tag:theconversation.com,2011:/africa/topics/fertility-442/articlesFertility – The Conversation2024-03-25T16:35:25Ztag:theconversation.com,2011:article/2265402024-03-25T16:35:25Z2024-03-25T16:35:25ZHoli: what the clouds of colour in the Hindu festival mean<figure><img src="https://images.theconversation.com/files/584050/original/file-20240325-24-zvddmg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/a-group-of-people-covered-in-colored-powder-lcjdiDVv9Bo">Dibakar Roy|Unsplash</a></span></figcaption></figure><p>Holi is one of the most vibrant and fun festivals in the <a href="https://theconversation.com/rihannas-ganesh-pendant-hinduism-is-a-religion-not-a-pretty-aesthetic-155597">Hindu</a> calendar. It’s practised across India (though mainly in the north), Nepal and throughout south Asian diasporic communities. </p>
<p>The date of Holi varies in accordance with the lunar calendar but the festival often takes place in February or March. In 2024, it’s celebrated on March 25.</p>
<p>People gather together to throw and smear <em>gulal</em> or coloured powders over each other in a symbolic celebration of spring, the harvest, new life and the triumph of good over evil. As with many Hindu festivals, there is more than one narrative explaining its symbolism, but it is the visual splendour of this festival that explains its appeal. </p>
<p>My research <a href="https://www.godscollections.org/case-studies/hindu-domestic-shrines">focuses</a>, in part, on the religious and material culture of Hinduism, especially in relation to its practice in contemporary culture. One of the most uplifting aspects of Holi is the way people from all walks of life come together. It is an expression of the dynamism of Hinduism and the power of fellowship.</p>
<h2>An explosion of colour</h2>
<p>Holi conveys the exuberance and multisensory character of many Hindu festivals. The <a href="https://economictimes.indiatimes.com/magazines/panache/why-is-holi-a-big-deal-in-india-the-appeal-lies-beyond-colour-play/articleshow/108717138.cms?from=mdr#:%7E:text=The%20colors%20seen%20during%20Holi,ritual%20and%20ceremony%20%2D%20symbolize%20auspiciousness.">coloured powders</a> are typically red, yellow and green, representing the colours of spring but each also carrying more individual significance. </p>
<p>Red, which is popularly used in marriage celebrations, is the colour of fertility. Yellow is regarded as an auspicious colour. Green symbolises new beginnings. </p>
<p><a href="https://www.ijcmas.com/10-2-2021/Puja%20Basumatary,%20et%20al.pdf">Traditionally</a>, the coloured powders used in Holi festivities were <a href="https://artsandculture.google.com/story/science-behind-holi-the-festival-of-colors-national-council-of-science-museums/VQXxht4neVRtLw?hl=en">organically sourced</a> from dried flowers and herbs. Today they are synthetic. Celebrants throw or smear handfuls on each other, or use water-filled balloons or <em>pichkaris</em> (water pistols) to disperse coloured waster, adding to the carnivalesque feel of the event. </p>
<p>It is an immersive experience. Everyone comes together and merges in the magic of the crowd. Traditional hierarchies are suspended. Spontaneity and excitement take over. People talk about “playing” Holi in the powdered clouds of colour. </p>
<p>As an ancient tradition with multiple regional variations, Holi is underpinned by two prevailing narratives. The <a href="https://www.vam.ac.uk/blog/asia-department/festival-holi">first</a> is the <a href="https://theconversation.com/why-the-love-story-of-radha-and-krishna-has-been-told-in-hinduism-for-centuries-198716">eternal divine love</a> between Lord Krishna (the incarnation of the Hindu deity, Vishnu) and the goddess Radha. </p>
<figure class="align-center ">
<img alt="A historic Indian painting." src="https://images.theconversation.com/files/584079/original/file-20240325-30-59owv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584079/original/file-20240325-30-59owv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=482&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584079/original/file-20240325-30-59owv8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=482&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584079/original/file-20240325-30-59owv8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=482&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584079/original/file-20240325-30-59owv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=605&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584079/original/file-20240325-30-59owv8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=605&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584079/original/file-20240325-30-59owv8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=605&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A watercolour depicting Krishna and Radha celebrating Holi from 1750.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Krishna_and_Radha_Celebrating_the_Holi_Festival_with_Companions_LACMA_M.81.280.2.jpg">LACMA|Wikimedia</a></span>
</figcaption>
</figure>
<p>The other tells of the demon king <a href="https://encyclopedia.pub/entry/34653">Hiranyakashipu’s</a> attempt to force his subjects to worship him. When his son, Prahlad, persisted in worshipping Lord Vishnu instead, Hiranyakashipu instructed his sister, Holika, to kill Prahlad. </p>
<p>Holika, who was invulnerable to fire, made the boy sit on her lap, on a pyre. Onlookers were astonished to see, however, that Prahlad’s devotion to Lord Vishnu saved him while Holika <a href="https://timesofindia.indiatimes.com/religion/festivals/history-of-holi-5-fascinating-legends-behind-holi-and-holika-dahan/articleshow/98439636.cms">burned to death</a>. </p>
<p>The event of playing with colour, now synonymous with Holi, is actually part of a larger series of rituals. The first night of festival, known as <a href="https://www.freepressjournal.in/bhopal/bhopal-city-immerses-in-holika-dahan-celebrations">Holika Dahan</a>, involves lighting bonfires and throwing on food such as grains. As a re-enactment of the death of the mythical demoness Holika, this ritual marks the end of winter and the overthrow of evil. </p>
<p>The next day, Rangwali Holi, sees people venturing out on to the streets to exchange colour. In the final part of this festival, in the evening, after washing off the colours and donning clean clothes, people gather with family and friends to eat traditional dishes including <em>gujiya</em> (a North Indian sweet fried dumpling).</p>
<p>Like <a href="https://theconversation.com/diwali-a-celebration-of-the-goddess-lakshmi-and-her-promise-of-prosperity-and-good-fortune-191992">Diwali</a> (the “festival of lights” as it is often known) and the Hindu new year, Holi is celebrated by the Hindu diaspora in the UK, the US, <a href="https://www.tandfonline.com/doi/abs/10.1080/07256860701759956">Fiji</a>, <a href="https://www.researchgate.net/publication/324539407_Hinduism_in_Mauritius">Mauritius</a> and beyond. Temple organisations host Holi in their venues. Unlike <a href="https://www.jstor.org/stable/44713556?mag=gender-and-caste-at-holi">in India</a> where festivities are public and widespread, diasporic celebrations are more regulated to specific spaces and times. </p>
<figure class="align-center ">
<img alt="A crowd under a sky of colours." src="https://images.theconversation.com/files/584055/original/file-20240325-22-au9246.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584055/original/file-20240325-22-au9246.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584055/original/file-20240325-22-au9246.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584055/original/file-20240325-22-au9246.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584055/original/file-20240325-22-au9246.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584055/original/file-20240325-22-au9246.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584055/original/file-20240325-22-au9246.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">A Holi festival in Spanish Fork, Utah.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/people-gathering-on-a-concert-LtE6W_JVTGc">John Thomas|Unsplash</a></span>
</figcaption>
</figure>
<p>Parties for Holi are not uncommon. You can routinely find events organised each year on platforms such as <a href="https://www.eventbrite.com/d/united-kingdom--london/holi-festival/">Eventbrite</a> where ticket sales often include the prior purchase of <a href="https://www.ministryofcolours.co.uk/">non-toxic powders</a>. </p>
<p>Some of these events are targeted at south Asian communities. They include renactments of plays, dance performances and further heritage elements. </p>
<p>Others capitalise on the spirit of revelry embodied by commercially driven <a href="https://time.com/5799354/what-is-holi/">colour marathons</a>. These have elicited claims of <a href="https://theconversation.com/diwali-in-the-uk-how-commodifying-minority-religions-can-risk-cultural-appropriation-192974">cultural appropriation</a> for their largely secular tone.</p><img src="https://counter.theconversation.com/content/226540/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rina Arya 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>Holi is a symbolic celebration of spring, the harvest, new life and the triumph of good over evil.Rina Arya, Professor of Critical and Cultural Theory and Head of the School of the Arts, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2244762024-02-29T13:40:25Z2024-02-29T13:40:25ZWhat is IVF? A nurse explains the evolving science and legality of in vitro fertilization<figure><img src="https://images.theconversation.com/files/578412/original/file-20240227-28-67xx7p.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some of the eggs and sperm in these tubes stored in liquid nitrogen may go on to form an embryo.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/january-2024-berlin-eggs-and-sperm-are-stored-in-a-liquid-news-photo/1954098470">Jens Kalaene/picture alliance via Getty Images</a></span></figcaption></figure><p><em>Since the <a href="https://www.npr.org/2022/06/24/1102305878/supreme-court-abortion-roe-v-wade-decision-overturn">overturning of Roe v. Wade in June 2022</a> ended the federal right to abortion, legislative attention has extended to many other aspects of reproductive rights, including access to assisted reproductive technologies such as in vitro fertilization, or IVF, after an Alabama Supreme Court ruling in February 2024.</em></p>
<p><em>University of Massachusetts Lowell associate professor and department chair of the school of nursing <a href="https://scholar.google.com/citations?user=6rrHhmUAAAAJ&hl=en">Heidi Collins Fantasia</a> explains how this decades-old procedure works and what its tenuous legal status means for prospective parents.</em></p>
<h2>What is IVF?</h2>
<p>IVF is a type of artificial reproductive technology that allows people with a range of fertility issues to conceive a child. It involves fertilizing an egg with sperm <a href="https://medlineplus.gov/ency/article/007279.htm">outside the body</a> to form an embryo that is then transferred into the uterus to develop.</p>
<p>IVF is used as a treatment <a href="https://asrmcongress.org/asrm-publishes-a-new-more-inclusive-definition-of-infertility/">for infertility</a>, which the <a href="https://asrmcongress.org/asrm-publishes-a-new-more-inclusive-definition-of-infertility/">American Society for Reproductive Medicine</a> defines as an inability to achieve pregnancy “based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing” or the “need for medical intervention.” </p>
<p>While originally developed as a fertility treatment for <a href="https://www.ncbi.nlm.nih.gov/books/NBK562266/">blocked fallopian tubes</a>, IVF is currently used for other conditions such as low sperm count or when the cause for infertility can’t be determined. <a href="https://www.usatoday.com/story/money/2023/06/13/ivf-cost-higher-for-lgbtq-couples/11135417002/">LGBTQ people</a> and <a href="https://www.nytimes.com/2020/05/05/parenting/single-moms-by-choice-photos.html">single parents</a> can also use IVF and other reproductive technologies to grow their families.</p>
<h2>How does IVF work?</h2>
<p>Typically during IVF, a patient takes hormones to stimulate the ovaries to produce eggs. Once a health professional retrieves the eggs using an ultrasound and a thin needle, they either incubate the sperm with the egg or <a href="https://www.ncbi.nlm.nih.gov/books/NBK562266/">inject the sperm into the egg</a> in the lab to fertilize it. Which specific type of IVF procedure a patient undergoes is determined on an individual basis with a health care provider.</p>
<p>Scientists began to develop IVF in the 1930s, beginning with the <a href="https://doi.org/10.1387/ijdb.180364mj">live birth of rabbits and mice</a> through the procedure. This research eventually led to the birth of the <a href="https://time.com/5344145/louise-brown-test-tube-baby/">first “test-tube baby”</a> in 1978. Physiologist Robert Edwards received the <a href="https://www.nobelprize.org/prizes/medicine/2010/press-release/">2010 Nobel Prize in physiology or medicine</a> for his research on IVF.</p>
<p>The technology has rapidly expanded since the first live human birth from IVF. The <a href="https://doi.org/10.1016/j.bbagen.2011.05.001">development of cryopreservation</a>, or the freezing of human eggs and embryos, has enabled people to pursue pregnancy later in life. <a href="https://doi.org/10.1016/j.bbagen.2011.05.001">Genetic screening</a> of cells from a developing embryo can identify genetic diseases and abnormalities.</p>
<p>The chance of a successful live birth through assisted reproductive technologies varies. <a href="https://www.cdc.gov/art/artdata/index.html">Success rates</a> depend on many factors, such as underlying cause of infertility, age and type of technology used.</p>
<h2>Who currently has access to IVF?</h2>
<p>Use of IVF has steadily increased since it was first introduced. In 2015, about <a href="http://dx.doi.org/10.15585/mmwr.ss6703a1">2% of all infants</a> in the U.S. were conceived as a result of IVF, and <a href="https://doi.org/10.1007/s10815-022-02687-7">public support for IVF is high</a> overall.</p>
<p>Approximately <a href="https://www.pewresearch.org/short-reads/2023/09/14/a-growing-share-of-americans-say-theyve-had-fertility-treatments-or-know-someone-who-has/">10% of women in the U.S.</a> have used some type of <a href="https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/">fertility service</a> to achieve a pregnancy. This includes fertility advice, medications to increase ovulation, fertility testing, surgery and IVF. </p>
<p>Because infertility increases with age, <a href="https://www.cdc.gov/nchs/fastats/infertility.htm">women older than 35</a> typically use these services more often than younger women. Women in the U.S. who <a href="https://doi.org/10.1016/j.fertnstert.2019.04.044">access infertility care the least</a> are often non-U.S. citizens and uninsured, and they typically have lower income and less education than women who do.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Clear batches of containers of eggs and embryos in a large, frozen circular container" src="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cryopreservation gives prospective parents more time to pursue pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/frozen-embryos-and-eggs-in-nitrogen-cooled-royalty-free-image/520157312">Ted Horowitz Photography/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<p><a href="https://www.cdc.gov/art/state-specific-surveillance/2021/figures.html#figure5">Differences in geography</a> also affect IVF access. In 2021, over 5% of all infants in Massachusetts were conceived from IVF, but this dropped to less than 1% in New Mexico, Arkansas and Mississippi.</p>
<p>Service availability and insurance coverage for IVF procedures differ by state, which could account for some of the differences in use. Only a <a href="https://resolve.org/learn/financial-resources-for-family-building/insurance-coverage/insurance-coverage-by-state/">small number of states</a> mandate that private insurers cover IVF. <a href="https://reproductiverights.org/fact-sheet-infertility-and-ivf-access-in-the-united-states-a-human-rights-based-policy-approach/">Public insurance coverage</a> for infertility services is even lower. </p>
<p>The <a href="https://doi.org/10.1186/s12958-022-00984-5">cost of IVF</a> has been the greatest barrier to infertility care. <a href="https://doi.org/10.1186/s12958-022-00984-5">Out-of-pocket costs</a> for people without insurance coverage can range from over US$10,000 to $25,000 per cycle, with rising costs per cycle.</p>
<h2>How do debates about when life begins affect IVF?</h2>
<p>Political views vary around reproductive rights, and <a href="https://www.cbsnews.com/news/republicans-senate-ivf-alabama-ruling/">access to IVF</a> is likely to become an issue in upcoming election cycles.</p>
<p>The <a href="https://www.washingtonpost.com/nation/2024/02/20/alabama-supreme-court-ivf-embryos/">Alabama Supreme Court ruled</a> in February 2024 that frozen embryos created during the process of IVF were people. While the ruling currently applies only to Alabama, it has caused <a href="https://www.theguardian.com/society/2024/feb/23/fertility-doctors-reaction-alabama-embryo-ruling">shock, confusion and concern</a> among health care providers. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/OsbGVgnHLBM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Clinicians and people relying on IVF to expand their families are concerned about U.S. legislation around reproduction.</span></figcaption>
</figure>
<p>As a result of the ruling, two major <a href="https://www.pbs.org/newshour/health/a-2nd-alabama-ivf-provider-pauses-parts-of-its-program-after-court-ruling-on-frozen-embryos">IVF providers in Alabama</a> have paused infertility care because of potential legal risk to health care providers. The main concern is whether providers can be held <a href="https://www.cnn.com/2024/02/24/health/alabama-ivf-roe-v-wade/index.html">liable for wrongful death</a> if frozen embryos don’t survive the thawing process. </p>
<p>Since the elimination of federal protection of abortion in 2022 with the overturning of Roe v. Wade, individual states have made their <a href="https://www.americanprogress.org/article/a-year-after-the-supreme-court-overturned-roe-v-wade-trends-in-state-abortion-laws-have-emerged/">own laws regarding abortion access</a>. Many patients, health care providers, researchers and legislators see the Alabama decision regarding IVF as a continuation of the increasing <a href="https://www.pbs.org/newshour/show/how-an-alabama-supreme-court-ruling-that-frozen-embryos-are-children-impacts-ivf">erosion of women’s reproductive rights</a>.</p><img src="https://counter.theconversation.com/content/224476/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heidi Collins Fantasia is the editor for Nursing for Women's Health. </span></em></p>IVF is a decades-old procedure that has allowed increasing numbers of prospective parents to have children. Evolving legislation may put it under threat.Heidi Collins Fantasia, Associate Professor of Nursing, UMass LowellLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2243652024-02-27T04:06:50Z2024-02-27T04:06:50ZAlabama ruling frozen embryos are equivalent to living children has worrying implications for IVF<figure><img src="https://images.theconversation.com/files/578118/original/file-20240227-28-8t4spu.jpg?ixlib=rb-1.1.0&rect=49%2C0%2C5472%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dewar-liquid-nitrogen-straws-frozenn-embryos-1225485064">Ekaterina Georgievskaia/Shutterstock</a></span></figcaption></figure><p>In <a href="https://static01.nyt.com/newsgraphics/documenttools/4b56014daa6dda84/a039b1d9-full.pdf">December 2020 in Alabama</a>, a hospital patient gained unauthorised access to an adjoining IVF storage facility, which was not adequately secured. The patient is said to have removed several frozen embryos, which they then dropped on the floor, owing to a freeze-burn to their hand. The embryos were destroyed.</p>
<p>In Alabama, the <a href="https://casetext.com/statute/code-of-alabama/title-6-civil-practice/chapter-5-actions/article-22-injury-and-death-of-minor/section-6-5-391-wrongful-death-of-minor">Wrongful Death of a Minor Act</a> allows parents of a deceased child to recover punitive damages for their child’s death, and <a href="https://www.abc.net.au/news/2024-02-25/ivf-frozen-embryo-alabama-supreme-court-ruling/103501872">three couples affected</a> by the incident subsequently brought lawsuits against the clinic under this legislation.</p>
<p>When this case was heard recently in the Supreme Court of Alabama, the majority of justices opined this statute <a href="https://static01.nyt.com/newsgraphics/documenttools/4b56014daa6dda84/a039b1d9-full.pdf">applies to frozen embryos</a> because:</p>
<blockquote>
<p>an unborn child is a genetically unique human being whose life begins at fertilization and ends at death.</p>
</blockquote>
<p>This essentially means frozen embryos are protected under Alabama law to the same extent as any living child. While this was a civil matter, it’s not inconceivable that, based on this interpretation, anyone who destroys a frozen embryo in Alabama – accidentally or on purpose – could face criminal penalties, such as manslaughter or even murder charges. </p>
<p>Likely for fear it’s too risky, clinics in the state are now limiting their IVF services, leaving patients having to <a href="https://www.today.com/video/more-clinics-in-alabama-stop-ivf-treatments-after-court-ruling-204773957818">seek treatment elsewhere</a>.</p>
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Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<p>Ascribing personhood to frozen embryos is not a novel idea, but such a conviction is held only by the very fringes of the religious and conservative spectrum. There are clear political dimensions to this ruling, which appears to be an extension of a radical agenda on the altar of which the <a href="https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf">Supreme Court of the United States</a> recently sacrificed the right to abortion. </p>
<p>This ruling from the Supreme Court of Alabama reflects a profound ignorance about how the process of IVF works.</p>
<h2>Creating multiple embryos is essential for overall IVF success</h2>
<p>The process of in vitro fertilisation, or IVF, begins with a “stimulated” cycle, where hormones are injected into a woman to stimulate an ovary to produce multiple eggs. These eggs are then collected and combined with sperm, forming embryos that are placed in an incubator to grow. </p>
<p>Five days later, the embryos are assessed. Some develop into “good quality” embryos suitable for transfer into a woman’s uterus. The hope is that following the transfer, the embryo will implant and result in a viable pregnancy, ultimately leading to the birth of a healthy child. Any good-quality embryos not used in a stimulated cycle are usually frozen for future attempts.</p>
<p>Unfortunately, IVF is somewhat inefficient, with attrition a prominent feature at every stage. Not all collected eggs are suitable for fertilisation, not all fertilise, not all embryos fertilise normally, and not all normally-fertilised embryos are of good quality. Poor-quality eggs, abnormally-fertilised embryos and poor-quality embryos are routinely discarded.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1760408483688534266"}"></div></p>
<p>The practical implications of this process and the heartbreaking reality for individuals and couples undergoing IVF is that it takes, on average, three to five eggs to produce <a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202021.pdf">one good-quality embryo</a>. However, this number is age-dependent and significantly higher for older women. </p>
<p>The chance of achieving pregnancy from one embryo transfer is also significantly influenced by <a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202021.pdf">the woman’s age</a>, being as high as 50% in younger women but decreasing exponentially as a woman gets older. At the age of 46, it can be as low as 1-2%. </p>
<p>So it’s vital to be able to safely produce as many good-quality embryos as possible from one stimulated IVF cycle in case multiple sequential embryo transfers are needed to achieve a healthy pregnancy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-business-of-ivf-how-human-eggs-went-from-simple-cells-to-a-valuable-commodity-119168">The business of IVF: how human eggs went from simple cells to a valuable commodity</a>
</strong>
</em>
</p>
<hr>
<p>Should the initial embryo transfer fail to produce a viable pregnancy, and frozen embryos are available, those can be thawed and transferred into a woman’s uterus in a “thaw” cycle. These cycles usually don’t require the use of injectable hormones or an egg collection and, in most instances, require only monitoring (including ultrasounds and blood tests), and timed embryo transfer.</p>
<p>The risks associated with IVF, such as bleeding and infections, are mostly confined to the stimulated cycles, while thaw cycles <a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202021.pdf">pose minimal risk</a>. Notably, the most labour-intensive, and, therefore, costly portion is the stimulated cycle, while a thaw cycle can be around three to four times cheaper. </p>
<p>Should embryo freezing become unavailable, all people undergoing IVF would have to rely solely on stimulated cycles to achieve pregnancy, significantly increasing the risks and radically escalating the costs.</p>
<h2>The judge’s error in interpreting Australian practice</h2>
<p>Tom Parker, the Chief Justice of the Supreme Court of Alabama, made the following statement in his judgement:</p>
<blockquote>
<p>in Australia and New Zealand, prevailing ethical standards dictate that physicians usually create only one embryo at a time.</p>
</blockquote>
<p>He implied that in Australia, the only IVF cycles ethically permitted are stimulated cycles, where just one embryo is created and transferred, with no embryos being frozen. </p>
<figure class="align-center ">
<img alt="A pregnant woman holding her stomach." src="https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.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 women need the help of IVF to become pregnant.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/image-pregnant-woman-touching-her-belly-147978782">10 FACE/Shutterstock</a></span>
</figcaption>
</figure>
<p>However, this assertion is demonstrably false. There are no guidelines or regulations in Australia that discourage the creation of multiple embryos, as this practice enhances overall pregnancy rates, while making IVF safer and more cost-effective. </p>
<p>What is discouraged is the <em>transfer</em> of multiple embryos at one time, as this increases the likelihood of multiple births, which carry <a href="https://www.fertilitysociety.com.au/wp-content/uploads/20211124-RTAC-ANZ-COP.pdf">heightened medical risks</a> for both mothers and babies.</p>
<p>It seems the Chief Justice has fundamentally misunderstood the Australian regulatory framework. Ironically, the <a href="https://www.varta.org.au/sites/default/files/2023-11/VARTA_AR2023.pdf">excellent IVF outcomes</a> and very low rates of multiple births in Australia are largely attributable to the widespread use of frozen embryo transfer cycles – a practice now <a href="https://www.today.com/video/more-clinics-in-alabama-stop-ivf-treatments-after-court-ruling-204773957818">under threat</a> in Alabama.</p><img src="https://counter.theconversation.com/content/224365/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am a fertility specialist and a Medical Director of Genea Fertility Melbourne, a private IVF unit.</span></em></p>A recent ruling from the Supreme Court of Alabama implies frozen embryos are legally equivalent to living children. This creates risks for IVF providers, and therefore problems for patients.Alex Polyakov, Medical Director, Genea Fertility Melbourne; Clinical Associate Professor, Faculty of Medicine, Dentistry & Health Sciences, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225672024-02-15T13:16:03Z2024-02-15T13:16:03ZMost people would be equally satisfied with having one child as with two or three – new research<figure><img src="https://images.theconversation.com/files/575046/original/file-20240212-18-cr3m9v.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2650%2C1918&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/diverse-culture-families-playing-children-on-644803663">Tint Media/Shutterstock</a></span></figcaption></figure><p>Picture your ideal family. Do you have children? How many?</p>
<p>It’s fairly well established that when asked about their ideal family, people <a href="https://uk.style.yahoo.com/parents-happiest-with-this-number-of-children-130657574.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAALSMoZY_favqh1RLJg3osUVkZY4Rcc-gZ73Db3kMC4q4wHFgjNXJeTMPDGEwWCJfcYMawoqwwsnmEprKNbIpz1qN6Dh3gSvg3SLmTlvez2ll1oiAXxQics4EvK5c5M4Kw73OjCf2ADaZ_uO3NxJkkhniFfs20KNzuUuLll_4-5Mi">tend to say</a> that <a href="https://www.businessinsider.com/american-families-ideal-number-of-kids-cost-raising-child-expensive-2023-11?r=US&IR=T">two children</a> is the best number to have. But this regularity has come about from asking the simple question: “Ideally, how many children would you like to have?”. </p>
<p>But if two children really was the best number to have, surely most people would have two – but they don’t. In South Korea, the average number of children is less than one per woman. In the US it’s 1.64. </p>
<p>A huge number of studies have tried to figure out why this is – why there’s a gap between the number of children people say they want, and how many they have. But it turns out we may have been asking the wrong questions. </p>
<p>When you take a different approach and ask people to rate different options of family life, you get a far more accurate idea of what people are happy with. <a href="https://www.pnas.org/doi/10.1073/pnas.2311847121">My research</a> with colleagues has done just this. I found that people still valued parenthood. But they valued having one child just as highly as having two or three. </p>
<h2>Family values</h2>
