tag:theconversation.com,2011:/uk/topics/female-fertility-5875/articlesFemale fertility – The Conversation2021-09-07T15:01:55Ztag:theconversation.com,2011:article/1674202021-09-07T15:01:55Z2021-09-07T15:01:55ZEgg freezing: why extending the ten-year limit won’t mean more older mums<figure><img src="https://images.theconversation.com/files/419802/original/file-20210907-24-14v82zs.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C7928%2C5304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The limit has been extended from ten years to up to 55 years. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worker-brown-latex-gloves-takes-material-1470930044">bezikus/ Shutterstock</a></span></figcaption></figure><p>The number of women choosing to freeze their eggs is <a href="https://academic.oup.com/hropen/article/2017/1/hox003/3092404">on the rise</a> in Europe, including in <a href="https://www.bbc.co.uk/news/health-48205986">the UK</a>. Even during the pandemic, fertility clinics have seen a <a href="https://www.bionews.org.uk/page_152631">sharp rise</a> in the number of women enquiring about egg freezing. While there are many reasons why a woman may elect to freeze her eggs, regulations in the UK are extremely restrictive, stipulating that eggs frozen for social reasons can only be stored for up to ten years. Then, a person would have to decide whether to use those eggs or destroy them.</p>
<p>Freezing technology has come a long way since regulations were first made, leading <a href="https://www.bionews.org.uk/page_135507">many experts to argue</a> there’s currently no medical reason to limit storage so restrictively. As a result, the UK government plans to extend the storage limit. This will allow people to be able to store frozen eggs, sperm and embryos for <a href="https://www.theguardian.com/science/2021/sep/06/people-able-to-freeze-embryos-sperm-and-eggs-for-up-to-55-years">up to 55 years</a> regardless of the reason for freezing – giving them more choice when it comes to their fertility.</p>
<p>Already, this has seen concerns that more women will <a href="https://www.dailymail.co.uk/health/article-9961003/Freeze-eggs-55-years-Fertility-revolution-sight-new-law-end-10-year-storage-limit.html">delay motherhood</a> until later in life – even into their 50s and 60s. Based on <a href="https://books.emeraldinsight.com/page/detail/Egg-Freezing-Fertility-and-Reproductive-ChoiceEgg-Freezing,-Fertility-and-Reproductive-Choice/?k=9781787564848">my own research</a> and that of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/soc4.12850">others</a>, many women who freeze their eggs do not want to delay motherhood into their 50s and 60s – and instead wish to have children as soon as they are able to. </p>
<p>It’s also worth noting that many UK fertility clinics will not routinely provide fertility treatment of any kind to a women much beyond the age of 50, whether this is with her own eggs or that of a donor. So these practices would also have to change in order for women to delay motherhood into their 50s. </p>
<p>Instead, the extended limit means more women in many different situations will be able to choose to become a mother at a time that is right for them which most often will be in their late 30s or early to mid 40s. </p>
<h2>Egg freezing</h2>
<p>Since 2013, the number of egg-freezing cycles performed by UK clinics has <a href="https://www.hfea.gov.uk/media/2656/egg-freezing-in-fertility-treatment-trends-and-figures-2010-2016-final.pdf">more than doubled</a> as greater numbers of women seek to have children later, even when their natural fertility may have otherwise declined. Women undergo egg freezing for <a href="https://theconversation.com/why-women-choose-to-freeze-their-eggs-new-research-95087">many different reasons</a> including illness or medical treatment (such as chemotherapy) that may leave them infertile, or because they lack a partner.</p>
<p>To <a href="https://theconversation.com/six-things-you-should-know-if-you-are-considering-freezing-your-eggs-94039">freeze their eggs</a>, a woman must undergo hormonal stimulation which helps her to produce more eggs than she would in her normal monthly cycle. Then, these eggs are surgically retrieved and frozen at -196°C for potential future use. </p>
<p>When egg freezing was first legalised and regulated in the UK in 2000, there were many unknowns about who would use the technology, why, and about how long the frozen eggs would remain viable. It’s now widely accepted that once frozen, eggs do <a href="https://www.degruyter.com/document/doi/10.18574/9781479868148/html">not age or decay</a> – so may be viable indefinitely. </p>
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<img alt="A woman is speaking with her gynaecologist. The gynaecologist is using a notebook to explain something." src="https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.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">Women may choose to freeze their eggs for many different reasons.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-visiting-her-gynecologist-clinic-1351229036">Pixel-Shot/ Shutterstock</a></span>
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<p>Before the pending change in regulations, only women who were freezing their eggs for medical reasons – such as chemotherapy – could store their eggs for up to 55 years. Women undergoing the procedure for social reasons (such as lacking a partner) were only able to freeze their eggs for up to ten years – at which point their eggs would have to be used or destroyed. But based on what we know about egg freezing, there was no medical reason for this limit – which is why myself and others argued to change it.</p>
<h2>Freedom to choose</h2>
<p>Currently, the <a href="https://pubmed.ncbi.nlm.nih.gov/26099440/">typical woman</a> who freezes her eggs for social reasons is around 37 years of age, single, and earning above average income. </p>
<p>The women I spoke to in my <a href="https://www.tandfonline.com/doi/abs/10.1080/0167482X.2018.1460352">previous research</a> said their decision to freeze their eggs was often shaped by the fear that they were running out of time to find the right partner and start a conventional family. Many also feared rushing into a relationship with the wrong partner just to have a child. Egg freezing gave these women a chance to find the right partner, and <a href="https://journals.sagepub.com/doi/full/10.5153/sro.4187?casa_token=tiey3sM_-kgAAAAA:JEr1WcrbwzvYdEaQlzwmFpu1ZY1u7xwTOiXVucfwJYjSMAG_Agw3nLvXfCrhe3LfMZTBjqF5LxY">build a secure relationship</a>. </p>
<p>Many of the women had also wanted a child for many years and would have preferred actively trying to conceive over freezing their eggs. Others felt they had not deliberately chosen to delay motherhood. Rather, they hadn’t become a mother for reasons outside their control. </p>
<p>Based on my research and <a href="https://www.tandfonline.com/doi/abs/10.1080/13691058.2014.951881">other studies</a> on the subject, egg freezing often isn’t about putting off motherhood for as long as possible. Rather, it’s about maintaining the possibility to have a child with a chosen partner in the future, or when a person feels they’re ready to have a child.</p>
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/1350506817742929">Research</a> also shows that women who freeze their eggs don’t want to pursue motherhood for the first time in their 50s and 60s. Rather, they want the option to use their eggs in their early to <a href="https://journals.sagepub.com/doi/full/10.1177/0003122418796807">mid-40s with a partner of their choosing</a>. </p>
<p>Egg freezing is expensive, invasive, painful and not without risk. While some women may choose to delay motherhood until much later as a result of these storage limit changes, it’s unlikely large numbers of women will delay childbearing as a result. Instead, increased storage time limits are likely to give women the option to use their eggs to conceive when it best suits them.</p><img src="https://counter.theconversation.com/content/167420/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Baldwin received funding from The Foundation for the Sociology of Health and Illness</span></em></p>Frozen eggs will be stored for up to 55 years in the UK.Kylie Baldwin, Senior Lecturer, De Montfort 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>
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<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/1089102019-02-05T19:15:10Z2019-02-05T19:15:10ZConsidering using IVF to have a baby? Here’s what you need to know<figure><img src="https://images.theconversation.com/files/257135/original/file-20190205-86210-1r11h6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Age is the biggest predictor of IVF success, but not all clinics are equal.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/Y3L_ZQaw9Wo">Brooke Cagle</a></span></figcaption></figure><p>If it’s not you, perhaps it’s someone you know. You don’t look infertile, you don’t feel infertile, but after many months (or years) of trying to start a family, followed by several months of monitoring your cycle in a fertility clinic, it’s time to discuss IVF.</p>
<p>This is a big decision. It will impact your time, your finances, your emotions, your relationships and your dreams of being a parent. </p>
<p>Despite the language of “falling pregnant”, inferring absolute simplicity, infertility is a reality for <a href="https://www.health.gov.au/internet/publications/publishing.nsf/Content/womens-health-policy-toc%7Ewomens-health-policy-experiences%7Ewomens-health-policy-experiences-reproductive%7Ewomens-health-policy-experiences-reproductive-maternal%7Ewomens-health-policy-experiences-reproductive-maternal-fert">one in six Australian couples</a>. </p>
