesis, a significant part of women’s lore, “a tradition kept alive by women, that tells the story of women’s lives, from 2000 BC to the present day”.</p>
<hr>
<p><em>Review: Woman’s Lore: 4,000 Years of Sirens, Serpents and Succubi – Sarah Clegg (Bloomsbury)</em></p>
<hr>
<p>Clegg begins with Lamashtu. Born of divine parents but quickly disowned because of her inherently evil nature, Lamashtu was the subject of curses written on clay tablets designed to drive her away from vulnerable mothers and children.</p>
<p>Included in the spells are some spectacularly graphic descriptions of her, such as the excerpt below, which comes from one of the oldest extant incantations (c. 1800 BCE):</p>
<blockquote>
<p>She has hardly any palms but very long fingers <br> </p>
<p>And very long claws.<br></p>
</blockquote>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/529026/original/file-20230530-21-d332p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/529026/original/file-20230530-21-d332p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529026/original/file-20230530-21-d332p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=773&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529026/original/file-20230530-21-d332p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=773&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529026/original/file-20230530-21-d332p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=773&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529026/original/file-20230530-21-d332p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=972&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529026/original/file-20230530-21-d332p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=972&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529026/original/file-20230530-21-d332p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=972&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Amulet with a Lamashtu demon ca. early 1st millennium BCE.</span>
<span class="attribution"><span class="source">The Met, Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>The spell describes her as having the face of a dog, and as slithering along “like a snake”. This physiognomy made Lamashtu perfectly designed to wreak havoc on her intended victims; her long fingers and claws were used to tear at babies’ stomachs to generate infection and to reach into mothers’ wombs and cause premature birth and miscarriage. </p>
<p>Belief in this figure of abjection and fear extended beyond Mesopotamia and there was a robust trade in amulets made of diverse materials, reflecting a belief in Lamashtu across different socio-economic groups. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/530004/original/file-20230605-230495-f1rer4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/530004/original/file-20230605-230495-f1rer4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/530004/original/file-20230605-230495-f1rer4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530004/original/file-20230605-230495-f1rer4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530004/original/file-20230605-230495-f1rer4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530004/original/file-20230605-230495-f1rer4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530004/original/file-20230605-230495-f1rer4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530004/original/file-20230605-230495-f1rer4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A plaque used for protection against Lamashtu. Neo-Assyrian, 10th-7th century BCE.</span>
<span class="attribution"><span class="source">World History Encyclopedia</span></span>
</figcaption>
</figure>
<p>Lamashtu’s body was subject to change, depending on the source. <a href="https://www.britishmuseum.org/collection/image/32627001">Clegg includes an amulet</a>, from 800–500 BCE, which depicts her with the head of a lion (a traditionally male symbol in Mesopotamian culture), clutching snakes and suckling animals. </p>
<p>She has bird talons for feet and stands atop a donkey (this donkey, it was hoped, would carry Lamashtu to the Netherworld and away from her victims). </p>
<p>Her embodiment as the antithesis of the archetypal mother is evident in her suckling animals, a dog and a pig, in a parody of the maternal figure who nurtures human babies.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hidden-women-of-history-enheduanna-princess-priestess-and-the-worlds-first-known-author-109185">Hidden women of history: Enheduanna, princess, priestess and the world's first known author</a>
</strong>
</em>
</p>
<hr>
<h2>Beauties and demons</h2>
<p>The ancient Greeks and Romans had their own equivalent to Lamashtu: Lamia, “a direct descendent of the Mesopotamian child-and mother-killing demon” (Clegg notes the etymological connection between the names Lamashtu and Lamia).</p>
<p>Lamia was also a seducer of young men – a skill she managed by concealing her monstrously snaky lower body parts. She also ate babies and children and, like other Mediterranean monsters, such as <a href="https://www.ancientgreecereloaded.com/files/ancient_greece_reloaded_website/legendary_monsters/mormo.php">Mormo</a> and <a href="https://www.theoi.com/Phasma/Empousai.html">Empousa</a>, was a shapeshifter. </p>
<p>Mythologies surrounding the origins of Lamia are redolent with themes of female loss and pain. In one version of how Lamia came into being, Durius of Samos, writing in the third century BCE, explains:</p>
<blockquote>
<p>Lamia was a beautiful woman in Libya. Zeus had sex with her. Because of Hera’s envy towards her she destroyed the children she bore. Consequently she became misshapen through grief, snatched other people’s children and killed them.</p>
</blockquote>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/530003/original/file-20230605-229680-8wjczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/530003/original/file-20230605-229680-8wjczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/530003/original/file-20230605-229680-8wjczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=965&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530003/original/file-20230605-229680-8wjczk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=965&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530003/original/file-20230605-229680-8wjczk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=965&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530003/original/file-20230605-229680-8wjczk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1212&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530003/original/file-20230605-229680-8wjczk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1212&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530003/original/file-20230605-229680-8wjczk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1212&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lamia, oil on canvas by John William Waterhouse, 1909, based on the Keats poem Lamia from 1820.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>While other accounts have Lamia as a fearsome and destructive monster from the start, Durius’ story highlights the vulnerability of women as subject to rape and subsequent punishment. Such plot lines are common in Greek and Roman myths, pointing to the casualisation of rape in certain socio-political circumstances. </p>
<p>Clegg’s first two chapters on these creatures examine women’s lore through the monstrous feminine. And, along the way, her book provides a host of related cultural history on magic, ritual, and ghost traditions, offering a series of poignant insights into women’s lives in these ancient societies. An excerpt from an incantation against Lamashtu composed for a woman to recite, reads: </p>
<blockquote>
<p>I was pregnant, but unable to bring my child to term; I gave birth but did not bring a child to life. May a woman who can grant success release me […] may I have a straightforward pregnancy […]</p>
</blockquote>
<p>Herein is the pain of a woman who did not carry her baby to term, the grief of still birth, and the desperation to bear a healthy child. </p>
<p>Such insights into women’s lived experiences are also evident in the category of demons called the Lilitus, whom, Mespotamians believed were “the spirits of young girls who had died still virgins, before marriage and before children”. </p>
<p>Robbed of a future, the Lilitus were forever seeking to fulfil sexual initiation or male contact, driving them to visit sleeping men. These visits were the Mesopotamian aetiology for wet dreams and night discharge. Clegg regards Lilitus as more to be pitied than hated, citing an incantation:</p>
<blockquote>
<p>She [a Lilitu] is a woman who has never seen a city feast, nor ever raises her eyes, who never rejoiced with the other girls, who was snatched away from her spouse, who had no spouse, nor bore a son.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/guide-to-the-classics-ovids-metamorphoses-and-reading-rape-65316">Guide to the classics: Ovid's Metamorphoses and reading rape</a>
</strong>
</em>
</p>
<hr>
<h2>Feisty Lilith</h2>
<p>Clegg’s book is divided into nine chapters, each covering a specific culture and demon or selection of demons (with some, such as Lilith, the first wife of Adam in Jewish folklore, occupying several chapters). There is also a useful timeline for readers without detailed knowledge of the chronology and a fascinating epilogue on contemporary remnants of these beliefs. </p>
<p>Judaic Lilith, like her sister-demons, has an aetiology that helps us understand her, albeit with a sense of fear or anxiety. As Clegg discusses, Lilith – as a prototypical feminist of sorts – flees the Garden of Eden when her husband denies her equality (in short: he refuses to let her “on top” during sex). </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/529025/original/file-20230530-21-a8jbqg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/529025/original/file-20230530-21-a8jbqg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529025/original/file-20230530-21-a8jbqg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=695&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529025/original/file-20230530-21-a8jbqg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=695&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529025/original/file-20230530-21-a8jbqg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=695&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529025/original/file-20230530-21-a8jbqg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=873&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529025/original/file-20230530-21-a8jbqg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=873&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529025/original/file-20230530-21-a8jbqg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=873&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lady Lilith, by Dante Gabriel Rossetti, 1886.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>She wreaks her revenge by hanging outside the walls of Eden, attacking pregnant women and children, and – no surprise – seducing men. </p>
<p>This manifestation of Lilith, its first extant documentation appearing in the <a href="https://www.jewishvirtuallibrary.org/alphabet-of-ben-sira">Alphabet of Ben Sira</a> (c. ninth or 10th century CE), intricately associates her with Eve as a kind of oppositional paradigm. While the feisty Lilith refuses to submit to patriarchy, a submissive Eve accepts the order of things. </p>
<p>In the <a href="https://reformjudaism.org/beliefs-practices/spirituality/what-kabbalah">Kabbalistic</a> tradition as it developed in the early modern era (c. 13th century) as illustrated in <a href="http://jewishchristianlit.com/Topics/Lilith/jacob_ha_kohen.html">The Treatise on the Left Emanation</a>, Lilith is permitted to justify her protest:</p>
<blockquote>
<p>I cannot return because of what is said in the Torah – ‘Her former husband who sent her away, may not take her again to be his wife, after that she is defiled,’ that is, when he was not the last to sleep with her. And the Great Demon has already slept with me.</p>
</blockquote>
<p>Herein, Lilith is given a voice and tells us that she did not, in fact, flee but was sent away by Adam. Additionally, once banished, a woman can never return. But, then again, who can trust the words of a demon?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534239/original/file-20230627-17-e69g5c.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/534239/original/file-20230627-17-e69g5c.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534239/original/file-20230627-17-e69g5c.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=414&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534239/original/file-20230627-17-e69g5c.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=414&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534239/original/file-20230627-17-e69g5c.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=414&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534239/original/file-20230627-17-e69g5c.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=520&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534239/original/file-20230627-17-e69g5c.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=520&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534239/original/file-20230627-17-e69g5c.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=520&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Adam clutches a child in the presence of the child-snatcher Lilith. Fresco by Filippino Lippi, basilica of Santa Maria Novella, Florence.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<h2>Enduring spells</h2>
<p>Clegg also discusses the ancient Greek demon, <a href="https://www.hellenicaworld.com/Greece/Mythology/en/Gello.html">Gello</a> who is, like the Lilitus, “a jealous ghost who murdered children and young women”. Traditionally associated with old wives’ tales – nursery stories to frighten and thereby control naughty children – Gello was the ghost of a young virgin who had died before fulfilling her social role of wife and mother. As a cultural signifier, Clegg explains:</p>
<blockquote>
<p>Gello, then, was a prematurely dead girl causing the premature deaths of other girls; a hideous, warped form of reproduction, whereby instead of having the children she so wanted, Gello turned other hopeful young girls into thwarted, jealous monsters like herself.</p>
</blockquote>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/530013/original/file-20230605-23-441g2k.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/530013/original/file-20230605-23-441g2k.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/530013/original/file-20230605-23-441g2k.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=919&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530013/original/file-20230605-23-441g2k.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=919&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530013/original/file-20230605-23-441g2k.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=919&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530013/original/file-20230605-23-441g2k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1155&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530013/original/file-20230605-23-441g2k.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1155&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530013/original/file-20230605-23-441g2k.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1155&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>By the <a href="https://www.history.com/topics/ancient-middle-east/byzantine-empire">Byzantine era</a>, however, scepticism grew as to the existence of such beings. Church law, writes Clegg, insisted that these monsters were “a deception of the devil, and not to be believed”. Nevertheless, Clegg notes, these traditions continued, often among women, who continued to believe in the effectiveness of magic for protection against such forces. </p>
<p>Like the curse tablets designed to drive away Lamashtu and the amulets made to protect individuals from her, there were also <a href="https://thegemara.com/article/naming-demons-the-aramaic-incantation-bowls-and-gittin/">demon (or incantation) bowls</a>, used in Upper Mesopotamia and Syria from the sixth to the eighth centuries CE. These earthenware bowls were inscribed with spells (mostly in Jewish-Aramaic) and magical images, such as crudely drawn pictures of the target of the spell, including Lilith. </p>
<p>They were designed to entice and then trap evil forces, and thus rid the bowl’s owner of danger, especially disease. </p>
<p>While magic was largely practised by men throughout the ancient Near East and the Mediterranean, Clegg includes several examples of women inscribing their own demon bowls.</p>
<p>For example, there is a cache of bowls written by the same woman, Giyonay (otherwise unknown). Giyonay writes one bowl spell to drive Lilith away from her husband and herself and others to protect members of her family. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/527754/original/file-20230523-15-7o5vwy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/527754/original/file-20230523-15-7o5vwy.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=284&fit=crop&dpr=1 600w, https://images.theconversation.com/files/527754/original/file-20230523-15-7o5vwy.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=284&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/527754/original/file-20230523-15-7o5vwy.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=284&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/527754/original/file-20230523-15-7o5vwy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=357&fit=crop&dpr=1 754w, https://images.theconversation.com/files/527754/original/file-20230523-15-7o5vwy.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=357&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/527754/original/file-20230523-15-7o5vwy.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=357&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Demon bowl.</span>
<span class="attribution"><span class="source">British Museum no. BM 135563</span></span>
</figcaption>
</figure>
<h2>Melusine and contemporary incarnations</h2>
<p>Clegg also examines mermaids, particularly in Medieval traditions, tracking their connections to earlier demons, such as the Lamia who, as Clegg notes, were believed to swim the waters of the Greek islands until the 1980s. </p>
<p>We also meet Melusine, a beautiful, serpentine female from Europe (particularly France, Luxembourg, and the <a href="https://www.britannica.com/summary/Low-Countries">Low Countries</a>). Clegg suggests that she is also a successor to Mediterranean and Eastern demons, including Byzantine fantasies of Gello possessing a snake-tail. She is, however, more akin to the fairy or <a href="https://en.wikipedia.org/wiki/Fairy">fae</a> creatures of Europe and Britain (which Clegg does concede).</p>
<p>Melusine’s backstory reads like a classic fairy tale, complete with feminine deception and a narrative taboo. Told by <a href="https://www.bl.uk/collection-items/miniature-of-an-aristocratic-marriage-from-jean-darrass-roman-de-melusine">Jean d’Arras</a> in <em>Roman de Mélusine</em> (The Story of Melusine) in the 14th century, it chronicles Melusine’s marriage to the mortal, Raymond. Like most marriages between mortals and non-mortals, Melusine and Raymond’s union ends in tears. While the couple are initially happy, their marital bliss ends when Raymond breaks the one taboo that Melusine insists on: not to enter her chambers on a Saturday.</p>
<p>The act, which reveals Melusine in her true form as she enjoys a bath, sets in chain a series of disasters, culminating in Raymond cursing her – at which point she transforms into a dragon and flies away forever. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/530006/original/file-20230605-188678-2owrp4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/530006/original/file-20230605-188678-2owrp4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530006/original/file-20230605-188678-2owrp4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=302&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530006/original/file-20230605-188678-2owrp4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=302&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530006/original/file-20230605-188678-2owrp4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=302&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530006/original/file-20230605-188678-2owrp4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=380&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530006/original/file-20230605-188678-2owrp4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=380&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530006/original/file-20230605-188678-2owrp4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=380&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Melusine’s secret discovered, illustration from folio 19 of the illuminated manuscript of The Romance of Melusine by Jean d'Arras, 15th century.