<p>A family isn’t just about the number of children. There are a whole range of other things to consider when thinking about what your ideal family might look like. Are you married, cohabiting, or a single parent? Who does the washing up and changes the nappies? What does the work-life balance in your family look like? </p>
<figure class="align-center ">
<img alt="Family of three in kitchen" src="https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575047/original/file-20240212-20-gm8rij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We found that number of children mattered less than you might expect.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-young-family-three-home-kitchen-45888763">michaeljung/Shutterstock</a></span>
</figcaption>
</figure>
<p>When you bring in factors like this, the ideal number of children starts to change. </p>
<p>We carried out research with around 10,000 people in a range of countries: the US, Norway, Italy, Spain, Japan, China, South Korea and Singapore. We showed each person in the study six scenarios with descriptions of different families. Half of the respondents were shown scenarios that included families with no children as well as with children, and the other half saw scenarios that included families with one, two or three children. </p>
<p>These scenarios had further varying factors, such as traditional or egalitarian gender roles and the amount of contact with extended family. In some, family members communicated well, and not in others. We asked the people in our study to rate these different scenarios on a scale from one to ten.</p>
<p>The findings are clear. Looking at all the responses, overall people do feel that a family with no children is not ideal. Parenthood still matters. But there is no discernable difference in how people rated the families with one, two or three children. </p>
<p>The only outlier is China, where people viewed having three children somewhat negatively: understandable after decades of policies curbing fertility. Nowhere in our study was having just one child viewed more negatively. </p>
<h2>Importance of communicating</h2>
<p>What does come out very strongly is the role of communication, both within the nuclear family but also with grandparents. This characteristic is the most important feature of the ideal family of today.</p>
<p>If you think about it, this finding is not all too unexpected. Good communication means strong emotional support – and that is what most people would like to receive from a family. If communication breaks down, then why bother with having a family if you can get the necessary support elsewhere through friends and other social networks?</p>
<p>Other features matter too – obviously. Respondents viewed low income negatively (apart from in Norway). More egalitarian gender roles and good work-life balance are important. But our findings, which are remarkably similar across different countries, show that good communication matters the most in people’s vision for good family life – more than the number of children they might have.</p><img src="https://counter.theconversation.com/content/222567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arnstein Aassve receives funding from Horizon Europe. </span></em></p>We found no discernable difference in how people rated family scenarios with one, two or three children.Arnstein Aassve, Professor in Demography, Bocconi UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2202822024-02-15T00:00:55Z2024-02-15T00:00:55ZFeminist narratives are being hijacked to market medical tests not backed by evidence<figure><img src="https://images.theconversation.com/files/575240/original/file-20240213-27-twey75.jpg?ixlib=rb-1.1.0&rect=252%2C97%2C6218%2C4210&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-sitting-on-floor-and-leaning-on-couch-using-laptop-Nv-vx3kUR2A">Thought Catalog/Unsplash</a></span></figcaption></figure><p>Corporations have used feminist language to promote their products for decades. In the 1980s, companies co-opted messaging about female autonomy to encourage women’s consumption of unhealthy commodities, <a href="https://www.mdpi.com/1660-4601/17/21/7902">such as tobacco and alcohol</a>. </p>
<p>Today, feminist narratives around empowerment and women’s rights are being co-opted to market interventions that are not backed by evidence across many areas of women’s health. This includes by commercial companies, industry, mass media and well-intentioned advocacy groups. </p>
<p>Some of these health technologies, tests and treatments are useful in certain situations and can be very beneficial to some women. </p>
<p>However, promoting them to a large group of asymptomatic healthy women that are unlikely to benefit, or without being transparent about the limitations, runs the risk of causing more harm than good. This includes inappropriate medicalisation, overdiagnosis and overtreatment. </p>
<p>In our analysis published today in the <a href="https://www.bmj.com/content/384/bmj-2023-076710">BMJ</a>, we examine this phenomenon in two current examples: the anti-mullerian hormone (AMH) test and breast density notification.</p>
<h2>The AMH test</h2>
<p>The AMH test is a blood test associated with the number of eggs in a woman’s ovaries and is sometimes referred to as the “egg timer” test. </p>
<p>Although often used in fertility treatment, the AMH test cannot reliably predict the <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">likelihood of pregnancy</a>, timing to pregnancy or <a href="https://academic.oup.com/humupd/article/29/3/327/6990969">specific age of menopause</a>. The American College of Obstetricians and Gynaecologists therefore <a href="https://pubmed.ncbi.nlm.nih.gov/30913192/">strongly discourages testing</a> for women not seeking fertility treatment. </p>
<figure class="align-center ">
<img alt="Woman sits in a medical waiting room" src="https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The AMH test can’t predict your chance of getting pregnant.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-sitting-on-a-bench-in-a-waiting-area-UssKpGyrBzw">Anastasia Vityukova/Unsplash</a></span>
</figcaption>
</figure>
<p>Despite this, several <a href="https://bmjopen.bmj.com/content/11/7/e046927.info">fertility clinics</a> and <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808552">online companies</a> market the AMH test to women not even trying to get pregnant. Some use feminist rhetoric promising empowerment, selling the test as a way to gain personalised insights into your fertility. For example, “<a href="https://www.ondemand.labcorp.com/lab-tests/womens-fertility-test">you deserve</a> to know your reproductive potential”, “<a href="https://kinfertility.com.au/fertility-test">be proactive</a> about your fertility” and “<a href="https://monashivf.com/services/early-intervention/amh-blood-test/">knowing your numbers</a> will empower you to make the best decisions when family planning”. </p>
<p>The use of feminist marketing makes these companies appear socially progressive and champions of female health. But they are selling a test that has no proven benefit outside of IVF and cannot inform women about their current or future fertility. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-believe-the-hype-egg-timer-tests-cant-reliably-predict-your-chance-of-conceiving-or-menopause-timing-207008">Don't believe the hype. 'Egg timer' tests can't reliably predict your chance of conceiving or menopause timing</a>
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</em>
</p>
<hr>
<p>Our <a href="https://academic.oup.com/humrep/article/38/8/1571/7193900?login=false">recent study</a> found around 30% of women having an AMH test in Australia may be having it for these reasons.</p>
<p>Misleading women to believe that the test can reliably predict fertility can create a false sense of security about delaying pregnancy. It can also create unnecessary anxiety, pressure to freeze eggs, conceive earlier than desired, or start fertility treatment when it may not be needed.</p>
<p>While some companies mention the test’s limitations if you read on, they are glossed over and contradicted by the calls to be proactive and messages of empowerment. </p>
<h2>Breast density notification</h2>
<p>Breast density is one of several independent risk factors for breast cancer. It’s also harder to see cancer on a mammogram image of breasts with high amounts of dense tissue than breasts with a greater proportion of fatty tissue. </p>
<p>While estimates vary, approximately 25–50% of women in the breast screening population <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200066/">have dense breasts</a>.</p>
<figure class="align-center ">
<img alt="Young woman has mammogram" src="https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dense breasts can make it harder to detect cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-taking-mammogram-xray-test-75178006">Tyler Olsen/Shutterstock</a></span>
</figcaption>
</figure>
<p>Stemming from valid concerns about the increased risk of cancer, advocacy efforts have used feminist language around women’s right to know <a href="https://insightplus.mja.com.au/2022/34/breast-density-we-can-handle-the-truth/#:%7E:text=%E2%80%9CWomen%20can%20handle%20the%20truth,need%20to%20know%20that%20truth.">such as</a> “women need to know the truth” and “women can handle the truth” to argue for widespread breast density notification. </p>
<p>However, this simplistic messaging overlooks that this is a complex issue and that <a href="https://ebm.bmj.com/content/26/6/309">more data is still needed</a> on whether the benefits of notifying and providing additional screening or tests to women with dense breasts outweigh the harms. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-breast-cancer-in-women-what-we-know-dont-know-and-suspect-86314">What causes breast cancer in women? What we know, don't know and suspect</a>
</strong>
</em>
</p>
<hr>
<p>Additional tests (ultrasound or MRI) are now being recommended for women with dense breasts as they have the ability to detect more cancer. Yet, there is no or little mention of the <a href="https://www.nejm.org/doi/full/10.1056/NEJMe1912943">lack of robust evidence</a> showing that it prevents breast cancer deaths. These extra tests also have out-of-pocket costs and high rates of false-positive results. </p>
<p>Large international advocacy groups are also sponsored by companies that will <a href="https://www.volparahealth.com/news/volpara-announces-expanded-sponsorship-of-densebreast-info-org-at-sbi-2023/">financially benefit from women being notified</a>.</p>
<p>While stronger patient autonomy is vital, campaigning for breast density notification without stating the limitations or unclear evidence of benefit may go against the empowerment being sought. </p>
<h2>Ensuring feminism isn’t hijacked</h2>
<p>Increased awareness and advocacy in women’s health are key to overcoming sex inequalities in health care. </p>
<p>But we need to ensure the goals of feminist health advocacy aren’t undermined through commercially driven use of feminist language pushing care that isn’t based on evidence. This includes more transparency about the risks and uncertainties of health technologies, tests and treatments and greater scrutiny of conflicts of interests. </p>
<p>Health professionals and governments must also ensure that easily understood, balanced information based on high quality scientific evidence is available. This will enable women to make more informed decisions about their health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/young-women-wont-be-told-how-to-behave-but-is-girlboss-just-deportment-by-another-name-132351">Young women won't be told how to behave, but is #girlboss just deportment by another name?</a>
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<img src="https://counter.theconversation.com/content/220282/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brooke Nickel receives fellowship funding from the National Health and Medical Research Council (NHMRC). She is on the Scientific Committee of the Preventing Overdiagnosis Conference.</span></em></p><p class="fine-print"><em><span>Tessa Copp receives fellowship funding from the National Health and Medical Research Council (NHMRC). She is also on the Scientific Committee of the Preventing Overdiagnosis Conference. </span></em></p>Corporate medicine is hijacking feminist narratives around empowerment and women’s rights to market technologies, tests and treatments that aren’t backed by evidence.Brooke Nickel, NHMRC Emerging Leader Research Fellow, University of SydneyTessa Copp, NHMRC Emerging Leader Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225332024-02-14T16:55:57Z2024-02-14T16:55:57ZMen become less fertile with age, but the same isn’t true for all animals – new study<figure><img src="https://images.theconversation.com/files/573049/original/file-20240202-27-wscv4y.jpg?ixlib=rb-1.1.0&rect=0%2C34%2C5833%2C3938&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/colorful-balloons-spermatozoid-shape-on-blue-1100465771">olliulli/Shutterstock</a></span></figcaption></figure><p>We take it for granted that humans find it <a href="https://www.tandfonline.com/doi/full/10.3109/09513590.2010.501889">more difficult to conceive</a> as they grow older. But <a href="https://www.nature.com/articles/s41467-024-44768-4">our recent study</a>, which analysed data from 157 animal species, found that male reproductive ageing seems to be a lot less common in other male animals. </p>
<p>With fertility in men <a href="https://www.bmj.com/content/305/6854/609">declining worldwide</a>, understanding ageing of sperm in other animals could give new insights into our own fertility. </p>
<p>Human fertility declines with age because sperm and eggs of older people are <a href="https://academic.oup.com/humupd/article/11/3/261/759255">more deteriorated</a> or fewer in number than those of young people. Reproducing at an older age not only affects your fertility, but can also <a href="https://www.nature.com/articles/nrurol.2013.18">reduce the fertility</a>, survival rate and physical and cognitive performance of the children you conceive.</p>
<h2>Humans versus other animals</h2>
<p>Humans <a href="https://link.springer.com/article/10.1007/s00239-019-09896-2">live considerably longer</a> than we did just a century ago. This <a href="https://www.pnas.org/doi/full/10.1073/pnas.0909606106">recent, rapid extension</a> in our longevity might be one reason why humans reproductively age at faster rates than other animals. Our reproductive ageing rate hasn’t slowed down yet to match our longer lifespans. </p>
<p>Animals might also face greater evolutionary pressure to maximise their reproductive potential at all ages, because most animals reproduce throughout their lives. But this isn’t the case for humans. We rarely <a href="https://academic.oup.com/humrep/article/29/6/1304/625687">reproduce</a> in our late life. </p>
<p>Additionally, we have <a href="https://academic.oup.com/humrep/article/37/4/629/6515525">fewer offspring</a> compared to our ancestors. This makes it harder for natural selection to select genes that improve human reproduction due to less variation in the population’s fecundity. </p>
<h2>Females versus males</h2>
<p>Males and females in many species age reproductively at different rates. </p>
<p>For instance, in red wolves, male reproductive success declines with age but it <a href="https://link.springer.com/article/10.1007/s00265-016-2241-9">does not</a> for females. Yet female killifish show stronger decline in fertility with age <a href="https://besjournals.onlinelibrary.wiley.com/doi/pdf/10.1111/1365-2656.13382">than males</a>. Despite the fact human females live longer than males, they tend to become infertile <a href="https://www.science.org/doi/abs/10.1126/science.3755843">earlier than men</a>, and go through menopause. </p>
<p>In some species, including humans, where females help raise their grand-offspring (such as humans and whales), females live <a href="https://www.sciencedirect.com/science/article/pii/S0960982218316828?via%3Dihub">much beyond the age</a> of reproduction. An <a href="https://royalsocietypublishing.org/doi/full/10.1098/rsos.191972">evolutionary explanation</a> for this is that older females can better pass on their genes by helping their relatives survive and rear young than by reproducing themselves.</p>
<p>There are some hypotheses that try to explain these <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/acel.13542">sex-specific differences</a> in reproductive ageing. </p>
<p>Sperm are continuously produced in males, but eggs in many species, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8769179/">including humans</a>, are produced early in the life of females. This might lead eggs to <a href="https://academic.oup.com/humupd/article/6/6/532/616993">accumulate more damage</a> due to being stored for longer durations inside older females than sperm are stored in old males. </p>
<p>Another hypothesis suggests that males might age faster because sperm DNA <a href="https://elifesciences.org/articles/80008">accumulate more</a> mutations than egg DNA. Sperm have poorer DNA repair machinery than eggs, causing males to <a href="https://www.nature.com/articles/s41586-023-05752-y">pass on more mutations</a> to the next generation than females with advancing age, a pattern observed across vertebrate animals.</p>
<p>Sexes also face different environmental pressures. For instance, in many mammals, males, <a href="https://theconversation.com/of-mice-and-matriarchs-the-female-led-societies-of-the-animal-kingdom-186875">but not females</a>, disperse away from the family group when they mature. This sort of environmental pressure leads to differences in the strategies males and females use to pass on their genes, which can create differences in <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/acel.13542">rates of reproductive ageing</a> between the sexes. </p>
<figure class="align-center ">
<img alt="Humpback whale mother with her calf" src="https://images.theconversation.com/files/573052/original/file-20240202-19-valjo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573052/original/file-20240202-19-valjo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573052/original/file-20240202-19-valjo5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573052/original/file-20240202-19-valjo5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573052/original/file-20240202-19-valjo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573052/original/file-20240202-19-valjo5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573052/original/file-20240202-19-valjo5.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">
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<span class="caption">Female whales live long after their reproductive window.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/humpback-whale-mother-calf-on-tonga-1907017690">Tomas Kotouc/Shutterstock</a></span>
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<h2>Patterns of reproductive ageing in animals</h2>
<p>In our study, we showed that reproductive ageing rates in males <a href="https://www.nature.com/articles/s41467-024-44768-4">vary vastly</a> across the animal kingdom. We found invertebrates such as crustacea and insects have some of the slowest rates of reproductive ageing, compared to lab rodents who had some of the fastest rates.
Generally though, male animals showed few signs of age-related declines in their ejaculate traits (such as sperm quality and quantity). </p>
<p>We also found that different ejaculate traits, such as sperm viability, number, motility or velocity, aged at different rates.</p>
<p>In species that grow throughout their lives, such as some fish and crustacea, old animals have a lower mortality risk and larger gonads than young males. This can cause old males <a href="https://royalsocietypublishing.org/doi/full/10.1098/rspb.2021.2146">in such species</a> to age at slower rates, with older males producing larger ejaculates than younger males.</p>
<p>In animals such as lab rodents, who have some genetic lines selected for accelerated ageing, reproductive ageing was universal across ejaculate traits. Lab rodents are generally kept in highly controlled environments where ageing is easier to detect – due to fewer confounding effects that could mask ageing. This suggests that a lot of the variation in male reproductive ageing between different species could be due to their environment. </p>
<p>We also discovered that closely related species showed similar rates of decline in ejaculates with age, suggested that ageing is also shaped by an animal’s evolutionary history. </p>
<p>Some of the patterns we mention above also reflected methodological differences between studies. For example, when studies kept male animals as virgins, old males can <a href="https://www.pnas.org/doi/full/10.1073/pnas.2009053117">accumulate more sperm</a> than young males, leading to old males producing larger ejaculates. </p>
<p>Additionally, studies that only sampled young to middle-aged males showed an increase in sperm quality and quantity with age, compared to studies that sampled middle-aged to old males, suggesting that fertility peaks around middle age in male animals generally.</p>
<h2>Reproductive ageing</h2>
<p>Reproductive ageing occurs because as individuals grow older, their sperm and eggs <a href="https://www.nature.com/articles/nrurol.2013.18">accumulate damage</a>. Organisms have evolved to reproduce earlier in life rather than when old, which leads to a <a href="https://academic.oup.com/genetics/article/156/3/927/6051413">weaker ability of natural selection</a> to weed out bad genes that are expressed in old but not young organisms, in turn promoting ageing.</p>
<p>There are however, opposing forces that determine whether old individuals will leave more copies of their genes to successive lineages compared to young animals, and reproductive ageing is only one process determining this. </p>
<p><a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/bies.201100157">An alternative hypothesis</a> is that parents who conceive at an older age would have more gene variants for longer lifespans which could benefit their offspring. This could lead to longer lived offspring from older conceiving parents. However evidence for this hypothesis is still limited. </p>
<p>While most scientists accept that at least some reproductive traits decline with age, biologists are still uncovering what the exact mechanisms and evolutionary reasons for these declines are. But by looking at other species to investigate the drivers of reproductive ageing, we can understand and perhaps even seek to alleviate our own reproductive decline with age.</p><img src="https://counter.theconversation.com/content/222533/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Krish Sanghvi receives funding from Society for the study of evolution (Rosemary grant award).</span></em></p><p class="fine-print"><em><span>Irem Sepil receives funding from the Royal Society, BBSRC and Wellcome Trust. </span></em></p><p class="fine-print"><em><span>Regina Vega-Trejo receives funding from Biotechnology and Biological Sciences Research Council.</span></em></p>Understanding how the ageing of sperm works in other animals is more important than ever as human male fertility is in decline.Krish Sanghvi, PhD student at the department of Biology, University of Oxford, University of OxfordIrem Sepil, Lecturer in Evolutionary Biology, University of OxfordRegina Vega-Trejo, Postdoctoral Research Assistant in Evolutionary Biology, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2191552024-01-21T08:55:26Z2024-01-21T08:55:26ZSouth Africa’s ageing population comes with new challenges. How best to adapt to them<p><em>Young people – under the age of 15 – currently make up 29% of South Africa’s population. But this will soon change: the aged portion of the population is forecast to rise from 2030, bringing many challenges. Lauren Johnston, an economics and political economy expert, recently published a <a href="https://saiia.org.za/research/poor-old-brics-demographic-trendsand-policy-challenges/">paper</a> on the subject. We asked her to put the developments into perspective.</em></p>
<h2>What is South Africa’s current population profile?</h2>
<p>South Africa is “young” among the Brics countries (Brazil, Russia, India and China), but “old” by African standards. For example, seniors make up 5.9% of South Africa’s population and children 28.6%. This <a href="https://saiia.org.za/research/poor-old-brics-demographic-trendsand-policy-challenges/">compares</a> with Russia’s 15.8% seniors and 17.2% children, and China’s 13.7% seniors and 17.7% children. </p>
<p>The sub-Saharan average is 3.0% for seniors and 41.8% for children. </p>
<h2>What’s up ahead?</h2>
<p>South Africa faces no fears of a substantially diminished working-age population, unlike a number of high-income countries. Nonetheless, population structure estimates suggest that it will be home to a rising number of seniors. </p>
<p><strong>Projected population structure, South Africa</strong></p>
<p>In general, the increase in population share of seniors is driven by falling rates of mortality and birth, leading to fewer younger people relative to elders. In South Africa’s case, a falling fertility rate <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN">from over six births per woman in 1960 to just over two today</a> is a key driver. </p>
<p>An ageing population is statistically defined as a population with 7% or more of people aged 65 and over. </p>
<p>In 2022, seniors made up 5.9% of South Africa’s population. So, it is not yet home to an ageing population. But the <a href="https://population.un.org/wpp/">United Nations</a> forecasts it will join the “population ageing” club as early as 2030. By around 2060 it will be home to an “aged” population – with seniors accounting for 14% of the population. </p>
<h2>What unique challenges lie ahead?</h2>
<p>In general, an ageing population puts added pressure on the working-age population. Each worker has to be more productive, just to maintain total output. Fiscal resources also come under pressure because there are fewer people of working age – net contributors to the economy. There are also more seniors requiring resources for their health and welfare. </p>
<p>For developing countries this can be especially precarious because budgets are often under strain. So are the resources needed for pursuing basic national development. Moreover, a trend of population ageing arising in developing countries is relatively new – just a few decades old. </p>
<h2>How prepared is South Africa for the challenges?</h2>
<p>One challenge for “young” South Africa is that the slower pace of demographic change reduces imminent and more obvious demographic change pressure. The very steady increase in the share of elders alongside pressing broader socioeconomic challenges gives the government little incentive to prioritise social or economic ageing-related issues on its policy agenda.</p>
<p>The array of socioeconomic challenges, including <a href="https://www.parliament.gov.za/storage/app/media/1_Stock/Events_Institutional/2020/womens_charter_2020/docs/19-02-2021/20210212_Womens_Charter_Review_KZN_19th_of_Feb_afternoon_Session_Final.pdf">poverty</a>, <a href="https://theconversation.com/south-africas-police-are-losing-the-war-on-crime-heres-how-they-need-to-rethink-their-approach-218048">crime</a>, entrenched <a href="https://theconversation.com/south-africa-cant-crack-the-inequality-curse-why-and-what-can-be-done-213132">inequality</a> and <a href="https://kleinmanenergy.upenn.edu/news-insights/shedding-the-load-power-shortages-widen-divides-in-south-africa/">energy access</a>, means that the need to respond to the demographic transition is less of an immediate priority. </p>
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Read more:
<a href="https://theconversation.com/millions-of-young-south-africans-are-jobless-study-finds-that-giving-them-soft-skills-like-networking-helps-their-prospects-202969">Millions of young South Africans are jobless: study finds that giving them 'soft' skills like networking helps their prospects</a>
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<p>As a result, very few older South Africans benefit from aged care services, and then only the very frail, with inconsistent reach across provinces. Moreover, according to an October 2023 University of Cape Town study, there is little support for older persons who have high care needs and are at home, <a href="https://www.news.uct.ac.za/article/-2023-10-02-funding-elder-care-in-south-africa-new-report#:%7E:text=Based%20on%20estimates%2C%20it%20is,older%20persons%20who%20need%20it.">or for active older persons</a>. Most elders do not have access to services that support their needs, but also fear rising healthcare costs, owing to the rising incidence of non-communicable diseases. These include strokes, cancer and diabetes.</p>
<p>Overall the basic national social welfare net is inadequate. For example, retirees living off less than 16% of their pre-retirement salaries are among those with the highest risk of <a href="https://theconversation.com/retired-women-in-south-africa-carry-a-huge-burden-of-poverty-177379">living in poverty</a>. This group is three times more at risk of poverty than any other group in South Africa. Black female widows are most at risk.</p>
<p>While the economic value of support to older persons has grown over time, the increase has been insufficient to <a href="https://www.news.uct.ac.za/article/-2023-10-02-funding-elder-care-in-south-africa-new-report#:%7E:text=Based%20on%20estimates%2C%20it%20is,older%20persons%20who%20need%20it.">meet the needs of this growing population</a>. Statistics South Africa estimates that population ageing alone is already adding around 0.3% to <a href="https://www.statssa.gov.za/?p=13445">expected health-related expenditures annually</a>. These trends suggest that without change, South Africa’s seniors will become even less adequately served with time.</p>
<h2>What needs to be done to prepare better?</h2>
<p>South Africa has committed to establishing frameworks for healthy ageing based on the <a href="https://www.who.int/initiatives/decade-of-healthy-ageing#:%7E:text=The%20United%20Nations%20Decade%20of,communities%20in%20which%20they%20live.">United Nations Decade of Healthy Ageing from 2020 to 2030</a>. The agenda has four core areas of priority – age-friendly environments, combating ageism, integrated care, and long-term care. To realise these goals, difficult political decisions would need to be made around taxation and redistribution, as more revenue is required to ensure basic dignity for South African seniors. </p>