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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>
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<h2>Infertility isn’t picky, but it is ageist!</h2>
<p>A woman’s age is the <a href="https://www.mja.com.au/journal/2017/207/3/assisted-reproductive-technology-australia-and-new-zealand-cumulative-live-birth">single best predictor</a> of IVF success. This is because a woman is born with all the eggs she will ever have, somewhere between one and four million. Our eggs are slowly trickling out of the ovary in a steady stream, until at menopause there are no eggs left. </p>
<p>Despite the fact that almost 400 eggs will begin to grow each month from puberty to menopause, only one egg will survive each month, bursting out of the ovary at ovulation ready to be fertilised.</p>
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<p>Sperm are an equally critical component of both IVF and natural fertility. </p>
<p>Despite the myth that male fertility is not impacted by age, a growing body of evidence shows men’s age – and lifestyle factors such as excess weight, smoking and heavy drinking – <a href="https://www.racgp.org.au/afp/2017/september/male-infertility/">affect fertility</a>.</p>
<p>Intracytoplasmic sperm injection (ICSI) has been developed so fertilisation in the lab can still be successful even if only one good quality sperm is available. </p>
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Read more:
<a href="https://theconversation.com/most-men-dont-realise-age-is-a-factor-in-their-fertility-too-67785">Most men don't realise age is a factor in their fertility too</a>
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<h2>What is the process and how will I feel?</h2>
<p>IVF artificially increases the number of mature eggs ready for fertilisation. Your treatment very much depends on what your infertility diagnosis is, but for most couples undergoing IVF, the process will look a bit like this.</p>
<p><strong>Step 1: ovarian stimulation</strong></p>
<p>The hormone which makes eggs grow (FSH or follicle stimulating hormone) is given by very tiny, self-given injections just under the skin, in high but tailored doses. This creates a hormone tsunami, giving many eggs a chance to ride this wave. </p>
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<img alt="" src="https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&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">Women self-administer the hormone injections.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/481981426?src=zMXyc3de8wm9uknCGlFhLA-1-1&size=huge_jpg">vchal/Shutterstock</a></span>
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<p>Using IVF, we can safely increase the number of eggs the woman produces in a cycle without risking multiple births. We take the eggs out of the body, in a process known as egg harvest or oocyte pickup, or OPU. Leaving the eggs in the body for fertilisation incurs an unacceptable risk of having twins, triplets, or more. </p>
<p>These hormones can have some side effects, which are usually mild, and may include tenderness at the injection site, hot flashes, blurred vision, nausea, headache, irritability and restlessness. Your doctor will outline them, and tell you what to monitor.</p>
<p><strong>Step 2: egg harvest (oocyte pickup)</strong></p>
<p>When the eggs are mature (generally up to 18 mm in size) and your estrogen levels are consistent with the egg numbers and size we need, we plan an egg harvest. </p>
<p>A trigger injection is given to finalise egg growth and development, and approximately 36 hours later, we perform the surgical procedure to collect them, ready to put them together with the sperm for in vitro fertilisation (IVF). </p>
<p>This procedure is more like a blood test than open surgery and in many units this procedure is done with pain relief while the female partner is awake. Other units use a light sedative anaesthetic, while they insert a narrow needle and camera (ultrasound) through the vagina to collect the eggs for IVF.</p>
<p><strong>Step 3: in vitro fertilisation (IVF)</strong></p>
<p>Over the next few hours, the embryologists will wash all the viable eggs and prepare them for fertilisation. They are then placed in a dish with thousands of sperm, which were collected previously and frozen, or collected on the same day from your partner. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?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"></a>
<figcaption>
<span class="caption">ICSI looks something like this.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/ivf-artificial-insemination-realistic-vector-design-1156125265?src=TwMKPKSqfztCJPeUqkfkrQ-1-21">Apl56/Shutterstock</a></span>
</figcaption>
</figure>
<p>Or, if you’re using intracytoplasmic sperm injection (ICSI), the embryologists directly inject one sperm into the cytoplasm of each egg. </p>
<p><strong>Step 4: embryo culture</strong></p>
<p>The day after IVF, the embryologist or nurse will phone you to tell you how many eggs were fertilised.</p>
<p>For the next few days, your embryos will live in a dish, in an oven heated to body temperature. Staff will monitor their growth and development and will eventually pick the right one for transfer back into the womb. </p>
<p>The embryo is gently transferred back into the womb on day five or six, in a process similar to that of a pap test. If you have many healthy embryos at this stage, they can be frozen for use later. </p>
<h2>Now you wait</h2>
<p>About a week-and-a-half to two weeks after your embryo was transferred, we can test to see if it’s attached to the womb. A simple blood test, or even home pregnancy test, will detect levels of human chorionic gonadotrophin (HCG), a sign that you are finally pregnant.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.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">There’s so much waiting when you go through IVF.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1081646393?src=MkcCgBb3qlTKDrT3OCxh-A-1-10&size=huge_jpg">Rawpixel/Shutterstock</a></span>
</figcaption>
</figure>
<p>For some, the test will be negative. If they have frozen embryos, they can try again without needing to take more injections and have a surgical procedure. </p>
<p>Others will receive a diagnosis after learning something about their eggs, sperm and embryos, which can help the IVF team adjust the cycle plan and improve the couple’s outcomes in future cycles. </p>
<p>For some, it was the last time they were going to try IVF, or fertilisation didn’t occur, or an embryo transfer could not be done. Disappointment, frustration and grief becomes part of the experience and couples may need support and counselling. </p>
<p>For many, a positive pregnancy test is the outcome. But there is still more waiting; after all, you are still 38 weeks away from delivery. A small number of pregnancies miscarry or are lost so support in early pregnancy and good obstetric care is vital. </p>
<h2>How much does it cost?</h2>
<p>The cost of IVF is hugely variable, and is dependent on your level of private health cover. The out of pocket costs, even with the highest level of cover may reach A$9,000 for the first cycle. And each test and process will change the price. </p>
<p>Sit down with your specialist and ask “can you talk me through all of the costs associated with this round of treatment?” and have them break it down.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-now-have-clearer-statistics-on-whether-ivf-is-likely-to-work-81256">Women now have clearer statistics on whether IVF is likely to work</a>
</strong>
</em>
</p>
<hr>
<h2>How do you find the right clinic?</h2>
<p>There is a big difference in the quality of fertility care you can receive across Australia, with some clinics having dramatically higher success rates than others. </p>
<p>But keep in mind some clinics may not show all the data. They may quote the pregnancy rates for “every started IVF cycle” or for “every embryo transfer”, meaning the cycles where there is no embryo to transfer are excluded – thus making the rates look unrealistically good. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.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 factors affect a couple’s success rate.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/rQTNkcUT8uk">Tina Bo</a></span>
</figcaption>
</figure>
<p>Despite the desire to shop for price, asking the clinic specifically about your chance of taking home a healthy baby in their clinic, and finding a health care provider you feel comfortable with is key. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-traps-to-be-aware-of-when-reading-success-rates-on-ivf-clinic-websites-68806">Five traps to be aware of when reading success rates on IVF clinic websites</a>
</strong>
</em>
</p>
<hr>
<p>Your personal success may not be equal across two clinics, and you may save yourself money by finding a clinician and clinic with high success rates, and with a specialist who specialises in your condition, whether it’s <a href="https://theconversation.com/explainer-what-is-polycystic-ovary-syndrome-37203">polycystic ovary syndrome</a> (PCOS), <a href="https://theconversation.com/au/topics/endometriosis-2405">endometriosis</a>, or something else. </p>
<p>Never be afraid to ask as many questions as you have, and to ask for clarity when you don’t understand. Undertaking IVF is a big step.</p><img src="https://counter.theconversation.com/content/108910/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Louise Hull owns no shares in any IVF companies. I work independently in private practice in North Adelaide and have an affiliation with REPROMED for embryology services. I also work in New Zealand at Genea-Oxford Fertility.