Bibliothèque nationale de France, Paris.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>While Melusine may be a monster, Clegg points out the positive aspects of her, including the cultural capital she brings to the mortal family tied to her. </p>
<blockquote>
<p>A child or a descendent of these fairy marriages was viewed as something to be proud of: a sign of greatness much like being a child or descendent of a god in ancient Greece or Rome. </p>
</blockquote>
<p>Additionally, Melusine builds, albeit by magic, some pretty impressive infrastructure for her husband, including – or so the story goes – the very real, <a href="https://www.frenchchateau.net/chateaux-of-poitou-charentes/chateau-de-lusignan.html">Château de Lusignan</a>.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/530010/original/file-20230605-27-kpv71o.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/530010/original/file-20230605-27-kpv71o.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/530010/original/file-20230605-27-kpv71o.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=784&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530010/original/file-20230605-27-kpv71o.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=784&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530010/original/file-20230605-27-kpv71o.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=784&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530010/original/file-20230605-27-kpv71o.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=986&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530010/original/file-20230605-27-kpv71o.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=986&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530010/original/file-20230605-27-kpv71o.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=986&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>Clegg’s final chapters deal with later receptions of these terrifying, seductive, bewitching, destructive and ultimately intriguing female monsters. </p>
<p>In chapter nine the reader meets some of these creatures in contemporary guises. Herein, Lilith dominates. We meet her as a symbol of second wave feminism through to the latest manifestations of the same and also an icon of modern spiritual worship. We read of the origins of the Australian feminist research journal, <a href="http://www.auswhn.org.au/lilith/">Lilith</a>, and the appropriation of the demon by <a href="https://www.octaviabutler.com/">Octavia E. Butler</a> in her <a href="https://tvtropes.org/pmwiki/pmwiki.php/Literature/LilithsBrood">Lilith’s Brood</a> trilogy.</p>
<p>Clegg also includes a revisioning of the tricksy Melusine, transformed in Serge Ecker’s 2013 statue, erected in Luxembourg for the city’s 1050th anniversary.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/530008/original/file-20230605-236601-g6p816.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/530008/original/file-20230605-236601-g6p816.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530008/original/file-20230605-236601-g6p816.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530008/original/file-20230605-236601-g6p816.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530008/original/file-20230605-236601-g6p816.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530008/original/file-20230605-236601-g6p816.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530008/original/file-20230605-236601-g6p816.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530008/original/file-20230605-236601-g6p816.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A modern statue of Melusine by Serge Ecker in Luxembourg.</span>
<span class="attribution"><span class="source">World History Encyclopedia</span></span>
</figcaption>
</figure>
<p>As Clegg rightly observes, these ancient figures: </p>
<blockquote>
<p>have proven enormously adaptable to women’s causes – symbolizing everything from the need to leave home and husband to find equality to sexual freedom and LGBTQ rights.</p>
</blockquote><img src="https://counter.theconversation.com/content/204751/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marguerite Johnson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From snake-like creatures with claws to jealous virgin ghosts, female monsters have long been a part of women’s lore. Such figures were Intimately tied to childbirth, sexuality and child mortality.Marguerite Johnson, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2070082023-06-13T06:26:48Z2023-06-13T06:26:48ZDon’t believe the hype. ‘Egg timer’ tests can’t reliably predict your chance of conceiving or menopause timing<figure><img src="https://images.theconversation.com/files/530788/original/file-20230608-27-rgqeqd.jpg?ixlib=rb-1.1.0&rect=0%2C603%2C4025%2C2408&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/AeZncpkqMVU">Caleb George/Unsplash</a></span></figcaption></figure><p>Many women who want to have children and are getting older worry about their fertility. The “egg timer” blood test is <a href="https://bmjopen.bmj.com/content/11/7/e046927">marketed</a> as an empowering way to give women insights to help them plan when to have children. </p>
<p>Online companies are now also selling the test directly to consumers to do at home, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953619306926">promoting the test</a> as a way for women to decide when to have a baby, even if they aren’t thinking of having one any time soon.</p>
<p>But it <a href="https://www.frontiersin.org/articles/10.3389/fendo.2021.695157/full">can’t reliably predict</a> the <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">likelihood of pregnancy</a> or how long it would take to get pregnant. </p>
<p>Despite this, egg timer testing is promoted to women not undergoing IVF as a way to assess their current and future fertility. </p>
<p>Our <a href="http://dx.doi.org/10.1136/bmjopen-2020-046927">analysis</a> of Australian and New Zealand fertility clinic websites found some claimed the test could predict a woman’s chance of conceiving or identify women at risk of early menopause.</p>
<h2>What can and can’t the test do?</h2>
<p>The test measures the level of anti-Mullerian hormone (AMH) in the blood and is known clinically as an AMH test. </p>
<p>AMH is produced by follicles in the ovaries (little fluid-filled sacs that contain immature eggs) and helps follicles and eggs grow during the menstrual cycle. Because the number of follicles in the ovaries drops with increasing age, the level of AMH also falls.</p>
<figure class="align-right ">
<img alt="African-Australian woman puts headphones on" src="https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">AMH testing can be used to indicate whether a medical condition or treatment, such as chemotherapy, has affected a woman’s ovarian reserve.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/d7JCyFstmqM">Dushawn Jovic/Unsplash</a></span>
</figcaption>
</figure>
<p>The AMH level <a href="https://doi.org/10.1530/EJE-19-0373">indicates</a> the number of eggs in the ovaries, or ovarian reserve. </p>
<p>It is often used in IVF treatment, as it <a href="https://doi.org/10.1093/humupd/dms041">can suggest</a> how many eggs a woman may get when her ovaries are stimulated with fertility drugs. </p>
<p>But it can’t tell you anything about egg quality. Women with low AMH levels have the <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">same chance</a> of conceiving as women with normal AMH levels.</p>
<p>It also <a href="https://academic.oup.com/humupd/article/29/3/327/6990969">can’t reliably predict</a> menopause <a href="https://pubmed.ncbi.nlm.nih.gov/30032277/">timing</a> for individual women. </p>
<p>Because of this, the American College of Obstetricians and Gynaecologists <a href="https://pubmed.ncbi.nlm.nih.gov/30913192/">strongly discourages</a> AMH testing in women who are not seeking fertility treatment. It states the test:</p>
<blockquote>
<p>should not be ordered or used to counsel women who are not infertile about their reproductive status and future fertility potential. </p>
</blockquote>
<p>No similar guidance has been published by the relevant colleges in Australia. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/womens-fertility-does-egg-timer-testing-work-and-what-are-the-other-options-109726">Women's fertility: does 'egg timer' testing work, and what are the other options?</a>
</strong>
</em>
</p>
<hr>
<h2>Who gets AMH tests and why?</h2>
<p>The test isn’t Medicare-subsidised. Most AMH tests are paid for privately by consumers, costing around A$80-$120. Because of this, data on current test usage is not publicly available. </p>
<p>To find out how many women in Australia are accessing AMH testing and why, we conducted the <a href="https://academic.oup.com/humrep/advance-article/doi/10.1093/humrep/dead111/7193900?searchresult=1">first investigation</a> into its use in Australia.</p>
<p>We surveyed a representative sample of 1,773 women aged 18 to 55, recruited through the <a href="https://srcentre.com.au/our-research/life-in-australia-study">Life in Australia</a> national study.</p>
<p>We asked them if and how they had heard about AMH testing, whether they had ever had an AMH test, their main reason for testing and how they accessed the test.</p>
<figure class="align-center ">
<img alt="Woman in jeans sits, cross-legged" src="https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We asked Australian women about their use of AMH testing.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/L1kLSwdclYQ">Imani Bahati/Unsplash</a></span>
</figcaption>
</figure>
<p>Our results, published today, show 13% of the women had heard about AMH testing and 7% had had an AMH test.</p>
<p>The majority had the test for medically indicated reasons, such as during infertility investigations (51%), or to find out if a medical condition had affected their fertility (11%). This included having had chemotherapy or radiotherapy, endometriosis, thyroid issues, and others.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/young-people-with-cancer-should-have-affordable-options-to-preserve-their-fertility-63457">Young people with cancer should have affordable options to preserve their fertility</a>
</strong>
</em>
</p>
<hr>
<p>Concerningly, one-third reported having had the test for other reasons. This included gaining insights into their fertility or inform their reproductive life planning (30%). </p>
<p>Most women who had an AMH test first heard about it from their GP or fertility specialist, suggesting doctors are currently the main drivers of test uptake. </p>
<p>However this may change with the recent emergence of direct-to-consumer AMH testing in Australia, as online companies increase their marketing.</p>
<h2>What are the downsides of having an AMH test?</h2>
<p>Getting the test to inform you about your fertility may lead you to make choices based on a false premise. </p>
<p>If you get a normal or high AMH result, it may give a false sense of security about delaying pregnancy, when age is the most important factor of female fertility. </p>
<p>If you receive a low result, it may cause unwarranted anxiety about not being able to conceive. This may cause pressure to conceive earlier than desired, or create a <a href="https://www.publish.csiro.au/PY/PY18040">sense of urgency</a> and haste towards fertility treatment, such as <a href="https://doi.org/10.1080/02646838.2016.1275533">egg freezing</a>.</p>
<figure class="align-center ">
<img alt="Woman sits on her longeroom floor, looking at her laptop" src="https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women need good evidence about the limitations of AMH testing.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Nv-vx3kUR2A">Unsplash/Thought Catalog</a></span>
</figcaption>
</figure>
<p>To make informed decisions about AMH testing, women need clear, evidence-based information. We have developed and are currently testing an evidence-based information guide to assist with this.</p>
<h2>Can other tests tell me about my fertility?</h2>
<p>Unfortunately, there is no reliable test of a woman’s fertility. </p>
<p>But it’s important to know a woman’s age is the greatest predictor of her chance of pregnancy. The only real way to know your fertility is by trying to get pregnant when you are ready.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-are-often-told-their-fertility-falls-off-a-cliff-at-35-but-is-that-right-189978">Women are often told their fertility 'falls off a cliff' at 35, but is that right?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/207008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tessa Copp is supported by an NHMRC Emerging Leader Research Fellowship (2009419). She is on the Scientific Committee of the Preventing Overdiagnosis Conference. </span></em></p><p class="fine-print"><em><span>Jenny Doust receives funding from Centre of Research Excellence on Women and Non-communicable Diseases (CRE-WaND) NHMRC APP1153420. </span></em></p><p class="fine-print"><em><span>Karin Hammarberg works part-time for the Victorian Assisted Reproductive Treatment Authority.</span></em></p>The ‘egg timer’ blood test is marketed as an empowering way to give women insights to help them plan when to have children. Problem is, it can’t deliver what it promises.Tessa Copp, NHMRC Emerging Leader Research Fellow, University of SydneyJenny Doust, Clinical Professorial Research Fellow, The University of QueenslandKarin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1986392023-02-16T06:10:43Z2023-02-16T06:10:43ZAt-home fertility tests: here’s what they can actually tell you<figure><img src="https://images.theconversation.com/files/510298/original/file-20230215-18-4vw2gt.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C5214%2C3468&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A large proportion of at-home fertility tests are aimed at women.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/concentrated-young-mixed-race-woman-unpacking-1477334057">fizkes/ Shutterstock</a></span></figcaption></figure><p>A growing number of us are waiting longer to become parents. In the UK, the average age of first-time parents is <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2020">between 30 and 33 years old</a>. Fifty years ago, the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2017">average age was 26</a>.</p>
<p>There are many reasons we’re choosing to have children later in life. On the one hand, waiting to have kids can allow us to create more stable lifestyles first, establishing a career and building our finances. But many of us also know that the longer we wait, the harder it can be to have children – with age being one of the biggest factors underlying infertility. </p>
<p>Given how big this decision is, it’s no wonder there’s growing interest in at-home fertility tests which are often advertised to people in their 20s and 30s. But while these test kits can provide you with some useful information, they can’t provide you with a full picture of your fertility.</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
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<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-things-research-can-teach-us-about-having-better-sex-according-to-a-sex-therapist-199360?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five things research can teach us about having better sex, according to a sex therapist</a></em></p>
<p><em><a href="https://theconversation.com/love-languages-might-help-you-understand-your-partner-but-its-not-exactly-science-199040?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">‘Love languages’ might help you understand your partner – but it’s not exactly science</a></em></p>
<p><em><a href="https://theconversation.com/tailoring-workouts-to-your-menstrual-cycle-may-help-your-physical-fitness-but-only-if-done-properly-195773?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Tailoring workouts to your menstrual cycle may help your physical fitness – but only if done properly</a></em></p>
<hr>
<h2>At-home tests</h2>
<p>For women, peak fertility occurs between their late teens and <a href="https://www.acog.org/womens-health/faqs/having-a-baby-after-age-35-how-aging-affects-fertility-and-pregnancy#:%7E:text=A%20woman's%20peak%20reproductive%20years,you%20reach%20your%20mid%2D30s.">late 20s</a>. After the age of 35, a woman’s fertility declines more rapidly until, by the age of about 45, getting pregnant naturally <a href="https://www.britishfertilitysociety.org.uk/fei/at-what-age-does-fertility-begin-to-decrease/">becomes unlikely</a>. While fertility also declines in men with age, they don’t experience such a dramatic drop from their mid-30s. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mens-fertility-also-declines-with-age-heres-what-to-know-if-youre-planning-to-wait-to-have-kids-187498">Men’s fertility also declines with age — here’s what to know if you’re planning to wait to have kids</a>
</strong>
</em>
</p>
<hr>
<p>So the best age to conceive is often when having children may be far from a woman’s mind. This may explain the appeal of at-home fertility test kits, which promise to give you a picture of your fertility so you can better plan when you may want to start trying for kids.</p>
<p>A number of these tests are currently aimed at women. This is likely because unlike men, who produce sperm continually from puberty, women are born with all the eggs they will ever have.</p>
<p>Most kits work by having users provide a small blood sample, which is then sent off to a lab to be tested. To get a picture of fertility, these kits typically look at levels of <a href="https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/reproductive-hormones">specific hormones</a> in the user’s blood – most commonly follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Mullerian hormone (AMH).</p>
<p>Tests which look at FSH and LH can give a general idea of a woman’s hormonal balance, and can indicate when ovulation may occur. This can help determine when it might be the best time to have sex if you’re trying to get pregnant. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32770239/">AMH</a> levels are used as a marker for the number of eggs remaining in the ovary. So tests which look at AMH levels might be able to indicate if your fertility is declining.</p>
<figure class="align-center ">
<img alt="A lab worker wearing medical gloves holds a test tube of blood in their hand. The tube is labelled 'AMH test'." src="https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The information you get will depend on what hormones the test is looking at.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/blood-sample-tube-amh-antimullerian-hormone-1934816009">Saiful52/ Shutterstock</a></span>
</figcaption>
</figure>
<p>These tests can tell you about your fertility now, but they can’t predict your fertility in five or ten years’ time. Furthermore, while they can help monitor hormone levels or the number of eggs still in the ovary, they can’t tell a woman <a href="https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/testing_and_interpreting_measures_of_ovarian_reserve.pdf">if she’s infertile</a>.</p>
<p>This is because they don’t measure the quality of a woman’s eggs or detect if she has any physical complications (such as blocked fallopian tubes) preventing her from becoming pregnant. This kind of information can only be shown through other tests, such as an abdominal scan. </p>
<p>Researchers have also recently warned against putting too much emphasis on determining fertility status from just a few, <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">select biological factors</a>. This is because fertility is regulated by a complex array of biological and <a href="https://tfp-fertility.com/en-gb/blog/9-lifestyle-factors-that-affect-fertility">lifestyle factors</a> such as weight, poor diet, smoking and excessive alcohol intake. </p>
<h2>Fertility problems</h2>
<p>While most of these at-home fertility tests are targeted at women, fertility is <a href="https://jamanetwork.com/journals/jama/fullarticle/265681">as much a consideration for men</a> as it is for women. </p>
<p>Approximately one in eight couples are affected by <a href="https://www.nhs.uk/conditions/infertility/">infertility</a>. This is defined as being <a href="https://www.britishfertilitysociety.org.uk/fei/what-is-infertility/">unable to get pregnant</a> after 12 months of regular, unprotected sex.</p>
<p>There are many reasons why infertility may happen, such as hormonal imbalances, problems ovulating, or ovulating eggs of poor quality. In women, <a href="https://www.nhs.uk/conditions/infertility/causes/">prior infections</a> can also be a factor. In men, infertility is often the result of a very low sperm count and can be a consequence of prior infection. But in many cases, the causes are unknown. </p>
<p>Many men may believe that if they can get an erection and ejaculate, there’s no problem with <a href="https://www.healthymale.org.au/news/debunking-myths-male-fertility#:%7E:text=Another%20common%20myth%20around%20men's,their%20partners%20to%20become%20pregnant">their fertility</a>. Men may also believe that age is not as much of <a href="https://www.yourfertility.org.au/everyone/age#:%7E:text=Age%20and%20sperm,healthy%20sperm%20than%20younger%20men.">an issue</a> for their fertility as it is for women. </p>
<p>However, infertility is increasing in men and is seen as a product of our modern lifestyle. Obesity, smoking, poor diet, excessive alcohol intake and recreational drug use have all been linked to <a href="https://www.inverse.com/mind-body/male-infertility-increasing">lower fertility in men</a>. </p>
<p>While men can also purchase home fertility testing kits online, these tests usually only tell you how many sperm you’re producing in each ejaculate. The shape (morphology) and speed (motility) of sperm are also <a href="https://www.mayoclinic.org/diseases-conditions/low-sperm-count/expert-answers/home-sperm-test/faq-20057836">crucial factors</a> in determining a man’s fertility – but these aren’t usually measured by these kits. Undergoing a full clinical semen analysis is still the best way for a man to assess his fertility. </p>
<p>The picture of modern fertility is changing – with fertility rates declining around the world. In many countries, fewer children are being born today than <a href="https://www.weforum.org/agenda/2022/06/global-decline-of-fertility-rates-visualised/#:%7E:text=For%20the%20last%2070%20years,increased%20cost%20of%20raising%20children">60 years ago</a>. Recent studies also show that sperm counts have <a href="https://www.focusonreproduction.eu/article/ESHRE-News-Sperm-count-decline#:%7E:text=The%20latest%20study%20found%20an,century%20at%20an%20accelerated%20pace">decreased by nearly 60%</a>. </p>
<p>However, making some simple lifestyle changes each day may help improve your fertility. For instance, losing weight and avoiding smoking and drinking in excess can all improve a couple’s chance of <a href="https://www.yourfertility.org.au/everyone/drugs-chemicals">getting pregnant</a>.</p>
<p>So if you are thinking of having children – whether in the near future or much later – making changes to your lifestyle is a good place to start if you’re concerned about your fertility.</p><img src="https://counter.theconversation.com/content/198639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Watkins receives funding from the Biotechnology and Biological Sciences Research Council. </span></em></p>At-home tests can only provide a partial picture of your fertility.Adam Watkins, Assistant Professor, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1933862022-11-21T01:16:08Z2022-11-21T01:16:08ZWe asked people why they don’t donate their eggs or sperm. Their responses could help us attract more donors<figure><img src="https://images.theconversation.com/files/493193/original/file-20221103-26-znvia5.jpg?ixlib=rb-1.1.0&rect=12%2C12%2C8155%2C5444&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Surface/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The demand for donor eggs and sperm outstrips supply in <a href="https://www.9news.com.au/national/why-australian-ivf-clinics-cant-keep-up-with-the-demand-for-donor-sperm/61bffa87-6f2b-491e-8afd-bbe94ba390ac">Australia</a>. To find out what can make donor recruitment more successful, we <a href="https://link.springer.com/epdf/10.1007/s43032-022-01112-9?sharing_token=jVsMD-q5q2uaHQElF8XbcPe4RwlQNchNByi7wbcMAY4u3V9IIU0LMQAvPKVDG4FHZcic2iWK4g1xppCVCf5G-157qKPZzSuXIp9ucB1jr9m9Oymr0VdkoT8uN69gV6UXATDexcKaTwvTmFAVcsP2fg7MfPYIhmTTcb09sKGgufg=">surveyed</a> 1,000 people about whether they had ever donated gametes (eggs or sperm) and if they hadn’t, we asked for the reasons why.</p>
<p>Only eight people had <a href="https://link.springer.com/epdf/10.1007/s43032-022-01112-9?sharing_token=jVsMD-q5q2uaHQElF8XbcPe4RwlQNchNByi7wbcMAY4u3V9IIU0LMQAvPKVDG4FHZcic2iWK4g1xppCVCf5G-157qKPZzSuXIp9ucB1jr9m9Oymr0VdkoT8uN69gV6UXATDexcKaTwvTmFAVcsP2fg7MfPYIhmTTcb09sKGgufg=">donated their gametes</a>. Of those who hadn’t donated, some gave reasons that showed that they would never even consider being a donor. However, others indicated that, under some circumstances, they might be willing to donate. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/problems-conceiving-are-not-just-about-women-male-infertility-is-behind-1-in-3-ivf-cycles-192183">Problems conceiving are not just about women. Male infertility is behind 1 in 3 IVF cycles</a>
</strong>
</em>
</p>
<hr>
<h2>Who needs donor eggs and sperm?</h2>
<p>In <a href="https://pubmed.ncbi.nlm.nih.gov/24851179/">Australia</a> and some other countries including the United Kingdom, New Zealand and Sweden, egg and sperm donors can’t be paid, and must agree that their identity can be known by any child born as a result of their donation once they turn 18. In other counties, including the United States and some countries in Europe, donors can be paid and <a href="https://www.institutobernabeu.com/en/spanish-law-on-assisted-reproduction/">remain anonymous</a>.</p>
<p>Donor eggs and sperm allow people who otherwise are unable to have children to become parents. Men in same-sex relationships can become parents with the help of an egg donor and a surrogate. </p>
<p>For women in same-sex relationships, single women, and heterosexual couples where the male partner doesn’t produce sperm, donor sperm makes parenthood possible. And for women who, due to their age, don’t produce viable eggs, eggs donated by a younger woman give them a <a href="https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/ajo.13179">good chance</a> of having a baby.</p>
<p>In countries where donors are paid to donate their eggs and sperm and can remain anonymous, donor eggs and sperm are available for those who need it and can afford it. </p>
<p>But in most countries where only altruistic donations are permitted and where donors can’t be anonymous, there is a shortage of donors. This means some people who need donor eggs or sperm have to join a waiting list, try to find their own donor (friend or relative), or <a href="https://www.degruyter.com/document/doi/10.1515/med-2019-0026/html">travel to a country</a> where they can access donor eggs or sperm. </p>
<p>The Victorian government recently announced Australia’s first <a href="https://www.health.vic.gov.au/news/delivering-public-fertility-care-to-support-more-victorian-families">public sperm and egg bank</a> will be established in Victoria. The announcement didn’t elaborate how this bank would find donors. The findings of our research about why people don’t donate their eggs or sperm might help recruitment strategies for donors to this and other donor programs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/493194/original/file-20221103-20-xwz79h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hands on a laptop keyboard" src="https://images.theconversation.com/files/493194/original/file-20221103-20-xwz79h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493194/original/file-20221103-20-xwz79h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493194/original/file-20221103-20-xwz79h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493194/original/file-20221103-20-xwz79h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493194/original/file-20221103-20-xwz79h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493194/original/file-20221103-20-xwz79h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493194/original/file-20221103-20-xwz79h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We surveyed over a thousand people, and only eight of them had donated eggs or sperm.</span>