<p>Guided by the <a href="https://www.justice.gov.za/legislation/acts/2006-013_olderpersons.pdf">Older Persons Act</a> and the <a href="https://social.desa.un.org/issues/ageing/madrid-plan-of-action-and-its-implementation-main/madrid-plan-of-action-and-its">Madrid Plan of Action on Ageing</a>, the Department of Social Development in partnership with other departments, and the <a href="https://saopf.org.za/">South African Older Persons Forum</a> should further implement <a href="https://www.gov.za/news/media-advisories/government-activities/minister-lindiwe-zulu-officially-opens-2022-active">South Africa’s Active Ageing Programme</a> to empower senior citizens to stay physically and intellectually active, to continue to enjoying healthy, purposeful lives. This should help reduce pressure on more intensive care sectors and needs. </p>
<p>As explained in my <a href="https://saiia.org.za/research/poor-old-brics-demographic-trendsand-policy-challenges/">paper</a>, South Africa should take advantage of the Brics grouping’s new population structure and <a href="https://brics2023.gov.za/wp-content/uploads/2023/08/Jhb-II-Declaration-24-August-2023-%201.pdf">development cooperation agenda</a>. That way, state officials, civil society and entrepreneurs may be better positioned to take advantage of opportunities to reduce healthcare and aged care costs. </p>
<p>To direct sustain the economy as the population ages, South Africa needs to ensure that the economy is robust enough to accommodate a worsening dependency burden. For example, young people must be proportionately empowered to drive productivity growth and innovation. That way, the increasing costs associated with the ageing population could be accommodated while <a href="https://www.uneca.org/stories/eca-discusses-african-middle-income-countries%E2%80%99-challenges-and-solutions-to-accelerate">continuing to drive national development</a>. </p>
<p>Digitisation trends and the Brics population and development agenda may, as examples, also foster opportunities for education and training among not only young South Africans, but all working-age people. This will help raise productivity potential per worker and <a href="https://saiia.org.za/research/poor-old-brics-demographic-trendsand-policy-challenges/">extend productive working lifespans</a>.</p>
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<strong>
Read more:
<a href="https://theconversation.com/drc-has-one-of-the-fastest-growing-populations-in-the-world-why-this-isnt-good-news-209420">DRC has one of the fastest growing populations in the world – why this isn't good news</a>
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<p>South African policy makers and entrepreneurs should also be cognisant of how population ageing affects <a href="https://saiia.org.za/wp-content/uploads/2023/11/OP-351-AGDP-Johnston-FINAL-WEB.pdf">not only other Brics economies</a>, but also patterns of trade and investment. For example, over the coming decades, population decline in middle-income China, and the rapid decline of its working-age population, is likely to push China away from labour-intensive industries, and <a href="https://www.econstor.eu/bitstream/10419/222235/1/GLO-DP-0593.pdf">towards capital-intensive industries and sectors</a>.</p>
<p>In other words, population ageing at home and abroad will shift economic demography-weighted opportunities and challenges at home. The more responsive South Africa can be to these changes, the better off will the nation be.</p><img src="https://counter.theconversation.com/content/219155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Johnston 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>In general, an ageing population puts added pressure on the working-age population to be more productive – just to maintain total output – amid growing fiscal constraints.Lauren Johnston, Associate Professor, China Studies Centre, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2202602024-01-11T12:50:06Z2024-01-11T12:50:06ZFour ways men and women can improve their health before trying to conceive<figure><img src="https://images.theconversation.com/files/568600/original/file-20240110-19-ykaqyo.jpg?ixlib=rb-1.1.0&rect=0%2C19%2C6523%2C3823&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exercising with your partner can help build healthy lifestyle habits for the future.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/healthier-you-happier-feel-shot-sporty-2141708349">PeopleImages.com - Yuri A/ Shutterstock</a></span></figcaption></figure><p>It’s well-known how important it is to look after your health during and after pregnancy. But it can also be just as important for both men and women to focus on their health even before they begin trying for a baby.</p>
<p><a href="https://cdn.who.int/media/docs/default-source/mca-documents/maternal-nb/preconception_care_presentation_slides.pdf?sfvrsn=c2a5dde6_5#:%7E:text=What%20is%20its%20aim%3F,and%20couples%20before%20conception%20occurs.">Preconception health</a> refers to the lifestyle changes you and your partner can make to create the best possible conditions for future pregnancies. </p>
<p>Taking care of your health before trying to conceive is crucial for both partners. But even people of reproductive age who may not be thinking of having children anytime soon might still want to <a href="https://assets.publishing.service.gov.uk/media/5b585b3a40f0b6338218d6f1/Making_the_case_for_preconception_care.pdf">improve their preconception health</a>. Doing so sets the stage for a healthier future for all, including any future generations.</p>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/planning-for-a-baby-why-both-men-and-women-should-consider-quitting-alcohol-before-and-during-pregnancy-198118?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Planning for a baby? Why both men and women should consider quitting alcohol before and during pregnancy</a></em></p>
<p><em><a href="https://theconversation.com/women-still-face-unfair-pressure-about-having-children-heres-what-to-expect-if-you-dont-have-kids-when-youre-young-217135?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Women still face unfair pressure about having children – here’s what to expect if you don’t have kids when you’re young</a></em></p>
<p><em><a href="https://theconversation.com/should-i-have-children-heres-what-the-philosophers-say-218466?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Should I have children? Here’s what the philosophers say</a></em></p>
<hr>
<p>So whether or not you consider yourself a future parent, here are a few easy things you can do to improve your preconception health.</p>
<h2>1. Focus on your diet</h2>
<p>It’s well known that a healthy diet is important for your wellbeing. It should be no surprise that this is also the case for preconception health.</p>
<p>Managing weight before conception is not only important for a woman’s wellbeing, it may also reduce the risk of pregnancy complications. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075697/">Studies</a> have shown that a consistently healthy diet, up to three years before pregnancy, is associated with a lower risk of gestational diabetes, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279097/#:%7E:text=Hypertensive%20disorders%20during%20pregnancy%20are,chronic%20hypertension%2C%20and%204">preeclamspia</a> (a condition which causes high blood pressure during and after pregnancy) and pre-term birth. </p>
<p>For men, diet can influence fertility and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8910394/#:%7E:text=Lastly%2C%20a%20low%2Dprotein%20diet,common%20target%20are%20the%20mitochondria.">how healthy sperm are</a>. This is why focusing on eating healthier at least three months before conception is important.</p>
<p>For a healthy diet <a href="https://www.nhs.uk/live-well/eat-well/how-to-eat-a-balanced-diet/eating-a-balanced-diet">it’s recommended</a> both men and women:</p>
<ul>
<li>consume five portions of fruit and veg daily</li>
<li>include high-fibre, starchy foods with each meal </li>
<li>eat plenty of protein </li>
<li>avoid excess unsaturated oils and spreads</li>
<li>drink at least <a href="https://www.nhsinform.scot/campaigns/hydration/">six to eight glasses of water</a> daily.</li>
</ul>
<p>Women are also advised to take 400mg of folic acid daily, three months before getting pregnant. This decreases the risk of certain congenital defects, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799525/">spina bifida</a> (a condition where the baby’s spinal cord doesn’t develop as it should in the womb).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-the-uk-should-fortify-flour-with-folic-acid-88354">Here's why the UK should fortify flour with folic acid</a>
</strong>
</em>
</p>
<hr>
<h2>2. Be more active</h2>
<p>Regular physical activity is essential when it comes to preconception health. </p>
<p>For women, exercise can help regulate weight and reduce stress. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986386/">Both of these factors</a> can also directly influence a woman’s ability to conceive and have a healthy pregnancy. <a href="https://www.rcog.org.uk/for-the-public/browse-our-patient-information/being-overweight-in-pregnancy-and-after-birth/#:%7E:text=The%20higher%20your%20BMI%2C%20the,anaesthetic%20complications%20and%20wound%20infections.">Maintaining a healthy weight</a> also reduces the risk of complications during pregnancy – including gestational diabetes, high blood pressure and pre-term birth. </p>
<p>For men, exercise not only helps keep weight stable, it can also <a href="https://pubmed.ncbi.nlm.nih.gov/31858122/">improve sperm quality</a>. In addition, maintaining a healthy weight may prevent obesity-related issues that affect fertility, such as <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108774">hormonal imbalances and decreased sperm quality</a>.</p>
<p>During the preconception period, it’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986386/">recommended men and women</a> aim to get between 150-300 minutes of moderate-intensity physical activity or 75-150 minutes of vigorous activity per week. But any physical activity is better than none, so find activities you enjoy doing.</p>
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/02654075211012086">Exercising with your partner</a> is also a good idea. Not only can this boost wellbeing, it may help you both build healthy lifestyle habits that you continue with into the future. </p>
<h2>3. Consider cutting alcohol and nicotine</h2>
<p>For couples trying to conceive, avoiding alcohol for <a href="https://journals.sagepub.com/doi/abs/10.1177/2047487319874530?journalCode=cprc">at least six months</a> before conception is advisable. Quitting drinking also offers advantages for soon-to-be parents, including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8895623/">improved sleep</a>, as well as <a href="https://pubmed.ncbi.nlm.nih.gov/14748948/">better energy levels</a> and concentration.</p>
<p>Research shows that when fathers drink during the pregnancy, it increases the chance that their partner <a href="https://www.sciencedirect.com/science/article/pii/S0749379716000660#bib8">will also drink</a>. Considering this influence, aiming for an alcohol-free household before conception may be beneficial in supporting any future pregnancies. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/planning-for-a-baby-why-both-men-and-women-should-consider-quitting-alcohol-before-and-during-pregnancy-198118">Planning for a baby? Why both men and women should consider quitting alcohol before and during pregnancy</a>
</strong>
</em>
</p>
<hr>
<p>Similarly, nicotine negatively affects fertility, reducing both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771515/#:%7E:text=Smoking%20has%20been%20frequently%20associated,(ROS)%20(4).">sperm quality</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/37318508/#:%7E:text=Conclusions%3A%20Smoking%20negatively%20impacts%20human,in%20women%20performing%20ICSI%20cycles.">egg quality</a>. It can also have serious consequences during pregnancy – including increasing risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969532/">miscarriage, premature birth and birth defects</a>. Even secondhand smoke <a href="https://pubmed.ncbi.nlm.nih.gov/30026189/#:%7E:text=Background%3A%20Secondhand%20smoke%20(SHS),birth%20weight%20and%20respiratory%20illnesses.">poses a risk</a> to pregnancy and foetal complications.</p>
<figure class="align-center ">
<img alt="A woman holds up her hand at a glass of red wine to say no." src="https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.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 are many benefits of giving up alcohol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-refuses-drink-alcohol-female-alcoholism-1275255349">goffkein.pro/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Prioritising an alcohol-free and smoke-free environment before conceiving sets the stage for a healthier pregnancy and a brighter start for any future children. </p>
<h2>4. Prioritise your mental health</h2>
<p>Prioritising your mental health in the preconception period is essential. It can equip people to handle stress, as well as navigate the emotional ups and downs of any future pregnancies. </p>
<p>Research also shows a positive mental state can <a href="https://www.psychiatry.org/news-room/apa-blogs/infertility-the-impact-of-stress-and-mental-health#:%7E:text=Stress%2C%20Anxiety%2C%20Depression%20and%20Grief&text=Having%20anxiety%20and%20depression%20may,most%20often%20depression%20or%20anxiety.">benefit fertility</a> due to improved stress levels. </p>
<p>If you’re struggling with your mental health or have been diagnosed with a mental health condition, you can receive specialised support <a href="https://www.gov.uk/government/publications/preconception-advice-for-women-with-serious-mental-illness">in the preconception period</a>, so consider speaking with your GP.</p>
<p>Regardless of whether you’re trying to have a baby or not, taking care of your health is crucial. Preconception health includes all people of reproductive age and it lays the groundwork for a healthy future. </p>
<p>Just remember to consult your doctor before making major changes to your lifestyle.</p><img src="https://counter.theconversation.com/content/220260/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Merissa Elizabeth Hickman receives funding from the Wellcome Trust for her academic appointment. </span></em></p>Preconception health refers to the many lifestyle changes you can make to benefit a future pregnancy.Merissa Elizabeth Hickman, Postgraduate Researcher in Preconception Health and Genetics., University of LeicesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190052023-12-14T19:19:48Z2023-12-14T19:19:48ZEggs from men, sperm from women: how stem cell science may change how we reproduce<figure><img src="https://images.theconversation.com/files/564442/original/file-20231208-17-22yb4u.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C748&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/morula-early-stage-embryo-consisting-cells-776035219">nobeastsofierce/Shutterstock</a></span></figcaption></figure><p>It may soon be possible to coax human skin cells into becoming functional eggs and sperm using a technique known as “in vitro gametogenesis”. This involves the creation (genesis) of eggs and sperm (gametes) outside the human body (in vitro). </p>
<p>In theory, a skin cell from a man could be turned into an egg and a skin cell from a woman can become a sperm. Then there’s the possibility of a child having multiple genetically-related parents, or only one.</p>
<p>Some scientists believe human applications of in vitro gametogenesis are a <a href="https://www.statnews.com/2023/10/02/ivg-ivf-replacement-reproductive-technology-hype/">long way off</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1708819232077533218"}"></div></p>
<p>However, scientists who work on human stem cells are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579208/">actively working</a> on overcoming the barriers. <a href="https://www.statnews.com/2023/04/08/ivf-eggs-hormones-gameto-reproductive-fertilo/">New</a> <a href="https://www.technologyreview.com/2021/10/28/1038172/conception-eggs-reproduction-vitro-gametogenesis/">biotechnology</a> <a href="https://www.newyorker.com/magazine/2023/04/24/the-future-of-fertility">start-ups</a> are also seeking to commercialise this technology.</p>
<p>Here’s what we know about the prospect of human in vitro gametogenesis and why we need to start talking about this now.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-are-stem-cells-14391">Explainer: what are stem cells?</a>
</strong>
</em>
</p>
<hr>
<h2>Is the technology available?</h2>
<p>In vitro gametogenesis begins with “pluripotent stem cells”, a kind of cell that can develop into many different cell types. The aim is to persuade these stem cells to become eggs or sperm.</p>
<p>These techniques could use stem cells taken from early embryos. But scientists have also worked out how to <a href="https://www.eurostemcell.org/stemcellshorts-what-are-induced-pluripotent-stem-cells">revert adult cells</a> to a pluripotent state. This opens up the possibility of creating eggs or sperm that “belong to” an existing human adult.</p>
<p>Animal studies have been promising. In <a href="https://www.nature.com/articles/490146b">2012</a>, scientists created live-born baby mice using eggs that began their life as skin cells on a mouse tail.</p>
<p>More recently, the technique has been used to facilitate same-sex reproduction. Earlier this year, scientists created mouse pups with <a href="https://www.nature.com/articles/d41586-023-00717-7">two genetic fathers</a> after transforming skin cells from male mice into eggs. Mouse pups with <a href="https://www.nature.com/articles/d41586-018-06999-6">two genetic mothers</a> have also been created.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/1ocWjHJgKcc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How scientists bred mice with two fathers.</span></figcaption>
</figure>
<p>Scientists have not yet managed to adapt these techniques to create human gametes. Perhaps because the technology is still in its infancy, Australia’s legal and regulatory systems do not address whether and how the technology should be used. </p>
<p>For example, the National Health and Medical Research Council’s <a href="https://www.nhmrc.gov.au/about-us/publications/art">assisted reproduction guidelines</a>, which were updated in 2023, do not include specific guidance for in vitro-derived gametes. These guidelines will need to be updated if in vitro gametogenesis becomes viable in humans.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-future-of-stem-cells-tackling-hype-versus-hope-72052">The future of stem cells: tackling hype versus hope</a>
</strong>
</em>
</p>
<hr>
<h2>The potential</h2>
<p>There are three distinct clinical applications of this technology.</p>
<p>First, in vitro gametogenesis could streamline IVF. Egg retrieval currently involves repeated hormone injections, a minor surgical procedure, and the <a href="https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697">risk</a> of overstimulating the ovaries. In vitro gametogenesis could eliminate these problems.</p>
<p>Second, the technology could circumvent some forms of medical infertility. For example, it could be used to generate eggs for women born without functioning ovaries or following early menopause.</p>
<p>Third, the technology could allow same-sex couples to have children who are genetically related to both parents.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/promising-assisted-reproductive-technologies-come-with-ethical-legal-and-social-challenges-a-developmental-biologist-and-a-bioethicist-discuss-ivf-abortion-and-the-mice-with-two-dads-208276">Promising assisted reproductive technologies come with ethical, legal and social challenges – a developmental biologist and a bioethicist discuss IVF, abortion and the mice with two dads</a>
</strong>
</em>
</p>
<hr>
<h2>Legal, regulatory and ethical issues</h2>
<p>If the technology becomes viable, in vitro gametogenesis will alter the dynamics of how we create families in unprecedented ways. How we should respond requires careful consideration.</p>
<p><strong>1. Is it safe?</strong></p>
<p>Careful trials, rigorous monitoring, and follow-up of any children born will be essential – as it has been for other <a href="https://theconversation.com/maeves-law-would-let-ivf-parents-access-technology-to-prevent-mitochondrial-disease-heres-what-the-senate-is-debating-176668">reproductive</a> <a href="https://theconversation.com/rest-assured-ivf-babies-grow-into-healthy-adults-23432">technologies</a>, including IVF.</p>
<p><strong>2. Is it equitable?</strong></p>
<p>Other issues relate to access. It might seem unjust if the technology is only available to the wealthy. Public funding could help – but whether this is appropriate depends on whether the state <a href="https://theconversation.com/ideas-for-australia-rethinking-funding-and-priorities-in-ivf-should-the-state-pay-for-people-to-have-babies-57036">ought to support</a> people’s reproductive projects.</p>
<p><strong>3. Should we restrict access?</strong></p>
<p>For instance, pregnancy is rare in older women, largely because egg count and quality <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/age-and-fertility">decline with age</a>. In vitro gametogenesis would theoretically provide “fresh” eggs for women of any age. But helping older women become parents is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566409/">controversial</a>, due to physical, psychological and other factors associated with having babies later in life.</p>
<p><strong>4. We’d still need surrogates</strong></p>
<p>If we took skin cells from each male partner and created an embryo, that embryo would still need a surrogate to carry the pregnancy. Unfortunately, Australia has a shortfall of surrogates. International surrogacy provides an alternative, but carries <a href="https://theconversation.com/its-hard-to-find-a-surrogate-in-australia-but-heading-overseas-comes-with-risks-206182">legal, ethical and practical difficulties</a>. Unless access to surrogacy is improved domestically, benefits to male couples will be limited. </p>
<p><strong>5. Who are the legal parents?</strong></p>
<p>In vitro gametogenesis also raises questions about who are the future child’s legal parents. We already see related legal debates surrounding non-traditional families formed through surrogacy, egg donation and sperm donation. </p>
<p>In vitro gametogenesis could theoretically also be used to create children with more than two genetic parents, or with only one. These possibilities likewise require us to update our current understandings of parenthood.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-may-one-day-grow-babies-outside-the-womb-but-there-are-many-things-to-consider-first-125709">We may one day grow babies outside the womb, but there are many things to consider first</a>
</strong>
</em>
</p>
<hr>
<h2>How far is too far?</h2>
<p>Of the potential uses already mentioned, same-sex reproduction is the most controversial. The reproductive limitations imposed by being in a same-sex relationship are sometimes seen as a “social” form of infertility the medical profession is not obligated to fix.</p>
<p>The moral stakes, however, are virtually identical regardless of whether in vitro gametogenesis is used by same-sex or opposite-sex couples. Both uses of the technology fulfil exactly the same goal: helping couples fulfil their desire to have a child genetically related to both parents. It would be unjust to deny access to only one of these groups.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Same-sex female couple cooking in kitchen, one feeding the other fruit" src="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Who should have access to this technology? How about same-sex couples?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lesbian-couple-cooking-kitchen-together-1071305168">Rawpixel.com/Shutterstock</a></span>
</figcaption>
</figure>
<p>But same-sex reproduction is only the tip of the iceberg. In vitro gametogenesis could theoretically facilitate “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973109/">solo reproduction</a>” by deriving both eggs and sperm from the same individual. Interestingly, a child created this way would not be a clone of its parent, since the process of gamete formation would shuffle the parent’s genetic material and create a genetically distinct individual.</p>
<p>Or people could engage in “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215291/">multiplex parenting</a>” combining genetic material from more than two individuals. Imagine, for example, that two couples create embryos via IVF. In vitro gametogenesis could then be used to derive eggs and sperm from each of these two separate embryos, which could subsequently be used to conceive a single child that is genetically related to all four adults.</p>
<p>Finally, in vitro gametogenesis could revolutionise prenatal genetic selection. We’d have <a href="https://rmanetwork.com/blog/number-of-eggs-good-ivf-in-vitro-fertilization/">many more embryos</a> than available during regular IVF to screen for genetic diseases and traits.</p>
<p>So it would be urgent to discuss “designer babies”, eugenics, and whether we have a <a href="https://bioedge.org/bioethics-d75/savulescu-interviewed-on-procreative-beneficence/">moral obligation</a> to conceive children with the best chance of a good life.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worlds-first-synthetic-embryo-why-this-research-is-more-important-than-you-think-188217">World's first 'synthetic embryo': why this research is more important than you think</a>
</strong>
</em>
</p>
<hr>
<h2>We need to start talking about this now</h2>
<p>Both law and ethics can lag behind new technologies, particularly when their implications are as profound and far-reaching as the implications of in vitro gametogenesis.</p>
<p>We need to discuss how this technology should be regulated before it is rolled out. Given how rapidly the science is developing, we should begin this discussion now. </p>
<hr>
<p><em>Laura Smith, a masters student from Monash University, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/219005/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Koplin receives research funding from Ferring Pharmaceuticals for an unrelated project.</span></em></p><p class="fine-print"><em><span>Neera Bhatia receives funding from UKRI Arts and Humanities Research Council for an unrelated project.</span></em></p>The technology may be here sooner than we think. But we have so much to discuss first.Julian Koplin, Lecturer in Bioethics, Monash University & Honorary fellow, Melbourne Law School, Monash UniversityNeera Bhatia, Associate Professor in Law, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2177872023-12-11T01:07:04Z2023-12-11T01:07:04ZMale infertility is more common than you may think. Here are 5 ways to protect your sperm<figure><img src="https://images.theconversation.com/files/562602/original/file-20231130-15-oj3ctt.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5126%2C3592&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Infertility is often thought of as a female problem but <a href="https://theconversation.com/problems-conceiving-are-not-just-about-women-male-infertility-is-behind-1-in-3-ivf-cycles-192183">one in three IVF cycles</a> in Australia involve male infertility.</p>
<p>We recently published a <a href="https://pubmed.ncbi.nlm.nih.gov/37695221/">review of the literature</a> on whether men diagnosed with male factor infertility experience greater psychological distress than fertile men or men with an infertile partner. We found irrespective of the cause of infertility, men in couples with infertility have more symptoms of depression, anxiety and general psychological distress, worse quality of some aspects of life, and lower self-esteem than fertile men. </p>
<p>Research also shows sperm counts are <a href="https://doi.org/10.1093/humupd/dmac035">declining worldwide</a>, and that lifestyle and environmental factors can reduce male fertility.</p>
<p>While most <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008178/">male causes of infertility</a> are not preventable, it’s important to know how to keep your sperm as healthy as possible. Here are five things men can do to boost their fertility. </p>
<h2>1. Try to be in the healthy weight range</h2>
<p>Obesity <a href="https://doi.org/10.1016/j.fertnstert.2023.10.017">causes hormonal changes</a> that have <a href="https://pubmed.ncbi.nlm.nih.gov/32399992/">negative effects on semen</a>, including the total number of sperm, the ability of the sperm to move, the number of live sperm, and the number of sperm with a normal shape. </p>
<p>These reduce the chance of both <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/andr.13552">spontaneous and IVF conception</a>.</p>
<p>The good news is the adverse effects on fertility caused by excess weight in men are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408383/">reversible</a>. Regular <a href="https://doi.org/10.1016/j.fertnstert.2023.10.017">exercise</a> and a healthy diet can help reduce weight and improve sperm quality. </p>
<p>There is strong evidence a healthy diet rich in fruits, vegetables, whole grains, nuts, low-fat dairy, and seafood, and low in red and processed meats, sweets, and sweetened beverages is linked to <a href="https://doi.org/10.1016/j.fertnstert.2023.10.013">better sperm quality</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/problems-conceiving-are-not-just-about-women-male-infertility-is-behind-1-in-3-ivf-cycles-192183">Problems conceiving are not just about women. Male infertility is behind 1 in 3 IVF cycles</a>
</strong>
</em>
</p>
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<h2>2. Avoid recreational drugs</h2>
<p>Recreational drug use is associated with poorer reproductive health. Psychoactive drugs such as cocaine, benzodiazepines, heroin, methamphetamine, oxycodone and ecstasy <a href="https://rbej.biomedcentral.com/articles/10.1186/s12958-023-01098-2">negatively affect male reproductive functions</a> including sexual urge, testosterone production, sperm production and sperm quality. </p>