I am an Associate Professor at The University of Adelaide. I have several small NGO grants for endometriosis and am a CIC on an NHMRC grant for implantation.</span></em></p><p class="fine-print"><em><span>Hannah Brown 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>If you’re one of the one in six Australian couples experiencing infertility, you’ve probably thought about IVF. Here’s a step by step breakdown of how it all works.Hannah Brown, Chief Science Storyteller, South Australian Health & Medical Research InstituteLouise Hull, Associate Professor and Fertility and Conception Theme Leader, The Robinson Research Institute, University of Adelaide, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/502732015-11-24T10:15:14Z2015-11-24T10:15:14ZClimate change’s hotter weather could reduce human fertility<figure><img src="https://images.theconversation.com/files/102857/original/image-20151123-18271-135wjwc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">How will climate change affect our conception chances? </span> <span class="attribution"><span class="source">Fetus ultrasound via www.shutterstock.com</span></span></figcaption></figure><p>Policymakers are tasked with addressing climate change in the face of uncertainty: the 2013 <a href="https://www.ipcc.ch/pdf/assessment-report/ar5/wg1/WG1AR5_SPM_FINAL.pdf">IPCC report</a> projects average global temperatures will increase by anywhere from 5 to 10 degrees Fahrenheit (3 to 6 degrees Celsius) in the coming century if we continue on our path of greenhouse gas emissions.</p>
<p>The uncertainty is compounded by the fact that the consequences of any temperature change are unknown, including how something as basic as human fertility might be affected. </p>
<p>Understanding how climate change will affect fertility is an important economic concern. According to <a href="http://data.worldbank.org/indicator/SP.DYN.TFRT.IN?order=w">World Bank</a> estimates, in the United States and many European countries, a woman has fewer than two children on average by the end of her reproductive life. </p>
<p>These “below-replacement” birth rates are already putting stress on programs that are funded by the working-age population, like Social Security. Any additional decline in births due to climate change could only make this worse. </p>
<h2>Links between temperature and fertility</h2>
<p>Global warming might directly affect fertility in two key ways. </p>
<p>First, hot weather could affect sexual behavior. After all, physically demanding activities are more difficult at high temperatures. </p>
<p>Second, temperature could negatively influence reproductive health factors such as sperm motility and menstruation. There are some pretty compelling <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781849/">experimental studies on mammals</a> to support this possibility. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/102680/original/image-20151121-408-1sq8z9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/102680/original/image-20151121-408-1sq8z9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102680/original/image-20151121-408-1sq8z9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102680/original/image-20151121-408-1sq8z9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102680/original/image-20151121-408-1sq8z9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102680/original/image-20151121-408-1sq8z9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102680/original/image-20151121-408-1sq8z9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Experimental studies show that hot weather harms the reproductive health of cattle.</span>
<span class="attribution"><span class="source">From Kelly Sikkema via unsplash.com</span></span>
</figcaption>
</figure>
<p>It is these two potential links that led us to hypothesize that global warming might be a threat to human reproduction, something that had yet to be thoroughly investigated by scientists and policymakers. </p>
<p>Our recent NBER study, “<a href="http://www.nber.org/papers/w21681?utm_campaign=ntw&utm_medium=email&utm_source=ntw">Maybe Next Month? Temperature Shocks, Climate Change, and Dynamic Adjustments in Birth Rates</a>,” tests this hypothesis using data on temperature and birth rates from the United States from 1931 to 2010.</p>
<h2>The ‘natural’ experiment</h2>
<p>Up until recently, there was little consensus regarding temperature’s effect on fertility due to the dearth of experimental evidence. We cannot quantify climate’s role by simply comparing birth rates in “hot” and “cold” places – Louisiana is different from New York in more ways than just weather. </p>
<p>To isolate the effects of temperature, our study relies on a natural experiment: weather fluctuations from year to year in each US state are effectively random. We tested to see if births in Louisiana changed after an <em>unusually</em> hot August. </p>
<p>Our study also controls for many social and economic factors that are changing over time, including economic opportunities for women and access to birth control. While we don’t discount their importance, we were interested in quantifying temperature’s effect above and beyond these other factors. </p>
<h2>Hot days and conception chances</h2>
<p>We focus on the effects of “hot days,” which we define as days where the average daily temperature is above 80F (27C). Because we averaged the minimum and maximum temperature, the daytime temperature on these days is usually above 90F (32C), which most of us would find to be very hot. </p>
<p>The core finding is that hot days lead to a reduction in birth rates eight to 10 months later. The effect size is largest at nine months: on average, each hot day reduces birth rates nine months later by 0.4% or about 1,100 births. Importantly, the data also show that air conditioning played a major role in minimizing the impact that hot days pose for fertility. </p>
<p>Our study also explores whether the initial decline in birth rates is offset by an increase in the following months. The data show only a partial (32%) “rebound” in birth rates in the three months after the initial decline, possibly due to lingering health effects, work constraints or the natural decline in reproductive health with age. This suggests that these shocks could reduce the number of children a woman has over the course of her reproductive life – <a href="https://www.ssa.gov/policy/docs/ssb/v70n3/v70n3p111.html">a growing concern for the United States and many countries</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/102725/original/image-20151122-408-1rxuick.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/102725/original/image-20151122-408-1rxuick.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102725/original/image-20151122-408-1rxuick.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102725/original/image-20151122-408-1rxuick.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102725/original/image-20151122-408-1rxuick.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=453&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102725/original/image-20151122-408-1rxuick.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=453&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102725/original/image-20151122-408-1rxuick.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=453&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Figure illustrates the estimated change in monthly birth rates from each additional hot day. The decline in births occurs eight to 10 months after the hot day, and is then followed by a rebound in months 11 to 13.</span>
</figcaption>
</figure>
<p>As one limitation of our study, we tested for a rebound in births for only up to one year after the initial decline, so there could be some longer-term rebound for which we do not account.</p>
<p>While sexual behavior could certainly be influenced by hot weather, we present some novel evidence to suggest that reproductive health is especially vulnerable. If the story were just about temperature making sex uncomfortable, then we would only see a fall in births eight to nine months later. Instead, we find that birth rates also fall 10 months later, suggesting that hot days have lasting health effects. However, more research is needed to definitively verify this hypothesis. </p>
<h2>Fertility costs of climate change</h2>
<p>Currently, the United States experiences nearly 30 hot days per year. A <a href="http://www.metoffice.gov.uk/research/modelling-systems/unified-model/climate-models/hadcm3">prominent global circulation model</a> projects that the United States will experience a tripling of the number of hot days to about 90 by the end of the 21st century. </p>
<p>We project that this warming will cause the number of births to fall by about 107,000 per year by then. There will also be more summer births, due to the rebound, which will expose pregnancies to considerably hotter days during the third trimester and will <a href="http://www.jstor.org/stable/25592401?Search=yes&resultItemClick=true&searchText=Climate&searchText=Change&searchText=and&searchText=Birth&searchText=Weight&searchUri=%2Faction%2FdoBasicSearch%3FQuery%3DClimate%2BChange%2Band%2BBirth%2BWeight%26amp%3Bacc%3Doff%26amp%3Bwc%3Don%26amp%3Bfc%3Doff%26amp%3Bgroup%3Dnone&seq=1#page_scan_tab_contents">threaten infant health</a>. </p>
<p>As a caveat, these projections focus exclusively on the fertility cost of heat stress and do not offer insight into the costs of natural disasters or other major social changes resulting from climate change. </p>
<p>Should nothing be done to mitigate climate change, our study indicates that air conditioning can lower the fertility costs. But, we caution that in order to avoid exacerbating climate change, any increase in energy use for air conditioning must be offset with decreases in emissions in other parts of the economy. </p>
<p>While our study offers lessons from the United States, it is uncertain how global warming might impact fertility elsewhere in the world. </p>
<p>Many developing countries, like India, already experience hotter climates than the United States. As a result, these developing countries are more likely to feel the effects of climate change, which could include worse fertility outcomes.</p>
<p>Unfortunately, this is one more area where the costs of climate change are uncertain.</p><img src="https://counter.theconversation.com/content/50273/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A world of warmer weather may be bad news for reproductive health and birth rates.Alan Barreca, Associate Professor of Economics, Tulane UniversityMelanie Guidi, Assistant Professor of Economics, University of Central FloridaOlivier Deschenes, Associate Professor, University of California, Santa BarbaraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/440932015-07-01T13:52:03Z2015-07-01T13:52:03ZThe secret to ovulation is in women’s faces (but men can’t see it)<figure><img src="https://images.theconversation.com/files/86898/original/image-20150630-5859-9fsmlr.jpg?ixlib=rb-1.1.0&rect=0%2C262%2C2244%2C1656&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Seeing red</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/alixklingenberg/90907254">alixklingenberg/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>It’s not difficult to tell when a female chimpanzee is in heat. As she nears ovulation — the point in her cycle when she’s most fertile – her bottom swells up like a balloon and turns bright pink. </p>
<p>Humans are obviously different. We don’t make a show of how fertile we are. But does this mean that women have evolved to conceal ovulation?</p>
<p>Women are most fertile during the late follicular phase of their menstrual cycle, which starts about a week after their period begins and ends a week later with ovulation. At this time, women experience subtle changes in their psychology, behaviour, and physiology that are akin to the changes we see in non-human primates.</p>