<span class="attribution"><span class="source">glenn carstens peters/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Why people don’t donate</h2>
<p>We know most people who donate their eggs and sperm are <a href="https://doi.org/10.1093/hropen/hoac042">motivated by altruism</a> and a desire to help infertile people <a href="https://www.tandfonline.com/doi/abs/10.1080/14647273.2021.2005263?journalCode=ihuf20">have children</a>. Where donors are paid, <a href="https://academic.oup.com/humupd/article/19/1/37/629150?login=true">financial compensation</a> is also a motivator. </p>
<p>But little is known about the vast majority of people who don’t donate. We conducted an <a href="https://link.springer.com/epdf/10.1007/s43032-022-01112-9?sharing_token=jVsMD-q5q2uaHQElF8XbcPe4RwlQNchNByi7wbcMAY4u3V9IIU0LMQAvPKVDG4FHZcic2iWK4g1xppCVCf5G-157qKPZzSuXIp9ucB1jr9m9Oymr0VdkoT8uN69gV6UXATDexcKaTwvTmFAVcsP2fg7MfPYIhmTTcb09sKGgufg=">online survey</a> where people were asked if they had ever donated sperm or eggs and if they hadn’t, we asked them to tell us why. </p>
<p>Of the 1,035 people who completed the survey, only eight had donated eggs or sperm. The written responses non-donors gave for why they hadn’t donated eggs or sperm were analysed and revealed four distinct themes. </p>
<p><strong>1: Barriers:</strong></p>
<p>Some people couldn’t donate, perhaps because they had had a vasectomy or were themselves infertile. </p>
<p><strong>2. Conscientious objectors:</strong></p>
<p>Some considered donating eggs or sperm to be against their religious beliefs or cultural norms, and some made comments which reflected a firm refusal without mention of any specific reason, for example, “There is no way I would do this in a million years.”</p>
<p><strong>3. Conditional willingness:</strong></p>
<p>Some comments suggested that some non-donors might consider becoming an egg or sperm donor if specified requirements were fulfilled. This included things like if they had more information about what donation entails, a family member or close friend needed eggs or sperm, they had completed their own family, a future partner supported them to donate eggs or sperm, or if they were paid to donate.</p>
<p><strong>4.Unconsidered:</strong> </p>
<p>Some people had never thought about or made an active decision about whether they would donate or not. This was reflected in comments such as “I’ve never really thought about it”, or “Nobody has asked me”.</p>
<p>Some people gave multiple reasons for not donating, and these sometimes fell into more than one theme. The most common theme was conditional willingness (approximately 65%) followed by the “unconsidered” (approximately 35%), and “barriers” themes (approximately 20%). The least common theme was the “conscientious objector” (approximately 12%).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/493195/original/file-20221103-13-ad6oyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Baby on mother's shoulder" src="https://images.theconversation.com/files/493195/original/file-20221103-13-ad6oyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493195/original/file-20221103-13-ad6oyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493195/original/file-20221103-13-ad6oyg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493195/original/file-20221103-13-ad6oyg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493195/original/file-20221103-13-ad6oyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493195/original/file-20221103-13-ad6oyg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493195/original/file-20221103-13-ad6oyg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In countries with only altruistic donation, there are shortages of donor eggs and sperm.</span>
<span class="attribution"><span class="source">hollie santos/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>How can we attract more donors?</h2>
<p>This study shows there is potential to increase the number of egg and sperm donors by improving awareness about the need for donors and how donations can help people who can’t have children any other way. </p>
<p>The <a href="https://www.health.vic.gov.au/patient-care/review-of-assisted-reproductive-treatment">Independent Review of Assisted Reproductive Treatment</a> commissioned by the Victorian government also emphasised the importance of public education, stating “a social marketing campaign that speaks to the value of donation and seeks to influence social views on donation” is needed to grow the pool of local donors. </p>
<p>Donors’ wellbeing also needs to be a priority if we want more people to volunteer to donate their eggs or sperm. Access to counselling and support before and <a href="https://pubmed.ncbi.nlm.nih.gov/33451270/">after donation</a>, out-of-hours options for donating, user-friendly booking systems, and exceptional and person-centred care are essential in <a href="https://www.health.vic.gov.au/patient-care/review-of-assisted-reproductive-treatment">donor programs</a>. </p>
<p>And finally, although altruism is a cornerstone in egg and sperm donation regulation in Australia, reasonable compensation for time and effort might increase the number of people willing to donate to help others achieve parenthood.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-about-freezing-your-eggs-to-have-a-baby-later-here-are-3-numbers-to-help-you-decide-187845">Thinking about freezing your eggs to have a baby later? Here are 3 numbers to help you decide</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/193386/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karin Hammarberg works for the Victorian Assisted Reproductive Treatment Authority</span></em></p><p class="fine-print"><em><span>Benno Torgler, Ho Fai Chan, and Stephen Whyte do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We asked 1,000 people why they hadn’t donated their eggs or sperm, and their responses tended to fall in four categories.Karin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityBenno Torgler, Professor, Business School, Queensland University of TechnologyHo Fai Chan, Postdoctoral Research Fellow, Queensland University of TechnologyStephen Whyte, Deputy Director, Centre for Behavioural Economics, Society and Technology, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1905312022-10-30T23:27:00Z2022-10-30T23:27:00ZStarting cancer treatment? You should discuss fertility first<figure><img src="https://images.theconversation.com/files/490573/original/file-20221019-20-rhatnq.jpg?ixlib=rb-1.1.0&rect=43%2C25%2C5708%2C3802&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/organic-baby-clothes-600w-261828743.jpg">Shutterstock</a></span></figcaption></figure><p>Not all Australians with cancer are getting the fertility care they need.</p>
<p>In 2022, it is predicted more than 8,200 Australians under 40 – in their reproductive years – will be <a href="https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-survival-by-age-visualisation">diagnosed with cancer</a>. This is more than double the rate in the 1980s. </p>
<p>The good news is more men, women and children than ever are surviving cancer. This is due to earlier diagnosis and more successful cancer treatments. Now <a href="https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-survival-by-age-visualisation">over 85%</a> of patients under 40 will still be alive five years after their cancer diagnosis. </p>
<p>However, many of them might not be aware of the potential decrease in fertility after cancer treatments, and their options for protecting their future ability to have children. Some estimates suggest <a href="https://academic.oup.com/humupd/article/25/2/159/5193422">only half</a> of people with cancer have a documented fertility preservation discussion.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1573592063051972611"}"></div></p>
<h2>How cancer treatment can affect fertility</h2>
<p>Both cancer and its treatments can reduce fertility for all genders.</p>
<p>Chemotherapy, radiation and surgery may <a href="https://www.fertstert.org/article/S0015-0282(18)30435-7/fulltext">permanently reduce</a> the number of egg and sperm cells, which may lead to difficulty conceiving in the future.</p>
<p>The store of eggs is laid down before birth, and to date there is no good evidence eggs can be replenished. Chemotherapy – chemical drug treatments that attack cancer cells – may also harm the delicate egg and sperm cells and reduce their numbers. </p>
<p>Likewise, radiotherapy – directed radiation energy at cancer cells – may scatter and cause scarring of the ovaries and testicular tissue. </p>
<p>Sometimes, with high-dose chemotherapy or radiotherapy, all the eggs, sperm cells and supporting tissues may be destroyed. Direct surgery to reproductive organs may lead to reduced fertility.</p>
<p>Often, it is not known what the full effect of cancer treatment will be on fertility, and the effect may be different for each individual.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/problems-conceiving-are-not-just-about-women-male-infertility-is-behind-1-in-3-ivf-cycles-192183">Problems conceiving are not just about women. Male infertility is behind 1 in 3 IVF cycles</a>
</strong>
</em>
</p>
<hr>
<h2>What is oncofertility, and how can it help?</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710491/">Oncofertility</a> is a relatively recently established medical field that provides options for fertility preservation. Addressing quality of life from a biological, psychological and social perspective acknowledges the potential distress that reduced fertility might cause cancer survivors.</p>
<p>Advances in assisted reproductive technology, such as <a href="https://pubmed.ncbi.nlm.nih.gov/25428012/">vitrification</a> (fast freezing), means we can preserve eggs, embryos, ovarian tissue, sperm and testicular tissue for future use. This is known as medical fertility preservation. </p>
<p>Fertility preservation may be someone’s best chance for biological children in the future. Oncofertility considers an individual’s future goals for family and parenthood, alongside cancer treatments. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-things-not-to-say-to-someone-struggling-with-infertility-138510">5 things not to say to someone struggling with infertility</a>
</strong>
</em>
</p>
<hr>
<h2>4 new things we know about oncofertility</h2>
<p>This year, the <a href="https://www.cancer.org.au/clinical-guidelines/cancer-fertility-preservation">Clinical Oncology Society of Australia</a> (COSA) updated its guidelines for fertility preservation for people with cancer. </p>
<p>It is based on advice from Australian experts including medical specialists, scientific researchers, psychologists, health managers and nurses, public consultation and feedback. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1544477144604090370"}"></div></p>
<p>The COSA guidelines discuss fertility treatment options, referral pathways and psychological support. They also cover contraception during cancer treatment (to avoid disruption to the treatment regimen), interrupting hormone treatment to conceive, assisted reproduction, and the risk of cancer recurrence. This guideline aims to support conception and pregnancy in cancer survivors. </p>
<p>In our paper published today in the <a href="https://www.mja.com.au/journal/2022/217/11/australian-fertility-preservation-guidelines-people-cancer-2022-review-and">Medical Journal of Australia</a> we update medical practitioners on the latest in oncofertility knowledge: </p>
<ol>
<li><p>that pregnancy rates after freezing eggs are similar to those after freezing embryos, with live birth rates of 46% and 54% respectively in <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.13559">one study</a> </p></li>
<li><p>ovarian tissue <a href="https://www.mivf.com.au/sites/mivf/files/2020-10/Preserving%20your%20fertility%20-%20About%20ovarian%20tissue%20freezing.pdf">freezing</a> and grafting for females is no longer considered “experimental”, however special oversight for pre-pubertal girls under the age of 13 years is recommended. This is because clinical experience of patients who were 20 years of age or younger at the time of fertility preservation <a href="https://pubmed.ncbi.nlm.nih.gov/30773394/">remains limited</a> </p></li>
<li><p>extracting sperm from testicular tissue by <a href="https://link.springer.com/article/10.1007/s10147-016-0998-5">microsurgery</a> may be considered for men who have already undergone cancer treatment and who were <a href="https://ascopubs.org/doi/full/10.1200/JCO.2010.33.7808">previously thought to have no sperm</a> </p></li>
<li><p>testicular tissue freezing in pre-pubertal boys is currently considered “<a href="https://onlinelibrary.wiley.com/doi/10.1111/cen.13377">experimental</a>” as there are no mature sperm cells. Clinical ethical oversight is required while new methods are trialled to use these early cells for fertility. </p></li>
</ol>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/GFgneVTs_Og?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Health professionals can support newly diagnosed patients through their oncofertility journey.</span></figcaption>
</figure>
<h2>Timing is important</h2>
<p>Once a diagnosis of cancer is made, discussion and decisions around fertility can be urgent and time-critical. </p>
<p>This is to allow time for referral to an oncofertility unit, appropriate counselling and informed decision-making to occur. </p>
<p>It takes time to plan and perform fertility preservation (for example, eggs may take around 14 days to grow and collect for freezing) so promptness is important to prevent delays in cancer treatment. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/researchers-have-grown-human-embryos-from-skin-cells-what-does-that-mean-and-is-it-ethical-157228">Researchers have grown 'human embryos' from skin cells. What does that mean, and is it ethical?</a>
</strong>
</em>
</p>
<hr>
<h2>Educating patients</h2>
<p>Not everyone of child-producing age who is diagnosed with cancer is referred to oncofertility health services promptly, if at all. This can lead to feelings of <a href="https://www.cancer.org.au/clinical-guidelines/cancer-fertility-preservation/referral-and-service-provision/Referral-rates-and-decisional-conflict">conflict and regret</a>. </p>
<p>Our team of fertility specialists from the <a href="https://www.thewomens.org.au/patients-visitors/clinics-and-services/fertility-genetics/fertility-preservation/">Royal Women’s</a> and <a href="https://www.rch.org.au/fertility/">Royal Children’s</a> Hospitals collaborated with the <a href="https://www.vics.org.au/wcmics-about-us">Western and Central Melbourne Integrated Cancer Service</a> to develop a suite of animated patient education videos to address this gap. </p>
<p>The <a href="http://www.fertilityaftercancer.org/">Fertility after Cancer</a> videos – available in multiple languages, reviewed by cancer patients and support groups, age-appropriate for children, adolescents, adults, and their families — discuss fertility preservation options, risks, benefits and alternatives.</p>
<p>Our goal is that all Australians with cancer have access to information, and support, regarding the impact of cancer treatments on their future fertility.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/AB2LExT4qo4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A quick guide to oncofertility choices.</span></figcaption>
</figure><img src="https://counter.theconversation.com/content/190531/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Violet Kieu is a Fertility Specialist at The Royal Women's Hospital and Melbourne IVF. To attend scientific conferences, she has received support from Merck, Gedeon Richter, and honorarium from Organon. In conjunction with the Western and Central Melbourne Integrated Cancer Service, Violet co-created the <a href="http://www.fertilityaftercancer.org">www.fertilityaftercancer.org</a> patient education videos.</span></em></p><p class="fine-print"><em><span>Kate Stern is a fertility specialist and head of the Fertility Preservation Service (FPS) at the Royal Women's Hospital and Melbourne IVF. These organisations both provide fertility preservation treatment for cancer patients. Kate is a board member of Fertility Matters, a not-for-profit organisation which develops fertility education tools for schools. The FPS has previously received non-directed grants for research from Merck-Serono and MSD. Kate is also a member of the Future Fertility Registry group which has developed a national and international database for fertility preservation patients. Previously this registry has received administrative support from Merck-Serono. Kate established the NOTTCS tissue transport program for young cancer patients and this receives support from Sony Foundation.</span></em></p>Both cancer and cancer treatment can impact someone’s ability to have biological children. It’s important to discuss fertility right after cancer diagnosis.Violet Kieu, Clinical Senior Lecturer, Department of Obstetrics & Gynaecology, The University of MelbourneKate Stern, Associate Professor,, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1904432022-09-15T20:03:29Z2022-09-15T20:03:29ZWhat are uterus transplants? Who donates their uterus? And what are the risks?<figure><img src="https://images.theconversation.com/files/484725/original/file-20220914-8999-dftuge.jpg?ixlib=rb-1.1.0&rect=0%2C366%2C2069%2C1228&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/ZSS60LG9xw8">Krishh/Unsplash</a></span></figcaption></figure><p>The opportunity to conceive, carry and give birth to a biologically related child is a deep desire for many women and their partners. Since the introduction of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140213/">IVF in 1978</a>, many people in countries such as Australia have accessed support and resources to help realise their reproductive goals.</p>
<p>For some women, the lack of a functioning uterus has kept that opportunity out of reach. This includes those with a congenital condition such as <a href="https://www.rch.org.au/rch_gynaecology/young-women-and-parents-and-carers/RCH_MRKH_information/">Mayer-Rokitansky-Küster-Hauser</a> syndrome, and those who had a hysterectomy for medical reasons. </p>
<p>For these women, the only options for parenthood have been surrogacy or adoption. Access to both is often difficult.</p>
<p>Uterus transplants are changing that. From next year, uterus transplants are being trialled in Australia. However, there are risks involved and ethical concerns which must be addressed before it can become mainstream clinical treatment.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1568061770136449024"}"></div></p>
<h2>How does the process work?</h2>
<p>Uterus transplantation is a <a href="https://pubmed.ncbi.nlm.nih.gov/24582522/">set of medical procedures</a> in which a donated uterus is surgically removed from a suitable donor and transplanted into an eligible recipient. </p>
<p>Hormones are used to stimulate menstruation in the recipient, and once the uterus is functioning normally, an IVF-created embryo is transferred into the woman’s uterus. </p>
<p>Following successful implantation and healthy development, the baby is delivered via caesarean section. This is because a uterus transplant pregnancy is regarded as high risk, and the woman may not be able to feel contractions. Women with the congenital absence of a uterus will not be able to deliver vaginally.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-are-womb-transplants-and-who-could-they-help-50342">Explainer: what are womb transplants and who could they help?</a>
</strong>
</em>
</p>
<hr>
<p>As with all transplants, the uterus recipient is prescribed immunosuppression medication to prevent rejection of the donor organ. These drugs are administered at levels deemed safe for the developing foetus. Close monitoring continues throughout the pregnancy to ensure the safety of both woman and foetus.</p>
<p>Immunosuppression continues until the delivery of up to two healthy babies or five years after the transplant, whichever is first. </p>
<figure class="align-center ">
<img alt="Pregnant woman holds her dress under her belly" src="https://images.theconversation.com/files/484759/original/file-20220915-13-aw32r5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484759/original/file-20220915-13-aw32r5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484759/original/file-20220915-13-aw32r5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484759/original/file-20220915-13-aw32r5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484759/original/file-20220915-13-aw32r5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484759/original/file-20220915-13-aw32r5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484759/original/file-20220915-13-aw32r5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Donor recipients take immunosuppressing medication at levels deemed safe during pregnancy.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/WI-x1wo_Jm4">Omurden Cengiz/Unsplash</a></span>
</figcaption>
</figure>
<p>The uterus is then surgically removed via hysterectomy, enabling immunosuppression – which carries risks and side-effects – to be ceased. Risks from immunosuppression include infection, reduced blood cell count, heart disease and suppression of bone marrow growth. And these risks increase with time.</p>
<p>Uterus transplantation is an “ephemeral” transplant: a non-life-saving temporary transplant, aimed solely at enabling reproduction. These features make it medically and ethically distinct from other transplants.</p>
<h2>When did uterus transplants start?</h2>
<p>Scientists started developing uterus transplantation in animals in the 1970s. The first attempts in humans occurred in <a href="https://www.nytimes.com/2002/03/07/world/medical-first-a-transplant-of-a-uterus.html">2000 (Saudi Arabia)</a> and <a href="https://www.reuters.com/article/us-turkey-transplant-idUKBRE94D0P720130514">2011 (Turkey)</a>, both of which failed. </p>
<p>After 14 years of research, Professor Mats Brannstrom and his team at Sweden’s Sahlgrenska University Hospital started the world’s first human trials in 2013. In 2014, the <a href="https://www.bbc.com/news/health-29485996">first healthy baby was born</a>.</p>
<p>With more than 25 countries now performing or planning uterus transplants, it is estimated that <a href="https://pubmed.ncbi.nlm.nih.gov/34636769/">at least 80 procedures</a> have been performed, resulting in more than 40 healthy live births. While not all transplants are successful, the live birth rate from a uterus that is functioning successfully after transplantation is <a href="https://pubmed.ncbi.nlm.nih.gov/34636769/">estimated at over 80%</a>. </p>
<p>In Australia, <a href="https://www.abc.net.au/news/health/2022-09-09/uterus-transplant-australian-first-royal-hospital-for-women/101422018">two trials</a> have been approved and plan to start within the next 12-18 months.</p>
<h2>Who donates?</h2>
<p>Most uterus transplants so far have used altruistic living donors, typically a mother donating to her daughter or an aunt to her niece.</p>
<figure class="align-center ">
<img alt="Mother and daughter lay on grass, looking at each other" src="https://images.theconversation.com/files/484757/original/file-20220915-1807-mq1lax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484757/original/file-20220915-1807-mq1lax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484757/original/file-20220915-1807-mq1lax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484757/original/file-20220915-1807-mq1lax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484757/original/file-20220915-1807-mq1lax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484757/original/file-20220915-1807-mq1lax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484757/original/file-20220915-1807-mq1lax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Donors tend to be mothers or aunts.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/0eErMhzFgvE">Bence Halmosi/Unsplash</a></span>
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<p>But cases using uteruses from deceased donors have also been successful, with <a href="https://www.mdpi.com/2077-0383/11/15/4516/pdf">at least four healthy live births reported</a>. </p>
<p>Uteruses from deceased donors are mostly provided through standard family consent methods for medical research. But in future they could be provided through organ donor registration processes modified to include the uterus. </p>
<p>Currently, only pre-menopausal women can be uterus donors, and living donors need to have had a successful pregnancy to be eligible to donate. But this <a href="https://www.fertstert.org/article/S0015-0282(19)30486-8/fulltext">may not need</a> to be a requirement for deceased donors, potentially enabling younger donors and increasing the availability of uteruses for transplantation. </p>
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<p>Of the two approved Australian trials, only one (led by Royal Hospital for Women, for which I provide independent ethical advice) will conduct both living and deceased donor uterus transplantation. The other (through Royal Prince Alfred hospital) will trial only living donor transplantation.</p>
<p>Participation in these uterus transplant trials will remain limited while uterus transplantation is still in the research phase, and will depend on the availability of funding.</p>
<h2>What are the risks of living donation?</h2>
<p>For recipients, the main surgical risks are organ rejection, infection, and blood clots or thrombosis, as well as risks arising from the surgery duration (average 5 hours) such as blood clots (including in the lung) and from immunosuppression. </p>
<p>While challenging, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1472648322004278">these risks have been minimised</a> through close monitoring and early intervention using blood thinners and encouraging recipients to move around soon after surgery.</p>
<p>For living donors, physical risks arise from surgery duration (6-11 hours) and operative and postoperative complications, the most common being urinary tract injury and infection.</p>
<p>There are also ethical and psychological risks. These include the possibility of a potential donor feeling pressured to donate to a family member, and experiencing guilt and failure if the transplant is not successful or results in adverse outcomes. </p>
<p>These risks may be reduced with appropriate counselling and support. But as with all altruistic organ donation, they cannot be entirely eliminated.</p>
<h2>What about deceased donation?</h2>
<p>Deceased donor transplantation also carries risks but involves less surgical time than living donor transplantation (typically 1-2 hours) and therefore less demand on medical resources and personnel.</p>
<p>Deceased donor transplantation may be less ethically fraught. There is no prospect of pressure, guilt or surgical risk to the deceased donor, who must have been declared brain dead and be suitable for multi-organ donation. Their organs may only be procured with proper consent, following the usual protocols and procedures.</p>
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Read more:
<a href="https://theconversation.com/would-you-donate-your-womb-when-you-die-48693">Would you donate your womb when you die?</a>
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<p>In Australia, as elsewhere, organ donors are in short supply. But deceased donors might be found via existing donation registries and consent processes, such as those managed by <a href="https://www.donatelife.gov.au/">DonateLife</a> and <a href="https://www.seslhd.health.nsw.gov.au/services-clinics/directory/nsw-organ-and-tissue-donation-service">NSW Organ and Tissue Donation Services</a>. </p>
<h2>Why investigate both types of donation?</h2>
<p>It’s important to be able to compare the outcomes of living and deceased donation in similar recipients and contexts. This will inform future guidelines and policies around uterus donation, and determine whether it can become mainstream clinical practice. </p>
<p>Emerging evidence suggests <a href="https://pubmed.ncbi.nlm.nih.gov/35956131/">deceased donation may yield better results for recipients</a>. Using deceased donor organs allows longer veins and arteries to be retrieved, enabling better blood flow for the uterus and potentially greater success in transplants and pregnancies.</p>