<p>While research on the link between <a href="https://doi.org/10.1111/andr.12585">marijuana use and sperm quality</a> is inconclusive, some evidence suggests frequent marijuana use can reduce sperm quality and is a risk factor for testicular cancer. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562606/original/file-20231130-23-6t0is.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man's hand holding up bag of white powder" src="https://images.theconversation.com/files/562606/original/file-20231130-23-6t0is.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562606/original/file-20231130-23-6t0is.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562606/original/file-20231130-23-6t0is.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562606/original/file-20231130-23-6t0is.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562606/original/file-20231130-23-6t0is.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562606/original/file-20231130-23-6t0is.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562606/original/file-20231130-23-6t0is.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Recreational drug use is associated with poorer reproductive health.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>3. Stay clear of anabolic steroids</h2>
<p>Some men use anabolic steroids to enhance their physical performance and appearance. Globally, it’s estimated about <a href="https://doi.org/10.1016/j.fertnstert.2023.09.016">one in 16 men</a> (6.4%) use anabolic steroids sometime during their life. Male weightlifters aged 20-39 years, fighters, and security personnel are among the most <a href="https://www.fertstert.org/article/S0015-0282(23)01882-4/pdf">common users of anabolic steroids</a>.</p>
<p>Anabolic steroids contribute to muscle growth and fat loss, but they also affect sexual function, including by reducing the <a href="https://www.fertstert.org/article/S0015-0282(23)01882-4/pdf">size of testicles</a>, reducing or stopping <a href="https://www.fertstert.org/article/S0015-0282(23)01882-4/pdf">sperm production</a>, and causing <a href="https://www.fertstert.org/article/S0015-0282(23)01882-4/pdf">impotence and infertility</a>.</p>
<p>Studies show most <a href="https://doi.org/10.1111/jsm.12890">men start producing sperm again</a> within a year of stopping anabolic steroids. But a <a href="https://doi.org/10.1016/j.fertnstert.2023.09.016">recent study</a> of men who became infertile as a result of anabolic steroids found that for some there is long-term damage to sperm production. </p>
<p>In this study of men who had stopped using anabolic steroids and had a six-month course of hormone treatment to improve sperm production, more than half still produced no sperm at all or very few sperm after six months. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/science-or-snake-oil-do-men-need-sperm-health-supplements-84379">Science or Snake Oil: do men need sperm health supplements?</a>
</strong>
</em>
</p>
<hr>
<h2>4. Quit smoking and vaping</h2>
<p>We all know tobacco smoking is terrible for our general health but there is now evidence it’s also bad for <a href="https://pubmed.ncbi.nlm.nih.gov/37628668/">male fertility</a> and <a href="https://doi.org/10.1080%2F00325481.2015.1015928">reproductive outcomes</a>.</p>
<p>In the past decade, vaping has become increasingly popular, especially among young adults. More than 500 e-cigarette brands and 8,000 flavours have been <a href="https://www.mdpi.com/2075-1729/13/3/827">commercialised</a>. There is now growing evidence from animal studies that vaping can <a href="https://doi.org/10.3390/life13030827">harm male reproductive health</a> and experts recommend avoiding vaping when <a href="https://www.mdpi.com/2075-1729/13/3/827">trying to conceive</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562609/original/file-20231130-29-subdcw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man blowing out vape vapour" src="https://images.theconversation.com/files/562609/original/file-20231130-29-subdcw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562609/original/file-20231130-29-subdcw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562609/original/file-20231130-29-subdcw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562609/original/file-20231130-29-subdcw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562609/original/file-20231130-29-subdcw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562609/original/file-20231130-29-subdcw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562609/original/file-20231130-29-subdcw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We know smoking harms reproductive health, and there’s increasing evidence vaping does too.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>5. Reduce exposure to environmental chemicals</h2>
<p>In our everyday lives we are exposed to many different environmental chemicals – through the products we use, the food we eat, and the air we breathe. So-called <a href="https://doi.org/10.1016/j.fertnstert.2023.10.008">endocrine-disrupting chemicals</a> can reduce the quality of sperm and cause problems with fertility because they can mimic or block male sex hormones. </p>
<p>It’s impossible to avoid these chemicals completely, because they are all around us. But you can take some simple steps to <a href="https://www.yourfertility.org.au/everyone/drugs-chemicals/chemicals-our-environment">reduce your exposure</a>, including:</p>
<ul>
<li><p>washing fruit and vegetables</p></li>
<li><p>eating fewer processed, canned or pre-packaged foods</p></li>
<li><p>drinking from glass or hard plastic bottles, rather than soft plastic bottles</p></li>
<li><p>heating food in a china or glass bowl covered with paper towel or a plate rather than using plastic takeaway containers or those covered with cling wrap. </p></li>
</ul>
<p>To inform men about how to look after their sperm, <a href="https://www.yourfertility.org.au/">Your Fertility</a>, a fertility health promotion program delivered by the Victorian Assisted Reproductive Treatment Authority, teamed up with Melbourne comedian Michael Shafar to create some helpful <a href="https://www.yourfertility.org.au/fertility-week-2022">educational videos</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/217787/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karin Hammarberg works for the Victorian Assisted Reproductive Treatment Authority which manages the Your Fertility program. </span></em></p>With sperm counts declining world wide, it’s important to know how to keep your sperm as healthy as possible.Karin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2173222023-11-30T14:22:54Z2023-11-30T14:22:54ZBeing child-free has been deemed ‘selfish’ for decades – the history of this misconception explained<figure><img src="https://images.theconversation.com/files/562173/original/file-20231128-18-m2by5b.jpg?ixlib=rb-1.1.0&rect=3%2C17%2C1260%2C943&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Waiting By The Window by Carl Holsøe.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Waiting_By_The_Window.jpg">Wiki Commons</a></span></figcaption></figure><p>Choosing to be child-free is <a href="https://www.pewresearch.org/short-reads/2021/11/19/growing-share-of-childless-adults-in-u-s-dont-expect-to-ever-have-children/">more common than ever before</a> in some countries, including the US. Many people see not having children an <a href="https://www.theguardian.com/world/2018/jun/20/give-up-having-children-couples-save-planet-climate-crisis">ethical and ecological choice</a>, made to protect the environment, people and other species. Being child-free is about being “green”. Consequently, more positive discourses around childlessness are emerging.</p>
<p>But this was not always the case. In societies that encourage an increased birthrate, motherhood is <a href="https://www.proquest.com/docview/232581954">often presented</a> as natural and caring. Meanwhile, women without children are often described as <a href="https://psycnet.apa.org/record/2022-00837-001">biological failures, or as deviant</a>. For example, when visible in popular culture – they are often not represented at all – women without children are either presented as animal-lovers like the “crazy cat lady” or animal-killers, like Cruella de Vil. In these examples, the focus on animal represents their supposed inability to care for humans (their species), their “unnaturalness”. </p>
<p>In the 19th century, women without children were already being described as selfish and unnatural. The natural world was conversely used to describe fertile women, who were often compared to flowers in bloom in literature.</p>
<hr>
<p><em><a href="https://theconversation.com/uk/topics/should-i-have-children-148388?utm_source=TCUK&utm_medium=InArticleTop&utm_campaign=Parenting2023">Should I have children?</a> The pieces in this series will help you answer this tough question – exploring fertility, climate change, the cost of living and social pressure.</em>
<em>We’ll keep the discussion going at a live event in London on November 30. <a href="https://www.waterstones.com/events/the-conversation-should-i-have-children/london-tottenham-court-road">Click here</a> for more information and tickets.</em></p>
<hr>
<p>The association of women with plants and fertility is an ancient one, found particularly in agricultural pagan figures. Demeter, the ancient Greek goddess of the harvest, for example, was the goddess of grains, but also of marriage and fertility. </p>
<p>Many expressions still link women’s reproductive systems and flowers. In French, the flower is a metaphor for a virgin sexual organ. To <em>avoir ses fleurs</em> (have your flowers) is an expression for having periods, and being <em>une jeune fille en fleur</em> (a young woman in flower) means that the young woman is ready for marriage – and therefore reproduction. </p>
<p>Women themselves are also compared to flowers: in English, both “pretty flower” and “English rose” describe attractive young women. Reducing women to flowers, through these comparisons, is not only misogynistic, but reinforces the social pressure to produce children “on time”. Timing is important in these comparisons, as flowers fade quickly.</p>
<h2>Being child-free in the 19th century</h2>
<p>But what about women without children, those flowers that will not produce seeds? <a href="https://library.oapen.org/bitstream/handle/20.500.12657/25269/1004825.pdf?sequence=1&isAllowed=y**">My research</a> into literature and paintings from the second half of the 19th century has shown that they were often represented as monstrous horticultural hybrids. </p>
<p>At the time, “hybrid flowers” – which were often sterile – became the preferred metaphor to describe sexually active women who were either unable or refused to bear children. In France, having and raising children was seen as a woman’s <a href="https://www.cambridge.org/core/books/debating-the-woman-question-in-the-french-third-republic-18701920/A1E670D26BDB0203197A734E856855C1#:%7E:text=Book%20description,neighbors%20from%201870%20to%201920.">natural and civic duty</a> for the nation. Conversely, women who were sexually active but without children were often seen as <a href="https://books.google.co.uk/books/about/Figures_of_Ill_Repute.html?id=jaSPKb2kJ5wC&redir_esc=y#:%7E:text=Ubiquitous%20in%20the%20streets%20and,%2C%20class%2C%20and%20the%20body.">unnatural and dangerous</a>.</p>
<p>Comparisons that described women as flowers were historically about fertility. How was it then that flowers became a metaphor for sterility at the end of the 19th century? </p>
<figure class="align-center ">
<img alt="Painting of a woman smelling roses" src="https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562174/original/file-20231128-25-guh58a.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fertile, childbearing women were compared to more classic flowers such as roses. Girl And Roses by Auguste Toulmouche (1879).</span>
<span class="attribution"><a class="source" href="https://www.artsy.net/artwork/auguste-toulmouche-woman-and-roses">Clark Art Institute</a></span>
</figcaption>
</figure>
<p>The emphasis on flowers as sexual organs and as a metaphor for women’s sexuality appears to have been used more often after the Swedish botanist Carl Linnaeus <a href="https://ucmp.berkeley.edu/history/linnaeus.html#:%7E:text=Biography%20of%20Linnaeus,from%20a%20very%20early%20age">openly discussed</a> the sexuality of plants with anthropomorphic language at the end of the 18th century.</p>
<p>It is important to note that, for a long time, if men knew at all that flowers were sexual organs, they believed they were unisexual and feminine. They did not believe that both male and female organs were involved in the production of fruits. </p>
<p>Once the sexual nature of plants had been established, the nature of the floral metaphor changed and the innocence of the flower was lost. Flowers progressively became the symbol of a young lady with an emerging sexuality or who was waiting to “bear fruit”.</p>
<h2>Horticultural hybrids</h2>
<p>During the second empire in France (1852-1870) and the beginning of the <a href="https://www.britannica.com/topic/Third-Republic-French-history">Third Republic</a> (1870-1840), horticultural hybrids were extremely popular. </p>
<p>Horticulturists developed large plants and flowers such as <a href="https://www.britannica.com/plant/cattleya">cattleya</a>, <a href="https://www.rhs.org.uk/plants/hibiscus/growing-guide">hibiscus</a>, <a href="https://www.britannica.com/plant/Nidularium">nidularium</a> which often looked like enlarged genitals (natural plants are often a lot smaller and less colourful). These hybrids made the sexual analogy even more obvious. </p>
<p>By the end of the 19th century, the artificial hybrids became used for describing, indirectly, near-pornographic scenes. Here is an example from <a href="https://global.oup.com/ukhe/product/the-kill-9780199536924?cc=gb&lang=en&">The Kill</a> (1895), a famous novel by <a href="https://www.britannica.com/biography/Emile-Zola">Émile Zola</a>. Instead of describing the characters making love, he describes the plants:</p>
<blockquote>
<p>As their glances penetrated into the corners of the hothouse, the darkness became filled with a more furious debauch of leaves and stalks; they could not distinguish on the terraces between the marantas, soft as velvet, the gloxinias, purple-belled, the dracoenas, like blades of old lacquer; it was a great dance of living plants pursuing one another with unsatisfied fervour.</p>
</blockquote>
<p>Many of the hybrids being created at this time were sterile. They therefore became a metaphor for “unproductive” sexuality. Because they were man-made, they could be seen as a perversion of the laws of nature. Comparing women to those hybrids was a way to criticise what was deemed the artificiality of their infertility, or decision not to have children. </p>
<p>Fertile, childbearing women were frequently compared to natural, more classic flowers such as roses or lilies.</p>
<p>At the time, France was obsessed with its low birth rate. Many politicians believed it explained why France had lost the war against Prussia (1870-1871). Childless women were therefore also seen as bad citizens.</p>
<p>Through their comparisons with hybrid, infertile flowers, women who could not or choose not to reproduce were deemed un-French, undesirable and, in some ways, monstruous. </p>
<p>Understanding how women are associated with nature and very often compared to flowers is essential to understanding how being childless continues to be demonised in contemporary society. As contemporary art, culture and the very language we use demonstrates, child-free women are still often described as “unnatural” or biologically deviant.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
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</figure>
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<hr><img src="https://counter.theconversation.com/content/217322/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aude Campmas is affiliated with:
I am a volunteer for Portsmouth Abuse and Rape Counselling Service.</span></em></p>Hybrid flowers became a metaphor for sterility at the end of the 19th century.Aude Campmas, Lecturer in French Studies, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2177262023-11-28T16:52:45Z2023-11-28T16:52:45ZWhy you should talk about fertility, even if you don’t want children – and what you should discuss<figure><img src="https://images.theconversation.com/files/561557/original/file-20231124-23-k697g6.jpg?ixlib=rb-1.1.0&rect=0%2C152%2C7551%2C4975&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/diverse-male-female-hipsters-having-positive-1746193439">GaudiLab/Shutterstock</a></span></figcaption></figure><p>Women (and men) are having their first child at older ages. As a result, couples are sometimes unable to conceive or require medical intervention in their pursuit of parenthood. Others may face a <a href="https://ifstudies.org/blog/the-global-fertility-gap#:%7E:text=While%20fertility%20ideals%20around%20the,children%20is%20a%20serious%20problem">“fertility gap”</a> between the number of children they anticipate having and those they actually have.</p>
<p>Young people often <a href="https://www.tandfonline.com/doi/abs/10.1080/14647273.2020.1798516">overestimate</a> womens’ capacity to become pregnant as they age, and the extent to which technology like IVF can help them conceive.</p>
<p>Despite these issues, conversations about fertility and childbearing remain taboo. <a href="https://www.emerald.com/insight/publication/doi/10.1108/9781787564831">I have found</a> that women in particular feel uncomfortable bringing it up in new relationships, fearing that discussing a desire for motherhood may “put off” potential romantic partners or make them appear “desperate” for a baby.</p>
<hr>
<p><em><a href="https://theconversation.com/uk/topics/should-i-have-children-148388?utm_source=TCUK&utm_medium=InArticleTop&utm_campaign=Parenting2023">Should I have children?</a> The pieces in this series will help you answer this tough question – exploring fertility, climate change, the cost of living and social pressure.</em></p>
<p><em>We’ll keep the discussion going at a live event in London on November 30. <a href="https://www.waterstones.com/events/the-conversation-should-i-have-children/london-tottenham-court-road">Click here</a> for more information and tickets.</em></p>
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<p>But these conversations can be crucial in preventing future relationship breakdown, and preparing for age-related fertility decline. No matter your situation – single, coupled-up, or childfree by choice – you might benefit from talking earlier and more often about your plans. </p>
<p>Here’s what to talk about depending on your situation.</p>
<h2>I want to have a child, but not yet</h2>
<p>Many factors are leading women and couples to delay having children. Women are participating more in the labour force, there are more reliable forms of contraception available, and it’s more accepted to have multiple relationships before getting married or having a child.</p>
<p>The growing gap between wages and the cost of living means it is harder to achieve the <a href="https://theconversation.com/more-young-people-in-the-uk-are-living-with-parents-and-grandparents-heres-what-you-need-to-know-if-youre-considering-it-216280">standard of living</a> that many deem necessary to become parents. </p>
<p>Whatever the reason, technology like egg or embryo freezing may offer the opportunity to preserve reproductive material for future use. </p>
<p>Egg freezing sees women undergo the same ovarian stimulation and retrieval process as IVF patients. A number of her eggs are then frozen and stored for future use. Used most often by women who do not yet have a partner, egg freezing <a href="https://theconversation.com/six-things-you-should-know-if-you-are-considering-freezing-your-eggs-94039">at any age</a> cannot guarantee a live birth. </p>
<p>Previously, the law only permitted eggs to be frozen for up to 10 years. This meant a woman who froze her eggs at 30 would have to use them by the time she was 40 or risk them being destroyed. A <a href="https://www.legislation.gov.uk/ukpga/2022/31/schedule/17/enacted">legal change</a> in 2021 means women in England and Wales are now able to freeze their eggs for up to 55 years, making this a more viable form of “fertility extension”.</p>
<p>The <a href="https://www.londoneggbank.com/news/blog/what-is-the-best-age-to-freeze-my-eggs/#:%7E:text=Indeed%2C%20more%20than%20any%20other,smaller%20number%20over%20age%2035.">optimum time</a> to undertake egg freezing is before the steepest decline in a woman’s fertility in her late 30s. The best results are generally from women who froze their eggs by the time they were 35.</p>
<figure class="align-center ">
<img alt="Close up of a woman looking solemnly at a pregnancy test" src="https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People are delaying pregnancy for a number of health and social reasons.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-pregnancy-test-hands-427218448">Pressmaster/Shutterstock</a></span>
</figcaption>
</figure>
<p>Embryo freezing – where eggs are fertilised and stored for later use – offers a greater chance of a live birth and can be achieved as part of a relationship, or with donor sperm. </p>
<p>Embryos created by a couple can lead to complications if the relationship breaks down. One party may want the genetic material destroyed against the other’s wishes. Embryo freezing may be an option for stable couples who need to delay parenthood due to issues like illness or overseas deployments. However, it is unlikely to be of use to those who aren’t ready to have a child due to the cost of living or who are trying to save for their first home. The cost of the procedure, like egg freezing, can often be between £3,000-£4,000 or more, plus annual storage fees. </p>
<h2>I’m not sure, and I’m getting older</h2>
<p>Fertility monitoring can provide some insights into reproductive health for both <a href="https://www.createfertility.co.uk/blog/whats-a-fertility-mot-and-why-are-experts-recommending-it-to-women#:%7E:text=What%20does%20a%20Fertility%20MOT,time%20in%20the%20menstrual%20cycle.">women</a> and <a href="https://www.londonivfandgenetics.co.uk/fertility-mot/male-mot/">men</a>.</p>
<p>Fertility “MOTs” are offered by clinics and as <a href="https://hertilityhealth.com/?tw_source=google&tw_adid=681259505447&tw_campaign=19778466649&gad_source=1&gclid=CjwKCAiAjfyqBhAsEiwA-UdzJP0C3Wl-suGdFy73atjNWo656QCKLzylw2_zjbzOmRqIosPmubgjaRoCBSsQAvD_BwE">at-home tests</a>. They can reveal sperm quantity and motility, give an indication of ovarian reserve and help identify factors which could inhibit conception. </p>
<p>However they cannot reliably be used to calculate how many “fertile years” a woman has, or provide detailed quantitative insights in to a woman’s ovarian reserve. They are also not provided on the NHS and clinics often charge in excess of £500 for such tests.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/at-home-fertility-tests-heres-what-they-can-actually-tell-you-198639">At-home fertility tests: here's what they can actually tell you</a>
</strong>
</em>
</p>
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<p>Like those in heterosexual relationships, LGBTQ+ couples can also access technologies like egg or embryo freezing through the use of donated gametes (egg and sperm) and can build their families with the help of a <a href="//www.sciencedirect.com/science/article/pii/S1472648313001806">surrogate</a>. Like most fertility treatment, these procedures are rarely fully funded by the NHS and can cost tens of thousands of pounds. </p>
<h2>I don’t want children – but what if I change my mind?</h2>
<p>Without question, technology has created more opportunities for people to have children later in life, even if they just want to keep their options open. But egg freezing and fertility monitoring have financial, physical and emotional costs, and are not a guarantee. </p>
<p>For many, the best form of preparation is a conversation. </p>
<p>If you are a young woman unsure about having children, this may mean speaking to immediate female family members about the age they experienced menopause and any fertility issues within the family. Even if you are not planning to have children, these conversations can be helpful for learning about other medical issues that may affect you in ways beyond fertility, such as endometriosis or PCOS.</p>
<p>Evidence has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717046/">also shown</a> that both women and men can improve their fertility chances by paying attention to issues such as their weight, stress levels, alcohol consumption and exercise patterns. These are all things that can benefit general health, regardless of your plans for children.</p>
<p>Talking more openly about fertility and the choice to have children or not can help break the stigma around these topics. Just as people (women especially) may face criticism for <a href="https://theconversation.com/women-still-face-unfair-pressure-about-having-children-heres-what-to-expect-if-you-dont-have-kids-when-youre-young-217135">delaying parenthood</a>, there are social taboos around deciding not to have children. The conversations you have now may help you, and future generations, make more informed decisions about their reproductive choices.</p><img src="https://counter.theconversation.com/content/217726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Baldwin receives funding from The Foundation for Sociology of Health and Illness</span></em></p>Talking about plans for childbearing is still seen as a taboo.Kylie Baldwin, Senior Lecturer, De Montfort UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2144912023-09-28T11:32:32Z2023-09-28T11:32:32ZWhy so many women in Spain are choosing to donate their eggs – The Conversation Weekly podcast<p>Spanish women are having fewer and fewer children, and yet the country has become the egg donation capital of Europe. In this episode of <em><a href="https://theconversation.com/uk/topics/the-conversation-weekly-98901">The Conversation Weekly</a></em> podcast, we find out about the experiences of women who decide to donate their eggs, and whether there are enough protections in place to prevent them from being exploited.</p>
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<p><iframe id="tc-infographic-561" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/561/4fbbd099d631750693d02bac632430b71b37cd5f/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Over the past 20 years, the number of egg donation cycles in Europe has been steadily increasing, <a href="https://pubmed.ncbi.nlm.nih.gov/35795850/">reaching more than 80,000</a> in 2018. Around half of these take place in Spain, which has positioned itself as Europe’s go-to destination for people seeking donated eggs. </p>
<p>According to Anna Molas, a research fellow in anthropology at the Autonomous University of Barcelona, Spain currently has “the most flexible assisted reproductive law across Europe”. There is no age-limit for women who want to use private clinics, and no access restrictions in terms of marital status or sexual orientation. </p>
<p>An egg donation industry has developed in Spain to feed the demand for donor eggs, much of which is driven by women over the age of 40 who need help to have a baby. Adverts on social media encouraging women to donate their eggs are common. Around 15,000 women go through egg donation cycles every year in Spain. </p>
<p>When Molas interviewed women in Spain about their experiences, she found that the main reason they chose to donate was economic. A donor typically receives €1,100 (US$1,150) for an egg donation cycle, and the amount of compensation increases each time they donate. </p>
<p>“Even if it is a low amount of money for all the process that it involves, it still appeals to a lot of women,” says Molas. However, under Spanish law, donors are considered to be motivated by altruism. “The fact that they are treated as donors, as volunteers, makes it very difficult to have a discussion about how much they should be paid,” she says. </p>
<p>Listen to the full interview on The Conversation Weekly podcast, and subscribe wherever you get your podcasts. You can also read <a href="https://theconversation.com/spain-is-the-egg-donation-capital-of-europe-heres-what-its-like-to-be-a-donor-205780">an article Anna Molas</a> wrote about her research, which is part of <a href="https://theconversation.com/spain-is-the-egg-donation-capital-of-europe-heres-what-its-like-to-be-a-donor-205780">Women’s Health Matters</a> – a series about the health and wellbeing of women and girls around the world. </p>
<p>A <a href="https://cdn.theconversation.com/static_files/files/2873/Spain_Egg_Donation_The_Conversation_Weekly_podcast_transcript.pdf?1697626904">transcript of this episode</a> is now available. </p>
<p><em>This episode was produced and written by Katie Flood with assistance from Mend Mariwany. Eloise Stevens does our sound design, and our theme music is by Neeta Sarl. Gemma Ware is the executive producer of The Conversation Weekly.</em> </p>
<p><em>You can find us on X, formerly known as Twitter, <a href="https://twitter.com/TC_Audio">@TC_Audio</a>, on Instagram at <a href="https://www.instagram.com/theconversationdotcom/">theconversationdotcom</a> or <a href="mailto:podcast@theconversation.com">via email</a>. You can also subscribe to The Conversation’s <a href="https://theconversation.com/newsletter">free daily email here</a>.</em> </p>
<p><em>Listen to The Conversation Weekly via any of the apps listed above, download it directly via our <a href="https://feeds.acast.com/public/shows/60087127b9687759d637bade">RSS feed</a> or find out <a href="https://theconversation.com/how-to-listen-to-the-conversations-podcasts-154131">how else to listen here</a>.</em></p><img src="https://counter.theconversation.com/content/214491/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Molas receives funding from the Independent Social Research Foundation (ISRF).</span></em></p>Spain is the egg donation capital of Europe. We hear what is driving women to donate in this episode of The Conversation Weekly podcast.Gemma Ware, Editor and Co-Host, The Conversation Weekly Podcast, The ConversationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2083152023-09-07T15:18:16Z2023-09-07T15:18:16ZWhen IVF fails it can be devastating – so why do clinics offer so little in the way of support?<p>Four in every ten people who start IVF treatment in the UK end it without having their child, according to <a href="https://doi.org/10.1136/bmj.i5735">data</a> from the UK fertility regulator, the <a href="https://www.hfea.gov.uk/">Human Fertilisation and Embryology Authority</a>. </p>