<p>You may have heard of Geoffrey Miller’s infamous <a href="http://bit.ly/1gbzCzH">lap-dancing study</a> from 2007. Miller asked professional exotic dancers to keep a record of their nightly tip earnings for two months. The women also reported when their periods began and ended, so Miller could calculate when they were most fertile.</p>
<p>He found that the dancers received about US$67 (£42) per hour when they were near ovulation, but only US$52 (£33) at less fertile times of the month (and US$37 (£23) during their periods). This suggests that women are sufficiently more attractive at peak fertility to persuade men to part with their hard-earned cash. But why?</p>
<p>We don’t know for sure but it was probably a mix of signals. Research has shown that as ovulation approaches, women’s voices <a href="http://bit.ly/1GZnvOT">rise in pitch</a>, their body odour becomes <a href="http://beheco.oxfordjournals.org/content/15/4/579.short?rss=1&ssource=mfr">more sexually attractive</a>, and they wear <a href="http://bit.ly/1NwSTpI">more revealing clothing</a>. </p>
<h2>The face of fertility</h2>
<p>There is also <a href="http://bit.ly/1FR1ayR">some evidence</a> that women’s faces are more attractive to both men and women near ovulation. The attractiveness effect is weaker when the women’s clothing and hair are obscured in the photograph. So clothing and hair are clearly important, but they’re not everything.</p>
<p>My research collaborators and I wondered whether womens’ faces might be changing colour across the month. This isn’t as far-fetched as it sounds. Women’s attractiveness to men <a href="http://bit.ly/1ej32dY">doesn’t vary</a> <a href="http://bit.ly/1gbzoIT">over the cycle</a> if the women are wearing make-up, which implies that make-up conceals natural changes in skin appearance. And other primates, such as rhesus and Japanese macaques and mandrills, develop a redder face when they’re most fertile.</p>
<p>Perhaps our own species experiences a similar – if less noticeable – change in facial redness. This could certainly explain the attractiveness effect: <a href="http://bit.ly/1FR14Hw">studies have found</a> men rate women with redder faces more attractive.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/87003/original/image-20150701-27143-ysj1e8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/87003/original/image-20150701-27143-ysj1e8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/87003/original/image-20150701-27143-ysj1e8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/87003/original/image-20150701-27143-ysj1e8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/87003/original/image-20150701-27143-ysj1e8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/87003/original/image-20150701-27143-ysj1e8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/87003/original/image-20150701-27143-ysj1e8.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">The eyes have it.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/zolivier/3152364898/in/photolist-5NyGfW-48RzZX-6Qf6sP-6v2jiD-bp3Qh-dvJT3z-6DTbrV-Eesrb-cuFjkE-5a5m9H-5UBfhz-oAiug-56U674-5h9gZe-75Mdz7-eSgezx-5PLkUm-eddrM-8hUa45-HmAXz-kBRM-9XVYY-7TVqKi-4upBXj-4Poagx-aJK6zz-ixYGKX-9kMdzs-pUxhq-kTbJB-tzbZYW-bC17Dp-dvgzXq-5V448F-fANrs-zfx47-xPtAp-6vx9Wo-6b177p-4atZp6-5Ljwox-kuQ2zw-4xtzDN-4oAthq-5HHt2W-dqTN9-4ay3fL-6Rf6Gf-6FsT8k-4atZNe">Olivier</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>To find out, we photographed 22 young women volunteers on an average of 13 occasions and monitored where they were in their cycles, using a camera that replicated the images seen by the human eye. We asked them to avoid make-up and wear a black hairdressers’ smock so that the colour of their clothes wouldn’t be reflected onto their face (women are <a href="http://bit.ly/1f0VJbN">more likely</a> to wear red or pink clothes when they’re fertile). Then we used a computer program to cut out patches of skin from the cheeks on each photograph.</p>
<p>We found women’s faces did change in redness over the cycle but not to a degree that could be seen by the human eye and therefore could not be detected by men, even unconsciously. Plus women are much more fertile just before ovulation than just after, but the redness of their faces at those two times was almost identical. </p>
<p>It is therefore pretty doubtful that facial skin colour is responsible for the effect of the menstrual cycle on women’s attractiveness to men. If our species ever advertised our fertility with noticeable changes in facial colour, we don’t any more. </p>
<h2>Looking for more</h2>
<p>It’s plausible that there are more obvious fluctuations in facial skin colour than those we detected. After all, we did only look at a small area of the cheek. Perhaps womens’ lips becomes especially red at peak fertility, even without the help of lipstick (women wear <a href="eric.ed.gov/?id=EJ1002522">more make-up</a> near ovulation).</p>
<p>Some indicators of women’s fertility are stronger when women are more stimulated. Straight women are more flirtatious when fertile, but only in the presence of <a href="http://bit.ly/1gbz64C">men they find attractive</a>. Men find dilated pupils attractive in a woman, and heterosexual womens’ pupils increase in diameter during the fertile phase, but only in response to photographs of their boyfriends.</p>
<p>Whatever is going on, women shouldn’t worry that they’re advertising their fertility status to men by way of a flushed red face. The changes in redness are related to cycle phase, but not to fertility or risk of conception.</p><img src="https://counter.theconversation.com/content/44093/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Burriss 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>New research shows women’s faces become redder at their more fertile times but men’s response remains a mystery.Robert Burriss, Research fellow in Psychology, Northumbria University, NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/377432015-05-21T20:04:19Z2015-05-21T20:04:19ZPeople who don’t want kids deserve respect for their choice<figure><img src="https://images.theconversation.com/files/82161/original/image-20150519-25432-f6c9hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's a sense that people who want to be child-free are somehow draft-dodging the duty of parenthood – we’ve done it and suffered, so why haven’t you?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/junglearctic/3629313995">Hanna Nikkanen/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>A conversation about the merits or otherwise of choosing not to have kids has been simmering away since Pope Francis designated people who have made the choice as “<a href="http://www.theguardian.com/world/2015/feb/11/pope-francis-the-choice-to-not-have-children-is-selfish">selfish</a>” earlier this year. </p>
<p>A couple of months after his comments, <a href="http://www.theguardian.com/commentisfree/2015/apr/08/why-justify-decision-child-free-culture-war-parenting">the issue was being discussed</a> because of the film <a href="http://www.imdb.com/title/tt1791682/">While We’re Young</a> and the US book <a href="http://www.brainpickings.org/2015/05/11/selfish-shallow-and-self-absorbed-meghan-daum/">Selfish, Shallow and Self-Absorbed</a>. And now, the <a href="http://www.abc.net.au/radionational/programs/lifematters/childless-or-child-free-listeners-speak-about-life-without-kids/6454548?utm_content=bufferfa378&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer">Australian media appears to be visiting</a> this perennially interesting issue. </p>
<p>There’s good reason for the enduring interest in people who choose not to breed. Societies overwhelmingly endorse reproduction; children grow up being told they’ll become parents one day, parents expect to become grandparents, and having children is universally endorsed as a good thing for all. </p>
<p>But even though we tend to expect everyone to reproduce, the number of childless people in <a href="http://www.oecd.org/els/family/database.htm">most developed countries</a> is increasing. Childlessness has steadily grown in all OECD countries but Australia has the <a href="http://www.familiesandsocieties.eu/wp-content/uploads/2015/03/WP33MiettinenEtAl2015.pdf">second-highest rate of people not having children</a>, after Italy. <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features10Dec+2010">Australian census data show</a> the number of childless women in the 40 to 49 age group increased from just 9% in 1976 to 11% in 1996 and 14% in 2006. </p>
<p><a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1633472">Research I did for my doctoral thesis</a> on voluntary childlessness in the United Kingdom suggested a variety of motives among people who choose to be childless. But some of the people I spoke to said many people were hostile to their decision not to have children and characterised them as selfish and even “unnatural”. Although I did that work about 30 years ago, current debates about the issue show the same holds today. </p>
<h2>To have or have not</h2>
<p>People often have strong reasons for why they don’t have children; they’ve often made the decision more thoughtfully than people who do choose to reproduce. Some of the people I spoke to made an idealistic decision based on their concern for the environment and were typically hoping to contribute to zero population growth. Others were hedonistic and preferred their Harley Davidson or other hobbies to children. </p>
<p>And some had practical reasons, such as a desire to not reproduce the depression that seemed recurrent in their family or their intention to pursue a career wholeheartedly rather than juggling parenting and a job. Some women feared not being supported in child rearing by their partner.</p>
<p>Emotional reasons drove some who noted they didn’t have maternal or paternal feelings, and had never felt any drive or desire to have children. All these reasons resonate today, and the decision not to reproduce is still regarded with hostility by some. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/82159/original/image-20150519-25422-1xm64do.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/82159/original/image-20150519-25422-1xm64do.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82159/original/image-20150519-25422-1xm64do.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82159/original/image-20150519-25422-1xm64do.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82159/original/image-20150519-25422-1xm64do.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82159/original/image-20150519-25422-1xm64do.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82159/original/image-20150519-25422-1xm64do.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children grow up being told they’ll become parents one day.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/niconelson/6654919703/">Nico Nelson/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Responses to childlessness are complex because the group includes people who are physically unable to have children even though they want them, and those who passively slid into childlessness with the passage of time, as well as people who have consciously chosen not to reproduce. </p>
<p>Unwanted childlessness often elicits pity and sympathy because the child-rearing experience is seen to be so rewarding that not to experience it becomes abnormal or unfortunate. But when people choose to be childless, this pity often tips over into approbation about how strange it is to not want the experience. </p>
<p>In part, there’s a sense that people who want to be child-free are somehow draft-dodging the duty of parenthood; we’ve done it and suffered, so why haven’t you? Or, all animals have to reproduce, so how come you haven’t done your bit for the species? </p>
<h2>Something not quite right</h2>
<p>Then there’s the perception that anyone who doesn’t want to have children must in some way be lacking. Behind this lies the idea that it’s natural and healthy to want to have children, and not wanting them suggests either selfishness or a psychological problem. Of course, childfree people may be selfish or have psychological problems, but many parents are too. </p>