<p>So although there are currently fewer cases of deceased donors, there are sound medical and ethical reasons for Australian uterus transplant research with both deceased and living donors.</p><img src="https://counter.theconversation.com/content/190443/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mianna Lotz provides independent ethical advice to the uterus transplant trial at Royal Hospital for Women.</span></em></p>From next year, uterus transplants are being trialled in Australia. But it’s likely to be a while before they becomes mainstream clinical treatment.Mianna Lotz, Associate Professor in Philosophy & Chair of Faculty of Arts Human Research Ethics Committee, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1869122022-07-18T20:06:14Z2022-07-18T20:06:14ZBluey casts a tender light on being childless not by choice. Here’s what women told me about living with involuntary childlessness<figure><img src="https://images.theconversation.com/files/474457/original/file-20220718-24-a99s2t.png?ixlib=rb-1.1.0&rect=0%2C2%2C1436%2C780&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">ABC</span></span></figcaption></figure><p>In a recent episode of Bluey, <a href="https://iview.abc.net.au/show/bluey/series/3/video/CH2003Q044S00">Onesies</a>, six-year-old Bluey asks her mum Chilli what’s wrong with Auntie Brandy, who has come to visit for the first time in four years.</p>
<p>“Is she sad?” Bluey asks. “And why have we only seen her once in our lives?”</p>
<p>It is hinted by the show Brandy is unable to have children. </p>
<p>“I’m sorry it’s been so long,” Brandy later says to her sister. “It’s just hard seeing you all, you know?” </p>
<p>“I know,” Chilli replies, reaching for her sister’s hand.</p>
<p>It is another example of the hit program’s gentle and insightful exploration of <a href="https://www.chicagotribune.com/entertainment/tv/sc-ent-bluey-disney-1023-20191017-fbd55bc67ncbjph4s6hvzdnwc4-story.html">complex issues</a>, sparking a flood of positive responses from viewers. As one person commented on the show’s Facebook page, “thank you Bluey, for showing the infertility and childless not by choice community”.</p>
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<p>Close to <a href="https://www.jeanhailes.org.au/health-a-z/fertility-pregnancy/having-trouble-conceiving">one in six couples</a> have experienced infertility. Those who haven’t usually know someone – a family member, colleague or friend – who has.</p>
<p>Shining a light on these experiences can help many who are going through it to feel less alone and lessen the sense of shame and stigma that unfortunately so often attends a diagnosis of infertility.</p>
<p>Much media coverage tends to focus only on IVF. But Bluey highlights another important aspect of infertility: the emotional and social toll of involuntary childlessness continues well past the period of actively trying to conceive.</p>
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Read more:
<a href="https://theconversation.com/an-idealised-australian-ethos-why-bluey-is-an-audience-favourite-even-for-adults-without-kids-168571">'An idealised Australian ethos': why Bluey is an audience favourite, even for adults without kids</a>
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<h2>‘An apology and a failure’</h2>
<p>As part of <a href="https://scholars.latrobe.edu.au/shealy">my research</a> into experiences of infertility, I have interviewed older generations of women living with involuntary childlessness. For these women, now in their 60s and 70s, the invisibility of their experiences in public discussion of infertility has had a lasting impact on their mental health and sense of community inclusion.</p>
<p>Some of the women who shared their stories experienced multiple miscarriages; some never found a reason for their infertility; some eventually had a child, while others did not.</p>
<p>For the women who were unable to have a child, the impact of infertility on their identity and relationships is long-lasting, reverberating through their lives well past the months or years they spent trying for a baby.</p>
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<p>Heather* and her husband are in their 60s. At 36, after having tried to conceive for three years, Heather had a miscarriage at eight weeks. They then underwent eight IVF cycles without becoming pregnant, and eventually decided to stop treatment. </p>
<p>Her miscarriage, which happened after she had seen her baby’s heartbeat and experienced bad morning sickness, was deeply traumatic for Heather. Her pregnancy remains special and meaningful to her.</p>
<p>Nearly 30 years later, there are situations she still avoids because of the emotions they trigger. Since retiring she has become active in University of the Third Age but avoids some classes because of the constant conversation about grandchildren: </p>
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<p>And then they ask me about my children and my grandchildren and I’ve got to tell them no, we don’t have any. And it’s almost like an apology […] an apology and a failure.</p>
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<p>For Mary*, in her 70s at the time of our interview, getting older has meant reliving the trauma of friends’ young children’s birthday parties. </p>
<p>She recalled in her 30s having to leave parties because they were “just too hard”, and those feelings are returning as her friends become caught up in being grandparents. She reflected, “I’m losing my friends again.”</p>
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<p>Renee*, 59 at the time of our interview, told me she no longer has people ask if she has children. “Now, it’s grandchildren,” she says.</p>
<p>The ongoing repercussions of childlessness are felt within families, too. </p>
<p>Greta* is 54, and has no children while her sister does. Her mother had moved interstate to live with her other daughter and grandchildren in her final months. </p>
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<p>I’m so pleased, now, that she had that time with them, but at the time, it was quite wrenching.</p>
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<p>She reflected how many people without children miss the connection to a multi-generational family. “That’s the longer-term impact. When I’m old, who’s going to care?”, she said.</p>
<h2>Rich and full lives</h2>
<p>Despite their ongoing grief, the women I spoke to who were unable to have a child emphasised their lives were rich and full. This included successful international careers, further study and career changes, running own businesses, becoming step-parents and step-grandparents.</p>
<p>But people who are childless not by choice continue to live with this reality long after their years of trying to conceive.</p>
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<p>We all need to hear stories that reflect our own life experiences, to feel seen, to feel we belong. Bringing a more inclusive approach and a longer perspective to public discussions about infertility helps to undo the isolation and invisibility so often felt by older women who are childless not by choice.</p>
<p>It is perhaps ironic, and a little bittersweet, it has taken a children’s program to remind us of this.</p>
<p><em>*Names have been changed.</em></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/half-of-women-over-35-who-want-a-child-dont-end-up-having-one-or-have-fewer-than-they-planned-173151">Half of women over 35 who want a child don't end up having one, or have fewer than they planned</a>
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<img src="https://counter.theconversation.com/content/186912/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sianan Healy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The emotional toll of involuntary childlessness continues well past the period of actively trying to conceive.Sianan Healy, Tracey Banivanua Mar Research Fellow, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1816642022-05-03T13:08:48Z2022-05-03T13:08:48ZFertility treatment use is on the rise – new legislation could increase protections for donors and families in an industry shrouded in secrecy<figure><img src="https://images.theconversation.com/files/460598/original/file-20220429-16-8n7qx3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Assisted reproductive technologies like in vitro fertilization can help expand families, but regulations aren't consistent across states. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/large-group-of-babies-royalty-free-image/77744444">moodboard/Image Source via Getty Images</a></span></figcaption></figure><p>The fertility industry generates approximately <a href="https://www.natlawreview.com/article/state-fertility-industry">US$8 billion in revenue</a> annually and plays a role in the birth of tens of thousands of children each year. Regulations are currently <a href="https://theconversation.com/sperm-donation-is-largely-unregulated-but-that-could-soon-change-as-lawsuits-multiply-174389">limited</a> even as technology evolves and demand increases. But a <a href="https://leg.colorado.gov/bills/sb22-224">new Colorado bill</a> introduced in late April 2022 could help the industry better meet the needs of those who use it. </p>
<p>Fertility treatments take a <a href="https://resolve.org/learn/what-are-my-options/">number of forms</a>. They may include fertility medication, intrauterine insemination, in vitro fertilization, or the use of donor sperm, eggs or embryos. Expenses for each treatment type vary widely, ranging from roughly <a href="https://www.forbes.com/health/family/how-much-does-ivf-cost/">$15,000 to $30,000</a> for a single IVF cycle to <a href="https://theconversation.com/sperm-donation-is-largely-unregulated-but-that-could-soon-change-as-lawsuits-multiply-174389">about $1,000</a> for a vial of sperm. Often, <a href="https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/">multiple tries</a> are needed to achieve a pregnancy, and the costs can add up.</p>
<p>Despite these costs, the <a href="https://www.cdc.gov/art/reports/2019/pdf/2019-Report-ART-Fertility-Clinic-National-Summary-h.pdf">number of people</a> who use reproductive technology is consistently rising. U.S. births assisted by fertility treatments increased <a href="https://www.pewresearch.org/fact-tank/2018/07/17/a-third-of-u-s-adults-say-they-have-used-fertility-treatments-or-know-someone-who-has/">more than threefold</a> from 1996 to 2015. </p>
<p>We are <a href="https://www.law.virginia.edu/faculty/profile/nrc8g/2915359">law professors</a> who <a href="https://www.law.gwu.edu/sonia-m-suter">study reproductive technology</a>. One of us has used these treatments ourselves. The <a href="https://coloradosun.com/2022/04/27/colorado-legislature-donor-conceived/">new Colorado bill</a> we testified in support of would be the first in the U.S. to require the identity of egg and sperm donors to be released upon request of their donor-conceived offspring when they turn 18. In the bill’s current version, it would also set a limit on the number of families per individual donor.</p>
<p>To understand the significance of Colorado’s proposed legislation, it’s worth examining the scope of issues surrounding fertility treatment in the U.S., and how the industry works.</p>
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<figcaption><span class="caption">In vitro fertilization is one of several types of fertility treatments available.</span></figcaption>
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<h2>Access to fertility services</h2>
<p>Twelve percent of women in the U.S. have received some form of <a href="https://www.nytimes.com/2020/04/16/parenting/fertility/ivf-long-term-effects.html">medical care</a> for infertility, a condition that affects roughly <a href="https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/">10%</a> to <a href="https://www.cdc.gov/reproductivehealth/infertility/index.htm">20%</a> of heterosexual people. Same-sex couples and single individuals who want to reproduce face <a href="https://www.newyorker.com/culture/annals-of-inquiry/the-case-for-social-infertility">social infertility</a>, where their relationships and social circumstances preclude the ability to conceive a child.</p>
<p>A small but increasing number of states <a href="https://www.ncsl.org/research/health/insurance-coverage-for-infertility-laws.aspx">require insurance companies</a> to offer fertility coverage, although the scope and nature of coverage <a href="https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/">varies by policy and by state</a>. </p>
<p><a href="https://www.wired.com/story/fertility-benefits-work/">More employers</a> are also offering fertility benefits. However, which services they cover vary, the most common being evaluation by an infertility specialist. An <a href="https://www.mercer.us/our-thinking/healthcare/new-survey-finds-employers-adding-fertility-benefits-to-promote-dei.html">increasing percentage</a> of companies are covering <a href="https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/">egg freezing</a> and in vitro fertilization.</p>
<p>While <a href="https://www.kff.org/report-section/medicaid-coverage-of-family-planning-benefits-results-from-a-state-survey-fertility-services/">some Medicaid programs</a> cover fertility testing, only one state covers a few types of treatment. Most states still do not require health insurance policies to cover fertility benefits, and some of those states that do limit benefits to <a href="https://www.reproductivefacts.org/resources/state-infertility-insurance-laws/states/arkansas/">heterosexual married people</a>.</p>
<p>A <a href="https://doi.org/10.1016/j.fertnstert.2017.02.101">lack of fertility specialists</a> in some areas of the U.S. also restricts access to fertility care. For example, as of 2019, <a href="https://www.cdc.gov/art/state-specific-surveillance/index.html">Alaska and Wyoming</a> have no fertility clinics offering assisted reproductive technology such as IVF. Similarly, <a href="https://www.kff.org/report-section/coverage-and-use-of-fertility-services-in-the-u-s-issue-brief/">Black and Hispanic women</a> are less likely than white women to have access to fertility care and to have successful IVF cycles, due in part to socioeconomic barriers.</p>
<h2>Tracking fertility treatment and privacy</h2>
<p>The federal government collects information about the <a href="https://www.cdc.gov/art/artdata/index.html">success rates</a> of fertility clinics. But little is known about one growing segment of that market: egg, sperm and embryo donation.</p>
<p>A 2019 report from the Centers for Disease Control and Prevention states that there were almost <a href="https://www.cdc.gov/art/reports/2019/pdf/2019-Report-ART-Fertility-Clinic-National-Summary-h.pdf">78,000 live births</a> stemming from fertility treatments. These births resulted from a total of 330,773 assisted reproductive technology cycles, 27,131 of which were from eggs and embryos. Because the federal government does not keep track of the number of <a href="https://dx.doi.org/10.1016%2Fj.fertnstert.2019.05.031">children born through sperm donation</a>, it is unclear exactly how many births were a result of egg, embryo or sperm donation.</p>
<p>Secrecy surrounding reproductive cell donation has long been embedded in the culture of the fertility industry, often leading doctors to urge parents <a href="https://www.theatlantic.com/science/archive/2021/10/do-we-have-right-know-our-biological-parents/620405/">not to tell</a> their children that they were donor-conceived. Such secrecy was <a href="https://theconversation.com/donor-conception-secrecy-and-the-search-for-information-44000">believed to be best for everyone</a> by creating the illusion of biological connection. It was also influenced by shame concerning infertility and a desire to prevent interference with the parent-child relationship.</p>
<p>While <a href="https://support.ancestry.com/s/article/Unexpected-DNA-Matches">genetic testing</a>, <a href="https://www.cbc.ca/news/science/sperm-donor-dna-testing-1.4500517">personal information on the internet</a> and <a href="https://store.lexisnexis.com/products/assisted-reproductive-technology-a-lawyers-guide-to-emerging-law-and-science-skuusSku-us-ebook-28407-epub">changing family structures</a> are challenging this culture of secrecy, donor anonymity is still common practice. A 2022 study from the <a href="https://www.dcc-usa.org/">U.S. Donor Conceived Council</a>, a nonprofit advocating for the interests of donor-conceived people, found that despite an increasing number of sperm banks allowing donor-conceived people to access information about their donor, <a href="https://www.dcc-usa.org/2022/04/19/2022-survey-of-us-sperm-banks/">70% still permit anonymous donation</a>.</p>
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<figcaption><span class="caption">What defines a parent or a family has changed over time.</span></figcaption>
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<h2>Protecting donors, parents and their children</h2>
<p>States are beginning to introduce ways to protect the interests of the parties affected by the fertility industry. Many states already have laws in place that follow some version of the <a href="https://law.justia.com/codes/colorado/2016/title-19/article-4/section-19-4-106#:%7E:text=(1)%20If%2C%20under%20the,of%20a%20child%20thereby%20conceived">Uniform Parentage Act</a>, which provides special rules for parentage when a child is donor conceived. An increasing number of states have enacted <a href="https://righttoknow.us/fertility-fraud-laws/">fertility fraud legislation</a> that criminalizes or provides civil remedies for donor misrepresentation, such as when a fertility doctor uses his own sperm without telling the parents.</p>
<p>Another area of growing interest is providing donor-conceived people and recipient parents <a href="https://www.nytimes.com/2016/04/12/science/extra-marital-paternity-less-common-than-assumed-scientists-find.html">important medical or personally identifying information</a> about their donor.</p>
<p>In 2011, <a href="https://healthland.time.com/2011/07/22/where-do-some-babies-come-from-in-washington-a-new-law-bans-anonymous-sperm-and-egg-donors/">Washington became</a> the first state to allow disclosure of donor-identifying information and medical history to children when they turn 18. Since then, a few other states have adopted the <a href="https://www.uniformlaws.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=e4a82c2a-f7cc-b33e-ed68-47ba88c36d92&forceDialog=0">Uniform Parentage Act</a>, which requires banks and fertility clinics to <a href="https://www.cga.ct.gov/2021/act/pa/pdf/2021PA-00015-R00HB-06321-PA.pdf">collect and release identifying donor information</a> to donor-conceived individuals if the donors had agreed to disclosure.</p>
<p><a href="https://www.nysenate.gov/legislation/bills/2021/s7602">Proposed legislation in New York</a> would require sperm and egg banks to gather, verify and share important information about a donor’s health, education and criminal history with prospective parents and donor-conceived people. Some countries have gone further with bans on donor anonymity, including <a href="https://doi.org/10.1093/humrep/15.9.2052">Sweden in 1985</a>, <a href="https://www.legislation.gov.uk/uksi/2004/1511/regulation/2/made?view=plain">the U.K. in 2004</a> and <a href="https://www.health.vic.gov.au/patient-care/right-to-know">the state of Victoria in Australia in 2016</a>.</p>
<h2>More protections</h2>
<p>Other protections may be coming down the line.</p>
<p>One measure is to limit the number of families using the same donor. This can protect donor-conceived people from feeling <a href="https://www.theatlantic.com/science/archive/2021/10/do-we-have-right-know-our-biological-parents/620405/">commodified and dehumanized</a> if they find that they were conceived in a large group as part of a moneymaking industry.</p>
<p>In the U.K., <a href="https://www.hfea.gov.uk/treatments/explore-all-treatments/using-donated-eggs-sperm-or-embryos-in-treatment/legal-implications-of-using-donated-sperm/">no more than 10 families</a> can use the same donor (excluding the donor’s own family), though there is no limit on the number of children conceived per family. And in Denmark, donor sperm may only be used for <a href="https://www.bbc.com/news/world-europe-19711565">12 inseminations</a>.</p>
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<p>No U.S. state currently sets such limits. While <a href="https://www.nytimes.com/2019/06/26/magazine/sperm-donor-questions.html">some sperm banks</a> have tried to impose limits, they are not required to keep track of how many children are born from an individual donor. Moreover, donors can give their sperm to another bank. Any limit would be difficult to monitor, much less enforce. </p>
<p>Lastly, regulations could ensure that donors and parents are fully informed about the <a href="https://leg.colorado.gov/bills/sb22-224">social and legal implications of donor conception</a>, including that other people may be conceived with the same donor’s gametes. Some states may also address the risk of <a href="https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/63745-30070">harmful health effects</a> of repeat egg donation by limiting the number of times a person can donate.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sleeping baby holding finger of parent with another parent's hand wrapped around their torso" src="https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460599/original/file-20220429-17-fxrd08.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pending legislation would give donor-conceived children and their parents medical and identifiable information about their donor.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mixed-race-family-together-royalty-free-image/1152471162">fitopardo/Moment via Getty Images</a></span>
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</figure>
<h2>Colorado’s bill</h2>
<p>Colorado took a groundbreaking step by <a href="https://leg.colorado.gov/bills/sb22-224">considering a bill</a> that introduces broad regulations that tie together trends across the industry. The law would ensure that donor-conceived people can learn the identity of the donor upon reaching adulthood and sets limits on the number of families to whom any one particular donor can provide their gametes. It would also ensure access to educational materials that guide families and donors through the process, including resources on how to discuss donor conception with children.</p>
<p>While there may be concerns that eliminating donor anonymity would <a href="https://doi.org/10.1093/jlb/lsv045">compromise donor privacy</a> and affect <a href="http://www.bu.edu/law/journals-archive/bulr/documents/bernstein.pdf">donor availability</a>, we believe there is substantial evidence to the contrary. </p>
<p>A <a href="https://doi.org/10.1093/jlb/lsw052">2016 study</a> of 161 sperm donors found that while some might be dissuaded by such laws, more than two-thirds would be willing to donate at an additional price of $60 per donation. In <a href="https://doi.org/10.1016/j.rbms.2021.07.006">Australia</a>, where payment for sperm donation is prohibited beyond <a href="https://www.ivf.com.au/treatments/donor-programme/donating-sperm">expense reimbursement</a>, the number of sperm donors actually <a href="https://pubmed.ncbi.nlm.nih.gov/27323639/">increased after anonymity was removed</a>. Similarly, a 2020 survey of 148 egg donors in South Africa, where donor anonymity is allowed, found that <a href="https://doi.org/10.1371/journal.pone.0226603">79% would have still donated their eggs</a> even if their identity were released.</p>
<p>We believe that the Colorado bill could set a precedent for how other states regulate fertility treatment and protect the interests of all those involved.</p><img src="https://counter.theconversation.com/content/181664/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Naomi Cahn co-wrote testimony in support of CO SB22-224 for the Colorado State Senate hearings.</span></em></p><p class="fine-print"><em><span>Sonia Suter co-wrote testimony in support of CO SB22-224 for the Colorado State Senate hearings.</span></em></p>A pending bill in Colorado would disclose donor information to children and their parents and set limits on how many families can use a single individual’s egg or sperm.Naomi Cahn, Professor of Law, University of VirginiaSonia Suter, Professor of Law, George Washington UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1785912022-04-11T19:01:35Z2022-04-11T19:01:35ZEndometriosis: How advocacy, awareness and algorithms could shorten the long wait for diagnosis and treatment<figure><img src="https://images.theconversation.com/files/456541/original/file-20220406-22-icfn7.jpg?ixlib=rb-1.1.0&rect=409%2C34%2C5119%2C3438&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite the prevalence of endometriosis, people often live with pain and other symptoms for years before being diagnosed.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/endometriosis--how-advocacy--awareness-and-algorithms-could-shorten-the-long-wait-for-diagnosis-and-treatment" width="100%" height="400"></iframe>
<p>Endometriosis affects an estimated <a href="https://www.endofound.org/endometriosis">200 million people worldwide</a>. Despite its prevalence, those living with the disease often wait an average of <a href="https://doi.org/10.1177%2F1750481318771430">7.5 years</a> between start of symptoms and diagnosis. This delay is due to a variety of reasons, including <a href="https://theconversation.com/endometriosis-three-reasons-care-still-hasnt-improved-157457">medical dismissal, a low prioritization of the condition and its overall misrepresentation</a> in research funding, policy and media.</p>
<p>Although often represented as a women’s reproductive disease, endometriosis also appears in people who have had hysterectomies, transgender men, genderfluid and non-binary people, pre-menstrual and post-menopausal people, and in rare cases, <a href="https://doi.org/10.1016/j.prp.2011.10.007">cisgender men</a>. </p>
<p>Its symptoms commonly include pain with menstruation, as well as chronic pain, infertility, pain with sexual intercourse, fatigue and more. Despite this full-body impact on one’s <a href="https://doi.org/10.1016/j.fertnstert.2011.05.090">quality of life</a>, endometriosis is commonly associated with just having “bad periods.”</p>
<p>We are four authors from three countries looking at different aspects of endometriosis diagnosis, awareness and patient advocacy. This article emerges from a <a href="https://www.eventbrite.com/e/young-people-endometriosis-social-perspectives-on-the-delay-to-diagnosis-tickets-237420941427#">joint online presentation</a> of our research looking at potential ways to improve awareness and patient care, and promote faster diagnosis.</p>
<p>Our methods include social scientific and qualitative research including interviews, surveys, focus groups, participant observations and collaborations with people living with endometriosis. We identified some clear changes that are needed to promote awareness of the disease, and subsequently reduce diagnostic timelines.</p>
<h2>Widespread endometriosis education</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A powerpoint slide showing the results of Maria Tomlinson's survey and quotes from young people about endometriosis." src="https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=334&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=334&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=334&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=420&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=420&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452013/original/file-20220314-15-2ebu8u.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=420&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Maria Tomlinson’s research surveyed young people about their awareness and knowledge of endometriosis.</span>
<span class="attribution"><span class="source">(Maria Kathryn Tomlinson)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our research suggests that endometriosis education is severely lacking, meaning that many people who have the condition do not even know it exists. </p>
<p>In focus groups with 77 16- to 19-year-olds in the United Kingdom, Maria found that only 28 had heard of endometriosis before. Of these, two were able to accurately define it. Most of those who had heard of the disease had done so through friends and family, with some also hearing about it on social media or the internet. None of them had been told about it in their formal education.</p>