<p>Fertility clinics’ websites are prone to promoting their success rates or enthusing about the <a href="https://www.sciencedirect.com/science/article/pii/S1472648320303928">latest technology</a> that will revolutionise treatment. But <a href="https://bmjopen.bmj.com/content/7/1/e012218">research has found</a> these websites often report on the clinic’s pregnancy or live birth rates without relevant information on how these figures were calculated, or how many patients were involved. </p>
<p>It has also been shown that some clinics <a href="https://bmjopen.bmj.com/content/6/11/e013940">make claims</a> about treatment benefits without including supporting evidence.</p>
<p>But what is less talked about is the effect that unsuccessful treatment has on patients.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<h2>The reality of failed IVF</h2>
<p>Ending treatment unsuccessfully can be <a href="https://edition.cnn.com/2022/11/19/health/ivf-women-jennifer-aniston-wellness-cec/index.html">devastating for patients</a>, throwing them into deep sadness, grief and loss. Those who go through this experience lose their sense of purpose and struggle to make sense of a new reality that denies a so desired family and parenting role. </p>
<p>Patients talk about feeling isolated from the “fertile world” and alone in their grief, with its constant pain making it hard to be with friends who have children. Indeed, the end of unsuccessful treatment is such a challenging experience that it takes on average <a href="https://doi.org/10.1002/j.1556-6676.2001.tb01991.x">two years</a> for patients to come to terms with their loss, recover their sense of balance and renew their hope for the future. </p>
<p>Research shows that <a href="https://academic.oup.com/humupd/article/23/3/322/2970305">mental health and wellbeing are significantly impaired</a> during this process and that <a href="https://doi.org/10.1093/humrep/dew131">around one in ten people never fully recover</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Going through a failed IVF cycle can be tough on couples.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/upset-black-couple-sitting-apart-at-home-5700169/">pexels/alex green</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>Research has also found that <a href="https://academic.oup.com/humupd/article/23/3/322/2970305">many of these patients</a> that are unsuccessful in their treatments say they feel abandoned by their fertility clinics when they most need support – which can lead them to become angry and frustrated. Indeed, as it currently stands there aren’t any support interventions <a href="https://bmjopen.bmj.com/content/5/1/e006592.short">available to infertile patients</a>, that are tailored to support them when treatment ends unsuccessfully. </p>
<p>The lack of evidence-based support for parents in this position is so striking that it prompted me and my colleagues to develop <a href="https://myjourney.pt/">MyJourney</a>, a free self-guided app that provides step-by-step support to ease the acceptance of an unfulfilled wish for children. <a href="https://doi.org/10.1093/humrep/deac168">Our research shows</a> that using MyJourney is linked to improvements in wellbeing within ten weeks – and that these improvements seem to last for at least six months.</p>
<h2>Support and care</h2>
<p>I believe that clinics need to do more to forewarn patients of the reality of IVF failure. Not only would this mean people go into the process properly informed, but it would also offer patients the opportunity to discuss and prepare for grief and sadness if it does happen. </p>
<p>Fertility staff also need to give patients a realistic view of treatment that does not soften its well-known challenges. Patients want to know what to expect and how to prepare for it. They want to have the “bigger picture” view of what the treatment entails so they can make informed decisions. <a href="https://doi.org/10.1093/humrep/dead096">Patients agree</a> these are difficult conversations to have but the research shows that most think the pros outweigh the cons. </p>
<p>Essentially the fertility industry needs to provide the best care for those who take a chance on IVF. And all patients should be able to access support during and after treatment, irrespective of its outcome.</p><img src="https://counter.theconversation.com/content/208315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Gameiro works for Cardiff University. She reports consultancy fees from TMRW Life Sciences
and Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International
and Gedeon Richter, grants from Merck Serono Ltd, an affiliate of Merck KgaA, Darmstadt, Germany.</span></em></p>IVF doesn’t always work, but clinics often don’t make that clear to patients.Sofia Gameiro, Reader at the School of Psychology, Cardiff University, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2103542023-08-23T09:01:57Z2023-08-23T09:01:57ZFertility is becoming a workplace issue but employer support can create winners and losers<figure><img src="https://images.theconversation.com/files/542291/original/file-20230811-23-ftk7sw.jpg?ixlib=rb-1.1.0&rect=43%2C34%2C5708%2C3199&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">kj-create/Shutterstock</span></span></figcaption></figure><iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/fertility-is-becoming-a-workplace-issue-but-employer-support-can-create-winners-and-losers-210354&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p>Since the world’s first human baby was born by in vitro fertilisation (IVF) in the UK in 1978, over 10 million IVF babies have been <a href="http://www.eshre.eu/Press-Room/Resources">born globally</a>. Assisted reproductive technologies (ART) have also <a href="https://www.wiley.com/en-gb/Clinical+Reproductive+Science-p-9781118975954">become even more sophisticated</a>, now including egg-freezing and intracytoplasmic sperm injection (ICSI).</p>
<p>But alongside these new fertility possibilities, the technology has also brought challenges. Access to publicly funded fertility treatment is not universal, and success rates are limited. This means many people globally are forced to pay privately – if they can afford it – often for multiple cycles of treatment. This can equate to <a href="https://www.fertilityclinicsabroad.com/ivf-costs/">tens of thousands of pounds</a>. </p>
<p>For some, it might also mean travel overseas. Inequalities in access and care in the UK have been linked to factors such as patient <a href="http://eprints.lse.ac.uk/90977/1/Smietana_Introduction-making-and-breaking.pdf">sexual orientation</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/32760816/">ethnicity</a>, age and weight.</p>
<p>Infertility is a disease of the reproductive system affecting one in six people, or around <a href="https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility#:%7E:text=Large%20numbers%20of%20people%20are,care%20for%20those%20in%20need.">17.5% of the global adult population</a>, according to the World Health Organization. </p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<p>As well as medical issues, sexual orientation or lack of a partner can affect the ability to conceive. But despite its prevalence among the working age population, and the considerable <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383794/">psychological and social tolls</a> it can bring, discussion of infertility has historically been silenced in public discourse and in the workplace. </p>
<p>Until recently, employers’ attention to reproductive journeys has been limited to mainly maternity provisions. This has been mandated by employment legislation in many countries for some time. </p>
<p>But changing social attitudes, advances in technology and business pressures have increased the attention being paid to fertility treatment by many employers in the developed world. This is often driven by business logic: supporting staff through IVF and the like will help with recruitment, performance, retention and engagement.</p>
<h2>Supporting different fertility journeys</h2>
<p>Indeed, employer interest in fertility treatment appears to have originated in Silicon Valley in the US. Apple and Facebook introduced fertility benefits (paid IVF and egg freezing) in 2014 as a weapon in the “war for talent”. This was controverisal, however, with companies accused of essentially trying to bribe women into <a href="https://www.theguardian.com/society/commentisfree/2017/apr/26/its-not-a-perk-when-big-employers-offer-egg-freezing-its-a-bogus-bribe#:%7E:text=5%20years%20old-,It">delayed childbearing</a>. </p>
<p>In the UK, the focus is generally on wellbeing. Workplace benefits often centre on fertility policies and time off, flexibility and workplace adjustments. But only 3% of employers said they offer such provisions to a significant extent in a <a href="https://www.cipd.org/globalassets/media/comms/news/ahealth-wellbeing-work-report-2022_tcm18-108440.pdf">2022 survey</a>. This puts fertility, alongside menstruation, bottom of the list of wellbeing supports aimed at certain employee groups.</p>
<p>Arguably, the emergence of <a href="https://journals.sagepub.com/doi/10.1177/09500170231155752">employer interest</a> in assisted fertility technology has furthered “reproductive stratification”. <a href="https://www.researchgate.net/publication/227872369_Conceiving_the_New_World_Order_The_Global_Politics_of_Reproduction">Research on this issue</a> defines this as when “some categories of people are empowered to nurture and reproduce, while others are disempowered” </p>
<p>Among the minority of employers that offer fertility-related policies and support, it tends to be aimed at permanent, highly valued staff in countries in the global north such as the US, UK and Japan. And so, large proportions of the world’s workforce are missing out. </p>
<p>Migrants and workers in precarious employment also miss out on other things that help with reproductive journeys. This can include job security, protection from dismissal, decent wages, access to sick leave, access to maternity and paternity provisions, and well-trained and supported line managers.</p>
<figure class="align-center ">
<img alt="Pad on desk showing handwritten egg freezing calculations, beside glasses, a pen and some other notebooks." src="https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542296/original/file-20230811-6955-2pufm4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Calculating the costs of IVF.</span>
<span class="attribution"><span class="source">Linaimages/Shutterstock</span></span>
</figcaption>
</figure>
<p>When policies are in place, they are not always inclusive of all employees and all fertility journeys. Our <a href="https://www.mmu.ac.uk/sites/default/files/2022-06/ComplexFertilityJourneysResearchProjectReport.pdf">research</a> shows policies often neglect partners and non-normative families (same-sex couples and those pursuing motherhood alone). They often focus on a set number of days off for treatment cycle(s). This may not be sufficient and also fails to consider the needs of staff where treatment is unsuccessful.</p>
<p>And even when employees can access fertility treatments via progressive employment provisions, they often end up being penalised via discrimination or <a href="https://onlinelibrary.wiley.com/doi/10.1111/gwao.12953">negative career consequences</a>. We found this during a study in which participants reported having to go part-time, switch career focus, leave jobs, or were just generally disadvantaged at work after embarking on a fertility journey. </p>
<p>Similar findings have been reported in international studies and surveys by campaign groups such as <a href="https://fertilitymattersatwork.com/fertility-struggles-the-impact-to-careers/">Fertility Matters at Work</a> and <a href="https://pregnantthenscrewed.com/one-in-four-women-undergoing-fertility-treatment-experience-unfair-treatment-at-work/#:%7E:text=As%20the%20new%20report%20shows,unfair%20treatment%20as%20a%20result.">Pregnant then Screwed</a>. Since women are most likely to experience these negative career consequences, this means increased take-up of fertility treatment could further existing gendered inequalities in the workplace.</p>
<h2>A more equitable future</h2>
<p>To fully optimise the hope created by ARTs, governments around the world should expand publicly funded provisions as much as possible (bearing in mind other healthcare commitments) and ensure equitable access and care. Employment legislation should also protect workers from discrimination on the grounds of accessing ARTs and allow suitable time off. </p>
<p>There is some hope. The UK parliament is currently considering a <a href="https://bills.parliament.uk/bills/3235">private members’ bill</a> to allow people to take time off work for appointments and treatment, but unfortunately it hasn’t made much progress to date.</p>
<p>A few other countries have <a href="https://ub-deposit.fernuni-hagen.de/servlets/MCRFileNodeServlet/mir_derivate_00002197/Koslowski_et_al_Leave_Policies_2021.pdf">already taken action</a>, however. Malta legislates for 100 hours’ paid IVF leave (per cycle, up to three cycles) split between the “receiving person” and their partner. Korea provides three days’ leave per year (one paid) and protection from discrimination. Japan has also introduced provisions for public workers.</p>
<p>Other recent UK developments include workplace <a href="https://www.cipd.org/uk/knowledge/guides/fertility-challenges/">guides</a> from professional body The Chartered Institute of Personnel and Development (CIPD) and <a href="https://healthcareandprotection.com/sixteen-organisations-share-1-97m-fund-for-womens-reproductive-health-at-work/">government funding</a> for charities to develop resources aimed at small and medium-sized enterprises (SMEs). These are welcome. </p>
<p>But until the government can step up to provide universal cover, organisations should not think of fertility benefits strictly in terms of a cost-benefit calculation. Employers must take a compassionate and fully inclusive approach to supporting their employees’ fertility journeys.</p><img src="https://counter.theconversation.com/content/210354/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Krystal was PI on an empirical research project connected to this article, which was funded by The Leverhulme Trust (Research Project Grant)
Krystal is a member of advisory boards for the charities Working Families and Tommy's. She has also contributed to resources (book chapters, surveys and guides) for the CIPD and is a CIPD member
</span></em></p><p class="fine-print"><em><span>Clare Mumford and Michael Carroll do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The landscape has been shifting when it comes to employer interest in employee fertility journeys.Krystal Wilkinson, Reader (Associate Professor) in Human Resource Management, Manchester Metropolitan UniversityClare Mumford, Research Associate, University of Central LancashireMichael Carroll, Reader / Associate Professor in Reproductive Science, Manchester Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2057802023-08-17T10:35:54Z2023-08-17T10:35:54ZSpain is the egg donation capital of Europe – here’s what it’s like to be a donor<p>Spain performs more than half of all <a href="https://pubmed.ncbi.nlm.nih.gov/35795850/">egg donation treatments across Europe</a>. The country is the largest provider of donor eggs across the continent. And every year, thousands of international fertility patients travel to Spain to access treatments.</p>
<p>Spain is a popular choice for private fertility treatments because any woman or man regardless of their civil status, sexual orientation or age can access them. Indeed, many come to Spain because of <a href="https://link.springer.com/chapter/10.1007/978-3-319-44667-7_14">restrictions and bans in their home countries</a>, particularly related to egg donation. Spain also tends to have very short waiting lists.</p>
<p>At the same time, egg banks in Spain <a href="https://anthrosource.onlinelibrary.wiley.com/doi/full/10.1111/maq.12767">have proliferated in recent years</a>, <a href="https://www.tandfonline.com/doi/abs/10.1080/17450101.2023.2220976">shipping donor eggs around the world</a>, as part of this multi-million-pound industry. </p>
<p>Close to 15,000 women undergo egg extraction cycles every year in Spain. Many are <a href="https://pubmed.ncbi.nlm.nih.gov/24626802/">financially motivated</a> – donors in Spain receive one of the highest rates of financial compensation across Europe (around €1,100 (£945) for a successful cycle). </p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<p>While research has previously shown that some women claim to give their eggs for <a href="https://pubmed.ncbi.nlm.nih.gov/24626802/">altruistic reasons</a> (often alongside financial motivation), very little is known about women’s experiences of egg donation. They are for the most part invisible. This is why I wanted to find out more about what it’s like being an egg donor in Spain.</p>
<p>As part of my research, I interviewed egg donors and doctors and also observed women in fertility clinics to get a better sense of what the process was actually like.</p>
<h2>The reality of egg donation</h2>
<p>Fertility clinics’ websites usually describe egg donation as a <a href="https://link.springer.com/article/10.1057/s41292-020-00218-0">fast and easy procedure</a>. But women wanting to become egg donors have to do a fair bit of preparation before the donation can actually take place.</p>
<p>First, a screening happens which includes health-related and psychological questionnaires as well as gynaecological and genetic tests. Potential donors will then be given hormone injections for about ten days. </p>
<p>After that, egg retrieval occurs which involves surgery under general anaesthetic to remove the eggs through a vaginal ultrasound scanner which is connected to a needle. It’s a time-consuming, inconvenient and at times painful process. </p>
<p>It also carries medical risks such as <a href="https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/ovarian-hyperstimulation-syndrome-patient-information-leaflet/">ovarian hyperstimulation syndrome</a>, which is when the ovaries become enlarged and can lead to several serious problems such as blood clots or bleeding. </p>
<p>Donors can also experience medication intolerance or side-effects alongside a risk of infection during surgery. But the longer-term risks of being an egg donor remain largely unknown, because of the limited amount of studies <a href="https://pubmed.ncbi.nlm.nih.gov/28473127/">carried out in this area</a>. </p>
<figure class="align-center ">
<img alt="A liquid nitrogen bank containing egg samples." src="https://images.theconversation.com/files/541471/original/file-20230807-27-kgcqd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541471/original/file-20230807-27-kgcqd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541471/original/file-20230807-27-kgcqd9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541471/original/file-20230807-27-kgcqd9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541471/original/file-20230807-27-kgcqd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541471/original/file-20230807-27-kgcqd9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541471/original/file-20230807-27-kgcqd9.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">Egg donors are not usually aware of how many times, where and when their eggs will end up being used.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/liquid-nitrogen-bank-containing-sperm-eggs-2341721623">HealthyCapture Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>I also discovered that the reality of egg donation can mean busy schedules balanced between work, studies and personal life. To avoid losing any income, most of the women I spoke to didn’t usually stop any of their usual activities during the cycle. Instead, they tried to make it all fit into their busy lives – which sometimes created risks in terms of their health. </p>
<p>This was particularly obvious when it came to the egg extraction. The scheduling of the surgery relies on the pace of the hormonal drugs in the body, so it cannot be decided according to the donors’ convenience. When the eggs are ready to be collected they are ready to be collected – and this can differ from patient to patient. When donors are ready, they have to administer the final injection, which is the one that makes them ovulate before they are scheduled for the surgery the next morning.</p>
<p>The result is that although clinics advise resting for 24-48 hours after the extraction, many egg donors work the next day, or even the same day, on their afternoon shifts.</p>
<h2>Payments and compensation</h2>
<p>Compensation for a cycle is usually paid in cash at the end of the process. And is only secured after the extraction surgery if there are extractable eggs – donors are paid the same amount regardless of the number of eggs.</p>
<p>If the process has to be stopped before the extraction for reasons that aren’t the donor’s fault, such as the medication not producing the expected effects on egg production, most clinics do not offer compensation. </p>
<p>If donors undergo the extraction surgery but there are no extractable eggs, the matter is usually discussed among doctors, with significant differences across clinics. If there is an indication that the donor may not have administrated the last injection of hormones or that she did so at the wrong time, the clinic will usually not pay her at all. </p>
<p>If the clinic believes she followed the rules but that she ovulated earlier than expected, different clinics have different rules: some might give her the full amount, others only a partial payment and some nothing at all.</p>
<p>Donors may also be required to reimburse all expenses for the treatments if they decide to abandon the process halfway through for <a href="https://www.tandfonline.com/doi/full/10.1080/25729861.2020.1781371">non-medical reasons</a> – something most can’t afford to do.</p>
<p>In the event of side effects or complications following the extraction, donors are usually referred to the emergency room of public hospitals, as the donation contract does not include private health insurance.</p>
<figure class="align-center ">
<img alt="Artificial insemination, in vitro fertilisation IVF of human egg cell." src="https://images.theconversation.com/files/541472/original/file-20230807-21-ue4ret.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541472/original/file-20230807-21-ue4ret.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=363&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541472/original/file-20230807-21-ue4ret.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=363&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541472/original/file-20230807-21-ue4ret.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=363&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541472/original/file-20230807-21-ue4ret.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=456&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541472/original/file-20230807-21-ue4ret.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=456&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541472/original/file-20230807-21-ue4ret.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=456&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Egg donation is used in IVF.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/ovum-artificial-insemination-202104430">Naeblys/Shutterstock</a></span>
</figcaption>
</figure>
<p>The few studies on egg donors’ experiences in Spain that do exist show problems and gaps in terms of the information donors are provided with and the conditions in <a href="https://journals.sagepub.com/doi/abs/10.1177/01622439231164666">which egg donation is undertaken</a>. </p>
<p>Most of the women I spoke to didn’t know how many eggs were extracted, the number of women that might be treated with them, or whether they will be used in the clinic, frozen to be banked or shipped abroad. </p>
<p>It is clear then that as the demand for egg donation increases, urgent action is needed to ensure that women in the global egg donation industry are properly informed, cared for and insured in case of complications and side-effects.</p><img src="https://counter.theconversation.com/content/205780/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Molas receives funding from the Independent Social Research Foundation (ISRF).</span></em></p>As part of my research, I interviewed egg donors and doctors and also observed women in fertility clinics to get a better sense of what the process was actually like.Anna Molas, Research Fellow in Anthropology, Autonomous University of BarcelonaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2107282023-08-13T09:13:34Z2023-08-13T09:13:34ZHow to grow rhinos in a lab: the science that could save an endangered species<figure><img src="https://images.theconversation.com/files/540701/original/file-20230802-27-i9629h.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Najin, one of two northern white rhinos left in the world, grazes in a paddock in Kenya. </span> <span class="attribution"><span class="source">Tony Karumba/AFP via Getty Images</span></span></figcaption></figure><p>There are several parallel projects running across the world to save the northern white rhinoceros (<em>Ceratotherium simum simum</em>), one of Africa’s captivating and iconic wildlife species. With the death of last male in <a href="https://www.bbc.com/news/world-africa-43468066">2018</a> and with only two females alive, the species is functionally extinct.</p>
<p>The most famous of these projects is an international research consortium called <a href="https://biorescue.org/en/home-0">BioRescue</a>. It was founded in 2019 by a team of scientists and conservationists under the leadership of the <a href="https://www.izw-berlin.de/en/mission-vision.html">Leibniz Institute for Zoo & Wildlife Research</a> in Berlin, Germany.</p>
<p>In one of its research lines, the BioRescue team collects mature eggs – scientifically called oocytes – from one of the only two northern white females. They reside in Kenya’s <a href="https://www.olpejetaconservancy.org/">Ol Pejeta Conservancy</a>, a privately run wildlife sanctuary. These eggs will be fertilised with frozen sperm that were collected from several northern white male rhinos before their death. </p>
<p>The two remaining females, Najin and Fatu, are not capable of delivering offspring anymore. Najin’s back legs are too weak to carry a pregnancy and Fatu has problems with her uterus. Therefore, the resulting embryos from the fertilised eggs will be transferred into surrogate mothers. </p>
<p>The most suitable surrogate mother would be a southern white rhino as it is the closest related species. But, placing a northern white rhino embryo in a southern white female rhino isn’t an easy task. However, there was <a href="https://phys.org/news/2023-07-embryos-surrogate-mothers-added-northern.html">promising news</a> in May 2023. Next to the addition of five more northern white embryos – which brings the total to 29 – two wild southern white rhinos were identified as suitable surrogates, as they can still get pregnant and are able to carry the pregnancy through. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-case-for-introducing-rhinos-to-australia-99585">The case for introducing rhinos to Australia</a>
</strong>
</em>
</p>
<hr>
<p>The goal of producing a new northern white rhino calf now seems more realistic than ever before. </p>
<p>Sometimes people <a href="https://theconversation.com/the-northern-white-rhino-should-not-be-brought-back-to-life-94153">question the funding and effort</a> spent on one species, but the science behind the rhinoceros story is much bigger. Any species going extinct has huge consequences on the ecosystem, and people’s survival depends on resources provided by this same ecosystem. As a recognisable, impressive and majestic animal, rhinos certainly have a role as a flagship of conservation efforts. </p>
<p>Further, joint efforts on one species can provide scientific knowledge that allows for a multi-species conservation approach. These techniques would not only save the northern white rhinoceros, but also other rhino species, related species with a common ancestor, and all other creatures in need.</p>
<h2>Different approaches</h2>
<p>Despite the great scientific strides made in efforts to save the northern white rhino, the success rate of embryo transplantation followed by pregnancy to term is <a href="https://raf.bioscientifica.com/view/journals/raf/4/3/RAF-23-0020.xml">extremely low</a>. Parallel initiatives focusing on different conservation approaches are indispensable to ensure the future of this species. </p>
<p>While BioRescue is collecting matured eggs after hormonal stimulation, the <a href="https://www.wrh.ox.ac.uk/research/rhino-fertility-project-1#:%7E:text=Prof%20Suzannah%20Williams%20and%20her,eggs%20in%20a%20laboratory%20setting.">Rhino Fertility Project</a> at the University of Oxford in the UK is focusing on growing follicles, which are structures found in the ovary containing an immature egg surrounded by a few layers of supporting cells. These supporting cells provide signals and components essential for the development of the eggs. The idea is to make use of the much greater potential of the ovary by collecting the very small follicles and growing them all in a petridish in the lab. </p>
<p>This would bypass atresia, which is the degradation of follicles that occurs during a natural hormonal cycle. As member of this project, one of us, Ruth Appeltant, was <a href="https://theconversation.com/only-two-northern-white-rhinos-remain-and-theyre-both-female-heres-how-we-could-make-more-147608">hopeful</a> that this method had the potential to quickly provide a vast number of in vitro-grown oocytes, or mature eggs. </p>