<p>Another common perception is that people will regret their decision not to have children when they are old and have no one to help them. Although there isn’t much research on this topic, <a href="http://sciencenordic.com/older-people-just-happy-without-children">a Norwegian survey</a> of 5,500 people between the ages of 40 and 80 found no evidence that childless adults have reduced well-being compared to people with children.</p>
<p>And US studies show that while childlessness <a href="http://parc.pop.upenn.edu/sites/parc.pop.upenn.edu/files/parc/PARCwps96-02.pdf">does not increase loneliness and depression</a> as such, older, divorced childless men are <a href="http://psychsocgerontology.oxfordjournals.org/content/56/5/S311.short">more likely to experience</a> them. </p>
<p>But living in a society that puts often insidious and not very subtle pressure on people to have children can make those who choose not to feel deviant and marginalised from mainstream society. When the answer to the still-ubiquitous question of how many children you have is none, the awkward silence or failure to further explore this answer that follows creates a social exclusion that childfree people have to learn to live with. </p>
<p>Such social exclusion <a href="http://bjp.rcpsych.org/content/191/6/477">may well lead to mental health issues</a> but that’s difficult to prove empirically. The childless are not a homogeneous group and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159916/#R51">US research suggests</a> negative attitudes towards childlessness are associated with higher levels of loneliness and depression.</p>
<p>People who choose to remain child-free have a range of motivations including some with a very well-honed social and environmental concern. Accepting all fertility choices will help us create a more inclusive and mentally healthy society.</p><img src="https://counter.theconversation.com/content/37743/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fran Baum 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>Societies overwhelmingly endorse reproduction, but the pressure this places on people who don’t want to have kids may be putting their health at risk.Fran Baum, Matthew Flinders Distinguished Professor, Foundation Director, Southgate Institute for Health, Society & Equity, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/372032015-02-11T04:08:33Z2015-02-11T04:08:33ZExplainer: what is polycystic ovary syndrome?<figure><img src="https://images.theconversation.com/files/71549/original/image-20150210-24697-dqhq5v.jpg?ixlib=rb-1.1.0&rect=0%2C288%2C1300%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women diagnosed with PCOS often will have good outcomes with diet and lifestyle changes.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/hey__paul/7687804892">Hey Paul Studios/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Polycystic ovary syndrome (PCOS) is a hormonal condition that disrupts ovulation and the menstrual cycle. It’s the most common female hormonal condition, affecting <a href="http://www.ncbi.nlm.nih.gov/pubmed/19910321">roughly one in 12 Australian women</a>. </p>
<p>Women with PCOS often have enlarged ovaries that contain small fluid-filled follicles, or cysts. These cysts are where the condition gets its name: polycystic = many cysts. </p>
<p>But although up to a third of women may have polycystic ovaries seen on an ultrasound, not all have the hormonal problems and physical symptoms that define PCOS. </p>
<p>For women with PCOS, the hormonal imbalances cause a number of symptoms such as irregular or absent periods, weight gain, acne, excessive body hair, mood changes, dark patches of skin and thinning head hair. </p>
<p>Because women with PCOS may not ovulate regularly or may not ovulate at all, some women may have difficulties getting pregnant. </p>
<p>While the cause for the hormonal imbalance is not yet known, it is believed to have some genetic basis.</p>
<h2>Symptoms and related illnesses</h2>
<p>PCOS is often first diagnosed in the late teen years, when young women notice the greasy skin of adolescence refusing to go away, as well as irregular and unpredictable periods.</p>
<p>To diagnose PCOS, GPs assess the patient’s symptoms and may take some blood test to check her hormone levels. The GP may also order an ultrasound of the uterus, ovaries and pelvis. </p>
<p>Women with PCOS are often more likely to put weight on around their waists. This form of body fat distribution is associated with the development of diabetes and heart disease later in life, so GPs may do further testing for these conditions.</p>
<p>Women with PCOS are also at increased risk of cancer of the womb, as the irregular periods and absent ovulation can lead to uncontrolled thickening of the lining of the womb. </p>
<p>But while some women with PCOS can present with a range of conditions, others may have no symptoms at all. These women may never develop any significant symptoms, or only experience symptoms when they are above a healthy weight.</p>
<h2>Treatment</h2>
<p>To decrease the risk of cancer, heart disease and diabetes, women with PCOS need to take particular care with their health from an early age. Doctors will provide advice to women with PCOS about diet and exercise, and some women may find their symptoms resolve as they lose weight.</p>
<p>To alleviate symptoms of PCOS, doctors may prescribe the contraceptive pill. The pill regulates hormones and is an excellent way to control greasy skin and irregular periods, as well as providing contraceptive protection.</p>
<p>Woman with early signs of diabetes may be prescribed <a href="http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html">metformin</a>, which addresses the cause of diabetes and helps with the symptoms of PCOS. It can also lead to regular ovulation for woman trying to get pregnant. Interestingly, if taken during pregnancy it may <a href="https://clinicaltrials.gov/ct2/show/NCT00994812">reduce the risk</a> of miscarriage. </p>
<p>The downsides to metformin treatment is it can make women feel sick, bloated or cause diarrhoea. </p>
<p>For symptoms related to high male hormones such as increased body hair, thinning head hair or acne, doctors may prescribe <a href="http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html">anti-androgen medications</a> to reduce these hormone levels. These medications are often combined with birth control pills and should not be taken when trying to get pregnant. </p>
<h2>Fertility</h2>
<p>Women with PCOS who are trying to get pregnant can often conceive naturally by achieving and maintaining a healthy weight. </p>
<p>Some women may need gentle stimulation of the ovary, by <a href="http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html">tablets or injections</a>, to stimulate ovulation (this also allows women to time sex around ovulation). Expert fertility doctors must oversee this process to ensure patients are not at risk of a multiple pregnancy. </p>
<p>Unless a woman has problems with her fallopian tubes or her partner’s sperm count, it’s rare that she will require IVF to get pregnant.</p>
<p>If, for other reasons, a woman with PCOS does need IVF treatment, she has a increased risk of an exaggerated response to the drugs: a condition known as “hyperstimulation”, where the ovaries become swollen and painful. However, under the care of a fertility doctor, the risk of hyperstimulation is very low.</p>
<p>If you’re concerned about PCOS, talk to your GP to get your symptoms under control and help reduce the risk of complications such as diabetes, heart disease and fertility problems.</p><img src="https://counter.theconversation.com/content/37203/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roger Hart consults and owns shares in Fertility Specialists of Western Australia. He receives funding from National Health and Medical Research Council. </span></em></p>Polycystic ovary syndrome (PCOS) is a hormonal condition that disrupts ovulation and the menstrual cycle. It’s the most common female hormonal condition, affecting roughly one in 12 Australian women. Women…Roger Hart, Professor of Reproductive Medicine, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/342732014-12-19T10:53:14Z2014-12-19T10:53:14ZBabies in your 30s? Don’t worry, your great-grandma did it too<figure><img src="https://images.theconversation.com/files/67375/original/image-20141216-14154-cwk1cx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Freeze your eggs or free your career?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&searchterm=working%20women&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=190732964">Woman via g-stockstudio/Shutterstock</a></span></figcaption></figure><p>The shift towards late motherhood – commonly defined as motherhood after 35 – is often presented as a story of progress and technological liberation from the biological clock.</p>
<p>The narrative goes something like this: Before the widespread availability of the Pill women had no choice but to have children in their teens and early twenties. But the introduction of effective contraception meant that women could trade babies for briefcases. And technologies such as IVF, egg donation and egg freezing allow women to beat the biological clock, freeing them from the tyranny of their own biology. A <a href="http://www.newsweek.com/2014/08/15/how-women-are-freezing-biological-clock-263339.html">recent Newsweek headline</a>, for example, announced that women can now “freeze” their biological clocks, while the <a href="http://www.businessweek.com/articles/2014-04-17/new-egg-freezing-technology-eases-womens-career-family-angst">cover of Businessweek</a> urged women to “Freeze Your Eggs, Free Your Career.” </p>
<p>While this triumphal narrative contains a few grains of truth, it is as simplistic as it is satisfying. History shows us that the “best age” to have a child is very much a product of the cultural and economic moment, not a just dictate of biology that we need to escape.</p>
<h2>Changes throughout the 20th century</h2>
<p>In motherhood manuals published in the early 20th century, <a href="https://books.google.com/books?id=9so0AQAAMAAJ&pg=PA14&dq=the+eugenic+marriage&hl=en&sa=X&ei=p1KPVLGDDMG1sQSgroCgAg&ved=0CCQQ6AEwAQ#v=onepage&q=the%20eugenic%20marriage&f=false">eugenicists warned</a> women to wait until they were at least 24 to have children, lest their offspring suffer from both their biological and emotional immaturity. But the manuals cautioned women from waiting too long, however, as postponing childbirth also increased the likelihood of sterility. </p>
<p>In the late 1920s, one sociologist <a href="http://www.jstor.org/stable/349246">recalled that</a> couples who had children soon after marriage were the targets of gossip and severe judgment. The Great Depression also added to the popularity of postponing pregnancy, as economic anxiety dampened the desire to procreate and American birthrates <a href="http://www.prb.org/publications/datasheets/2012/world-population-data-sheet/fact-sheet-us-population.aspx">dropped</a>.</p>
<p>In 1942, physician and editor of the Journal of the American Medical Association Morris Fishbein <a href="https://books.google.com/books?id=JQOuiPk68YgC&q=modern+medical+home+advisor+fishbein&dq=modern+medical+home+advisor+fishbein&hl=en&sa=X&ei=eVOPVPP7Eo37sASLyYCgAw&ved=0CDAQ6AEwAA">complained of the selfishness</a> of young couples who preferred consumer comforts to the demands of child rearing.</p>