<p>Eileen’s survey of 271 people with endometriosis showed that only nine people (3.3 per cent) heard about endometriosis from grade school (elementary, junior or high school) with a few mentioning that they had heard about it briefly in nursing school.</p>
<p>Although Eileen’s interviews and surveys showed that social media can be very beneficial to people who live with endometriosis, Maria’s focus groups showed that social media is not very effective at reaching people who do not have the condition. People with endometriosis often put enormous amounts of work into <a href="https://theconversation.com/what-is-endometriosis-patients-turn-to-social-media-for-information-and-support-160852">sharing endometriosis information online</a>, but it often does not reach the broader population.</p>
<h2>Accurately represent menstrual pain and endometriosis pain</h2>
<p>As Mie identifies in her fieldwork on menstruation among teenagers and interviews with endometriosis patients from Denmark, the normalization of menstrual pain is one of the main factors delaying diagnosis for people with endometriosis. </p>
<p>Although not everyone who has endometriosis menstruates or has menstrual pain, <a href="https://doi.org/10.1177/0884217503261085">it is one of the most common and symptoms, and one of the earliest</a>. Many people are encouraged to use painkillers and hormonal contraceptives to manage their pain, instead of having it investigated. Being prescribed birth control pills without a thorough investigation of symptoms, or consideration for gender identity, were also concerns identified by participants in Maria’s focus groups.</p>
<figure class="align-center ">
<img alt="Cropped image of a pharmacist's hands holding birth control pills with a woman seen from behind" src="https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456542/original/file-20220406-21-lb9ifc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many people are encouraged to use painkillers and hormonal contraceptives to manage their pain instead of having it investigated.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Maria’s participants also explained how they believe menstrual product advertisements undermined the severity of menstrual pain. They thought that more realistic representations of painful periods might encourage more young people with periods to seek medical help when needed. </p>
<p>Mie’s work identifies the often cyclical nature of endometriosis symptoms as something that can discourage patients from seeking care, as they feel their symptoms are not as extreme when they are not menstruating. Better awareness that cyclical symptoms can also indicate diseases might help patients seek care earlier.</p>
<p>Eileen’s social media analysis shows that people with endometriosis often use social media to represent their lived experiences of menstrual pain and endometriosis with complexity, in contrast to common media representations. </p>
<figure class="align-center ">
<img alt="A word cloud resonding to the question 'What does 'endometriosis' mean to you?' The most prominent words are pain, time and life." src="https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&rect=12%2C6%2C1172%2C661&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452010/original/file-20220314-130173-ynrimv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A word cloud responding to the question, ‘What does endometriosis mean to you?’</span>
<span class="attribution"><span class="source">(Eileen Mary Holowka)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>In a recent example, Amy Corfeli from the podcast and social media platform <a href="https://www.instagram.com/p/CasRLDBuR52/">@in16yearsofendo</a> used Instagram, Twitter and <a href="https://medium.com/@amycorfeli/dear-greys-anatomy-your-endometriosis-info-needs-updating-4fbb942e616b"><em>Medium</em></a> to address inaccuracies in the television show <em>Grey’s Anatomy</em>’s representation of endometriosis. Unfortunately, <em>Grey’s Anatomy</em> has a larger platform, but social media pages like Amy’s, <a href="https://www.instagram.com/endoqueer/">@endoQueer</a> and <a href="https://www.instagram.com/endo_black/">@endo_black</a> attempt to bring more nuance and diversity into the media depictions of endometriosis.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CasRLDBuR52","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Improving diagnostic time</h2>
<p>Endometriosis is an “invisible” condition, meaning it cannot be seen by just looking at someone. Including endometriosis in grade school curricula, covering it more extensively in medical school, and representing it more broadly in media, would help make the disease more apparent so people with symptoms seek care sooner.</p>
<p>However, the burden of care cannot be on patients alone, particularly for a condition like endometriosis which comes with <a href="https://endometriosis.org/resources/clinical-books/googling-endometriosis-david-redwine/">a long history of patient-blaming</a>. Interventions are needed on the medical side, but limited resources, long wait times, suboptimal diagnostic techniques and knowledge, and the low prioritization of endometriosis all <a href="https://theconversation.com/1-in-10-women-are-affected-by-endometriosis-so-why-does-it-take-so-long-to-diagnose-141803">increase diagnostic delays</a>. </p>
<p>It is possible that interventions such as the <a href="https://findingendometriosis.eu/">FEMaLe</a> (Finding Endometriosis using Machine Learning) project, co-ordinated by Ulrik, could help improve diagnosis in the future. This project, emerging out of Denmark, aims to develop and demonstrate a platform that uses algorithms to detect and help diagnose and treat people with endometriosis, in collaboration with their health-care providers. </p>
<p>In order to develop this kind of work, a multidisciplinary approach to endometriosis is needed, including not only medical research, but also the kind of qualitative work outlined in this story.</p><img src="https://counter.theconversation.com/content/178591/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eileen Mary Holowka receives funding from the Canadian Social Sciences and Humanities Research Council and is a member of the Endometriosis Educational Organization of Canada.</span></em></p><p class="fine-print"><em><span>Dr. Maria Kathryn Tomlinson receives funding from the Leverhulme Trust under Grant ECF-2019-232. Her project is entitled "Menstrual Activism in the Media: Reducing Stigma and Tackling Inequalities".</span></em></p><p class="fine-print"><em><span>Mie Kusk Søndergaard receives funding from the Danish Cancer Society and University of Southern Denmark. She has previously collaborated with the Danish endometriosis association Endometriose Foreningen. </span></em></p><p class="fine-print"><em><span>Ulrik Bak Kirk receives funding from the EU under the H2020 Research and Innovation Action for the 'Finding Endometriosis using Machine Learning' (FEMaLe) project (grant agreement ID: 101017562).</span></em></p>People living with endometriosis wait an average of 7.5 years for a diagnosis. Social science researchers are working to identify ways to help reduce this timeline.Eileen Mary Holowka, PhD Candidate, Communication Studies, Concordia UniversityMaria Kathryn Tomlinson, Leverhulme Early Career Researcher, Department of Journalism Studies, University of SheffieldMie Kusk Søndergaard, PhD fellow, Department of Public Health, University of Southern DenmarkUlrik Bak Kirk, PhD Fellow, FEMaLe Coordinator, Aarhus UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1775382022-04-04T01:29:01Z2022-04-04T01:29:01ZAnger, grief and gradual insight in Sian Prior’s memoir Childless<figure><img src="https://images.theconversation.com/files/455201/original/file-20220330-4833-m2t1zn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p>There are six of us: high school and university friends I have stayed in close touch with over the years; we are all in our mid-40s now. We are nurses, social workers, educators, writers, massage therapists and political activists. We are past the ideal childbearing years. Three of us had children and the other three did not. </p>
<p>For one it was a choice; for the other two it was circumstance. One of those two who struggled with infertility decided it was meant to be, and she is glad now for the independence it has given her. </p>
<hr>
<p><em>Review: Childless, A Story of Freedom and Longing - Sian Prior (Text Publishing)</em></p>
<hr>
<p>But for the other it has been a source of lasting sorrow. She would have been the best mother of all of us, in the way the universe works; she is the best auntie and gift-giver, listener and game player. I thought of her often while reading Sian Prior’s new memoir, Childless. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/447430/original/file-20220221-28-ei6fbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/447430/original/file-20220221-28-ei6fbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=918&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447430/original/file-20220221-28-ei6fbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=918&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447430/original/file-20220221-28-ei6fbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=918&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447430/original/file-20220221-28-ei6fbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1154&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447430/original/file-20220221-28-ei6fbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1154&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447430/original/file-20220221-28-ei6fbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1154&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
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<p>Memoirs allow us to slip into someone else’s skin, to see the world through their eyes for a little while and expand our understanding. Prior uses short chapters which jump through narrative time to tell her story of being childless not by choice but by circumstance. </p>
<p>They are rich with evocative detail and cover a broad spectrum of subjects and spaces. They paint discrete scenes, which build up to a full picture of the grief of not having a child, the anger when Prior sees parents with children who are not cherishing them, the desire to have a child alongside concern about the environmental impact. </p>
<p>Prior does not hide her rage at those who have children whom she judges unworthy of them and at times it made me uncomfortable – I felt guilty. I thought of the times when I was a bad mother: I shouted at my children for not getting their shoes on quickly enough, I looked at my phone when I ought to have been looking at them. No parent is perfect. But I think she is honest, as well, to show us her rage: it’s not sensible, but it is real. And with acceptance of it comes gradual insight as well. </p>
<blockquote>
<p>Through all these years I spent trying to have a child, I thought giving birth would stop me feeling like a failure. Probably it would have just been the beginning of a different way of failing.</p>
</blockquote>
<p>This is Prior’s second memoir; her first, <a href="https://www.goodreads.com/book/show/22040760-shy">Shy</a> (2014), examined her own social anxieties and the causes and symptoms of shyness, and the way it had influenced her life. In Childless, she turns the lens on herself again, although there is less external research and more focus on her own experience. </p>
<p>At times, the observations she makes are not backed up by references. “Here in Australia, real children are increasingly depressed, neglected, abused, violent and suicidal,” Prior writes at one point. I believe children are facing greater challenges than they once were, but I’d still like to know the source of such a sweeping statement. And I wonder if abuse, depression and anxiety are also reported more frequently now than at any point in our history. </p>
<p>I thought here of author Mary Karr’s advice to memoir writers from her book <a href="https://www.harpercollins.com/products/the-art-of-memoir-mary-karr">The Art of Memoir</a>: “The goal of a voice is not to speak with objective authority but with subjective curiosity.” That subjective curiosity was sometimes missing in Childless. </p>
<p>In another memoir of childlessness and unsuccessful attempts at IVF, <a href="https://www.penguin.com.au/books/avalanche-9781926428758">Avalanche</a> (2016), Julia Leigh writes about her own experience with infertility but also about the ethics of the IVF clinics that promise something to desperate couples, fudging figures and making a great deal of money out of the desire for a child.</p>
<p>At one point in Avalanche, Leigh asks her doctor how many women her age bring home a baby after fertility treatment and his answer is shocking: 2%. It is a moment that stayed with me, a deeper reflection on the culture we live in, the desperation this industry is tapping into, and the greed of the clinics. Leigh’s curiosity gives us this moment, her desire to dig deeper into why she was unable to have a child.</p>
<p>This is not Prior’s focus, but at the end of Childless I could not say exactly what her focus was. There is some grace found, some acceptance, but there is also blame and many missed opportunities to be involved in other children’s lives. Perhaps it is the messiness of it all that Prior is embracing. There is no neat narrative arc here, this is life and things don’t work that way. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/shyness-isnt-nice-but-shyness-shouldnt-stop-you-28010">Shyness isn't nice, but shyness shouldn't stop you </a>
</strong>
</em>
</p>
<hr>
<h2>Beyond binaries</h2>
<p>“The problem with true stories is that there are too many different truths,” Prior writes at one point. And the problem with Google is that when she mentions a famous musician/songwriter ex-partner by a pseudonym you find him in seconds. There is a lot of focus on this relationship, as there was in Shy.</p>
<p>One of the complicating factors is that he has children from previous marriages and a vasectomy, so decides not to participate in IVF with her. The memoir opens with one of these scenes: they are together, in a hotel room on his tour, and she is injecting herself with IVF hormones but doing it alone. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/455202/original/file-20220330-23-1nn343s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/455202/original/file-20220330-23-1nn343s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455202/original/file-20220330-23-1nn343s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455202/original/file-20220330-23-1nn343s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455202/original/file-20220330-23-1nn343s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455202/original/file-20220330-23-1nn343s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455202/original/file-20220330-23-1nn343s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455202/original/file-20220330-23-1nn343s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In vitro fertilisation of a human female cell. Microscopic view, 3D rendering.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>She watches him not watching her, “because this has nothing to do with him”. He does not offer to drive her to medical appointments; he is present but absent. It is complex and fraught. Of course it has something to do with him, in the end, and Prior seems to circle and circle these scenes, seeking out answers. </p>
<p>At one point, she asks, “What choices do I have because I’m not getting what I most wanted.” </p>
<p>I think of my dear childless friend here, who spends weeks every year with her nephews, who was able to help care for her father in his final months. Who will sit with a child and craft for hours. Sew costumes for Halloween. Who has always had the time to listen.</p>
<p>I think it is easy to get distracted now by binaries: the vaccinated and anti-vaxxers, the vegans and the paleos, the parents and the child-free. Memoirs like Prior’s remind us that human experience is far more complex, that there are so many gradations, so much light and shadow. </p>
<p>Our choices are one thing, but we are also made up of our disappointments. Of what we have lost and what we never had the chance to have.</p><img src="https://counter.theconversation.com/content/177538/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eleanor Limprecht does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rich with evocative detail, an author’s personal account of childlessness has no neat narrative arc, but is touched by grace and acceptance.Eleanor Limprecht, Lecturer, Creative Writing, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1785872022-03-21T18:54:18Z2022-03-21T18:54:18ZResearch dispels myth that COVID-19 vaccines cause infertility, but misinformation persists<figure><img src="https://images.theconversation.com/files/453231/original/file-20220321-19-10uqz5z.jpg?ixlib=rb-1.1.0&rect=714%2C14%2C4191%2C3130&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Misinformation about COVID-19 vaccines affecting fertility have no realistic basis.</span> <span class="attribution"><span class="source"> (AP Photo/John Locher)</span></span></figcaption></figure><p><a href="https://theconversation.com/the-fault-in-our-stars-aaron-rodgers-reminds-us-why-celebrity-shouldnt-trump-science-171648">Misinformation</a> about <a href="https://www.npr.org/sections/health-shots/2021/07/20/1016912079/the-life-cycle-of-a-covid-19-vaccine-lie">COVID-19 vaccines and fertility</a> has propagated online despite the vaccines’ <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html">clear safety profile</a>. </p>
<p>Fortunately, those considering having kids can relax when it comes to these crucial shots. These claims <a href="https://doi.org/10.1001/jama.2022.2404">lack any realistic basis</a>. As a medical doctor and a COVID-19 genetics researcher, I’d like to discuss what the evidence says.</p>
<h2>Misinformation about fertility</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>Some sources of <a href="https://www.factcheck.org/2021/06/scicheck-research-rebuts-baseless-claims-linking-covid-19-vaccines-to-male-infertility/">misinformation claim that the COVID-19 vaccines cause male sterility</a>. For this to be true, the vaccines would have to damage sperm quality, drastically reduce sperm count or interfere with the mechanisms inherent in male ejaculation. Quality clinical evidence has demonstrated that none of these parameters are affected by the vaccine, so men are not being made sterile. </p>
<p>A <a href="https://doi.org/10.1001/jama.2021.9976">study in Florida</a> recruited around 45 men and compared their sperm measures before and after receiving a COVID-19 vaccine. Interestingly, the study found that men who received the vaccine had more sperm, greater semen volume, and sperm more able to move around and fertilize an egg.</p>
<p>Pregnancy can be an exciting time but can also <a href="https://www.anxietycanada.com/articles/common-worries-during-pregnancy/">provoke worry</a> about the the safety of anything that enters the body, including vaccines. Fortunately, the COVID-19 vaccines are safe during pregnancy. </p>
<p>Sources of misinformation have claimed that COVID-19 vaccines can lead to loss of pregnancy, <a href="https://www.bbc.com/news/health-57552527">with vague references to antibody responses or other concepts that sound scientific</a>. However, the COVID-19 vaccines will not make a pregnant woman any more likely to have a miscarriage. </p>
<figure class="align-center ">
<img alt="A pregnant woman sitting a table across from a health-care worker in scrubs and a face mask who is preparing to give her a shot." src="https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID-19 vaccines do not increase the risk of miscarriage.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>A group of physicians spanning the United States <a href="https://doi.org/10.1001/jama.2021.15494">studied the pregnancy outcomes for over 100,000 pregnancies</a>. When the study was done, around 14 per cent of everyone investigated had received at least one dose of the COVID vaccine. They found that women who had the shot were no more likely to have a miscarriage than those who did not. </p>
<p><a href="https://doi.org/10.1001/jama.2022.2404">There are other misinformation claims along the lines of antibodies attacking the placenta, shots equating with infertility or interference with hormones</a>. Unsurprisingly, all of these have been debunked.</p>
<h2>The real danger is COVID-19 infection</h2>
<p>While there is no evidence that the COVID-19 vaccine can impact fertility or pregnancy, there is evidence that a COVID-19 infection can cause harm. At its extreme, the disease can be fatal — <a href="https://doi.org/10.1136/bmj.m3320">an outcome that is more likely if COVID-19 infection happens during pregnancy</a>. </p>
<p><a href="https://doi.org/10.1371/journal.pone.0255994">Multiple studies have also documented an increased risk of miscarriage following a COVID-19 infection</a>. However, miscarriage is not the only risk. The respiratory distress that can come with COVID-19, as well as the inflammation, can affect fetal growth, which could lead to <a href="https://doi.org/10.1016/j.brainres.2011.01.032">health and developmental problems</a> in a baby carried to term. </p>
<p>Carried to term is an important point here because pregnant women with COVID-19 are more likely to <a href="https://doi.org/10.1136/bmj.m3320">deliver their babies early</a>. This is associated with health risks for the baby, including an increased risk of <a href="https://www.ncbi.nlm.nih.gov/books/NBK11385/">requiring intensive care</a>.</p>
<h2>The case for COVID-19 vaccination</h2>
<p>It makes sense to get a COVID-19 vaccine. The risk of developing COVID-19 still exists and is still dangerous. This remains true while the case counts have trended downwards in North America to the tens of thousands from nearly one million a day in January. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A line graph showing decreasing COVID-19 cases since the end of December 2021 until March 19, 2022." src="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As COVID-19 remains a danger, vaccination remains the best protection.</span>
<span class="attribution"><span class="source">(Johns Hopkins University CSSE COVID-19 Data)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Fortunately, the <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html">vaccine offers excellent protection</a> against developing an infection. It also dramatically decreases the chance of severe disease if infection does occur. When considering what poses the greatest danger to a pregnant woman or a couple looking to have children, severe illness poses the most significant risk of causing fertility or pregnancy problems.</p>
<p>COVID-19 misinformation is not going to go away. Previous vaccine misinformation has lingered despite a complete lack of evidence. For example, <a href="https://dx.doi.org/10.1503/cmaj.109-3179">the myth of a vaccine-autism link was debunked in 1998</a>, but vaccine hesitancy has persisted despite copious amounts of clinical evidence that these claims lack any sound basis. Articles like this one will not change some people’s minds, but ultimately that is not the goal. </p>
<p>The goal of sharing medical information from a physician’s point of view is to provide people with the knowledge that they need to make an informed health-care decision. While I strongly recommend the vaccine to everyone, individuals are the ones who choose what they seek to do with their bodies. </p>
<p>Public health can appropriately guide individuals towards making decisions in their and their community’s best interests, as with vaccine mandates. Individuals still maintain their autonomy, even if accompanied by consequences like employment issues. If one reflects on what is best for a baby, the evidence is clear. It is an individual’s prerogative on what to do with that information.</p><img src="https://counter.theconversation.com/content/178587/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Daniel Sunday Willett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some of the most persistent myths about COVID-19 vaccination have been false rumours that it can affect fertility in men or women. There has never been any evidence to support this misinformation.Julian Daniel Sunday Willett, PhD Candidate, Quantitative Life Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1760152022-02-08T00:51:34Z2022-02-08T00:51:34Z‘It changed who I felt I was.’ Women tell of devastation at early menopause diagnosis<figure><img src="https://images.theconversation.com/files/444714/original/file-20220207-999-577ipn.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5463%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1495482336510-f7716cc28940?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=2070&q=80">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>For Mary*, being told she’d entered menopause much earlier than expected was a shock …</p>
<blockquote>
<p>It was sort of like I’d gone from 39 […] instead of turning 40, I’d almost turned 80. So I’d sort of skipped 40 years.</p>
</blockquote>
<p>Around <a href="https://pubmed.ncbi.nlm.nih.gov/33434933/">10% of women</a> – including many who <a href="https://www.theguardian.com/lifeandstyle/2021/jun/19/i-was-a-31-year-old-newlywed-then-the-menopause-hit">believe</a> they have the prospect having children ahead of them – are suddenly told they are at the end of their fertile life, and at greater risk of diseases normally associated with middle age.</p>
<p>In the course of our <a href="https://whirlcre.edu.au">work with women and research</a>, hundreds of women have <a href="https://www.healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/overview-womens-experiences/">shared their experiences</a> of early menopause. They provide insights into how the physical changes have affected their sense of self and their relationships.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/making-sense-of-menopausal-hormone-therapy-means-understanding-the-benefits-as-well-as-the-risks-124084">Making sense of menopausal hormone therapy means understanding the benefits as well as the risks</a>
</strong>
</em>
</p>
<hr>
<h2>What is early menopause?</h2>
<p><a href="https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Patient%20information/Menopause-pamphlet.pdf?ext=.pdf">Menopause</a> refers to the time in a woman’s life when the ovaries stop producing eggs, periods stop, and oestrogen levels dramatically drop. </p>
<p>The usual age of menopause, defined as 12 months without periods, is around 51 years. Early menopause occurs before 45 years. Premature menopause or <a href="https://www.menopause.org.au/hp/information-sheets/spontaneous-premature-ovarian-insufficiency">premature ovarian insufficiency</a> (POI), occurs before age 40. </p>
<p>Early menopause can happen without warning and the <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/premature-and-early-menopause">causes</a> may never be known; although a family history of POI, autoimmune disease, smoking, early development and social factors are risk factors. It can also result from <a href="https://www.menopause.org.au/hp/information-sheets/early-menopause-due-to-chemotherapy-radiotherapy">medical care</a> such as chemotherapy, radiotherapy or the surgical removal of both ovaries. Except for women who have their ovaries removed, predicting who will experience early menopause is very difficult.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/BszMBDSVOUE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Early and premature menopause occurs in as many as one in ten women. It can run in families.</span></figcaption>
</figure>
<h2>Hot flushes, night sweats and the rest</h2>
<p>The symptoms of early menopause can be similar to those associated with usual menopause (hot flushes, night sweats, mood changes, vaginal dryness, sleep disturbance, sexual problems, fatigue, joint pain, and brain fade), but happen to much younger women and may be more severe. The problem is that no one expects young women to be experiencing menopausal symptoms.</p>
<p>Some women may not have any menopausal symptoms and only experience their periods stopping without warning. Others discover they are unable to become pregnant.