<p>Unfortunately, it became clear that the ovarian tissue of older rhinoceroses contained extremely few to no oocytes. These eggs were needed as the starting material for the project. Without eggs, there is nothing to grow. Ongoing efforts are now looking to establish ways to localise and process the few remaining follicles in old ovarian tissue.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/540161/original/file-20230731-21-xk1xya.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/540161/original/file-20230731-21-xk1xya.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540161/original/file-20230731-21-xk1xya.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540161/original/file-20230731-21-xk1xya.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540161/original/file-20230731-21-xk1xya.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540161/original/file-20230731-21-xk1xya.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540161/original/file-20230731-21-xk1xya.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540161/original/file-20230731-21-xk1xya.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An overview of the focus of different initiatives around the world to save the northern white rhino.</span>
<span class="attribution"><span class="source">Ruth Appeltant</span></span>
</figcaption>
</figure>
<p>This bottleneck led us to the area of <a href="https://blog.uantwerpen.be/fbd/meet-our-researchers-prof-ruth-appeltant/">stem cell technologies</a>. At the <a href="https://www.uantwerpen.be/en/research-groups/veterinary-physiology-biochemistry/research-mission-and-members/research-mission/">Gamete Research Centre</a> of the University of Antwerp in Belgium, our group is aiming to produce eggs outside the body from stem cells. These could be used to conserve endangered species like the rhinoceros.</p>
<p>The BioRescue project and a <a href="https://science.sandiegozoo.org/species/white-rhino">research group at the San Diego Zoo</a> in the US are also aiming to produce artificial eggs from body cells present in tissues. </p>
<p>The common thread is turning cells into <a href="https://www.britannica.com/science/induced-pluripotent-stem-cell">induced pluripotent stem cells</a>, which are immature cells generated from mature cells, and that can in turn differentiate into eggs. In fact, this process can transform a skin cell into an egg. The procedure has so far been <a href="https://www.nature.com/articles/nature20104">completed successfully</a> in mice and could already provide a kind of precursor to oocytes in the northern white rhino. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/even-if-you-were-the-last-rhino-on-earth-why-populations-cant-be-saved-by-a-single-breeding-pair-93733">Even if you were the last rhino on Earth... why populations can't be saved by a single breeding pair</a>
</strong>
</em>
</p>
<hr>
<p>The collection of oocytes is a really tricky process due to the technical difficulties in reaching the site of the ovaries in living animals. Advanced artificial reproductive techniques using body cells, such as skin cells, introduce a spectrum of new possibilities. Most biological samples stored to date consist of small skin samples, but not of oocytes. </p>
<p>A downside to this approach is the fact that scientists first need to succeed in producing stem cells in the species of interest. </p>
<p>At the University of Antwerp’s <a href="https://www.uantwerpen.be/en/research-groups/veterinary-physiology-biochemistry/research-mission-and-members/research-mission/">Gamete Research Centre</a>, we’re not only interested in developing stem cell technologies based on induced pluripotent stem cells, but are currently establishing the in vitro gametogenesis – or “in vitro oocyte-creation” technique – based on stem cells present in the ovary. Due to a scarcity of tissues from endangered species, we are using the pig as a large animal model. This will give us more in-depth knowledge on how to approach egg creation from stem cells already present in the animal, termed endogenous stem cells. </p>
<h2>What next?</h2>
<p>When we do not have eggs, let’s create them. When we have stem cells, let’s use them. Researchers now know that samples of the northern white rhino individuals currently stored in biobanks have enough genetic variability to establish a viable and sustainable population. </p>
<p>A decade ago, we would have never imagined eggs could be produced from other cells. This is becoming a reality that gives us hope, motivation and energy to save the northern white rhino.</p><img src="https://counter.theconversation.com/content/210728/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruth Appeltant receives funding from the University of Antwerp.</span></em></p><p class="fine-print"><em><span>Rita L. Sousa receives funding from the University of Antwerp.</span></em></p>Efforts to save one species can provide scientific knowledge that enables us to save other creatures in need.Ruth Appeltant, Assistant research professor, University of AntwerpRita L. Sousa, PhD Candidate, University of AntwerpLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2071072023-06-27T12:23:02Z2023-06-27T12:23:02ZSouth Korea has the lowest fertility rate in the world – and that doesn’t bode well for its economy<figure><img src="https://images.theconversation.com/files/534163/original/file-20230626-5418-k0jzlq.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7842%2C4032&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An aging population, a tired economy.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-elderly-lady-rests-near-her-street-stall-as-pedestrians-news-photo/1251981087?adppopup=true">Anthony Wallace/AFP via Getty Images</a></span></figcaption></figure><p>Around <a href="https://www.livescience.com/worlds-population-could-plummet-to-six-billion-by-the-end-of-the-century-new-study-suggests">the world</a>, nations are looking at the <a href="https://www.economist.com/podcasts/2023/06/20/what-does-a-shrinking-population-mean-for-china">prospect of shrinking</a>, <a href="https://www.washingtonpost.com/wellness/2023/02/14/aging-boomers-more-older-americans/">aging populations</a> – but none more so than <a href="https://www.aljazeera.com/news/2023/2/22/s-korea-breaks-record-for-worlds-lowest-fertility-rate-again">South Korea</a>.</p>
<p>Over the last 60 years, South Korea has undergone the most rapid fertility decline in recorded human history. In 1960, the nation’s total fertility rate – the number of children, on average, that a woman has during her reproductive years – stood at just under six children per woman. In 2022, that figure was 0.78. South Korea is the only country in the world to register a fertility rate of <a href="https://www.npr.org/2023/03/19/1163341684/south-korea-fertility-rate">less than one child per woman</a>, although others – <a href="https://www.npr.org/2023/02/22/1155943055/ukraine-low-birth-rate-russia-war">Ukraine</a>, <a href="https://www.project-syndicate.org/commentary/china-low-fertility-rate-population-decline-by-yi-fuxian-2023-02">China</a> and <a href="https://www.aa.com.tr/en/europe/births-in-spain-drop-to-lowest-level-on-record/2614667">Spain</a> – are close.</p>
<p><iframe id="FNa7q" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/FNa7q/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>As <a href="https://scholar.google.com/citations?user=jAfhO2YAAAAJ&hl=en">a demographer</a> who over the past four decades has conducted extensive research on Asian populations, I know that this prolonged and steep decline will have huge impacts on South Korea. It may <a href="https://www.koreaherald.com/view.php?ud=20230102000602">slow down economic growth</a>, contributing to a shift that will see the country <a href="https://carnegieendowment.org/2021/06/29/south-korea-s-demographic-crisis-is-challenging-its-national-story-pub-84820">end up less rich and with a smaller population</a>.</p>
<h2>Older, poorer, more dependent</h2>
<p>Countries need a total fertility rate of 2.1 children per woman to replace their population, when the effects of immigration and emigration aren’t considered. And South Korea’s fertility rate has been consistently below that number since 1984, when it dropped to 1.93, from 2.17 the year before.</p>
<p>What makes the South Korean fertility rate decline more astonishing is the relatively short period in which it has occurred.</p>
<p>Back in 1800, the U.S. total fertility rate was <a href="https://www.statista.com/statistics/1033027/fertility-rate-us-1800-2020/">well over 6.0</a>. But it took the U.S. around 170 years to consistently drop below the replacement level. Moreover, in the little over 60 years in which South Korea’s fertility rate fell from 6.0 to 0.8, the U.S. saw a more gradual decline from 3.0 to 1.7.</p>
<p>Fertility decline can have a positive effect in certain circumstances, via something demographers refer to as “<a href="https://www.prb.org/resources/fact-sheet-attaining-the-demographic-dividend/">the demographic dividend</a>.” This dividend refers to accelerated increases in a country’s economy that follow a decline in birth rates and subsequent changes in its age composition that result in more working-age people and fewer dependent young children and elderly people.</p>
<p>And that is what happened in South Korea – a decline in fertility helped convert South Korea from a very poor country <a href="https://www.hks.harvard.edu/publications/miracle-maturity-growth-korean-economy">to a very rich one</a>.</p>
<h2>Behind the economic miracle</h2>
<p>South Korea’s fertility decline began in the early 1960s when the government adopted an <a href="https://countrystudies.us/south-korea/47.htm">economic planning program</a> and a <a href="https://doi.org//10.3349/ymj.1971.12.1.55">population and family planning program</a>.</p>
<p>By that time, South Korea was languishing, having seen its <a href="https://ciaotest.cc.columbia.edu/journals/ijoks/v5i1/f_0013337_10833.pdf">economy and society destroyed</a> by the Korean War of 1950 to 1953. Indeed by the late-1950s, South Korea was one of the poorest countries in the world. In 1961, its annual per capita income <a href="https://doi.org/10.1093/acprof:oso/9780198796954.003.0006">was only about US$82</a>. </p>
<p>But dramatic increases in economic growth began in 1962, when the South Korean government introduced a five-year economic development plan. </p>
<p>Crucially, the government also introduced a population planning program in a bid to bring down the nation’s fertility rate. This included a goal of getting <a href="https://doi.org//10.3349/ymj.1971.12.1.55">45% of married couples</a> to use contraception – until then, very few Koreans used contraception.</p>
<p>This further contributed to the fertility reduction, as many couples realized that having fewer children would often lead to improvements in family living standards. </p>
<p>Both the economic and family planning programs were instrumental in moving South Korea from one with a high fertility rate to one with a low fertility rate.</p>
<p>As a result, the country’s dependent population – the young and the elderly – grew smaller in relation to its working-age population.</p>
<p>The demographic change kick-started economic growth that continued well into the mid-1990s. Increases in productivity, combined with an increasing labor force and a gradual reduction of unemployment, produced average annual growth rates in gross domestic product <a href="https://www.macrotrends.net/countries/KOR/south-korea/gnp-gross-national-product">of between 6% and 10% for many years</a>.</p>
<p>South Korea today is <a href="https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?most_recent_value_desc=true">one of the richest countries</a>
in the world with a <a href="https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=KR">per capita income of $35,000</a>.</p>
<h2>Losing people every year</h2>
<p>Much of this transformation of South Korea from a poor country to a rich country has been due to the demographic dividend realized during the country’s fertility decline. But the demographic dividend only works in the short term. Long-term fertility declines are often <a href="https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2022/12/the-long-term-decline-in-fertility-and-what-it-means-for-state-budgets">disastrous for a nation’s economy</a>. </p>
<p>With an extremely low fertility rate of 0.78, South Korea is losing population each year and experiencing more deaths than births. The once-vibrant nation is on the way to becoming a country with lots of elderly people and fewer workers.</p>
<p>The Korean Statistical Office reported recently that the <a href="https://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1B8000F&language=en">country lost population</a> in the past three years: It was down by 32,611 people in 2020, 57,118 in 2021 and 123,800 in 2022.</p>
<p>If this trend continues, and if the country doesn’t welcome millions of immigrants, South Korea’s present population of 51 million <a href="https://www.koreatimes.co.kr/www/biz/2023/06/602_335593.html">will drop to under 38 million</a> in the next four or five decades.</p>
<p>And a growing proportion of the society will be over the age of 65.</p>
<p>South Korea’s population aged 65 and over comprised under 7% of the population in 2000. Today, <a href="https://www.cia.gov/the-world-factbook/countries/korea-south/#people-and-society">nearly 17% of South Koreans</a> are older people.</p>
<p>The older people population is projected to be 20% of the country by 2025 and could reach an unprecedented and astoundingly high 46% in 2067. South Korea’s working-age population will then be smaller in size than its population of people over the age of 65.</p>
<p>In a bid to avert a demographic nightmare, the South Korean government is <a href="https://www.yahoo.com/lifestyle/south-korea-families-770-month-183500253.html">providing financial incentives</a> for couples to have children and is boosting the monthly allowance already in place for parents. President Yoon Suk Yeol has also <a href="https://koreajoongangdaily.joins.com/2023/03/28/national/politics/Korea-birth-rate-Yoon-Suk-Yeol/20230328184849297.html">established a new government team</a> to establish policies to increase the birth rate.</p>
<p>But to date, programs to increase the low fertility rate have had little effect. Since 2006, the South Korean government has already <a href="https://www.cnn.com/2022/12/03/asia/south-korea-worlds-lowest-fertility-rate-intl-hnk-dst/index.html">spent over $200 billion</a> in programs to increase the birth rate, with virtually no impact.</p>
<h2>Opening the trapdoor</h2>
<p>The South Korean fertility rate has not increased in the past 16 years. Rather, it has continued to decrease. This is due to what demographers refer to as the “<a href="https://www.jstor.org/stable/23025482">low-fertility trap</a>.” The principle, set forth by demographers in the early 2000s, states that once a country’s fertility rate drops below 1.5 or 1.4, it is difficult – if not impossible – to increase it significantly. </p>
<p>South Korea, along with many other countries – including France, Australia and Russia – have developed policies to encourage fertility rate increases, but with little to no success. </p>
<p>The only real way for South Korea to turn this around would be to rely heavily on immigration.</p>
<p>Migrants are <a href="https://www.imf.org/en/Blogs/Articles/2020/06/19/blog-weo-chapter4-migration-to-advanced-economies-can-raise-growth">typically young and productive</a> and usually have more children than the native-born population. But South Korea has a <a href="https://www.nytimes.com/interactive/2018/02/16/upshot/comparing-immigration-policies-across-countries.html">very restrictive immigration policy</a> with no path for immigrants to become citizens or permanent residents unless they marry South Koreans.</p>
<p>Indeed, the foreign-born population in 2022 was just over 1.6 million, which is around <a href="https://www.koreaherald.com/view.php?ud=20220414000692">3.1% of the population</a>. In contrast, the U.S. has always relied on immigration to bolster its working population, with foreign-born residents now <a href="https://www.americanimmigrationcouncil.org/research/immigrants-in-the-united-states">comprising over 14%</a> of the population.</p>
<p>For immigration to offset South Korea’s declining fertility rate, the number of foreign workers would likely need to rise almost tenfold.</p>
<p>Without that, South Korea’s demographic destiny will have the nation continuing to lose population every year and becoming one of the oldest – if not the oldest – country in the world.</p><img src="https://counter.theconversation.com/content/207107/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dudley L. Poston Jr. 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>South Korea’s fertility rate fell below the level needed to sustain a population in the mid-1980s – and it never recovered. It is now below one child per woman during her reproductive years.Dudley L. Poston Jr., Professor of Sociology, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2070082023-06-13T06:26:48Z2023-06-13T06:26:48ZDon’t believe the hype. ‘Egg timer’ tests can’t reliably predict your chance of conceiving or menopause timing<figure><img src="https://images.theconversation.com/files/530788/original/file-20230608-27-rgqeqd.jpg?ixlib=rb-1.1.0&rect=0%2C603%2C4025%2C2408&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/AeZncpkqMVU">Caleb George/Unsplash</a></span></figcaption></figure><p>Many women who want to have children and are getting older worry about their fertility. The “egg timer” blood test is <a href="https://bmjopen.bmj.com/content/11/7/e046927">marketed</a> as an empowering way to give women insights to help them plan when to have children. </p>
<p>Online companies are now also selling the test directly to consumers to do at home, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953619306926">promoting the test</a> as a way for women to decide when to have a baby, even if they aren’t thinking of having one any time soon.</p>
<p>But it <a href="https://www.frontiersin.org/articles/10.3389/fendo.2021.695157/full">can’t reliably predict</a> the <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">likelihood of pregnancy</a> or how long it would take to get pregnant. </p>
<p>Despite this, egg timer testing is promoted to women not undergoing IVF as a way to assess their current and future fertility. </p>
<p>Our <a href="http://dx.doi.org/10.1136/bmjopen-2020-046927">analysis</a> of Australian and New Zealand fertility clinic websites found some claimed the test could predict a woman’s chance of conceiving or identify women at risk of early menopause.</p>
<h2>What can and can’t the test do?</h2>
<p>The test measures the level of anti-Mullerian hormone (AMH) in the blood and is known clinically as an AMH test. </p>
<p>AMH is produced by follicles in the ovaries (little fluid-filled sacs that contain immature eggs) and helps follicles and eggs grow during the menstrual cycle. Because the number of follicles in the ovaries drops with increasing age, the level of AMH also falls.</p>
<figure class="align-right ">
<img alt="African-Australian woman puts headphones on" src="https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530789/original/file-20230608-19-jdt55.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">AMH testing can be used to indicate whether a medical condition or treatment, such as chemotherapy, has affected a woman’s ovarian reserve.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/d7JCyFstmqM">Dushawn Jovic/Unsplash</a></span>
</figcaption>
</figure>
<p>The AMH level <a href="https://doi.org/10.1530/EJE-19-0373">indicates</a> the number of eggs in the ovaries, or ovarian reserve. </p>
<p>It is often used in IVF treatment, as it <a href="https://doi.org/10.1093/humupd/dms041">can suggest</a> how many eggs a woman may get when her ovaries are stimulated with fertility drugs. </p>
<p>But it can’t tell you anything about egg quality. Women with low AMH levels have the <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">same chance</a> of conceiving as women with normal AMH levels.</p>
<p>It also <a href="https://academic.oup.com/humupd/article/29/3/327/6990969">can’t reliably predict</a> menopause <a href="https://pubmed.ncbi.nlm.nih.gov/30032277/">timing</a> for individual women. </p>
<p>Because of this, the American College of Obstetricians and Gynaecologists <a href="https://pubmed.ncbi.nlm.nih.gov/30913192/">strongly discourages</a> AMH testing in women who are not seeking fertility treatment. It states the test:</p>
<blockquote>
<p>should not be ordered or used to counsel women who are not infertile about their reproductive status and future fertility potential. </p>
</blockquote>
<p>No similar guidance has been published by the relevant colleges in Australia. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/womens-fertility-does-egg-timer-testing-work-and-what-are-the-other-options-109726">Women's fertility: does 'egg timer' testing work, and what are the other options?</a>
</strong>
</em>
</p>
<hr>
<h2>Who gets AMH tests and why?</h2>
<p>The test isn’t Medicare-subsidised. Most AMH tests are paid for privately by consumers, costing around A$80-$120. Because of this, data on current test usage is not publicly available. </p>
<p>To find out how many women in Australia are accessing AMH testing and why, we conducted the <a href="https://academic.oup.com/humrep/advance-article/doi/10.1093/humrep/dead111/7193900?searchresult=1">first investigation</a> into its use in Australia.</p>
<p>We surveyed a representative sample of 1,773 women aged 18 to 55, recruited through the <a href="https://srcentre.com.au/our-research/life-in-australia-study">Life in Australia</a> national study.</p>
<p>We asked them if and how they had heard about AMH testing, whether they had ever had an AMH test, their main reason for testing and how they accessed the test.</p>
<figure class="align-center ">
<img alt="Woman in jeans sits, cross-legged" src="https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530791/original/file-20230608-25-2bax4c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We asked Australian women about their use of AMH testing.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/L1kLSwdclYQ">Imani Bahati/Unsplash</a></span>
</figcaption>
</figure>
<p>Our results, published today, show 13% of the women had heard about AMH testing and 7% had had an AMH test.</p>
<p>The majority had the test for medically indicated reasons, such as during infertility investigations (51%), or to find out if a medical condition had affected their fertility (11%). This included having had chemotherapy or radiotherapy, endometriosis, thyroid issues, and others.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/young-people-with-cancer-should-have-affordable-options-to-preserve-their-fertility-63457">Young people with cancer should have affordable options to preserve their fertility</a>
</strong>
</em>
</p>
<hr>
<p>Concerningly, one-third reported having had the test for other reasons. This included gaining insights into their fertility or inform their reproductive life planning (30%). </p>
<p>Most women who had an AMH test first heard about it from their GP or fertility specialist, suggesting doctors are currently the main drivers of test uptake. </p>
<p>However this may change with the recent emergence of direct-to-consumer AMH testing in Australia, as online companies increase their marketing.</p>
<h2>What are the downsides of having an AMH test?</h2>
<p>Getting the test to inform you about your fertility may lead you to make choices based on a false premise. </p>
<p>If you get a normal or high AMH result, it may give a false sense of security about delaying pregnancy, when age is the most important factor of female fertility. </p>
<p>If you receive a low result, it may cause unwarranted anxiety about not being able to conceive. This may cause pressure to conceive earlier than desired, or create a <a href="https://www.publish.csiro.au/PY/PY18040">sense of urgency</a> and haste towards fertility treatment, such as <a href="https://doi.org/10.1080/02646838.2016.1275533">egg freezing</a>.</p>
<figure class="align-center ">
<img alt="Woman sits on her longeroom floor, looking at her laptop" src="https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530792/original/file-20230608-18-n32955.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women need good evidence about the limitations of AMH testing.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Nv-vx3kUR2A">Unsplash/Thought Catalog</a></span>
</figcaption>
</figure>
<p>To make informed decisions about AMH testing, women need clear, evidence-based information. We have developed and are currently testing an evidence-based information guide to assist with this.</p>
<h2>Can other tests tell me about my fertility?</h2>
<p>Unfortunately, there is no reliable test of a woman’s fertility. </p>
<p>But it’s important to know a woman’s age is the greatest predictor of her chance of pregnancy. The only real way to know your fertility is by trying to get pregnant when you are ready.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-are-often-told-their-fertility-falls-off-a-cliff-at-35-but-is-that-right-189978">Women are often told their fertility 'falls off a cliff' at 35, but is that right?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/207008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tessa Copp is supported by an NHMRC Emerging Leader Research Fellowship (2009419). She is on the Scientific Committee of the Preventing Overdiagnosis Conference. </span></em></p><p class="fine-print"><em><span>Jenny Doust receives funding from Centre of Research Excellence on Women and Non-communicable Diseases (CRE-WaND) NHMRC APP1153420. </span></em></p><p class="fine-print"><em><span>Karin Hammarberg works part-time for the Victorian Assisted Reproductive Treatment Authority.</span></em></p>The ‘egg timer’ blood test is marketed as an empowering way to give women insights to help them plan when to have children. Problem is, it can’t deliver what it promises.Tessa Copp, NHMRC Emerging Leader Research Fellow, University of SydneyJenny Doust, Clinical Professorial Research Fellow, The University of QueenslandKarin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2065722023-06-07T12:24:04Z2023-06-07T12:24:04ZThe ugly side of beauty: Chemicals in cosmetics threaten college-age women’s reproductive health<figure><img src="https://images.theconversation.com/files/530352/original/file-20230606-20-19o8gg.jpg?ixlib=rb-1.1.0&rect=1300%2C0%2C3332%2C2010&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many types of makeup contain endocrine-disrupting chemicals.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/two-young-women-sitting-applying-make-up-royalty-free-image/200425913-004">Charles Gullung/The Image Bank via Getty Imagges</a></span></figcaption></figure><p>Walk through the personal care aisles of your local store and you’ll see dozens of products that promise to soften your skin, make you smell better, extend your lashes, decrease wrinkling, tame your curly hair, or even semi-permanently change the color of your lips, hair or skin.</p>
<p>Remember the adage “If it seems too good to be true, it probably is”?</p>
<p>Many of product promises like these are based on chemicals that can also be hazardous to your health, including endocrine-disrupting chemicals that can interfere with <a href="https://doi.org/10.1002/mrd.23541">fertility and reproduction</a>, <a href="https://doi.org/10.1289/ehp.11681">fetal growth</a> and <a href="https://doi.org/10.1289/ehp.1003178">infant development</a>.</p>
<p>That’s a big concern, because these products are heavily marketed to young women in the years before they might consider starting a family.</p>
<p>Recent studies have demonstrated that <a href="https://doi.org/10.1038/s41370-019-0170-1">college-age women</a> use cosmetic products <a href="https://doi.org/10.1016/j.hazadv.2022.100117">at higher rates</a> than other groups. Additionally, many of these young women are unaware of the health risks from frequent use of popular products containing <a href="https://doi.org/10.1186/1752-153X-8-15">contaminants of emerging concern</a>. And finding cleaner alternatives often means paying more. </p>
<figure class="align-center ">
<img alt="A person's hands test colors of lipstick in store in front of a counter filled with cosmetics." src="https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.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">Cosmetics designed to be free of endocrine-disrupting chemicals are often more expensive.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/this-picture-taken-on-july-29-2018-shows-jiang-cheng-news-photo/1014162178">Wang Zhao/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>As <a href="https://scholar.google.com/citations?view_op=list_works&hl=en&user=tQJksK8AAAAJ">an epidemiologist</a> who has fought my own fertility battles, I study exposure to endocrine-disrupting chemicals found in everyday products, such as cosmetics, shampoos, lotions and plastics. I have been working to raise awareness of the health risks to young people and encourage prudent use of cosmetic products.</p>
<h2>Unregulated and potentially risky</h2>
<p>According to the <a href="https://www.fda.gov/industry/fda-basics-industry/are-all-personal-care-products-regulated-cosmetics">U.S. Food and Drug Administration</a>, the term “cosmetic” can include deodorants, perfumes, lotions, nail polish, shampoos and other hair products, as well as eye, lip and face makeup.</p>
<p>This is important to know, because unless these products are used to treat a condition, such as dandruff or perspiration, they are not federally regulated in the same way drugs are. That leaves it up to cosmetic companies to decide how to communicate product safety.</p>
<p>Personal care products contain many types of chemicals that manufacturers add for specific purposes, including some that can interfere with or disrupt the normal functioning of the endocrine system. For example, they commonly add UV filters like oxybenzone <a href="https://www.cdc.gov/biomonitoring/Benzophenone-3_FactSheet.html">to protect skin from sun damage</a>, phthalates to <a href="https://doi.org/10.1016/j.envres.2011.01.013">enhance fragrance</a>, parabens and triclosan for their <a href="https://www.fda.gov/cosmetics/cosmetic-ingredients/parabens-cosmetics">antimicrobial properties</a>, and per- and polyfluoroalkyl substances, or PFAS, to <a href="https://doi.org/10.1021/acs.estlett.1c00240">enhance durability</a>.</p>