<p>In fact, it was only after second world war that early parenthood became a cultural norm. A strong economy and widespread embrace of domesticity encouraged both early marriage and childbearing, resulting in a “baby boom” that lasted almost two decades. In 1957, birthrates among American teenagers hit an <a href="http://www.cdc.gov/nchs/data/series/sr_04/sr04_001acc.pdf">all-time high</a>, at 96.3 births per 1000 adolescents aged 15-19. To compare, the <a href="http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/teen-pregnancy/trends.html">current birth rate</a> for teenage girls aged 15-19 sits at 26.6 births per 1000 women. The postwar tendency towards early childbearing, which we now imagine to be the product of some kind of biological inevitability, was actually a cultural aberration. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/67322/original/image-20141216-24316-1lgtwo7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/67322/original/image-20141216-24316-1lgtwo7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/67322/original/image-20141216-24316-1lgtwo7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/67322/original/image-20141216-24316-1lgtwo7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/67322/original/image-20141216-24316-1lgtwo7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/67322/original/image-20141216-24316-1lgtwo7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/67322/original/image-20141216-24316-1lgtwo7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The ‘best age’ to have a child is very much a product of the cultural and economic moment.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/leon_77/1968619626">Leonardo D'Amico</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<h2>Economic necessity</h2>
<p>The roots of our modern discussion on delayed parenthood lie in the 1970s, when the average age at first birth began to increase dramatically. The number of women having their first child between the ages of 30 and 34 <a href="http://www.cdc.gov/nchs/data/series/sr_21/sr21_047.pdf">almost doubled</a>, from 7.3 births per 1000 women in 1970 to 12.8 per 1000 in 1980. <em>But</em> the 1980 figures mirror those <a href="http://www.nber.org/vital-stats-books/vsrates1900_40.CV.pdf">recorded between 1920 and 1940</a>, where the number of first births among women aged 30 to 34 averaged 12.1 births per 1000 women. By 1986, the first time pregnancy rate for women between 30 and 34 hit 17.5 per 1000 births, <a href="http://www.cdc.gov/nchs/data/series/sr_21/sr21_047.pdf">an increase of 140%</a> over 1970 levels. By the late 1980s, post-30 motherhood was becoming the middle-class norm. And the trend has only intensified: in 2013, the first time pregnancy rate for women between 30 and 34 hit <a href="http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_02.pdf">29.5 per 1000 births</a>. </p>
<p>This shift towards midlife pregnancy that started in the 1970s was, of course, connected to both the widespread availability of new contraceptive technologies, as well the successes of second-wave feminism. But there is a third, often overlooked, catalyst in this story: the flagging economy. </p>
<p>The 1970s saw the combination of runaway inflation with stagnating growth. The real value of wages fell dramatically. In this environment, the movement of middle-class women into the workplace was not just liberating – it was an economic necessity. Two working parents were now required to achieve the middle-class status that a single income used to support.</p>
<p>The return to delayed childbearing was not a dramatic break with the past, but a continuation of a trend that began before the second world war. Delaying parenthood to invest more time in education and career development became a favored strategy for surviving in an increasingly competitive marketplace.</p>
<p>This move back to later parenthood produced its fair share of cultural anxiety. In 1978, a columnist in the Washington Post coined the expression “biological clock” to describe the dilemma of women who had delayed childbearing. The media had a heyday after a study published in the New England Journal of Medicine in 1982 <a href="http://www.nejm.org/doi/full/10.1056/NEJM198202183060706">warned</a> that female fertility dropped off sharply after the age of 30. A self-help industry of pregnancy guidebooks, courses on tape, and magazine features tackled the challenges of “Pregnancy Over 30.” </p>
<h2>Using technology to escape biology</h2>
<p>Reproductive technologies are often cast as the heroes of this story. Women who waited too long to have children were “saved” by the ingenuity of these technologies, tricking their own biology to have children later and later in life. </p>
<p>This narrative has two problems. First, it implies that women who have children in their 30s or even their 40s always need reproductive technologies to conceive – they don’t. Fertility is highly individual, influenced by both members of the couple hoping to conceive. <a href="http://www.theatlantic.com/magazine/archive/2013/07/how-long-can-you-wait-to-have-a-baby/309374/">Surprisingly little is known</a> about the exact decline of fertility with age. There is no magic age limit for pregnancy that applies to all women. </p>
<p>Second, it implies that using fertility technologies to delay pregnancy is a story of progress, of technology trumping biological limitation. Carl Djressai, father of the birth control pill, <a href="http://www.telegraph.co.uk/health/healthnews/11217750/Sex-will-soon-be-just-for-fun-not-babies-says-father-of-the-Pill.html">recently predicted</a> that by 2050 all women would use egg freezing and IVF to reproduce. The resulting “Manana” generation will be able to delay pregnancy indefinitely and without consequence. This is not inevitable. In fact, this vision of the future may be less about triumphing over biology, and more a statement of how our society and corporate culture treats working mothers.</p>
<p>If we continue to treat childbearing as an impediment to economic productivity (see Facebook and Apple’s egg freezing programs, <a href="http://www.nbcnews.com/news/us-news/perk-facebook-apple-now-pay-women-freeze-eggs-n225011">for example</a>), we may be closer to Djressai’s vision of the future than we think.</p><img src="https://counter.theconversation.com/content/34273/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenna Healey 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>The shift towards late motherhood – commonly defined as motherhood after 35 – is often presented as a story of progress and technological liberation from the biological clock. The narrative goes something…Jenna Healey, PhD Candidate , Yale UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/323022014-11-10T10:36:47Z2014-11-10T10:36:47ZCommon disinfectants impair mouse fertility<figure><img src="https://images.theconversation.com/files/61193/original/mzr7mhj3-1412792612.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">I'll have a clean cage with a side of fertility issues.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-113191711/stock-photo-white-rat-isolated-on-white-background.html?src=5cE6rZw16K1Xlun-jj_48A-1-47">Mouse image via www.shutterstock.com</a></span></figcaption></figure><p>Mice possess a notable talent: they are excellent at making more mice. Their ability to reproduce at a breakneck pace is one reason they are often used as experimental research subjects. Thus, when Dr. Terry Hrubec realized that the mice in her veterinary research lab at Virginia Tech were showing sudden and dramatic declines in reproductive success, she knew she had a problem. </p>
<p>After combing through the literature for possible explanations, Hrubec discovered that a researcher at the University of Washington, Dr. Patricia Hunt, was having a similar experience with mice in her lab. Hrubec, Hunt, and several of their graduate students combined forces to find an explanation. </p>
<p>Hunt noted that a pinworm outbreak in her colony had resulted in intense cleaning efforts as staff worked to decontaminate cages and other lab equipment. Soon after, they began to notice changes in reproductive performance of the mice. Likewise, Hrubec recalled that the problems with her mice had appeared shortly after laboratory staff had started to use a similar disinfectant during routine cleaning procedures. Both disinfectants contained substances known as <a href="http://www.cdc.gov/hicpac/disinfection_sterilization/9_0pceticacidhydropoxide.html#a2">quaternary ammonium compounds</a> (QACs). </p>
<h2>Finding the culprits</h2>
<p>The researchers tested the hypothesis that QACs were impairing lab mouse reproduction. In a small study, they exposed ten breeding pairs of mice to two QACs from their cleaning products: alkyl dimethyl benzalkonium chloride (ADBAC) and didecyl dimethylammonium chloride (DDAC). The mice ate the chemicals in their food rations, at a dosage of either 60 or 120 mg per kg of body mass.</p>
<p>The results of the six-month-long experiment confirmed Hrubec and Hunt’s suspicions: exposed female mice took longer to produce their first litters, had longer intervals between litters, produced fewer pups per litter, and ultimately produced fewer total litters in a given period than did females not exposed to QACs.</p>
<p>Even more disturbing: forty percent of females exposed to the chemicals died either in late pregnancy or in the process of giving birth. The animals became lethargic, lost their appetites, began to lose control of their muscles, struggled to breathe and eventually suffered vaginal hemorrhaging and obstructed births, which frequently led to their deaths. The <a href="http://www.sciencedirect.com/science/article/pii/S0890623814001920">findings</a> are reported in a recent issue of the journal Reproductive Toxicology.</p>
<p>Although <a href="http://www.inchem.org/documents/pims/chemical/pimg022.htm#SectionTitle:2.1%20%20Main%20risk%20and%20target%20organs">toxic or caustic effects of QACs</a> had been documented in the past, it seems no one had previously reported their effects on lab mouse fertility.</p>
<h2>Dangerous combinations</h2>
<p>QACs have been in use since the 1950s, and small amounts are found in dozens of products that most people keep in their homes, as well as research labs and hospitals across the country. They’re commonly <a href="http://www.foodsafetymagazine.com/magazine-archive1/augustseptember-2011/sanitizers-and-disinfectants-the-chemicals-of-prevention/">found</a> in products designed to be applied directly to human skin such as body lotions, hand sanitizers, cosmetics, and shampoos. They are also found in fabric softeners, hand sanitizers, and a variety of household cleaning products. Why hadn’t anyone reported these effects earlier?</p>
<p>First, the United States’ <a href="http://www2.epa.gov/laws-regulations/summary-toxic-substances-control-act">Toxic Substances Control Act</a> (TSCA) does not actually require that all of the ingredients used in consumer products be tested – all substances already in use when the act was passed in 1976 were <a href="http://saferchemicals.org/get-the-facts/what-is-tsca/">grandfathered in</a> to automatic approval without testing. The TSCA also does not classify chemicals as “toxic” or “non-toxic.” Rather, it aims to regulate the marketing and distribution of chemicals that pose “<a href="http://www.epa.gov/oppt/newchems/pubs/unrerisk.htm">unreasonable risk</a> to health or the environment.”</p>
<p>Currently, chemical safety testing – which assesses effects like physical corrosiveness as well as biological damage – has only been done on isolated QACs. This means that safety guidelines could potentially miss interactions between substances that make them more harmful when combined. By exposing mice to two QACs often used together, Hunt and Hrubec’s study highlights the importance of toxicity testing for combinations of chemicals that are frequently found in the same products, rather than basing toxicity assessments solely on isolated ingredients.</p>
<h2>More investigation is needed</h2>
<p>Hunt and Hrubec demonstrated that the very disinfectants that are supposed to protect laboratory animals from infection could actually be altering their biological functions. This discovery has implications for lab animal health procedures in research facilities across the globe. Scientists conducting research related to fertility and reproduction will likely be especially concerned about any chemical exposures that could affect the results of their studies. </p>