Sonia* remembers: </p>
<blockquote>
<p>Around 35, 36 I started to skip periods […] I just thought it was stress and overwork, and that sort of thing. But then the gaps between periods got longer and longer, and I started to experience night sweats. And I became concerned at that point, not because I thought that I was going through menopause – it didn’t occur to me.</p>
</blockquote>
<p>Although we think of oestrogen as a reproductive hormone, it also plays an important <a href="https://jnnp.bmj.com/content/74/7/837">role in brain function, particularly memory</a>. Women who experience early menopause often report frustration at not mentally performing in the way they used to, and also find mood changes difficult to cope with. The cause of early menopause (such as chemotherapy) and the symptoms experienced (like sleep disturbance) can also impact thinking and mood.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">'Brain fog' during menopause is real – it can disrupt women's work and spark dementia fears</a>
</strong>
</em>
</p>
<hr>
<h2>Feeling less than sexy</h2>
<p>Early menopause can affect sexual function in many ways. Vaginal dryness can cause pain with sexual intercourse. Women often say they lose desire for sex, which can strain intimate relationships.</p>
<p>Cathy told us she wanted to be left alone:</p>
<blockquote>
<p>It changed who I felt I was […] It’s hard to be sexy when you’re cranky […] To think of yourself as a sexual being [is difficult] when you are experiencing hot flushes every hour and you’re going, ‘I don’t want anyone near me. All I want to do is feel cool.‘ </p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/444715/original/file-20220207-17-1bap7sn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman in loose tshirt" src="https://images.theconversation.com/files/444715/original/file-20220207-17-1bap7sn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/444715/original/file-20220207-17-1bap7sn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444715/original/file-20220207-17-1bap7sn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444715/original/file-20220207-17-1bap7sn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444715/original/file-20220207-17-1bap7sn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444715/original/file-20220207-17-1bap7sn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444715/original/file-20220207-17-1bap7sn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hot flushes and mood changes can make women worried.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/womens-breast-chest-health-checks-600w-1756805414.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Losing a future family</h2>
<p>For many women who go through early menopause the sudden lose of fertility can be devastating. Jenni remembers going through menopause at an age when many of her peers were becoming parents:</p>
<blockquote>
<p>Watching the joy my friends were experiencing getting pregnant and giving birth, felt like a special kind of hell. I was so happy for them, but I had to distance myself because it was just too hard.</p>
</blockquote>
<p>Women describe feelings of shock and trauma after being told they were infertile. They feel grief for the children they had hoped to have. </p>
<p>Rarely, women with spontaneous POI will conceive. For the majority, pregnancy is only possible with <a href="https://www.varta.org.au">assisted reproduction technology</a> using donor egg or embryo. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1488738483652943872"}"></div></p>
<h2>No cure but symptoms can be treated</h2>
<p>There is no cure for early menopause and no way to restore egg production. Instead, the focus of treatment is on managing symptoms and the increased risks of <a href="https://pubmed.ncbi.nlm.nih.gov/32896176/">bone</a> and <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0040-1722318">heart disease</a> after menopause. </p>
<p>Hormone replacement therapy (HRT) is usually <a href="https://pubmed.ncbi.nlm.nih.gov/32896176/">recommended</a> up until the age of usual menopause to manage symptoms and reduce your risk of heart disease and osteoporosis. The risks of taking HRT seen in older women do not necessarily apply to <a href="https://www.menopause.org.au/health-info/fact-sheets/menopause-before-40-and-spontaneous-poi">younger women</a>. Consult with your doctor about the <a href="https://www.menopause.org.au/health-info/fact-sheets/what-is-menopausal-hormone-therapy-mht-and-is-it-safe">best HRT for you</a>.</p>
<p>If you have not had a period for 4-6 months (and you are not pregnant or on treatment that stops periods) then you should see your doctor about whether you may be experiencing early menopause or POI. You can also find doctors who <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">have a special interest in women’s health and menopause</a>.</p>
<p>We developed the <a href="https://www.askearlymenopause.org/">AskEarlyMenopause</a> website and app to provide accurate information and a discussion forum for women to share experiences and get expert advice.</p>
<p><em>*Names changed for privacy</em></p><img src="https://counter.theconversation.com/content/176015/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Vincent receives grant funding from NHMRC and MRFF. She has received honoraria from Besins and Theramex, manufacturers of menopausal hormone therapy. . </span></em></p><p class="fine-print"><em><span>Rhonda Garad does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Around 10% of women stop having periods and see the end of their fertile years much earlier than expected.Rhonda Garad, Senior Lecturer and Research Fellow in Knowledge Translation, Monash UniversityAmanda Vincent, Adjunct Clinical Associate Professor and Endocrinologist, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1731512021-12-06T19:06:20Z2021-12-06T19:06:20ZHalf of women over 35 who want a child don’t end up having one, or have fewer than they planned<figure><img src="https://images.theconversation.com/files/435731/original/file-20211205-15-1adyinb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/tBtuxtLvAZs">Matthew Henry/Unsplash</a></span></figcaption></figure><p>At age 35, one in four Australian women and one in three men were hoping to have a child or more children in the future. But by age 49, about half report they haven’t yet had the number of children they hoped for.</p>
<p>That’s according to the <a href="https://melbourneinstitute.unimelb.edu.au/hilda">Household, Income and Labour Dynamics in Australia</a> (HILDA) 2021 report, released today. Over 20 years, HILDA has tracked more than 17,500 people in 9,500 households.</p>
<p>While some of the 49-year-old men may still father a child later in life, this is unlikely to be the case for women at that age. </p>
<p>In Australia and other high-income countries, there has been a long-term downward trend in the fertility rate: the average number of births per woman. In 2019, Australia hit a record-low of <a href="https://www.abc.net.au/news/2021-08-24/fertility-rates-in-australia-at-all-time-low-cause-for-concern/100367258">1.66 babies per woman</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australians-want-more-children-than-they-have-so-are-we-in-the-midst-of-a-demographic-crisis-81547">Australians want more children than they have, so are we in the midst of a demographic crisis?</a>
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</em>
</p>
<hr>
<p>Low fertility rates are partly a result of more people <a href="https://apo.org.au/sites/default/files/resource-files/2020-07/apo-nid306881.pdf">not having children</a>, either by choice or through circumstance. About a quarter of Australian women in their reproductive years are likely <a href="https://www.abs.gov.au/AUSSTATS/abs@.nsf/bb8db737e2af84b8ca2571780015701e/1e8c8e4887c33955ca2570ec000a9fe5!OpenDocument">to never have children</a>. </p>
<h2>Why are women having fewer children?</h2>
<p>There are many reasons why people have no or fewer children than planned towards the end of their reproductive years. </p>
<p>One contributing factor is the average age when women have their first child has increased in the last few decades and is now almost <a href="https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-data-visualisations/contents/demographics-of-mothers-and-babies/maternal-age">30 years</a>. This is in part explained by women spending more time in education and the workforce than they <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529638/">used to</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/balancing-work-and-fertility-isnt-easy-but-reproductive-leave-can-help-171497">Balancing work and fertility isn't easy – but reproductive leave can help</a>
</strong>
</em>
</p>
<hr>
<p>Another reason is some women don’t find a <a href="https://rbej.biomedcentral.com/articles/10.1186/s12958-018-0389-z">suitable partner</a> or have a partner who is unwilling or “not ready” to commit to parenthood. </p>
<p>It’s also possible <a href="https://www.fertstert.org/article/S0015-0282(12)02343-6/fulltext">limited knowledge</a> about the factors affecting fertility leads to missed opportunities to have the number of children originally planned.</p>
<p>But whatever the reason, having children later in life will inevitably affect the number of children people ultimately have. While most women who try for a baby will succeed, some won’t, and some will have fewer children than they had planned to have. </p>
<h2>Fertility declines with age – so does IVF success</h2>
<p>The risk of not achieving pregnancy increases as a woman gets older because the number and quality of her eggs decline. </p>
<p>By 40, a woman’s fertility is about half the level it was when she was <a href="https://www.fertstert.org/article/S0015-0282(16)62849-2/fulltext">30</a>. And sperm quality decreases with age too, starting at around <a href="https://pubmed.ncbi.nlm.nih.gov/12801554/">age 45</a>. </p>
<figure class="align-center ">
<img alt="Man leans against a bike while looking at his phone." src="https://images.theconversation.com/files/435745/original/file-20211206-25-sh7k7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435745/original/file-20211206-25-sh7k7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435745/original/file-20211206-25-sh7k7m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435745/original/file-20211206-25-sh7k7m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435745/original/file-20211206-25-sh7k7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435745/original/file-20211206-25-sh7k7m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435745/original/file-20211206-25-sh7k7m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Men’s sperm quality also declines with age.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/zn2aUVfbUrk">Unsplash</a></span>
</figcaption>
</figure>
<p>Increasingly, people who struggle to conceive turn to assisted reproductive technology (ART) such as in-vitro fertilisation (IVF). </p>
<p>There was a 27% increase in the number of treatment cycles in the 2020–2021 financial year compared to the previous year, according to <a href="https://www.varta.org.au/resources/annual-reports">data released today</a> by the Victorian Assisted Reproductive Treatment Authority (VARTA). </p>
<p>But unfortunately, IVF is not a good back-up plan for age-related infertility. </p>
<p>On behalf of VARTA, researchers at the University of New South Wales tracked thousands of women who started IVF in Victoria in 2016 to see what had happened to them by June 30, 2020. The graph below shows the proportions of women who had a baby after one, two or three stimulated IVF cycles, including the transfer of all fresh and frozen embryos that resulted from these. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/435762/original/file-20211206-19-mq97.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435762/original/file-20211206-19-mq97.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435762/original/file-20211206-19-mq97.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435762/original/file-20211206-19-mq97.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435762/original/file-20211206-19-mq97.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=537&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435762/original/file-20211206-19-mq97.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=537&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435762/original/file-20211206-19-mq97.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=537&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Victorian Assisted Reproductive Treatment Authority</span></span>
</figcaption>
</figure>
<p>Women who started IVF when they were 30 years old had a 48% chance of a baby after one stimulated cycle, a 62% chance after two cycles and a 67% chance after three cycles. </p>
<p>But for a woman who started IVF at age 40, there was only a 13% chance of a baby after one stimulated cycle, a 21% chance after two cycles and a 25% chance after three cycles.</p>
<h2>Fertility options for over-35s</h2>
<p>So, what are the options for women in their mid-30s who want to have a child or more children? </p>
<p>The <a href="https://www.varta.org.au/resources/annual-reports">Victorian Assisted Reproductive Treatment Authority data</a> reveal some women aren’t waiting to find a partner. Over four years, there has been a 48% increase in single women using donor sperm to have a child, and a 50% increase among same-sex couples. </p>
<p>But the number of men who donate sperm in Victoria has remained the same, so there is now a shortage of donor sperm.</p>
<figure class="align-center ">
<img alt="Woman sits reading in a medical waiting room." src="https://images.theconversation.com/files/435746/original/file-20211206-15-3tu035.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435746/original/file-20211206-15-3tu035.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435746/original/file-20211206-15-3tu035.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435746/original/file-20211206-15-3tu035.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435746/original/file-20211206-15-3tu035.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435746/original/file-20211206-15-3tu035.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435746/original/file-20211206-15-3tu035.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Single women are increasingly using donor sperm to have a baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-patient-reading-magazine-waiting-room-421203046">Shutterstock</a></span>
</figcaption>
</figure>
<p>The option of freezing eggs for later use is also used by more and more women. Almost 5,000 women now have frozen eggs in storage in Victoria, up 23% on the previous year. </p>
<p>But it’s important to remember that although having stored eggs offers the chance of a baby, it’s <a href="https://www.varta.org.au/resources/news-and-blogs/whats-your-chance-having-baby-frozen-eggs">not a guarantee</a>. </p>
<p>For women in their 40s, using eggs donated by a younger woman increases their chance of having a baby. Our study showed women aged 40 and over who used donor eggs were five times more likely to have a live birth than women who used their <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/ajo.13179">own eggs</a>. </p>
<p>But finding a woman who is willing to donate her eggs can be <a href="https://www.tandfonline.com/doi/full/10.1080/14647273.2021.1873430">difficult</a>. Most women who use donated eggs recruit their donor themselves and some use eggs imported from overseas <a href="https://www.varta.org.au/resources/annual-reports">egg banks</a>.</p>
<p>So while people might think pregnancy will happen as soon as they stop contraception, having a baby is <a href="https://www.yourfertility.org.au/fertility-week-2021">not always easy</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/egg-freezing-wont-insure-women-against-infertility-or-help-break-the-glass-ceiling-46619">Egg freezing won't insure women against infertility or help break the glass ceiling</a>
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</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/173151/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karin Hammarberg receives funding from The Australian Government Department of Health. She is a Senior Research Officer at the Victorian Assisted Reproductive Treatment Authority. </span></em></p>While most women who try for a baby will succeed, some won’t, and some will have fewer children than they had planned to have.Karin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1665352021-08-25T12:28:09Z2021-08-25T12:28:09ZPregnant or worried about infertility? Get vaccinated against COVID-19<figure><img src="https://images.theconversation.com/files/417466/original/file-20210823-27-1vwqfzl.jpg?ixlib=rb-1.1.0&rect=3634%2C0%2C7799%2C3805&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite rampant misinformation, studies show that COVID-19 vaccines are safe for both the mom and baby.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pregnant-vaccination-pregnant-woman-in-face-mask-royalty-free-image/1306737732?adppopup=true"> Marina Demidiuk/iStock via Getty Images Plus</a></span></figcaption></figure><p>As the <a href="https://www.nytimes.com/2021/08/16/us/covid-delta-variant-us.html">delta variant of SARS-CoV-2 surges</a> across the U.S., <a href="https://news.gallup.com/poll/353081/one-five-americans-remain-vaccine-resistant.aspx">almost 1 in 5 Americans</a> continue to <a href="https://www.forbes.com/sites/alisondurkee/2021/06/11/here-are-the-biggest-groups-that-are-still-refusing-the-covid-19-vaccine-poll-finds/?sh=2cf3b28a42cc">resist getting shots</a> that are <a href="https://www.statnews.com/2021/07/20/states-are-sitting-on-millions-of-surplus-covid-19-vaccine-doses-as-expiration-dates-approach/">widely available</a>, <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html">safe</a> and <a href="https://www.washingtonpost.com/health/2021/08/18/covid-vaccine-effectiveness/">effective</a> – particularly for preventing the most severe outcomes of the virus. </p>
<p>While people have many different justifications for not getting the shot, one particularly insidious bit of <a href="https://medical.mit.edu/covid-19-updates/2021/02/want-to-get-pregnant-should-i-avoid-vaccine">pseudoscience</a> has surfaced. It is routinely invoked in the <a href="https://heavy.com/news/dr-sean-brooks-phd-oxford-ohio-video/">contentious debate over vaccine policy</a> in the U.S. and continues to stir <a href="https://www.dw.com/en/why-many-africans-are-wary-of-covid-19-vaccines/a-56774599">confusion and skepticism</a> toward vaccines in young women <a href="https://www.hindustantimes.com/india-news/no-covid-19-vaccine-affects-fertility-clarifies-health-ministry-101625050744190.html">across the globe</a>.</p>
<p>This misinformed argument reasons that the coronavirus vaccines could <a href="https://doi.org/10.1515/jom-2021-0059">affect fertility in women</a> by mistakenly triggering the creation of antibodies that react with an important placental protein called syncytin-1. This protein contains minor similarities to the <a href="https://doi.org/10.1038/s41541-021-00369-6">coronavirus spike protein</a> used in all current COVID-19 vaccines. Thus, the false narrative goes, the immune system will not be able to differentiate between the two and will create antibodies that interfere with proper development of the placenta. </p>
<p>This argument lacks understanding of how the immune system does its job. </p>
<p>As <a href="https://scholar.google.com/citations?user=-oDHlFYAAAAJ&hl=en">an immunologist</a> who studies <a href="https://www.nature.com/articles/s41590-020-00814-z">COVID-19 infection</a> and the ways it can cause the immune system to <a href="https://theconversation.com/covid-19-causes-some-patients-immune-systems-to-attack-their-own-bodies-which-may-contribute-to-severe-illness-148509">turn against itself</a>, this misunderstanding comes up frequently in my conversations with friends, family members and even medical workers who are legitimately concerned about their health and their future ability to have children. </p>
<p>It is completely understandable to have questions about how a new vaccine might affect reproductive health. But the <a href="https://www.medrxiv.org/content/10.1101/2021.05.23.21257686v1">science is clear</a> that getting vaccinated does not put women at risk for infertility. It protects women, their unborn children and their families from a serious disease that, ironically, could in fact <a href="https://theconversation.com/covid-19-could-cause-male-infertility-and-sexual-dysfunction-but-vaccines-do-not-164139">affect fertility in men</a>.</p>
<h2>Antibodies rarely make mistakes</h2>
<p>The immune system is an immensely complicated network of cells, tissues and proteins that interact with one another – and the outside world. It works to maintain a balanced, healthy environment so the rest of the cells in the body can do their jobs. Among other things, the immune system helps direct <a href="https://doi.org/10.3389/fimmu.2019.02729">fetal development</a>, oversees and <a href="https://doi.org/10.1038/s41422-020-0332-7">manages the microbes</a> that aid in digestion and, of course, fights off infection.</p>