<p><iframe id="0B09y" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/0B09y/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>However, not all of these chemicals are present in all products, so figuring out how to avoid exposure can be complicated. For example, in a <a href="https://doi.org/10.1016/j.talanta.2021.122642">2021 review</a> of studies detecting endocrine-disrupting chemicals in daily-use cosmetic products, phthalates were present in perfumes, shower gels, shampoo and nail polish. Parabens were detected in lotions, creams, shampoos, body wash, face cleansers and lipstick. Triclosan was detected in toothpastes, soaps and other cleansers. And UV filters were present in sunscreens, lotions, toothpaste, and lipstick. </p>
<p>Many of these chemicals can co-occur in products, putting consumers at risk of <a href="https://doi.org/10.1289/ehp.1104052">exposure to multiple chemicals</a> at once, and sometimes without warning, as labels <a href="https://www.fda.gov/cosmetics/cosmetics-labeling-regulations/summary-cosmetics-labeling-requirements">do not always list</a> endocrine-disrupting chemicals among the ingredients.</p>
<h2>Why are chemicals in cosmetics a health risk?</h2>
<p>As you rub cosmetic products onto your skin, breathe in their scent or use them to brush your teeth, <a href="https://www.ewg.org/the-toxic-twelve-chemicals-and-contaminants-in-cosmetics">the chemicals</a> found within can travel throughout your body, targeting your endocrine, nervous and cardiovascular systems.</p>
<p>When these chemicals are endocrine disruptors, such as phthalates, parabens, triclosan <a href="https://theconversation.com/toxic-chemicals-in-cosmetics-and-personal-care-products-remain-in-our-bodies-and-environments-for-a-very-very-long-time-201137">and PFAS</a>, they can mimic naturally produced hormones or block hormone receptors. Their presence can result in abnormal hormone production, secretion or transport throughout the body.</p>
<p>These hormonal changes can lead to reproductive problems, including <a href="https://doi.org/10.1097/01.EDE.0000059950.11836.16">poor sperm quality</a>, <a href="https://doi.org/10.1038/s41370-023-00533-1">miscarriage</a> and <a href="https://doi.org/10.1016/j.envres.2020.110342">endometriosis</a>. They can also lead to <a href="https://doi.org/10.1016/j.envres.2018.05.005">thyroid disruption</a> and <a href="https://doi.org/10.1016/j.envres.2008.08.007">abnormal growth and development</a>.</p>
<p>Neurological conditions such as <a href="https://doi.org/10.3390/ijerph19052849">attention-deficit/hyperactivity disorder (ADHD)</a>, <a href="https://doi.org/10.1016/j.envint.2019.01.023">cognitive impairment</a> and <a href="https://doi.org/10.1016/j.chemosphere.2023.139031">depression</a> have also been linked to chemicals added to cosmetic products. So have cardiovascular issues such as <a href="https://doi.org/10.1007/s11356-018-2367-6">high blood pressure</a>, <a href="https://doi.org/10.1016/j.scitotenv.2022.158218">insulin resistance</a> and <a href="https://doi.org/10.1021/acs.est.2c06488">coronary heart disease</a>.</p>
<p>The level of risk is often difficult to measure and depends in part on the amount of exposure, the type of chemical and how the chemical interacts with the endocrine system. One study of women ages 18-44 in Utah and California found increased exposure to a common phthalate was associated with twice the <a href="https://doi.org/10.1016%2Fj.fertnstert.2013.03.026">odds of developing endometriosis</a>, which can be painful and interfere with pregnancy. In a <a href="https://doi.org/10.1289%2FEHP208">meta-analysis</a> of pregnant women with occupational exposure to endocrine-disrupting chemicals, researchers calculated a 25% increase in the odds of low birth weight when mothers were exposed to more than one type of endocrine-disrupting chemical.</p>
<h2>States are starting to ban these chemicals</h2>
<p>Our <a href="https://doi.org/10.1038/s41370-019-0170-1">study of college-age females</a> found that, on average, young women use eight different personal care products each day that can contain endocrine-disrupting chemicals, but some report as many as 17. This is concerning, as the number of products people use has been <a href="https://doi.org/10.1038/s41370-017-0003-z">linked to higher exposure to endocrine-disrupting chemicals</a>.</p>
<p>Furthermore, 80% of the women we surveyed did not know whether their cosmetic products contained harmful chemicals.</p>
<figure class="align-center ">
<img alt="Two young women in party dresses stand in front of a mirror putting on makeup. The counter in front of them has many types of cosmetics that can contain harmful chemicals." src="https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=753&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=753&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=753&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=947&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=947&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=947&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many young women aren’t aware of the risks chemicals in cosmetics can contain.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenage-girls-applying-make-up-in-bathroom-royalty-free-image/200389334-001">Shannon Fagan/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<p>Studies have found significantly higher exposure to phthalates and other chemicals among adolescent girls who <a href="https://doi.org/10.1038/s41370-017-0003-z">wore foundation, blush and mascara</a> than among those who did not. One found that when adolescent girls <a href="https://doi.org/10.1289/ehp.1510514">stopped using products containing endocrine-disrupting chemicals</a>, the concentrations in their urine dropped by as much as 45%.</p>
<p>The <a href="https://www.safecosmetics.org/resources/regulations/">European Union has led</a> the way on regulating the use of these chemicals in cosmetic products, with U.S. policies generally lagging behind, but that’s changing.</p>
<p><a href="https://toxicfreefuture.org/press-room/strongest-law-in-the-u-s-regulating-toxic-chemicals-in-cosmetics-signed-by-washington-state-governor-today/">Washington</a> state recently passed legislation that bans <a href="https://toxicfreefuture.org/toxic-chemicals/pfas-forever-chemicals/">PFAS</a>, <a href="https://toxicfreefuture.org/toxic-chemicals/lead/">lead</a>, <a href="https://toxicfreefuture.org/toxic-chemicals/phthalates/">phthalates</a>, <a href="https://toxicfreefuture.org/toxic-chemicals/formaldehyde/">formaldehyde</a> and other harmful chemicals starting in 2025 and creates new incentives for companies to produce safer products. <a href="https://toxicfreefuture.org/press-room/strongest-law-in-the-u-s-regulating-toxic-chemicals-in-cosmetics-signed-by-washington-state-governor-today/">New York</a> banned mercury, a neurotoxin that can be used as a skin lightener, effective June 1, 2023. <a href="https://www.ewg.org/news-insights/news-release/2023/02/california-bill-would-ban-cosmetics-chemicals-linked-cancer">California</a>, <a href="https://legiscan.com/MN/text/HF458/id/731206">Minnesota</a> and <a href="https://www.jdsupra.com/legalnews/maine-makes-a-bold-move-in-banning-most-3530524/">Maine</a> also have broad restrictions on chemical additives in cosmetics.</p>
<p>While many cosmetic companies offer alternative products without endocrine-disrupting chemicals, they tend to cost more, which can put safer products out of reach of young people. I believe a national ban on the use of harmful chemicals in cosmetic products would be the most equitable means for reducing everyone’s exposure.</p><img src="https://counter.theconversation.com/content/206572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leslie Hart receives funding from The National Institute of Environmental Health Sciences. </span></em></p>Finding cosmetics that are free of hormone- disrupting chemicals often means paying more. An epidemiologist explains the risk, particularly for young women.Leslie Hart, Associate Professor of Public Health, College of CharlestonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2028542023-05-31T01:58:39Z2023-05-31T01:58:39ZTrying for a baby? What you need to know about a vital part of your womb (and how to look after it)<figure><img src="https://images.theconversation.com/files/525306/original/file-20230510-19-vyabvw.jpg?ixlib=rb-1.1.0&rect=50%2C101%2C4128%2C2720&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-photo-young-woman-picking-sanitary-528070513">Shutterstock</a></span></figcaption></figure><p>Human reproduction is completely dependent on the healthy function of an underestimated but vital organ: the endometrium. This is the spongy tissue that lines the inner surface of the womb.</p>
<p>In the first half of the menstrual cycle, a healthy endometrium expands in response to the estrogen produced by a growing egg. The endometrium is then shed each month during menstruation. </p>
<p>Or, in the case of pregnancy, the endometrium accepts and nurtures the embryo.</p>
<h2>So you’re trying to get pregnant. What happens?</h2>
<p>When ovulation is triggered, the ovary starts to produce the hormones estrogen and progesterone. Progesterone causes the endometrial cells to prepare to accept an embryo, in a unique transition called “decidualisation”.</p>
<p>During decidualisation, endometrial cells display proteins that indicate it’s receptive for embryo attachment. After attachment, the junctions between endometrial cells loosen so an embryo can move beneath the endometrial surface. </p>
<p>Endometrial cells secrete substances that nurture the embryo, while immune cells protect the embryo and the endometrium while they move together and the placenta develops. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-to-get-pregnant-30529">Health Check: how to get pregnant</a>
</strong>
</em>
</p>
<hr>
<p>The surface of the endometrium is covered by a shield of glycoproteins (proteins attached to sugars) which protects it from bacteria and viruses. This shield can also <a href="https://doi.org/10.1038/s41598-021-03425-2">prevent an embryo from attaching to the lining</a>.</p>
<p>Progesterone helps to remove this glycoprotein shield about five days after ovulation. This is carefully timed so a fertilised egg will have developed into a blastocyst-stage embryo and be starting to hatch from its shell ready to interact with the exposed endometrial cells.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=554&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=554&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=554&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The stages of embryo development.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com">Shutterstock</a></span>
</figcaption>
</figure>
<h2>It prevents the body rejecting the father’s sperm</h2>
<p>The endometrium must also retrain its immune cells to accept an embryo that contains the father’s foreign biological material, or “antigens”. </p>
<p>Tissues bearing these foreign antigens would usually provoke an immune rejection response, but the endometrium has adapted its immune response so an embryo can be accepted, and implant and grow, without rejection. </p>
<p>Although not essential for pregnancy, prior contact with the father’s semen <a href="https://www.jci.org/articles/view/122182">primes the mother’s immune response</a> and promotes acceptance of an embryo. Sexual activity enables paternal antigens, which are present in the fluid around sperm, to interact with the mother’s immune cells in the cervix and endometrium. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-point-of-sex-its-communication-at-a-biological-level-67847">What's the point of sex? It's communication at a biological level</a>
</strong>
</em>
</p>
<hr>
<p>Paternal antigens are taken to lymph glands in the pelvic cavity where they are processed in a way that encourages the mother’s immune response to tolerate – not reject – these paternal antigens. </p>
<p>When paternal antigens on the embryo are next seen by the mother’s endometrial immune cells, they accept the embryo and nurture it. Implantation and placental development can then occur, maximising the chance of progression to a healthy pregnancy.</p>
<h2>Then what happens?</h2>
<p>For an embryo to grow beyond being a blastocyst, it must secure access to a robust blood supply. Oxygen and nutrients are sourced from the mother’s endometrium (called decidua in early pregnancy) during implantation via the placenta which is formed from outer cells of the embryo.</p>
<p>The process of implantation involves a complex sequence of cellular steps that must progress correctly for pregnancy to occur. </p>
<p>The endometrial tissues have to be reorganised so the blood vessels grow towards the embryo. These vessels then open up to allow blood to flow into blood-filled spaces (called lacunae) that bathe the surface of the placenta. This allows oxygen and nutrients to move from the mother’s to the fetus’s blood supply.<br>
As these connections form, there can be minor bleeding a few days before a menstrual period is due. This is called “implantation bleeding”.</p>
<p>If any of these steps go awry, the embryo may fail to implant, there may be a brief interaction between the embryo and the endometrium that becomes disrupted (a “biochemical pregnancy” or very early miscarriage), or there may be implantation faults that cause a miscarriage some weeks later. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1188930437558820865"}"></div></p>
<h2>What can go wrong?</h2>
<p>The events at implantation have consequences for the rest of the pregnancy. </p>
<p>Even minor defects in the embryo or endometrial interaction at implantation can <a href="https://doi.org/10.3389/fimmu.2019.00478">increase the risk</a> of common pregnancy conditions such as:</p>
<ul>
<li>preterm labour</li>
<li>high blood pressure (preeclampsia)</li>
<li>sub-optimal fetal growth</li>
<li>premature delivery</li>
<li>pregnancy loss.</li>
</ul>
<h2>What conditions affect the endometrium?</h2>
<p>Inflammation is the hallmark of an unhealthy endometrium and contributes significantly to implantation disorders and miscarriage.</p>
<p>Endometritis (infection of the endometrium) and inflammatory fluid from blocked fallopian tubes (hydrosalpinx) can damage endometrial cells. </p>
<p>Dying and damaged cells attract immune cells that attack and engulf them. When damaged or dying cells are in the endometrium (decidua), the placenta doesn’t grow well and the pregnancy can be affected. </p>
<figure class="align-center ">
<img alt="Woman holds. her pelvis" src="https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.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">Inflammation can contribute to implantation disorders and miscarriage.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/close-up-photo-of-woman-touching-her-abdomen-3958579/">Pexels/Polina Zimmerman</a></span>
</figcaption>
</figure>
<p><a href="https://theconversation.com/au/topics/endometriosis-2405">Endometriosis</a> (endometrial tissue outside the uterus) and <a href="https://theconversation.com/adenomyosis-causes-pain-heavy-periods-and-infertility-but-youve-probably-never-heard-of-it-104412">adenomyosis</a> (endometrial tissue in the muscle of the uterus) also increase inflammation. In these conditions, endometrial cells in the wrong location grow and then die in response to cyclic menstrual cycle hormones. The immune system then has to be activated to clear the dead cells, creating an inflammatory environment. </p>
<p>Autoimmune conditions and metabolic disorders such as diabetes and insulin resistance also activate the immune system and create an inflammatory endometrial environment. These conditions <a href="https://pubmed.ncbi.nlm.nih.gov/36192117/">have been linked</a> to recurrent miscarriage. </p>
<h2>How can you improve your endometrial health?</h2>
<p>There are several things you can do to support a healthy endometrium. </p>
<p>First, manage the lifestyle factors that increase stress on cells and promote inflammation. This will decrease the chances of implantation problems and miscarriage. </p>
<p>Cutting down on <a href="https://academic.oup.com/humrep/article/22/2/543/2939206">smoking</a>, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0890623819300073?via%3Dihub">marijuana</a>, too much <a href="https://academic.oup.com/biolreprod/article/99/6/1266/5049471">coffee</a> or <a href="https://academic.oup.com/humrep/article/36/9/2538/6294415">alcohol</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S0002916522007663?via%3Dihub">avoiding</a> sugary and processed foods will make it easier for the endometrium to stay healthy. </p>
<p>For some women, the diagnosis and treatment of medical conditions that cause inflammation, such as diabetes and autoimmune problems, ensures treatments can start. Treating these conditions can reduce the risk of miscarriage and pregnancy complications.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/202854/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Louise Hull is Professor and leader of the endometriosis and endometrium group at and at the Robinson Research Institute at the University of Adelaide.
She works as a Fertility Specialist (FRANZCOG, CREI) and is also the Medical Director / Owner of Embrace Fertility, Adelaide.
Louise has previously received funding from the Federal Government Grant for the EndoZone project and MRFF Funding for Imagendo.
Louise Hull also works as a Staff Specialist Consultant at the Women's and Children's Hospital Adelaide </span></em></p><p class="fine-print"><em><span>Sarah Robertson receives funding from the National Health and Medical Research Council of Australia, and the Australian Research Council.</span></em></p>Human reproduction is completely dependent on the health of an underestimated but vital organ: the endometrium. Here’s how it works.Louise Hull, Professor and Endometriosis Group Leader, The Robinson Research Institute, University of AdelaideSarah Robertson, Professor and Director, Robinson Research Institute, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2021772023-03-28T16:38:12Z2023-03-28T16:38:12ZFive important things you should have learned in sex ed – but probably didn’t<figure><img src="https://images.theconversation.com/files/517650/original/file-20230327-20-w4as1y.jpg?ixlib=rb-1.1.0&rect=60%2C0%2C6720%2C4466&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's important to talk about sex with your partner.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/warm-toned-portrait-modern-young-couple-1686595822">SeventyFour/ Shutterstock</a></span></figcaption></figure><p>If you grew up in the 90s and 00s, you may feel that sex education didn’t teach you much of <a href="https://bmjopen.bmj.com/content/6/9/e011329.full">practical value</a>. Most sex education during this time followed a “prevention” approach, focusing on avoiding pregnancy and STIs, with most information largely targeted at heterosexual people.</p>
<p>While some schools are now making their sex education more <a href="https://www.sciencedirect.com/science/article/pii/S1054139X20304560">“sex positive” and inclusive</a>, that doesn’t change the fact that many in their 20s and 30s feel they’ve missed out on vital education that could have helped them better navigate the complex world of relationships and sexuality as adults. </p>
<p>But it’s never too late to learn. Here are five important lessons that sex ed should have taught you. </p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/love-languages-might-help-you-understand-your-partner-but-its-not-exactly-science-199040?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">‘Love languages’ might help you understand your partner – but it’s not exactly science</a></em></p>
<p><em><a href="https://theconversation.com/at-home-fertility-tests-heres-what-they-can-actually-tell-you-198639?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">At-home fertility tests: here’s what they can actually tell you</a></em></p>
<p><em><a href="https://theconversation.com/mens-fertility-also-declines-with-age-heres-what-to-know-if-youre-planning-to-wait-to-have-kids-187498?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Men’s fertility also declines with age — here’s what to know if you’re planning to wait to have kids</a></em></p>
<hr>
<h2>1. ‘Normal’ sex drive is a myth</h2>
<p>Sex education never taught us that sex drive is highly variable and has <a href="https://rightasrain.uwmedicine.org/life/sex/your-sex-drive-normal-probably">no universal normal</a>. While some may want sex several times a week, others may find once a month or less sufficient.</p>
<p>Regardless of how often you want or have sex, more important is understanding sex drive is <a href="https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/loss-of-libido">affected by many factors</a>, and may change throughout your lifetime. Many factors, such as hormone fluctuations, stress, certain medications (including <a href="https://www.blueheart.io/post/antidepressants-and-sex-drive">antidepressants</a> and <a href="https://academic.oup.com/jsm/article-abstract/9/9/2213/6886777">hormonal contraceptives</a>), as well <a href="https://www.sciencedirect.com/science/article/abs/pii/S1743609518301243">lifestyle factors</a> (such as smoking, drinking, exercise and diet) can all affect libido. </p>
<p>The most important thing is aspiring to understand your own <a href="https://theconversation.com/five-things-research-can-teach-us-about-having-better-sex-according-to-a-sex-therapist-199360">sexual needs and desires</a> and communicating these to your partner. This is important for <a href="https://www.psychologytoday.com/us/blog/loving-bravely/202001/great-sex-begins-sexual-self-awareness">personal wellbeing and healthy relationships</a>. </p>
<p>Sex drive should only be considered problematic if you’re unhappy with it. If you’re concerned with it in any way, it’s worth <a href="https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/loss-of-libido">checking with your GP</a>.</p>
<h2>2. Talking about sex is important</h2>
<p>Many of us remember how sex ed tended to focus on discussing the harms that can come from sex. As such, some of us may now see the subject as taboo, and may shy away from talking about sex with our partner.</p>
<p>But research shows that sexual communication is associated with <a href="https://psycnet.apa.org/record/2022-17919-001">higher relationship and sexual satisfaction</a>. When we openly communicate about sex, we’re revealing otherwise private aspects of ourselves (such as our desires or fantasies) to our partner. Doing so may, in turn, boost sexual satisfaction and feelings of intimacy, which may <a href="https://journals.sagepub.com/doi/pdf/10.1177/0265407510386833">improve relationship satisfaction</a> overall.</p>
<p>Thankfully, there’s ample advice online to help you learn how to <a href="https://www.brook.org.uk/your-life/talking-about-sex/">start this conversation</a> and know what sort of <a href="https://www.theguardian.com/lifeandstyle/2019/may/20/start-low-and-go-slow-how-to-talk-to-your-partner-about-sex">questions to ask your partner</a>. Some <a href="https://www.hachette.co.uk/titles/justin-j-lehmiller/tell-me-what-you-want/9781472142238">relationship psychologists suggest</a> starting these conversations as early as possible in relationships, to clarify needs and help ensure sexual compatibility. </p>
<p>They also suggest you continue sharing sexual fantasies as trust in the relationship grows, regularly asking your partner what they enjoy and sharing what you prefer as well. </p>
<h2>3. Sexuality can be fluid</h2>
<p>Most sex education in the 90s and 00s was largely skewed towards people who were <a href="https://journals.sagepub.com/doi/full/10.1177/10598405211043394">heterosexual and cisgendered</a>. This left those who identified as lesbian, gay, bisexual, non-binary or any other sexual or gender identity with little or no relevant information on how to negotiate sex and relationships.</p>
<p>This also means many people weren’t taught that sexuality can be <a href="https://link.springer.com/article/10.1007/s11930-016-0092-z#Sec4">multifaceted and fluid</a>. Your sexuality is influenced by a combination of many biological, psychological and social factors, and may shift throughout your lifetime. So it’s perfectly normal for your sexual desire and who you’re attracted to change. </p>
<figure class="align-center ">
<img alt="Two women hold hands while walking through a city." src="https://images.theconversation.com/files/517652/original/file-20230327-24-p63yy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517652/original/file-20230327-24-p63yy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517652/original/file-20230327-24-p63yy9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517652/original/file-20230327-24-p63yy9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517652/original/file-20230327-24-p63yy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517652/original/file-20230327-24-p63yy9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517652/original/file-20230327-24-p63yy9.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">It’s normal for sexuality to shift throughout your lifetime.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girls-best-friends-holding-hands-walking-750054541">William Perugini/ Shutterstock</a></span>
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<p>Research indicates that sexual fluidity may be <a href="https://www.sciencedirect.com/science/article/pii/S2352250X22002184?casa_token=6qwVGFCUAssAAAAA:ibhzUWOFLyAUdf6Hu__q5NASe1tzzWtwE9bjYHShpZRCtAybU1PX8WnwJGTNdkQQZWQLhEIgFlk">more common</a> among cisgender women and sexual minorities. It’s difficult to discern a clear reason for this, but one possibility is that men who identify as heterosexual may be less likely to act on same-sex attractions, perhaps for fear of negative reactions from those in their social circle. </p>
<p>There’s also evidence that same-sex attraction and sexual fluidity are influenced, in part, by <a href="https://www.science.org/doi/abs/10.1126/science.aat7693">genetics</a>, showing us just how natural diversity in human sexuality is. </p>
<p>Understanding that sexuality can be fluid may help people to let go of potentially harmful misconceptions about themselves and others, and feel more open to express themselves and explore their sexual identity.</p>
<h2>4. Sexually transmitted infections are very common</h2>
<p>STIs are common, with one person being diagnosed <a href="https://www.gov.uk/government/news/an-sti-is-diagnosed-in-a-young-person-every-4-minutes-in-england">every four minutes</a> in the UK.</p>
<p>But most of us remember our sex ed classes focusing on prevention, resulting in <a href="https://www.publish.csiro.au/sh/sh10070">stigmatised perceptions</a> of STIs. This stigma can be harmful, and can impact a person’s <a href="https://www.tandfonline.com/doi/abs/10.1080/14681990500058341">mental and physical health</a>, as well as their <a href="https://www.mdpi.com/1660-4601/18/13/7179">willingness to disclose</a> their STI status to partners.</p>
<p>This prevention approach also meant we learned very little about how to recognise symptoms and treat STIs and fuelled the rise of myths surrounding STIs. </p>
<p>For example, one myth is that people with genital herpes can never have sex again without infecting their partner. Not only is this not true but also, as with all STIs, the earlier you’re <a href="https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/#:%7E:text=You%2520can%2520see%2520a%2520GP,turn%2520up%2520without%2520an%2520appointment.">diagnosed and treated</a>, the easier it will be to avoid future complications such as infertility.</p>
<h2>5. Navigating pregnancy and your fertility</h2>
<p>Planning for pregnancy and parenthood is important for <a href="https://www.qub.ac.uk/sites/involve-fp/results/">both women and men</a>. But with sex ed’s focus so strongly placed on avoiding pregnancy, this means we missed out on important education relating to pregnancy and fertility. This means many women may not be <a href="https://www.nhs.uk/pregnancy/trying-for-a-baby/planning-your-pregnancy/">properly educated</a> about the many bodily changes that occur during pregnancy and afterwards. </p>
<p>Sex ed also failed to teach us that around 10%-15% of all pregnancies <a href="https://www.sciencedirect.com/science/article/pii/S0140673621006826">end in miscarriage</a>. This can be a <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04585-3">traumatic event</a>, even in cases of early pregnancy loss. But knowing how common it is and having appropriate support could reassure many women that it isn’t their fault.</p>
<p>Many of us also won’t have learned about other aspects of fertility, such as how <a href="https://www.sciencedirect.com/science/article/abs/pii/0002937895904891">waiting</a> to have children may affect your chances of getting pregnant. Nor will you have been taught about how <a href="https://academic.oup.com/humupd/article/13/3/209/2457838">lifestyle factors</a> such as weight, diet, and exercise can also affect your chances of becoming pregnant. We also weren’t taught about how common problems with <a href="https://theconversation.com/mens-fertility-also-declines-with-age-heres-what-to-know-if-youre-planning-to-wait-to-have-kids-187498">men’s fertility</a> are, and how it can also decline with age.</p>