<p>More research on dosage-dependency and different routes of QAC exposure is needed. Is there a threshold of exposure below which QAC exposure does not have these effects? The mice in this study were exposed to QACs through their food. The initial observations that QAC-containing products were associated with reproductive troubles suggest that ambient exposure can be harmful, which needs to be investigated. </p>
<p>The effects of QACs on mouse reproduction are alarming, but it is too early to jump to conclusions about potential effects on human beings. Though there is evidence that QACs can <a href="http://erj.ersjournals.com/content/40/Suppl_56/P4356.full.pdf+html">cause bronchial problems for human beings</a>, the jury is out on whether chronic exposure affects our fertility. Given the vast differences in body size and reproductive patterns between mice and people, studies may show that QACs aren’t cause for fertility concerns in human beings, but Hunt and Hrubec’s initial small study will serve as a springboard to bring the issue to the public’s attention.</p>
<hr>
<p><em>This article has been updated to correct the dosage of chemicals the mice were fed in the study.</em></p><img src="https://counter.theconversation.com/content/32302/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne-Marie Hodge 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>Mice possess a notable talent: they are excellent at making more mice. Their ability to reproduce at a breakneck pace is one reason they are often used as experimental research subjects. Thus, when Dr…Anne-Marie Hodge, PhD student, University of WyomingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/222532014-01-23T19:41:09Z2014-01-23T19:41:09ZExplainer: what causes women’s fertility to decline with age?<figure><img src="https://images.theconversation.com/files/39731/original/sjqh8gv5-1390440946.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It all comes down to egg supply.</span> <span class="attribution"><span class="source">Image from shutterstock.com</span></span></figcaption></figure><p>We’ve known for over 50 years that reproductive ageing results in a gradual loss of fertility <a href="http://www.ncbi.nlm.nih.gov/pubmed/12099629">until about age 37</a>, when the rate of decline accelerates dramatically. The loss of fertility is accompanied by increased risks of miscarriage and of conceiving babies with <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Down_syndrome_explained">Down syndrome</a>. </p>
<p>But we have not been clear on the precise mechanism by which this occurs – <a href="http://www.jbiomedsci.com/content/20/1/93">until now</a>. </p>
<p>All of a woman’s eggs are produced before she is born and remain in a preserved state within structures called <a href="http://en.wikipedia.org/wiki/Folliculogenesis">primordial follicles</a> for several decades. </p>
<p>Follicles are gradually recruited to grow; this process begins soon after they are formed and continues throughout the woman’s reproductive life. Once a follicle is triggered to re-initiate development, it enters into the pool of growing follicles, most of which will disintegrate along the way. </p>
<p>Hundreds of thousands of follicles are lost before puberty but once puberty occurs, follicles go through an extra phase of maturation so that each month, one follicle (usually) is ovulated and a single egg released. The majority of follicles are still lost along the way.</p>
<p>The last three months of growth and maturation of recruited follicles are critical for normal development and this is when the ageing environment causes problems. Strangely enough, having a low number of remaining follicles causes the problem. Such a lot of follicles have been wasted during the woman’s life that as she ages there just isn’t the critical mass remaining to give out the correct hormonal signals. </p>
<p>The size of the pool can be measured by the <a href="http://ivf.com.au/ovarian-reserve-amh-test">AMH (anti-muellarian hormone) test</a> or slightly less accurately by the <a href="http://www.nytimes.com/health/guides/test/fsh/overview.html">FSH (follicle stimulating hormone) test</a>. A low AMH or a high FSH result is a sign that the pool is near or at a critically low level.</p>
<p>Some younger women have a condition known as reduced ovarian reserve, which has similar outcomes to ageing. This is caused by several different genes, the best known of which is the <a href="http://fragilex.org.au/what-is-fragile-x/what-causes-fragile-x/">Fragile X gene</a>, which causes learning difficulties in affected males. Women carrying this gene have low ovarian reserves and higher risks of having Down syndrome babies, as well as of sons with fragile X. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/39735/original/bpzbvvmx-1390442076.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/39735/original/bpzbvvmx-1390442076.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/39735/original/bpzbvvmx-1390442076.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/39735/original/bpzbvvmx-1390442076.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/39735/original/bpzbvvmx-1390442076.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/39735/original/bpzbvvmx-1390442076.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/39735/original/bpzbvvmx-1390442076.jpg?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">Blood tests can measure AMH and FSH.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Anyone who is experiencing reduced fertility, however young, would be wise to have FSH or AMH testing before undertaking any fertility treatment. </p>
<p>When the follicle number is below the critical mass, the levels of a hormone <a href="http://www.ncbi.nlm.nih.gov/pubmed/12790766">inhibin B</a> become very low. This in turn reduces the synthesis of a hormone called DHEA <a href="http://umm.edu/health/medical/altmed/supplement/dehydroepiandrosterone%20or%20DHEA">dehydroepiandrosterone</a>, which is produced both by the ovarian <a href="http://www.ncbi.nlm.nih.gov/pubmed/15833266">theca cells</a> and the adrenal gland. </p>
<p>DHEA controls critical elements of the ovarian environment at the earliest stage of maturation of the follicles, some 70 days before ovulation. DHEA is the precursor of hormones (both androgens and oestrogens) that are necessary for many aspects of follicle development. </p>
<p>However, normal levels of DHEA are also required for the activation of another hormone called <a href="http://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_alpha">PPAR alpha</a> which controls over 200 genes, especially those regulating mitochondria (the powerhouse of the cell) and fat metabolism. </p>
<p>Oddly enough, the reduced fat metabolism caused by low follicle number not only changes the metabolism of the developing follicle but causes more follicles to self-destruct. So as well as improving egg quality, DHEA also stops the rapid loss of follicles and reduces the rate of ageing.</p>
<p>Many clinics in Europe and the United States now are treating women with DHEA supplementation and <a href="http://www.ncbi.nlm.nih.gov/pubmed/16997936?dopt=Abstract">clinics report</a> that taking pharmaceutical DHEA for about three months may restore the quality of the eggs so that women can conceive normally. Age of about 40 may be the upper limit.</p>
<p>But to date, the published results on DHEA treatment have <a href="http://www.jbiomedsci.com/content/20/1/93">been mixed</a>, possibly because IVF clinics have treated women who have a range of different reasons for their infertility. As such it’s not routinely prescribed in Australia. </p>
<p>DHEA supplementation may also be dangerous for some women, especially those with polycystic ovarian syndrome where there is often already excess DHEA. It is vital that DHEA levels are measured before any supplements are taken. </p><img src="https://counter.theconversation.com/content/22253/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Judy Ford provides information on fertility and commercial fertility services at ez-fertility.com.au and egs.com.au.</span></em></p>We’ve known for over 50 years that reproductive ageing results in a gradual loss of fertility until about age 37, when the rate of decline accelerates dramatically. The loss of fertility is accompanied…Judy Ford, Lecturer, Research Education LTU & affiliate Research Fellow, Centre for Rural Health & Community Development, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/184772013-09-24T04:47:16Z2013-09-24T04:47:16ZPolitics of the pill: why we don’t have better contraceptives<figure><img src="https://images.theconversation.com/files/31822/original/kcht2kk8-1379987185.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women are generally comfortable with post-sex contraceptives but anti-abortion campaigners aren't.</span> <span class="attribution"><span class="source">WarmSleepy</span></span></figcaption></figure><p>More than 50 years after Australian women <a href="https://theconversation.com/the-pills-50th-anniversary-do-we-have-freer-sex-and-better-managed-fertility-4379">first had access to the oral contraceptive pill</a>, research into new contraceptives has stalled and women are stuck with new versions of old products to manage their fertility. Why? Sadly, the answer comes down to politics. </p>
<p>US obstetrician-gynaecologist and researcher Elizabeth Raymond and her colleagues write in today’s <a href="http://press.psprings.co.uk/jfprhc/september/jfprhc100702.pdf">Journal of Family Planning and Reproductive Health Care</a> about a contraceptive pill that could be taken once a month, when a woman’s period was delayed, to prevent pregnancy. They say that such a pill is scientifically feasible and should be researched. </p>
<p>But they fear politics is standing in the way of research into these novel methods because so-called “post-fertilisation fertility control agents” are seen as unacceptable to anti-abortion activists.</p>
<p>There is some subtlety to their argument. Fertilisation occurs when the sperm and egg join, and implantation of the fertilised egg in the uterus wall is considered the commencement of pregnancy. In order to be called a contraceptive, a technology needs to work before implantation. A drug capable of disrupting implantation is considered an abortifacient – a drug that induces abortion. </p>
<p>The authors argue that some women would be comfortable with a technology that acts in this brief window after fertilisation and before implantation.</p>
<h2>Mimicking nature</h2>
<p>When we look back over the history of research and development into contraceptives, it’s clear that women’s needs and concerns are rarely at the forefront. In the 1930s, for instance, researchers knew that female sex hormones could be used as a contraceptive, but this finding was not followed up due to fear of upsetting the Catholic Church.</p>
<p>The introduction of the pill would have occurred much later than 1960 if it were not for feminist philanthropist Katherine McCormick. She became increasingly frustrated while funding birth control clinics in the 1950s because of the lack of safe, reliable birth control options for women. </p>
<p>She and birth control activist Margaret Sanger offered money to an unconventional researcher, Gregory Pincus, who was working outside of academia, to pursue this unpopular line of research. Pincus recruited John Rock, and the pill was developed in secrecy and trialled in Puerto Rica and Haiti. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/31823/original/7h4fvbmq-1379987412.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/31823/original/7h4fvbmq-1379987412.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/31823/original/7h4fvbmq-1379987412.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/31823/original/7h4fvbmq-1379987412.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/31823/original/7h4fvbmq-1379987412.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=564&fit=crop&dpr=1 754w, https://images.theconversation.com/files/31823/original/7h4fvbmq-1379987412.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=564&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/31823/original/7h4fvbmq-1379987412.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=564&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pill was introduced in Australia in 1961 but was initially available only to married women to control their family size.</span>