<p>One of the immune system’s most critical jobs is to differentiate between the body’s own cells and those of outside invaders to prevent accidental <a href="https://www.healthline.com/health/autoimmune-disorders">attacks on itself</a>. In immunology, this careful selection of responses is called “immune tolerance.” People whose immune systems fail to maintain this tolerance and instead attack their own cells and tissues are diagnosed with <a href="https://www.healthline.com/health/autoimmune-disorders">autoimmune disorders</a>. These can range in symptoms and severity depending on the tissue being attacked. An example is <a href="https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648">rheumatoid arthritis</a> – a misdirected antibody attack on soft tissue in the joints.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417467/original/file-20210823-20-1vbx9kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Conceptual illustration of antibodies attacking neurons" src="https://images.theconversation.com/files/417467/original/file-20210823-20-1vbx9kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417467/original/file-20210823-20-1vbx9kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417467/original/file-20210823-20-1vbx9kp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417467/original/file-20210823-20-1vbx9kp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417467/original/file-20210823-20-1vbx9kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417467/original/file-20210823-20-1vbx9kp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417467/original/file-20210823-20-1vbx9kp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This depiction of antibodies attacking neurons illustrates what happens in some individuals with autoimmune disorders.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/antibodies-attacking-neurons-conceptual-royalty-free-illustration/1265278544?adppopup=true">Kateryna Kon/Science Photo Library via Getty Images</a></span>
</figcaption>
</figure>
<p>The immune system has a series of checks and balances that are intended to prevent such autoimmune attacks. When B-cells – the cells in the immune system that produce antibodies – are first “born,” <a href="https://www.nature.com/articles/nri.2017.19">they carefully screen themselves</a> to make sure that they won’t target the body’s own organs. That <a href="https://doi.org/10.1038/nri.2017.19">self-screening continues</a> as B-cells patrol the body looking for an infection to fight; if they find something potentially threatening, <a href="https://theconversation.com/vaccines-against-sars-cov-2-will-have-side-effects-thats-a-good-thing-151090">like a vaccine</a>, they engage in a <a href="https://doi.org/10.1146/annurev-immunol-051116-052510">highly orchestrated dance</a> with other immune cells. Through that weeks-long process, only B-cells that produce antibodies against the outside invader survive. B-cells with self-destructive potential are killed. </p>
<p>Importantly, in parts of the body where it is absolutely critical that the immune system not mistakenly turn on its own cells – such as a developing placenta or in the brain – the entire region is immunosuppressive. This means that the threshold for activating the body’s immune response in those areas is set at an even higher bar.</p>
<p>This is not emerging science. These are well-established concepts among immunology experts. and have been <a href="https://doi.org/10.1111/j.1600-065X.1975.tb00162.x">for almost a half-century</a>. As a result, it was not particularly noteworthy that a new preliminary study of women with fully developed immune responses against coronavirus showed <a href="https://doi.org/10.1101/2021.05.23.21257686">no activity</a> against the placental protein syncytin-1. Another study unsurprisingly demonstrated that the vaccine <a href="https://doi.org/10.1097/AOG.0000000000004457">does not damage the placenta</a>.</p>
<h2>COVID-19 is the real threat to the immune system</h2>
<p>It is important to remember that the COVID-19 vaccines authorized – and in the case of <a href="https://theconversation.com/what-does-full-fda-approval-of-a-vaccine-do-if-its-already-authorized-for-emergency-use-165654">Pfizer-BioNTech, fully approved</a> – in the U.S. <a href="https://getvaccineanswers.org/question/vaccine-protection?gclid=Cj0KCQjwsZKJBhC0ARIsAJ96n3XY7rtZpPJ_zn0o3B2anb87qVjKu0t82izbmZP0oHT2wYtz_PpUyvwaApJFEALw_wcB">carry the instructions</a> to make the same spike protein that the virus uses to force its way into cells. Regardless of whether a person is infected with COVID-19 or receives a vaccine that emulates part of the virus, the immune system will respond aggressively to the spike protein that the body sees as foreign. <a href="https://doi.org/10.1126/sciimmunol.abe5511">Study</a> after <a href="https://doi.org/10.4049/immunohorizons.2100011">study</a> confirm that in people who contract the virus, the majority of the immune response is directed at the spike protein.</p>
<p>However, there is one critical difference between vaccination and infection.</p>
<p>When you get vaccinated, your immune system has the time to respond under relatively low-risk circumstances. In other words, the immune system senses a threat and begins to build up its arsenal without rushing. But when it is confronted with a severe infection, the immune system recruits every weapon it has, as quickly as possible, to fend off severe infection or death. </p>
<p>[<em>Understand new developments in science, health and technology each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p>
<p>This is important because we now know that under the severe stress of fighting COVID-19, the immune system fires up <a href="https://theconversation.com/an-autoimmune-like-antibody-response-is-linked-with-severe-covid-19-146255">an emergency response pathway</a> and begins producing antibodies that are not well selected. Many of these antibodies will target the virus, but <a href="https://doi.org/10.1101/2020.10.21.20216192">our work now under review</a> and <a href="https://doi.org/10.1038/s41586-021-03631-y">others’ published findings</a> confirm that in more than half of severe patients, a large number of antibodies also target their own cells.</p>
<p>Simply put: The danger of this kind of “auto-reactivity” in COVID-19 doesn’t come from responding against the spike protein in a vaccine – it occurs when the body has to fight a real COVID-19 infection.</p>
<h2>Getting vaccinated protects unborn children</h2>
<p>Getting vaccinated costs people a couple of days of <a href="https://theconversation.com/vaccines-against-sars-cov-2-will-have-side-effects-thats-a-good-thing-151090">not feeling 100%</a>. In return, it provides protection from contracting a serious disease with the potential to cause serious illness or death. Being vaccinated also gives <a href="https://www.news-medical.net/news/20210411/mRNA-based-COVID-19-vaccination-during-pregnancy-provides-passive-SARS-CoV-2-immunity-to-neonates-16-days-after-first-dose.aspx">crossover protection</a> to an unborn child.</p>
<p>COVID-19 infection, on the other hand, puts pregnant women at risk of <a href="https://doi.org/10.1001/jamapediatrics.2021.1050">severe disease, pregnancy complications and death</a>. It may also affect a couple’s ability to have children by decreasing a man’s <a href="https://theconversation.com/covid-19-could-cause-male-infertility-and-sexual-dysfunction-but-vaccines-do-not-164139">sperm counts and causing erectile dysfunction</a>.</p>
<p>The science is clear, but for me this is also deeply personal. My wife was vaccinated in March, and we are expecting a baby in December. We are both deeply grateful for a vaccine that has given us the confidence to support a healthy pregnancy in the midst of a pandemic.</p><img src="https://counter.theconversation.com/content/166535/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Woodruff's research is supported by the National Institute of Health. </span></em></p>A COVID-19 vaccine does not cause infertility – but it can protect you from the dangerous complications of contracting the virus.Matthew Woodruff, Instructor of Human Immunology, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1637922021-08-23T18:37:26Z2021-08-23T18:37:26ZThe fertility industry is poorly regulated – and would-be parents can lose out on having children as a result<figure><img src="https://images.theconversation.com/files/416106/original/file-20210813-22-wv89iu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Louise Brown, who was the world's first baby to be born from in vitro fertilization (IVF) in 1978, poses with equipment used in early IVF treatments.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/louise-brown-who-in-1978-became-the-worlds-first-baby-to-be-news-photo/1004176610?adppopup=true"> Daniel Leal-Olivas/ Getty</a></span></figcaption></figure><p>When embryologist <a href="https://www.courthousenews.com/lab-workers-were-devastated-by-tank-failure-that-destroyed-human-embryos/">Joseph Conaghan arrived at work</a> at San Francisco’s Pacific Fertility Center on March 4, 2018, nothing seemed awry. He did routine inspections of the facility’s cryogenic tanks, which store frozen embryos and eggs for clients who hope to someday have biological children. </p>
<p>But what he found was not routine; it was an emergency. Almost all of the liquid nitrogen inside Tank 4 had drained out. Conaghan and his staff tried to save 80 metal boxes of frozen reproductive material, but it was too late. The contents had warmed, damaging or destroying 1,500 eggs and 2,500 embryos. </p>
<p>Some belonged to a couple who traveled cross-country from their farm in Ohio, hoping to build their family from frozen embryos. A single woman in her early 40s was hoping to soon use her preserved eggs with “Mr. Right.”</p>
<p>For many, infertility is a significant challenge: In 2018, 12.7% of American women sought infertility services, according to a <a href="https://www.cdc.gov/nchs/nsfg/key_statistics/i_2015-2017.htm#infertilityservices">U.S. Centers for Disease Control and Prevention report</a>. As experts on regulation of the fertility industry, we are concerned about protecting those who need these interventions. There is little oversight in the U.S. of the industry, with <a href="https://www.fertstertreports.org/action/showPdf?pii=S2666-3341%2820%2930039-8">no requirement</a> that clinics report problems – including tank failures. As Professor Dov Fox of the University of San Diego Law School told a reporter: “<a href="https://www.washingtonpost.com/health/2021/06/11/fertility-clinic-egg-embryo-verdict/">These tanks specifically, they’re not regulated any better than kitchen appliances or farm tools</a>.”</p>
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<figcaption><span class="caption">The science behind making a baby in a lab.</span></figcaption>
</figure>
<h2>Reproductive innovations</h2>
<p>The current age of reproductive technology dates to 1944, when lab technician <a href="https://www.bbc.com/future/article/20200103-the-female-scientist-who-changed-human-fertility-forever">Miriam Menkin</a> successfully fertilized a human egg in a petri dish. She made history, creating a new method of human conception.</p>
<p>That year, 30 fertility experts founded the <a href="https://www.asrm.org/about-us/history-of-asrm/">American Society for Reproductive Medicine</a>. Today it is a global organization of <a href="https://www.asrm.org/news-and-publications/news-and-research/announcements/asrm-task-force-on-diversity-equity-and-inclusion-issues-statement-recommendations/">about 8,000</a>, including doctors, nurses, health care professionals and others.</p>
<p>But it wasn’t until 1978 that in vitro fertilization emerged as a groundbreaking and controversial technology. That year marked the birth of <a href="https://time.com/5344145/louise-brown-test-tube-baby/">Louise Brown</a>, the first “test tube baby.”</p>
<p>Since then, the procedure has produced more than <a href="https://www.sciencedaily.com/releases/2018/07/180703084127.htm">8 million children</a> worldwide. Some <a href="https://www.cdc.gov/art/artdata/index.html">80,000 children</a> are born yearly in the U.S. through IVF, accounting for <a href="https://www.cdc.gov/art/artdata/index.html">1.9% of births.</a></p>
<h2>Little regulation</h2>
<p>Assisted reproduction is now a multibillion-dollar industry, with more than <a href="https://www.cdc.gov/art/nass/index.html">440 U.S. clinics</a>. In other industrialized nations, including the U.K., fertility treatment is <a href="https://www.hfea.gov.uk/about-us/">monitored</a> by independent, comprehensive regulators. In the U.S., government regulation is so light that the U.S. fertility industry has been called the “<a href="https://www.nytimes.com/roomfordebate/2011/09/13/making-laws-about-making-babies/fertility-industry-is-a-wild-west">Wild West</a>.” U.S. lawmakers have largely steered clear: The contentious battle over abortion has created a political minefield around any issue concerning conception or embryos.</p>
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<p>Minimal <a href="https://www.asrm.org/globalassets/asrm/asrm-content/about-us/pdfs/oversiteofart.pdf">regulations</a> are scattered among <a href="https://www.today.com/health/lack-oversight-regulations-may-lead-ivf-mishaps-t157872">federal, state and professional entities</a>. Meanwhile, the U.S. Centers for Disease Control and Prevention offers limited oversight, <a href="https://www.cdc.gov/art/nass/index.html">auditing or inspecting</a> only a sample of clinics each year, mostly to validate data. </p>
<p>Under a 1992 <a href="https://www.govinfo.gov/content/pkg/STATUTE-106/pdf/STATUTE-106-Pg3146.pdf">U.S. federal law</a>, clinics must <a href="https://www.cdc.gov/art/nass/index.html">report assisted reproduction success rates</a> to the CDC. Labs can be <a href="https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry">certified</a> by <a href="https://www.cap.org/laboratory-improvement/accreditation/reproductive-accreditation-program">one</a> of <a href="https://www.jointcommission.org">two</a> <a href="https://www.cdc.gov/art/nass/policy.html">accrediting, nonprofit organizations</a>. While some states <a href="https://www.washingtonpost.com/news/to-your-health/wp/2018/03/14/faq-are-my-frozen-embryos-safe-everything-you-need-to-know-given-two-fertility-clinics-recent-problems/">require fertility labs to be accredited,</a> others do not; certification <a href="https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/cryostorage_of_reproductive_tissues.pdf">requires the monitoring of tanks</a>.</p>
<p>Without comprehensive monitoring, there is little known about problems within this industry. Some of the most complete information on frozen embryo mishaps comes from a <a href="https://www.google.com/url?sa=D&q=https://www.fertstertreports.org/action/showPdf%3Fpii%3DS2666-3341%252820%252930039-8&ust=1627324440000000&usg=AOvVaw3blyWRCntiDd2el33sY9SB&hl=en&source=gmail">study</a> analyzing lawsuits from 2009 through 2019. </p>
<p>The authors reported 133 cases of embryo loss. More than half were related to two catastrophic freezer failures, including the San Francisco event and another that occurred, in a bizarre coincidence, on the same day at Ohio’s <a href="https://www.cleveland.com/news/2019/09/uh-freezer-malfunction-update-more-than-150-families-settle-lawsuits-in-loss-of-embryos.html">Ahuja Medical Center</a>. The Ohio malfunction thawed 4,000 eggs, affecting more than 900 women or families.</p>
<p>But this study only includes cases that can be tracked because of legal filings. Clinics often require patients to sign arbitration agreements that keep cases out of court and out of the public eye. </p>
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<h2>The Pacific Fertility Center case</h2>
<p>Cryogenic tank failures should never happen. Although they store often irreplaceable genetic material, this equipment is minimally regulated. </p>
<p>The <a href="https://www.ecfr.gov/cgi-bin/text-idx?SID=13f55385af12d02f3c7cf85f833911fb&mc=true&node=se21.8.884_16120&rgn=div8">U.S. Food and Drug Administration</a> categorizes these tanks as Class II devices and exempts them from <a href="https://www.fda.gov/medical-devices/premarket-submissions/premarket-notification-510k">premarket</a> scientific and regulatory <a href="https://www.fda.gov/medical-devices/premarket-submissions/premarket-approval-pma">review</a> on safety and effectiveness. </p>
<p>There is also little oversight on the equipment while it’s in use. The American Society for Reproductive Medicine issued <a href="https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/cryostorage_of_reproductive_tissues.pdf">guidance</a> on best practices for cryopreservation in 2020, noting that a “known” source of potential mishaps included “human errors,” such as a “lack of quality control including liquid nitrogen filling schedule” and “inadequate inventory records.”</p>
<p>Basic federal standards for the manufacturing and use of cryopreservation tanks would prevent future storage tank failures and the loss of frozen eggs and embryos. In lieu of federal action, New Jersey became the <a href="https://abovethelaw.com/2020/03/new-jersey-is-the-first-state-to-regulate-the-storage-of-human-embryos/">first state</a> to regulate embryo storage through a law enacted in December 2019. </p>
<p>But ultimately, we believe only federal regulations can ensure uniformity so that standards don’t vary from state to state. Clinics also need greater government oversight to ensure prompt communication about errors. </p>
<p>Many who hope to someday have a genetically related child — like the couple from Ohio and that single woman looking for the right partner — must place their trust in fertility specialists, clinics and equipment manufacturers that provide needed services and devices. Even minimal regulation would help ensure that others are spared from devastating losses in the future. </p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/163792/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dena Sharp's law firm, Girard Sharp, worked on the cases relating to the tank failure at Pacific Fertility that are discussed in this article. </span></em></p><p class="fine-print"><em><span>Naomi Cahn does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An unknown number of people have lost their dreams of parenthood because of storage disasters at fertility clinics. These experts note poor government oversight and the need for stronger regulation.Naomi Cahn, Professor of Law, University of VirginiaDena Sharp, Guest lecturer, University of California College of the Law, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1660562021-08-17T14:37:56Z2021-08-17T14:37:56ZWhat women in Malawi told us about infertility and seeking help<figure><img src="https://images.theconversation.com/files/416043/original/file-20210813-28-l2brv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Malawi, childbearing remains an important and expected part of married adult life. </span> <span class="attribution"><span class="source">Jeffrey Davis/GettyImages</span></span></figcaption></figure><p>In Malawi, about <a href="https://pubmed.ncbi.nlm.nih.gov/23271957/">2%</a> of childless women experience infertility – difficulty conceiving or carrying a pregnancy to term. Another 10.5% experience infertility after the birth of at least one child. </p>
<p>Both men and women can be infertile, but the responsibility for infertility and childbearing often falls more heavily on women. Those who aren’t able to reproduce can face stigmatisation, mental distress, marital instability, and even exposure to domestic violence.</p>
<p>Childbearing remains an important and expected part of married adult life in a country where the total fertility rate – the average number of children expected per woman over a lifetime – is around <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=MW">4.12</a>. </p>
<p>The World Health Organisation says <a href="https://www.who.int/westernpacific/health-topics/reproductive-health">reproductive health</a> includes the ability to decide if, when and how often to reproduce. Infertility, however, limits this ability. </p>
<p>Despite the substantial negative impacts of infertility on health and well-being, it’s a neglected public health issue throughout much of the Global South, including Malawi.</p>
<p>To understand women’s own perceptions of their ability to become pregnant, and carry a pregnancy to term, I <a href="https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1965179">analysed</a> survey data collected in 2010 for Malawian women aged between 16 and 26 living within 7km of Balaka township in the country’s southern region. </p>
<p>The survey remains a rare and valuable source because it asked for women’s own perceptions of their ability to conceive and carry a pregnancy. There is little reason to expect that the incidence of perceived fertility impairments has changed dramatically in the last decade. </p>
<p>Women in the study were asked questions about their health and social lives. I focused on data relating to perceived fertility impairments for the 915 women in the survey who had ever tried to conceive. Among the 117 women who reported fertility impairments, I also looked at what they did to seek help. </p>
<p>I found that a large minority of women reported fertility impairments. Most sought some kind of help for their fertility impairments. Some looked for help from multiple sources.</p>
<p>These findings highlight the need to reduce stigma and scale up public health support for infertility.</p>
<h2>Perceived fertility impairments</h2>
<p>Some existing <a href="https://academic.oup.com/ije/article/29/2/285/758134?login=true">large-scale</a> studies of infertility in the Global South use <a href="https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1965179">survey data</a>. They often <a href="https://pubmed.ncbi.nlm.nih.gov/15820788/#:%7E:text=Conclusion(s)%3A%20The%20infertility,and%20research%20among%20different%20disciplines.">measure infertility</a> by examining whether <a href="https://link.springer.com/article/10.1186/1478-7954-10-17">sexually active women</a> who are not using contraceptives have children within in a given timeframe. This ‘objective’ measurement is useful for estimating the prevalence of infertility. </p>
<p>However, it is sometimes poorly aligned with women’s own perceptions of their ability to conceive and <a href="https://www.cambridge.org/core/journals/journal-of-biosocial-science/article/abs/impaired-fertility-and-perceived-difficulties-conceiving-in-ghana-measurement-problems-and-prospects/0B45F2EBA0F7162DEB41738E453F54F2">carry a pregnancy to term</a>. </p>
<p>Women’s views of their own bodies are worth investigating, and people act based on their perceptions. That is why, in this study, I looked instead at women’s own reports of whether they had ever experienced a fertility impairment. Women were asked whether they had ever experienced difficulties conceiving a pregnancy or difficulties carrying a pregnancy to term.</p>