<p>Even if you did miss out on key sex ed in your earlier years, it’s never too late to begin exploring what healthy relationships and sexuality mean to you.</p><img src="https://counter.theconversation.com/content/202177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Áine Aventin 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>Many people in their 20s and 30s now feel their sex education was lacking when it came to learning things of practical value.Áine Aventin, Lecturer, School of Nursing and Midwifery, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1986392023-02-16T06:10:43Z2023-02-16T06:10:43ZAt-home fertility tests: here’s what they can actually tell you<figure><img src="https://images.theconversation.com/files/510298/original/file-20230215-18-4vw2gt.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C5214%2C3468&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A large proportion of at-home fertility tests are aimed at women.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/concentrated-young-mixed-race-woman-unpacking-1477334057">fizkes/ Shutterstock</a></span></figcaption></figure><p>A growing number of us are waiting longer to become parents. In the UK, the average age of first-time parents is <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2020">between 30 and 33 years old</a>. Fifty years ago, the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2017">average age was 26</a>.</p>
<p>There are many reasons we’re choosing to have children later in life. On the one hand, waiting to have kids can allow us to create more stable lifestyles first, establishing a career and building our finances. But many of us also know that the longer we wait, the harder it can be to have children – with age being one of the biggest factors underlying infertility. </p>
<p>Given how big this decision is, it’s no wonder there’s growing interest in at-home fertility tests which are often advertised to people in their 20s and 30s. But while these test kits can provide you with some useful information, they can’t provide you with a full picture of your fertility.</p>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-things-research-can-teach-us-about-having-better-sex-according-to-a-sex-therapist-199360?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five things research can teach us about having better sex, according to a sex therapist</a></em></p>
<p><em><a href="https://theconversation.com/love-languages-might-help-you-understand-your-partner-but-its-not-exactly-science-199040?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">‘Love languages’ might help you understand your partner – but it’s not exactly science</a></em></p>
<p><em><a href="https://theconversation.com/tailoring-workouts-to-your-menstrual-cycle-may-help-your-physical-fitness-but-only-if-done-properly-195773?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Tailoring workouts to your menstrual cycle may help your physical fitness – but only if done properly</a></em></p>
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<h2>At-home tests</h2>
<p>For women, peak fertility occurs between their late teens and <a href="https://www.acog.org/womens-health/faqs/having-a-baby-after-age-35-how-aging-affects-fertility-and-pregnancy#:%7E:text=A%20woman's%20peak%20reproductive%20years,you%20reach%20your%20mid%2D30s.">late 20s</a>. After the age of 35, a woman’s fertility declines more rapidly until, by the age of about 45, getting pregnant naturally <a href="https://www.britishfertilitysociety.org.uk/fei/at-what-age-does-fertility-begin-to-decrease/">becomes unlikely</a>. While fertility also declines in men with age, they don’t experience such a dramatic drop from their mid-30s. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/mens-fertility-also-declines-with-age-heres-what-to-know-if-youre-planning-to-wait-to-have-kids-187498">Men’s fertility also declines with age — here’s what to know if you’re planning to wait to have kids</a>
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</em>
</p>
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<p>So the best age to conceive is often when having children may be far from a woman’s mind. This may explain the appeal of at-home fertility test kits, which promise to give you a picture of your fertility so you can better plan when you may want to start trying for kids.</p>
<p>A number of these tests are currently aimed at women. This is likely because unlike men, who produce sperm continually from puberty, women are born with all the eggs they will ever have.</p>
<p>Most kits work by having users provide a small blood sample, which is then sent off to a lab to be tested. To get a picture of fertility, these kits typically look at levels of <a href="https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/reproductive-hormones">specific hormones</a> in the user’s blood – most commonly follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Mullerian hormone (AMH).</p>
<p>Tests which look at FSH and LH can give a general idea of a woman’s hormonal balance, and can indicate when ovulation may occur. This can help determine when it might be the best time to have sex if you’re trying to get pregnant. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32770239/">AMH</a> levels are used as a marker for the number of eggs remaining in the ovary. So tests which look at AMH levels might be able to indicate if your fertility is declining.</p>
<figure class="align-center ">
<img alt="A lab worker wearing medical gloves holds a test tube of blood in their hand. The tube is labelled 'AMH test'." src="https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The information you get will depend on what hormones the test is looking at.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/blood-sample-tube-amh-antimullerian-hormone-1934816009">Saiful52/ Shutterstock</a></span>
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<p>These tests can tell you about your fertility now, but they can’t predict your fertility in five or ten years’ time. Furthermore, while they can help monitor hormone levels or the number of eggs still in the ovary, they can’t tell a woman <a href="https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/testing_and_interpreting_measures_of_ovarian_reserve.pdf">if she’s infertile</a>.</p>
<p>This is because they don’t measure the quality of a woman’s eggs or detect if she has any physical complications (such as blocked fallopian tubes) preventing her from becoming pregnant. This kind of information can only be shown through other tests, such as an abdominal scan. </p>
<p>Researchers have also recently warned against putting too much emphasis on determining fertility status from just a few, <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">select biological factors</a>. This is because fertility is regulated by a complex array of biological and <a href="https://tfp-fertility.com/en-gb/blog/9-lifestyle-factors-that-affect-fertility">lifestyle factors</a> such as weight, poor diet, smoking and excessive alcohol intake. </p>
<h2>Fertility problems</h2>
<p>While most of these at-home fertility tests are targeted at women, fertility is <a href="https://jamanetwork.com/journals/jama/fullarticle/265681">as much a consideration for men</a> as it is for women. </p>
<p>Approximately one in eight couples are affected by <a href="https://www.nhs.uk/conditions/infertility/">infertility</a>. This is defined as being <a href="https://www.britishfertilitysociety.org.uk/fei/what-is-infertility/">unable to get pregnant</a> after 12 months of regular, unprotected sex.</p>
<p>There are many reasons why infertility may happen, such as hormonal imbalances, problems ovulating, or ovulating eggs of poor quality. In women, <a href="https://www.nhs.uk/conditions/infertility/causes/">prior infections</a> can also be a factor. In men, infertility is often the result of a very low sperm count and can be a consequence of prior infection. But in many cases, the causes are unknown. </p>
<p>Many men may believe that if they can get an erection and ejaculate, there’s no problem with <a href="https://www.healthymale.org.au/news/debunking-myths-male-fertility#:%7E:text=Another%20common%20myth%20around%20men's,their%20partners%20to%20become%20pregnant">their fertility</a>. Men may also believe that age is not as much of <a href="https://www.yourfertility.org.au/everyone/age#:%7E:text=Age%20and%20sperm,healthy%20sperm%20than%20younger%20men.">an issue</a> for their fertility as it is for women. </p>
<p>However, infertility is increasing in men and is seen as a product of our modern lifestyle. Obesity, smoking, poor diet, excessive alcohol intake and recreational drug use have all been linked to <a href="https://www.inverse.com/mind-body/male-infertility-increasing">lower fertility in men</a>. </p>
<p>While men can also purchase home fertility testing kits online, these tests usually only tell you how many sperm you’re producing in each ejaculate. The shape (morphology) and speed (motility) of sperm are also <a href="https://www.mayoclinic.org/diseases-conditions/low-sperm-count/expert-answers/home-sperm-test/faq-20057836">crucial factors</a> in determining a man’s fertility – but these aren’t usually measured by these kits. Undergoing a full clinical semen analysis is still the best way for a man to assess his fertility. </p>
<p>The picture of modern fertility is changing – with fertility rates declining around the world. In many countries, fewer children are being born today than <a href="https://www.weforum.org/agenda/2022/06/global-decline-of-fertility-rates-visualised/#:%7E:text=For%20the%20last%2070%20years,increased%20cost%20of%20raising%20children">60 years ago</a>. Recent studies also show that sperm counts have <a href="https://www.focusonreproduction.eu/article/ESHRE-News-Sperm-count-decline#:%7E:text=The%20latest%20study%20found%20an,century%20at%20an%20accelerated%20pace">decreased by nearly 60%</a>. </p>
<p>However, making some simple lifestyle changes each day may help improve your fertility. For instance, losing weight and avoiding smoking and drinking in excess can all improve a couple’s chance of <a href="https://www.yourfertility.org.au/everyone/drugs-chemicals">getting pregnant</a>.</p>
<p>So if you are thinking of having children – whether in the near future or much later – making changes to your lifestyle is a good place to start if you’re concerned about your fertility.</p><img src="https://counter.theconversation.com/content/198639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Watkins receives funding from the Biotechnology and Biological Sciences Research Council. </span></em></p>At-home tests can only provide a partial picture of your fertility.Adam Watkins, Assistant Professor, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1899782022-11-30T00:55:27Z2022-11-30T00:55:27ZWomen are often told their fertility ‘falls off a cliff’ at 35, but is that right?<figure><img src="https://images.theconversation.com/files/488678/original/file-20221007-22-3zo9sd.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C3988%2C2646&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>It’s a fact women’s fertility declines as they age. But the common description of fertility decline after age 35 as a “cliff” is more anxiety-provoking than factual.</p>
<p>If you want children, it’s important to understand the biology of fertility. This can help those who have a choice about timing to decide when to start trying for a baby. </p>
<p>And for those who don’t have a choice about timing, knowing what the options are can help make the best possible decisions.</p>
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<h2>Female ageing, egg numbers and quality</h2>
<p>A baby girl is born with about one million eggs in her tiny ovaries, but by the time she reaches puberty there are only about 300,000 eggs left. This is a normal physiological process called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429023/">atresia</a>.</p>
<p>Of the eggs that remain when a woman starts having periods, only 300-400 will mature and be released in ovulation during the reproductive years. By the time a woman reaches menopause, there are no more functioning eggs in her ovaries. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Newborn baby being held by a nurse" src="https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.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"></a>
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<span class="caption">When a baby girl is born, she has about a million eggs in her ovaries.</span>
<span class="attribution"><span class="source">Christian Bowen/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>While women in their mid- to late forties sometimes have “miracle babies”, the <a href="https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/age-and-fertility/">chance of pregnancy is minimal</a> in the five to ten years leading up to menopause.</p>
<p>As women age, egg quality declines too. It’s estimated about 20% of all human eggs are “aneuploid”, which means they have the wrong number of chromosomes. This <a href="https://academic.oup.com/humupd/article/14/2/143/609857">proportion increases as women age</a>.</p>
<p>When an aneuploid egg is fertilised by a sperm it gives rise to an aneuploid embryo – which in most cases stops developing or ends in an <a href="https://www.sciencedirect.com/science/article/abs/pii/S1383574220300405?via%3Dihub">early miscarriage</a>.</p>
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<strong>
Read more:
<a href="https://theconversation.com/mens-fertility-also-declines-with-age-heres-what-to-know-if-youre-planning-to-wait-to-have-kids-187498">Men’s fertility also declines with age — here’s what to know if you’re planning to wait to have kids</a>
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<h2>What does this mean for the chance of a baby at different ages?</h2>
<p>A woman’s most fertile years are between her late teens and late 20s. By around age 30, fertility starts to slowly decline and by mid-30s the decline speeds up. </p>
<p>But the decrease in chance of pregnancy after age 35 is gradual and more like a slope than a cliff, at least until age 40.</p>
<p>A <a href="https://www.fertstert.org/article/S0015-0282(16)00152-7/fulltext">large study</a> that followed women trying for a baby found the chance of pregnancy after 12 months was 87% for women aged 30-31. This dropped to 76% at age 36-37, and 54% at age 40-41. </p>
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<p>So up to age 41, most women who try for a baby will be pregnant after trying for up to 12 months. But the proportion who don’t achieve pregnancy increases with age, and the drop in chance is more noticeable after age 35.</p>
<p>Unfortunately, because the number of chromosomally abnormal (aneuploid) eggs increase with age, the risk of miscarriage increases as women age. For women in their early to mid-30s the <a href="https://www.bmj.com/content/364/bmj.l869">risk of miscarriage</a> is about one in ten. This increases to about one in three for women aged 40-44 years. </p>
<h2>What about men’s age and fertility?</h2>
<p>While it happens later in life than for women, <a href="https://rbej.biomedcentral.com/articles/10.1186/s12958-015-0028-x">men’s age</a> affects the chance of pregnancy too. Sperm quality and fertility <a href="https://www.fertstert.org/article/S0015-0282(03)00366-2/fulltext">decline around age 45</a> and pregnancies fathered by men aged 45 or older are almost <a href="https://academic.oup.com/humupd/article/26/5/650/5827629">50% more likely to miscarry</a> than pregnancies fathered by men aged 25-29. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488709/original/file-20221007-16-9xadgh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man staring into camera" src="https://images.theconversation.com/files/488709/original/file-20221007-16-9xadgh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488709/original/file-20221007-16-9xadgh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488709/original/file-20221007-16-9xadgh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488709/original/file-20221007-16-9xadgh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488709/original/file-20221007-16-9xadgh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488709/original/file-20221007-16-9xadgh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488709/original/file-20221007-16-9xadgh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Many men don’t realise their fertility declines with age too.</span>
<span class="attribution"><span class="source">Pexels/Nathan Cowley</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>IVF is not a good plan B</h2>
<p>Unfortunately, IVF can’t improve the quality of eggs, and the woman’s age is the biggest determinant of IVF success. <a href="https://www.varta.org.au/resources/news-and-blogs/how-likely-are-you-have-baby-after-one-two-or-three-ivf-cycles">Data from Victoria</a> show that after three completed IVF cycles, 61% of women aged 34-35 when they started treatment had a baby. </p>
<p>The chance of a baby after three cycles at age 36-37 was 50% and at age 38-39 it was 38%. But by age 40-41 only 25% of women had a baby after three IVF cycles. </p>
<p>The chance of IVF success is also affected by the male partner’s age. <a href="https://doi.org/10.1016/j.fertnstert.2021.03.033">Studies</a> show that live-birth rates are lower in couples where the male partner is aged 45 or older than in couples where the male partner is younger than this. </p>
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Read more:
<a href="https://theconversation.com/thinking-about-freezing-your-eggs-to-have-a-baby-later-here-are-3-numbers-to-help-you-decide-187845">Thinking about freezing your eggs to have a baby later? Here are 3 numbers to help you decide</a>
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<h2>What are the options?</h2>
<p>Life circumstances, including not finding a partner who is willing to commit to parenthood, can prevent people from having children during their most fertile years. </p>
<p>Here are some options if you are worried about how age might affect your chance of having a baby: </p>
<ul>
<li><p>going it alone: if you are single, you can consider joining the <a href="https://www.smcaustralia.org.au/">growing group of women</a> who use donor sperm to become “solo mums by choice”. The <a href="https://www.varta.org.au/resources/news-and-blogs/media-release-victorians-warned-about-risks-informal-sperm-donation">safest option</a> for you and your baby is to find a donor through a fertility clinic.</p></li>
<li><p>freezing eggs for later: while this might seem an attractive option, it’s costly and there is no guarantee of a baby down the track. To help you decide if this is the right option for you, <a href="https://theconversation.com/thinking-about-freezing-your-eggs-to-have-a-baby-later-here-are-3-numbers-to-help-you-decide-187845">here are some facts</a> about egg freezing.</p></li>
<li><p>having IVF: if you are 35 years or older and have been trying for a baby for six months or more, see your GP for advice and basic fertility tests. Depending on test results, your GP can refer you to a fertility specialist. If you need IVF, sooner is better than later because age affects the chance of IVF success.</p></li>
<li><p>using donor eggs: the chance of a baby with IVF is negligible after age 40 unless you use eggs donated by a younger woman. <a href="https://doi.org/10.1111/ajo.13179">Studies show</a> after age 40, women using donor eggs are five times more likely to have a baby than women using their own eggs. </p></li>
</ul>
<p>Finally, a word of caution. <a href="https://bmjopen.bmj.com/content/11/7/e046927">Ovarian reserve testing</a> is often promoted as a way for women to find out their fertility and chance of getting pregnant.</p>
<p>The so called “egg timer” test measures the level of anti-mullerian hormone (AMH) in the blood, a hormone produced by reproductive tissues. The thinking is the more eggs present, the more AMH will be present, so it’s marketed as a type of “egg counting”.</p>
<p>However, <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">research shows</a> the test is not a reliable test of a woman’s fertility. On average, women of the same age have the same monthly chance of getting pregnant, regardless of their AMH level.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/womens-fertility-does-egg-timer-testing-work-and-what-are-the-other-options-109726">Women's fertility: does 'egg timer' testing work, and what are the other options?</a>
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<img src="https://counter.theconversation.com/content/189978/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karin Hammarberg works for the Victorian Assisted Reproductive Treatment Authority</span></em></p>Women’s fertility declines with age, but the ‘cliff’ we often hear about at age 35 is a myth: it’s more of a gentle slope.Karin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1943692022-11-14T15:42:24Z2022-11-14T15:42:24Z8 billion people: why trying to control the population is often futile – and harmful<figure><img src="https://images.theconversation.com/files/495067/original/file-20221114-25-n29rk9.jpg?ixlib=rb-1.1.0&rect=75%2C46%2C3815%2C2164&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/aerial-people-crowd-on-pedestrian-crosswalk-1486465109">Varavin88 / Shutterstock</a></span></figcaption></figure><p>The world’s population is expected to hit <a href="https://www.un.org/en/desa/world-population-reach-8-billion-15-november-2022">8 billion people</a> on November 15, according to the UN. Already this has prompted <a href="https://theconversation.com/8-billion-people-four-ways-climate-change-and-population-growth-combine-to-threaten-public-health-with-global-consequences-193077">worry</a> about whether there will be enough food, water and energy to support our growing population. While human activity is undoubtedly <a href="https://www.un.org/en/climatechange/science/causes-effects-climate-change">driving the climate crisis</a>, population growth is a red herring. </p>
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<p><em>You can listen to more articles from The Conversation, narrated by Noa, <a href="https://theconversation.com/us/topics/audio-narrated-99682">here</a>.</em></p>
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<p>Alarmism about population growth has a long and chequered history. On one side are concerns that there are too many people, and that sheer numbers are causing our current environmental crisis. On the other side are arguments that we have too few people. <a href="https://www.cnn.com/2022/08/30/health/elon-musk-population-collapse-wellness">Elon Musk</a> has said that “population collapse due to low fertility rates is a much bigger risk to civilization than global warming”. And <a href="https://www.thetimes.co.uk/article/should-we-tax-the-childless-j7h9c297r">a recent column in the Sunday Times</a> naively argued that the UK should “tax the childless” in order to address declining fertility rates.</p>
<p>As demographers – experts in the study of population – we see both of these arguments as misguided and fundamentally answering the wrong question. Instead of wondering whether we have too many or too few people, we should be asking how we can sustainably meet the needs of the people we have.</p>
<p>While 8 billion is a significant milestone, its magnitude is misleading. The population growth rate <a href="https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf">peaked 50 years ago (around 1962-65)</a> and is now less than 1% per year. Globally, the average number of births per woman is now 2.3, little more than “replacement level” – the 2.1 required for a population to stay the same. We are certainly not facing an “empty planet” or “population collapse”. The UN projects that the world population will peak at over 10 billion <a href="https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf">in approximately 2086</a>.</p>
<p>Arguing whether we have under or overpopulation is unhelpful and distracting when, in reality, there is very little we can do to influence population growth. Worse, these arguments often have racist, eugenicist <a href="https://www.jstor.org/stable/10.1363/intsexrephea.46.2020.0147?seq=2#metadata_info_tab_contents">undertones</a>. Overpopulation arguments frequently originate in the global north and aim at reducing fertility in the global south (developing countries in Africa, Asia and Latin America), where the majority of the world’s black, brown, indigenous and multi-heritage people live. </p>
<p>Meanwhile, suggestions that we should tax the childless and take other measures to increase fertility are aimed at countries in the global north, where the majority of the world’s white people live. Likewise, infertility is popularly imagined to affect mainly white, middle-class women in the global north, but in fact, the highest rates of infertility in the world are in the global south. Health systems and population policies often <a href="https://academic.oup.com/heapol/article/33/1/34/4563650?login=false">reflect (and perpetuate) this misperception</a>.</p>
<figure class="align-center ">
<img alt="Four pregnant women wearing sports bras and cradling their bellies" src="https://images.theconversation.com/files/495081/original/file-20221114-16-uojhs1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495081/original/file-20221114-16-uojhs1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495081/original/file-20221114-16-uojhs1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495081/original/file-20221114-16-uojhs1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495081/original/file-20221114-16-uojhs1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495081/original/file-20221114-16-uojhs1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495081/original/file-20221114-16-uojhs1.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">Arguments about fertility often have racist undertones.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnancy-466552304">Pressmaster / Shutterstock</a></span>
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<p>Global population growth is shaped by births and deaths, though migration can also impact regional populations. Another factor is also at play: population momentum. This concept explains why the age structure of a population can cause it to grow even as fertility declines below replacement level. In essence, even if the fertility rate is declining, there is still a large absolute number of people of reproductive age in the population, resulting in more births than deaths.</p>
<p>For example, in Nigeria <a href="https://population.un.org/wpp/Download/Standard/MostUsed/">the UN projects</a> that if the fertility rate dropped to replacement level today, the population would continue to grow for the rest of the century, with 124 million more people than today in 2100 (an increase of 57%). In contrast, <a href="https://www.washingtonpost.com/world/2022/06/03/japan-low-births-population-decline-2021/">fertility rates in Japan</a> have been below replacement level since 1959 leading to a much older population, but population size only started to decline in 2005.</p>
<p>If all fertility rates were at replacement level, then the world population would still hit 9 billion in 2039 – only two years later than current projections. </p>
<p>Short of an unprecedented disaster, the population will continue to grow. Even COVID-19 mortality had a very small effect on the size of the global population. The World Health Organization estimates that <a href="https://www.who.int/news/item/05-05-2022-14.9-million-excess-deaths-were-associated-with-the-covid-19-pandemic-in-2020-and-2021">14.9 million excess deaths</a> were associated with COVID in 2020 and 2021. This is a very large absolute number, but it is dwarfed by the 269 million births that happened in the same period. </p>
<h2>The problem with population policies</h2>
<p>Of course, the number of children that people have still has a big effect on the ultimate size of world population. From an environmental perspective, some would argue that decreasing the fertility rate is still important. However, <a href="https://ourworldindata.org/co2-and-other-greenhouse-gas-emissions">the carbon footprint</a> of a child born in a “low fertility” country in the global north is, on average, many times larger than a child born in a “high fertility” country in the global south.</p>
<p>Moreover, policies designed to directly influence childbearing decisions are not generally that successful. In China, where a one-child policy was famously implemented for many years, <a href="https://doi.org/10.1371/journal.pone.0220170">research suggests</a> that the effect on fertility rates has been overstated, and that similar reductions in fertility would have resulted from economic growth alone. <a href="https://link.springer.com/chapter/10.1007/978-3-031-11840-1_4#Sec3">Education and development are incredibly effective</a> at reducing the number of children that people want, while modern contraception has given people the ability to plan their number and timing better than ever before.</p>
<p>According to a UN database, <a href="https://www.aeaweb.org/articles?id=10.1257/jep.31.4.205">70% of national governments</a> wish to either lower or raise fertility rates. But the gap between these targets and actual fertility rates shows just how hard it is to achieve any specific fertility rate, especially while maintaining reproductive rights.</p>
<p>For instance, forced sterilisation camps were set up in India <a href="https://www.bbc.co.uk/news/world-asia-india-30040790">during the 1970s</a>, and sterilisation targets continue today. It is estimated that <a href="https://doi.org/10.1177/00195561221082984">one-third of sterilised women did not consent</a> to the procedure. </p>
<p>The demographic future is not easy to manipulate, especially without violating human rights. Instead, we must plan for our demographic reality. Eight billion people is neither too few, nor too many – it is simply the number of people on the planet. Rather than trying to increase or decrease the number of people, we must build a planet that enables everyone to live their lives freely, sustainably and with dignity.</p><img src="https://counter.theconversation.com/content/194369/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melanie Channon is Honorary Secretary of the British Society for Population Studies. She receives funding from UKRI (grant number EP/X02265X/1).</span></em></p><p class="fine-print"><em><span>Jasmine Fledderjohann receives funding from UKRI in the form of a Future Leaders Fellowship (grant number MR/T021950/1). </span></em></p>Arguments about population growth are unhelpful, distracting and often racist.Melanie Channon, Reader in Social Policy, University of BathJasmine Fledderjohann, Senior Lecturer in Sociology, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.