<span class="attribution"><span class="source">State Library of South Australia</span></span>
</figcaption>
</figure>
<p>Early trials did not mention the word “contraceptive”. While the researchers knew it was possible to stop a woman menstruating with the pill, they instead manipulated the regimen of the pill so that users would menstruate and have a 28-day cycle. In this way, the pill’s promoters were able to argue that the hormones in the pill were “mimicking nature” and were therefore “natural”. This was necessary to convince conservative forces to support its introduction. </p>
<p>The pill’s cause was also helped greatly by the population control movement, which was concerned about rapidly increasing populations, and the eugenics movement, which was concerned about high fertility rates among the poor.</p>
<h2>Modern battles</h2>
<p>There is <a href="http://www.theaustralian.com.au/higher-education/coalition-angers-research-community/story-e6frgcjx-1226712215714">plenty of evidence</a> that political forces still influence research agendas today. The introduction of <a href="https://theconversation.com/finally-greater-access-to-ru486-now-lets-collect-abortion-data-15722">medication abortion</a> in Australia was delayed due to <a href="https://theconversation.com/politics-v-womens-health-ru486-and-the-tga-saga-9472">political opposition</a>, and has only this year become more widely available in Australia, despite being used successfully in Europe for many years. </p>
<p>There is also no evidence of innovation in contraceptive methods. New methods introduced since 1960 are just different delivery methods for the same types of hormones used in the pill (implants and injectables) or newer versions of the IUD (Mirena). Nothing genuinely new has been developed. </p>
<p>And where is that male pill? It has been touted as <a href="https://theconversation.com/male-contraceptive-pill-a-step-closer-8905">being on the verge of release</a> for years.</p>
<p>We now accept that contraception is a fact of life. Women expect to be having sex for a number of years before commencing child-bearing, if at all, and they manage this using contraception. </p>
<p>But we still have trouble with abortion. Despite one in three Australian women <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Abortion_in_Australia">having an abortion in their lifetime</a>, we still blame the woman, and lament the poor decisions that led to her need for abortion. </p>
<p>We wrongly define women as either “good” managers of fertility, or “bad” ones. “Bad” managers of fertility either have a failure of contraception and need an abortion, or contracept after sex (using the emergency contraception), while “good” managers of fertility contracept before sex (using a hormonal or barrier method, or both).</p>
<p>We leave women carrying a lot of baggage around managing fertility – and blame them when something goes wrong – without many tools to do so.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/31825/original/t4vq6rwd-1379988237.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/31825/original/t4vq6rwd-1379988237.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/31825/original/t4vq6rwd-1379988237.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/31825/original/t4vq6rwd-1379988237.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/31825/original/t4vq6rwd-1379988237.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/31825/original/t4vq6rwd-1379988237.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/31825/original/t4vq6rwd-1379988237.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women expect to be having sex for a number of years before commencing child-bearing, if at all.</span>
<span class="attribution"><span class="source">Flickr/gareth Computer Malfunction Solved</span></span>
</figcaption>
</figure>
<h2>Towards real innovation</h2>
<p>An idea developed in social science studies of technology is that our science and technology reflect back to us our values as a society. If this is so, then the research into contraceptive technology indicates we believe contraception is a “woman’s” problem, not a man’s, and that it is okay to contracept before sex, but not after. </p>
<p>However, if we are serious about reducing the number of abortions in Australia, we need to find better contraceptives, offer men and women more options, and support them to use them as effectively as possible. </p>
<p>We need another Katherine McCormick: someone who is inspired to put resources into addressing the issues that women face today, because if history is anything to go by, governments and business are unlikely to take the risk.</p>
<p>We also need the imagination to devise genuinely new options and we need to break out of the old stereotypes about good and bad women, and instead look at how the technology we have limits and constrains our choices.</p><img src="https://counter.theconversation.com/content/18477/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Louise Keogh receives funding from the National Health and Medical Research Council.</span></em></p>More than 50 years after Australian women first had access to the oral contraceptive pill, research into new contraceptives has stalled and women are stuck with new versions of old products to manage their…Louise Keogh, Health Sociologist & Senior Lecturer, Centre for Women's Health, Gender & Society, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/151032013-06-12T05:32:45Z2013-06-12T05:32:45ZExplainer: why does female fertility decline?<figure><img src="https://images.theconversation.com/files/25378/original/j9jk57np-1371010042.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lisa Curry is attempting IVF to have a fourth child at the age of 51.</span> <span class="attribution"><span class="source">John Donegan/AAP Image</span></span></figcaption></figure><p>Former Olympic swimmer Lisa Curry has announced she will undergo fertility treatment to try to have a baby with her partner of three years. <a href="http://www.news.com.au/entertainment/celebrity/lisa-curry-reveals-she-is-trying-for-a-baby-at-51/story-fn907478-1226661688746">News reports</a> say doctors estimate she has less than a 10% chance of success.</p>
<p>Given her doctors also note Curry’s ovaries are in “much better shape than expected”, why is it that her chances of having a child through IVF are so low? After all, Curry already has three children, which shows she has been fertile. The main factor is her age – 51.</p>
<p>While age also affects male fertility (sperm quality decreases with age), men generate new sperm throughout most of their lives. A woman, on the other hand, is born with a finite number of oocytes (eggs) that start to develop soon after she is conceived.</p>
<h2>Declining numbers</h2>
<p>At birth, a girl will have approximately one million eggs but, through natural cell attrition, she’ll have around 400,000 left by the time she reaches puberty. These eggs will have remained in a quiescent, dormant stage until the onset of puberty. </p>
<p>In response to hormone surges, one egg (on average) will undergo the final stages of growth and be ovulated approximately every 28 days for between four and five decades.</p>
<p>The ovum is unique for being the largest cell in the body and the fact that can’t be regenerated. By the time it has ovulated and is ready to be fertilised, it’ll be at least a couple of decades old. Indeed, an ovum awaiting fertilisation can be up to 40 years old.</p>
<p>At peak <a href="http://yourfertility.org.au/">fertility</a> (between the ages of 17 and 25), a sexually active woman has a 20% to 25% chance of becoming pregnant each month. At 32, her fertility starts to decline and by 40, it has halved.</p>
<p>She now also has a higher risk of miscarriage, pregnancy complications, gestational diabetes and birth defects.</p>
<p>So what is happening?</p>
<h2>Deteriorating function</h2>
<p>We carry 46 chromosomes, with each parent contributing 23 of these. For this inheritance to go smoothly, eggs and sperm need to contain half the number of chromosomes as normal cells. </p>
<p>If sperm and eggs contained a full set of chromosomes (46), at the time of fertilisation, the resulting embryo would contain 92 chromosomes. Your parents contributing equal numbers of chromosomes also aids genetic variability (allowing you to inherit traits from both your mum and dad). </p>
<p>When the final stages of egg growth is triggered just before ovulation, it undergoes a process called meiosis. The main purpose of meiosis is to shed half the number of chromosomes in the egg (from 46 to 23). In order for meiosis to occur correctly, chromosomes are moved around the cell on scaffolding called spindles.</p>
<p>As women get older, <a href="http://www.ijdb.ehu.es/web/paper.php?doi=10.1387/ijdb.120141ue">the components of meiosis</a>, including the expression of genes that control its rate, the spindles and other repair mechanisms, deteriorate. This results in increasing numbers of eggs with incorrect numbers of chromosomes (this is called aneuploidy). </p>
<p>While most aneuploidies result in implantation failures (the inability for the embryo to embed in the uterine wall) or miscarriage, not all of them are lethal to the embryo. Incorrect numbers of chromosomes also result in Downs Syndrome, where a child has an extra chromosome 21.</p>
<p><a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8871716">Studies in mice</a> have revealed that the rate of chromosome misalignments increases from 15% in young mice (six to eight weeks old, which is their peak fertility) compared to 50% in aged mice (12 months old).</p>
<h2>Chromosome quality</h2>
<p>The quality of the chromosomes themselves is also compromised by age. </p>
<p>Telomeres are structures that protect chromosomes from damage, similar to the plastic bit at the end of shoelaces. Shortening of telomeres is associated with cell ageing throughout the body, including ageing eggs. </p>
<p>Eggs have shorter telomeres from decades of inactivity. In comparison, telomere length within sperm is not affected as sperm-producing cells contain <a href="http://www.fertstert.org/article/S0015-0282(12)02451-X/abstract">high levels of telomerase</a>, the enzymes involved in repairing telomeres. </p>
<p>The ability of eggs to produce energy also decreases with age. All cells contain organelles called mitochondria that produce energy. <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0064955">Comparisons between aged and young mice</a> show that ageing results in a 40% decrease in energy levels, 44% lower mitochondrial DNA and significant changes in the mitochondrial structure within the egg.</p>
<p>The combination of these and other factors, as well as the natural decline of the egg pool as women age, contribute to their decreasing fertility.</p>
<p>The introduction of the contraceptive pill, increased education and career opportunities have contributed to the increasing age of mothers. </p>
<p>Lisa Curry may have brought this issue into the spotlight but it is something that affects all of us, one way or another. </p><img src="https://counter.theconversation.com/content/15103/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melanie McDowall receives funding from National Health and Medical Research Council. She is affiliated with the Robinson Institute (The University of Adelaide).</span></em></p>Former Olympic swimmer Lisa Curry has announced she will undergo fertility treatment to try to have a baby with her partner of three years. News reports say doctors estimate she has less than a 10% chance…Mel McDowall, Researcher, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.