<p>I found that 117 women (12.8% of the sample) reported experiencing at least one fertility impairment. Breaking this figure down, 7.4% of women reported difficulties conceiving and 7.3% reported difficulties carrying a pregnancy to term. (These add up to more than 12.8% because 15 women experienced both kinds of impairment.)</p>
<p>Next, I wanted to understand who was most at risk. Older women were more likely to report a fertility impairment. This is a young sample and biologically, infertility increases with age. Nonetheless, some women as young as 16 reported fertility impairments. This could reflect in part the significant social pressure women are under to conceive early. </p>
<h2>Seeking help</h2>
<p>I also wanted to understand what actions women take to seek help. Based on what was asked in the survey, I considered five kinds of help-seeking: visiting a hospital or clinic; visiting a traditional healer; visiting a church or mosque, or praying; finding a new partner; and starting a secret sexual partnership outside one’s relationship to try to conceive.</p>
<p>Most women (85.5%) who reported a fertility impairment sought help. More than a quarter (27.4%) used multiple strategies. However, none of the women who reported a fertility impairment said they found a new partner or started a secret relationship to conceive.</p>
<p>Going to a hospital or clinic was the most common way of seeking help. Almost one-third (29.9%) chose this option only. Visiting a traditional healer only was the choice of 22.2%, and 5.9% looked for religious help only. The remainder of women used multiple strategies. Just 4.3% tried all three options.</p>
<p>Importantly, women with different kinds of fertility impairments used different help-seeking strategies. Over one-fifth (22.6%) who reported difficulties conceiving did not take any action. Only around one-tenth (10.2%) who reported difficulties carrying to term did not take action. Everyone who reported both difficulties sought some form of help, and these women were more likely to use multiple strategies.</p>
<p>Women reporting difficulties conceiving more commonly visited a traditional healer. Visiting a hospital was most common for difficulties carrying to term. These differences could, in part, reflect the urgency of addressing some impairments. Some pregnancy complications require immediate medical care, which may prompt urgent care at a hospital. Difficulties conceiving are less likely to require emergency medical care. </p>
<h2>What now?</h2>
<p>The study shows that it’s important to consider women’s perceptions of their own bodies, and to recognise that even young women may report fertility impairments. Also, studies which focus on hospitals and clinics may miss experiences that occur outside these spaces. Less privileged women may be especially likely to be left out of these spaces.</p>
<p>It is quite possible that help-seeking strategies may have changed, both in terms of overall uptake and specific combinations of help-seeking.</p>
<p>It is not clear yet whether or how the COVID-19 pandemic is affecting the availability and accessibility of different help-seeking options. This is why it’s vital to continue monitoring infertility as a pressing public health issue, taking women’s own views into account.</p>
<p>Many family planning programmes throughout sub-Saharan Africa do not offer infertility services. If the aim is indeed to help women plan their families, rather than just reduce fertility and prevent unwanted pregnancy, then infertility support (such as screening and treatment) should be part of existing programmes.</p><img src="https://counter.theconversation.com/content/166056/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jasmine Fledderjohann receives funding from UKRI in the form of a Future Leaders Fellowship. </span></em></p>Despite the substantial negative impacts of infertility on health and well-being, it’s a neglected public health issue throughout much of the Global South, including Malawi.Jasmine Fledderjohann, Senior Lecturer in Sociology and Social Work, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1610372021-06-02T13:24:16Z2021-06-02T13:24:16ZToxic chemicals linked to lower egg counts in women<figure><img src="https://images.theconversation.com/files/403992/original/file-20210602-25-1ab7ae9.jpg?ixlib=rb-1.1.0&rect=51%2C0%2C5760%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This is the first study to investigate how chemical exposure impacts the number of eggs a woman has.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/gynecologist-communicates-her-patient-indicating-menstrual-1837168822">Peakstock/ Shutterstock</a></span></figcaption></figure><p>Birth <a href="https://www.bbc.co.uk/news/health-53409521">rates are</a> decreasing <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN">worldwide</a>. In all European countries they’re even dropping below <a href="https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Fertility_statistics">population replacement levels</a>, which refers to the number of children needed per woman to keep a population stable. While these decreases might be due to many adults intentionally postponing when they have their first child – or actively choosing not to have children – an <a href="https://doi.org/10.1016/j.fertnstert.2019.08.001">increasing number of studies suggests</a> these don’t fully explain decreasing birth rates. Some research also indicates that decreasing fertility is a major contributing factor in this decline. </p>
<p>One factor linked to decreased fertility is the presence of industrial chemicals found in our environment. Much is known about the impact of these chemicals on <a href="https://theconversation.com/male-fertility-how-everyday-chemicals-are-destroying-sperm-counts-in-humans-and-animals-158097">male fertility</a>, but little research has looked into how they affect women. This is what our recent study sought to do. </p>
<p>We found that exposure to common chemical contaminants was associated with <a href="https://doi.org/10.1016/j.envint.2021.106589">reduced egg counts</a> in the ovaries of reproductive-aged women. Though these chemicals have since been banned, they were once used in household products like flame retardants and mosquito sprays, and are still present in the environment and in foods like fatty fish.</p>
<h2>Fewer eggs</h2>
<p>We measured the levels of 31 common industrial chemicals, such as HCB (an agricultural fungicide) and DDT (an insecticide), in the blood of 60 women. To gauge their fertility, we measured the number of immature eggs they had in their ovaries by counting them in ovarian tissue samples using a microscope. Because ovaries are located inside the body and would require surgery to access, we chose pregnant women who were having a caesarean section, as this made it possible to access tissue samples without additional surgery. </p>
<p>We found that women with higher levels of chemicals in their blood sample also had fewer immature eggs left in their ovaries. We found significant connections between reduced egg numbers and certain chemicals, including PCB (used in coolants), DDE (a by-product of DDT) and PBDE (a flame retardant). As female fertility is <a href="https://academic.oup.com/humupd/article/8/2/141/624668">age-dependent</a>, we made sure to adjust our calculations accordingly depending on the age of the woman in question. This showed us that exposure to these chemicals resulted in fewer eggs for women of all ages.</p>
<p>We also found that women with higher chemical levels in their blood had to try for longer to get pregnant. For the women with the highest levels of chemicals in their blood, it took more than a year.</p>
<figure class="align-center ">
<img alt="A woman holds a positive pregnancy test in her hand." src="https://images.theconversation.com/files/403994/original/file-20210602-21-1wj7u03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/403994/original/file-20210602-21-1wj7u03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403994/original/file-20210602-21-1wj7u03.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403994/original/file-20210602-21-1wj7u03.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403994/original/file-20210602-21-1wj7u03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403994/original/file-20210602-21-1wj7u03.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403994/original/file-20210602-21-1wj7u03.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Those with the highest levels of chemicals took over a year to become pregnant.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnancy-test-female-hand-on-blurred-620722475">Africa Studio/ Shutterstock</a></span>
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<p>Unlike men, women are only born with a <a href="https://www.ncbi.nlm.nih.gov/books/NBK532300/">fixed set of immature eggs</a> in their ovaries, and cannot produce new ones after birth. A woman’s “reserve” (the number of eggs in her ovaries) naturally diminishes through monthly ovulations, as well as by normal follicle death. When depleted below a critical level, natural fertility ends and <a href="https://www.ncbi.nlm.nih.gov/books/NBK532300/">menopause</a> begins. Our findings imply that toxic chemicals may speed up the disappearance of ovarian follicles, which could lead to reduced fertility and earlier menopause. </p>
<h2>Chemical soup</h2>
<p>We’re <a href="https://www.cdc.gov/biomonitoring/environmental_chemicals.html">exposed to industrial chemicals</a> through our food, the products we put on our skin, and even through our mothers while developing in the womb. </p>
<p>The number of industrial chemicals, as well as their abundance in the environment, has steadily <a href="https://www.who.int/ceh/publications/endocrine/en/">increased since the 1940s</a> – with devastating effects on <a href="https://pubs.er.usgs.gov/publication/70148108">ecosystems</a>, <a href="https://doi.org/10.1111/brv.12360">wildlife</a> and even <a href="https://theconversation.com/male-fertility-how-everyday-chemicals-are-destroying-sperm-counts-in-humans-and-animals-158097">human fertility</a>. Many chemicals were introduced to the market with <a href="https://www.europarl.europa.eu/RegData/etudes/STUD/2019/608866/IPOL_STU(2019)608866_EN.pdf">little testing for safety</a>. This has led to a situation where humans and the environment are exposed to an extensive “soup” of industrial chemicals.</p>
<p>So far, multiple chemicals have been found to be harmful to reproduction after only decades of consumer use. These include <a href="http://www.c8sciencepanel.org">PFAS</a> (the chemical used in Teflon, Scotch Guard, and firefighting foam), <a href="https://echa.europa.eu/-/endocrine-disrupting-properties-to-be-added-for-four-phthalates-in-the-authorisation-list">phthalates</a> (used in plastic packaging, medical equipment and soaps and shampoos), as well as <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2659554">pesticides</a> and other <a href="https://www.fertstert.org/article/S0015-0282(19)31989-2/abstract">industrial chemicals</a> like PCBs. </p>
<p>The negative effects include <a href="https://www.simonandschuster.com/books/Count-Down/Shanna-H-Swan/9781982113667">reduced sperm counts</a> in men, and potentially the ability of women to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721012/pdf/IUPS_125_1727073.pdf">become pregnant</a>. Our study is the first to investigate the link between chemical exposure and the number of eggs a woman has.</p>
<p>The chemicals we studied were all “persistent”, meaning they build up in the body over time. Strikingly, the chemicals that we found to be associated with lower egg counts were restricted by an <a href="http://www.pops.int">international treaty</a> decades ago. Yet because of <a href="https://ec.europa.eu/commission/presscorner/detail/en/MEMO_03_219">their persistence</a>, they still contaminate the ecosystem and our food. </p>
<p>Interestingly, PCBs (one of the chemicals we studied) have also been connected to decreased sperm counts and <a href="https://www.efsa.europa.eu/en/press/news/dioxins-and-related-pcbs-tolerable-intake-level-updated">infertility in men</a>. Simultaneous decreases in male and female fertility could make it more difficult for couples to get pregnant. </p>
<p>In future, researchers should investigate whether the fertility of all women – as opposed to pregnant women – is similarly affected by these chemicals. But these findings may encourage us to rethink chemical safety to take fertility into consideration during safety assessments. Avoiding certain foods (such as <a href="https://www.epa.gov/choose-fish-and-shellfish-wisely/fish-and-shellfish-advisories-and-safe-eating-guidelines">seafood</a>) and certain products (such as those we put on our skin and hair) may also help minimise the negative effects of chemicals on our chances of having a baby.</p><img src="https://counter.theconversation.com/content/161037/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paulina receives funding from the Swedish Research Council, Swedish Research Council for Sustainable Development, Jane & Aatos Erkko Foundation, Karolinska Institutet funds and foundations, and the European Commission. </span></em></p><p class="fine-print"><em><span>Richelle receives funding from Birgitta and Carl-Axel Rydbeck Research Foundation. </span></em></p><p class="fine-print"><em><span>Jasmin Hassan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The higher the chemical levels found in a woman’s blood, the fewer eggs they had left in their ovaries.Jasmin Hassan, PhD Candidate in Reproductive Medicine, Karolinska InstitutetPauliina Damdimopoulou, Senior Researcher, Chemicals and Female Fertility, Karolinska InstitutetRichelle Duque Björvang, PhD Candidate in Reproductive Medicine, Karolinska InstitutetLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1616112021-05-27T10:38:23Z2021-05-27T10:38:23ZGrowing human embryos in the lab and why scientists just tweaked the rules – podcast<figure><img src="https://images.theconversation.com/files/402947/original/file-20210526-21-1u5rsa0.jpg?ixlib=rb-1.1.0&rect=0%2C52%2C4865%2C3540&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Illustration of an early stage human embryo. </span> <span class="attribution"><span class="source">nobeastsofierce via Shutterstock</span></span></figcaption></figure><p>In this week’s episode of <a href="https://theconversation.com/uk/topics/the-conversation-weekly-98901">The Conversation Weekly</a>, as new scientific guidelines are released on embryo research and the use of stem cells, we talk to experts about what’s changed – including a recommendation to relax the 14-day time limit for human embryo research. And we hear about a wave of romantic comedy films emerging from South Africa that are re-imagining the city of Johannesburg. </p>
<iframe src="https://embed.acast.com/60087127b9687759d637bade/60af6da2a7e7e20012444626?cover=true" frameborder="0" allow="autoplay" width="100%" height="110"></iframe>
<p><iframe id="tc-infographic-561" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/561/4fbbd099d631750693d02bac632430b71b37cd5f/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>It’s been five years since the last set of guidelines from the International Society for Stem Cell Research (ISSCR) were published. Since then, scientists have made significant developments in stem cell and embryo research – including the creation of <a href="https://theconversation.com/researchers-have-grown-human-embryos-from-skin-cells-what-does-that-mean-and-is-it-ethical-157228">human embryo models</a> and the <a href="https://theconversation.com/first-human-monkey-embryos-created-a-small-step-towards-a-huge-ethical-problem-159355">first human-monkey embryos</a>. </p>
<p>Now, <a href="https://www.isscr.org/policy/guidelines-for-stem-cell-research-and-clinical-translation">new ISSCR guidelines</a> have just been published. One of the most significant shifts concerns what’s called the 14-day rule. This has prohibited researchers – by law in some countries, <a href="https://www.legislation.gov.uk/ukpga/2008/22">such as the UK</a> – from growing human embryos in the lab for more than 14 days. The revised guidelines no longer strictly prohibit this, rather they recommend that a panel of experts should approve research proposals on a case-by-case basis. And they also call on countries to start national conversations about the issue and whether such research should be allowed.</p>
<p>The ISSCR guidelines are not international law, but their recommendations are used by countries around the world to guide their own national regulations and legislation. And also by countries that don’t have laws governing this kind of research using embryos and stem cells. </p>
<p>For this episode, we talk to Megan Munsie, deputy director for the Centre for Stem Cell Systems at the University of Melbourne and one of the scientists who sat on the panel that reviewed the guidelines. She tells us there have been advances that mean that we can now grow sperm-egg embryos for more than 14 days, “and the guideline is calling for consideration about whether we should”. She says that in a very small number of cases there may be justification for doing so.</p>
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Read more:
<a href="https://theconversation.com/new-global-guidelines-for-stem-cell-research-aim-to-drive-discussions-not-lay-down-the-law-161578">New global guidelines for stem cell research aim to drive discussions, not lay down the law</a>
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<p>The guidelines stress that doing research using human embryos should be a last resort – only turned to if there is no other way to get the same information. And this is where human embryo models come in. We speak to Jun Wu, assistant professor in molecular biology at the University of Texas Southwestern Medical Center, whose lab recently <a href="https://www.nature.com/articles/s41586-021-03356-y%C2%A0">made a breakthrough</a> by creating a human embryo model, called a blastoid, using human pluripotent stem cells. He explains how he did it and why this kind of research is so important to help understand what happens in the earliest stages of pregnancy, when the embryo implants into the womb lining. “This process of implantation is essentially a black box,” Wu says. “We don’t know much about it.” </p>
<p>And we speak to César Palacios-González senior research fellow in practical ethics at the Uehiro Centre for Practical Ethics at the University of Oxford, about some of the moral dilemmas that the 14-day rule and research using human embryos provoke. “Philosophers like myself love thinking about these things,” he told us. “The main ethical question that people have in mind is the moral value that human embryos have, and if actually we should even be carrying out this particular type of research.” He explains the arguments on both sides. </p>
<p>In our second story (at 25:20), we head to South Africa, where a wave of romantic comedies has hit the big screen in recent years. Many of these films are set in Johannesburg – a city that’s had a violent portrayal in film. Pier Paolo Frassinelli, professor of communication and media studies at the University of Johannesburg has <a href="https://www.tandfonline.com/doi/abs/10.1080/02533952.2021.1899734?journalCode=rsdy20">just published new research</a> looking at the way Black South African filmmakers are now portraying Joburg in a different light through these romcoms. “Even though the films try to present a certain image of upper-middle-class Johannesburg, the films cannot quite push away the tensions, the contradictions, the complexities of the city,” Frassinelli tells us. </p>
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Read more:
<a href="https://theconversation.com/south-africas-romcom-revolution-and-how-it-reimagines-joburg-159255">South Africa's romcom revolution and how it reimagines Joburg</a>
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<p>And Wale Fatade, commissioning editor at The Conversation in Lagos, Nigeria, gives us his recommended reading. </p>
<p>The Conversation Weekly is produced by Mend Mariwany and Gemma Ware, with sound design by Eloise Stevens. Our theme music is by Neeta Sarl. You can find us on Twitter <a href="https://twitter.com/TC_Audio">@TC_Audio</a>, on Instagram at <a href="https://www.instagram.com/theconversationdotcom/?hl=en">theconversationdotcom</a>. or via email on podcast@theconversation.com. You can also sign up to <a href="https://theconversation.com/newsletter?utm_campaign=PodcastTCWeekly&utm_content=newsletter&utm_source=podcast">The Conversation’s free daily email here</a>.</p>
<p>A transcript of this episode will be available soon. </p>
<p>News clips in this episode are from <a href="https://www.youtube.com/watch?v=GF1ZoSLMZVo">ABC News Australia</a>, <a href="https://www.youtube.com/watch?v=C9V3mqswbv0">AP News</a>, <a href="https://www.youtube.com/watch?v=oBMDMXDftnM">Rififi Pictures Trailer: Tell me Sweet Something</a>, <a href="https://www.youtube.com/watch?v=teS_BiLulVs">Showmax, Trailer: Happiness is a Four Letter Word</a>, <a href="https://www.youtube.com/watch?v=9gcty69_R74">Mrs Right Guy Official, Trailer: Mrs Right Guy</a>, <a href="https://www.youtube.com/watch?v=DyLUwOcR5pk">Sony Picture Entertainment: District 9 - Official Trailer</a> and <a href="https://www.youtube.com/watch?v=t6EohBg3QoY">Movieclips Classic Trailers, Trailer: Jerusalema</a>. </p>
<p><em>You can listen to The Conversation Weekly via any of the apps listed above, our <a href="https://feeds.acast.com/public/shows/60087127b9687759d637bade">RSS feed</a>, or find out how else to <a href="https://theconversation.com/how-to-listen-to-the-conversations-podcasts-154131">listen here</a>.</em></p><img src="https://counter.theconversation.com/content/161611/count.gif" alt="The Conversation" width="1" height="1" />
Plus, how a new wave of South African romcoms is reimagining Johannesburg. Listen to episode 17 of The Conversation Weekly podcast.Gemma Ware, Head of AudioDaniel Merino, Associate Breaking News Editor and Co-Host of The Conversation Weekly PodcastLicensed as Creative Commons – attribution, no derivatives.