Do you think it's the place of a GP to warn you of decreasing fertility over 35 when giving you a prescription for contraceptive?

[TheCountessOlenska]

I am not sure what I think!

On the one hand - your GP knows nothing of your life and choices, so it's not really their business.

On the other hand - I guess they don't want to see you come back wanting IVF in a few years and feel that they didn't warn you? (or maybe it could be a concern about the drain on NHS funds!)

This actually happened to someone I know and she's only 30! She was

I think it's good for GPs to mention it, though obviously not heavy-handedly - for all they know, a couple might have been trying for a few years and not got to the point of asking for help.

Course they also need to warn because of the increases in possible genetic problems, too.

Em, I thought fertility actually starts declining in your late twenties, so that's probably why the G.P. brought it up with your 30 year old friend. Seems fine to me.

Oh for heavens sake everyone bombards us with the 'fact' that if we don't get ourselves up the duff by ooh 34 at the latest we will be doomed to IVF and probably - horror - childlessness.

Which is makes it even more jolly when your 30s are whizzing past and you are finding it impossible to hold down a relationship with someone who might actually want to impregnate you.

Personally, had a GP proffered that helpful advice to me in my 30s, I would have cried. Just rub it in, won't you, that I am a hideous old boot incapable of attracting a man for more than a transitory shag.

Classic example of extrapolating your own experience, there. Look outside your bubble, MI.

I am perfectly aware I am projecting; but honestly, you can't get way from Women Reproduce Now information. It's everywhere. You really do need to be living under a stone not to notice it.

It isn't "advice" though. It is an observation of a medical fact, in the same way that saying if you don't take the pill as prescribed, or you get a stomach upset it may not be as effective are observation of facts.

Perhaps it's the same as a GP reminding people about safe drinking limits. We all 'know' it maybe but it's their job to prevent problems as far as they can.

Miles better to risk offending someone who knows it all, than the possibility that not knowing may fundamentally and badly affect someone's life choices, IMHO. Though, I can see others may prefer their GPs less engaged.

I think the GP was reasonable. Despite some comments above, I agree with those who have said that the information seems sadly ill understood.

As an anecdote by way of example, I have a friend with PCOS who was told it was advisable to have children 'early' if she wanted them. Although she and her DH desperately want a family, she is still dithering at 34 and seems to think she's got another couple of years before she needs to start trying. I really worry for her.

I am acutely aware that my fertility may well decline fairly young. My mother made a point of teaching me that timing of menopause runs in families, that fertility declines long before periods cease and that she started the menopause comparatively early. I always wanted kids reasonably young (for a professional couple anyway, where lots of my friends seem to wait for mid/late 30s) and was pregnant with DD1 at 29.

I agree that it must be hard if you find yourself whizzing through your 30s without the right relationship, but on the other hand maybe a reminder about fertility would be the kick up the arse some patients would need to leave the shit boyfriend who is never father material. It could cut both ways.

Treats Tue 15-May-12 10:16:56

The message I always had as a young woman was that I should have a good career and enjoy myself before settling down to have babies. I think the advice I will give to my DD will be a bit more nuanced - live your own life as much as you can but don't leave babies too late. I wonder if that's just me (and a product of my own experience) or whether we'll see a generational shift in attitudes.

I'm not sure if there will be a general shift in attitudes, but I agree with you. I had dc1 at 35 and dc2 at 38 and personally I find being an older mum exhausting. I didn't have the patience for kids any younger, and before I met dh didn't really see myself having kids anyway. I didn't meet dh until 28 (so I'd had time to mellow! ), but I will be suggesting to my two that if they want us to be capable of babysitting and helping them with their kids then they'd be foolish to wait as long as we did unnecessarily.

I do find that in my case though the difference is highlighted because so many of dc2's classmates' mums are young enough that I could be their mum, and that's just scary!

My male GP took the place of my mum for nagging me about ticking clocks. I would go to see him with a throat infection and he'd say "now then, you are 35, you'll have to start soon if you are going to do this...." Etc.

Exactly adversecamber - I think that having somebody dispassionately pointing out the facts about fertility at the right time could help you take off the rose-tinted glasses you might be wearing about the relationship you're in. Or not in, in your SIL's case.

motherinferior - I disagree that it's EVERYWHERE. I only started thinking about it/noticing it when I decided to start ttc. What is EVERYWHERE is the assumption that women who don't start to reproduce until later (if at all) are selfish career bitches or whatever. And I think this is unhelpful because it muddies the message - you don't identify with the scenario because you're not a highflying career woman and you definitely want to have kids soon. Therefore it's probably not going to be a problem for you. But 'soon' starts to drag on for all kinds of reasons beyond your control.

This reminds me of the time I was asked at my smear test what contraception I was using & the nurse raised an eyebrow.

I had to point out politely that just because I had had sex in my life & was having a smear, didn't mean I was sexually active right now!

The nurse looked a bit sheepish & apologised but I felt like I was walking out of there with a big sign on my head saying 'Ha Ha Marsh doesn't have a boyfriend!'

x-posted Muddling. I know what you mean about waiting unnecessarily. I met DH when I was 21, and married him at 25. I think I can remember why we didn't have kids for another 7 years, but now that I'm older, sadder and wiser, I wish we hadn't.

The trick will be to pass on that lesson to DD without sounding like I'm nagging....

Doctors have the medical facts, these do not change depending on our feelings about them. Biology is not sensitive to our feelings, moods, or opinions. Biology is not politically correct and does not care what your life goals are.

Doctors have a responsibility to present these facts to patients, especially when they are prescribing drugs which alter and distort our physiology.

If it is not the job of a medic to impart medical information where would you like it to come from?

Sorry that should say 'the nurse raised an eyebrow when I said NONE'.

Beautiful precis.

After having recently spoken to a group of young women, I'm not sure they do realise that their fertility is on the declines from the age of 30. They seemed to think 'people have babies quite late now' so therefore it was possible but didnt know about the possibility it may not be that easy. Also the use of IVF has lulled them into a false sense of.... well there is IVF if things are difficult.

These were well educated women but were cluseless and a bit gobsmacked when I told them they couldn't rely on their fertility being A1 if they left it until their late 30's

I had a lecture from a family planning nurse one week after my 30th birthday. The thing she kept saying over and over again was "you've got to have a plan". I pointed out I was single and on the pill for menstrual problems but she still wouldn't let it go. She was really aggressive about it . I met DH 8 months later.

The way my mum got the message to me was by saying that my Grandma always said to have your first baby by 30, (she married late and had her first later than this)

Luckily I was married at 24 and was able to have my first at 26 and 2nd at 29. Actually I wish we'd had them a bit earlier

I remember being a regular Times reader in my mid-late twenties. And every bloody day (the way I remember it) there would be an article scaremongering about women's declining fertility.

This directly influenced my decision to have kids at 30 rather than get some sort of career. My friends all thought I was loopy (they all have great careers now and I don't, so they had a point).

However, I am now 35 and googling 'early menopause'. My periods have nearly stopped, I'm getting flushes...I am so thankful that I've had my kids already. I suspect my breeding time is nearly up and I am grateful to the Times for scaring me into it!

I think the information is everywhere... if you already know. I see stuff about it everywhere, certainly, but not dispassionate figures. More human-interest style stuff, which ties into what I already know. I can't say I'd necessarily be able to put two and two together from such slush, without prior knowledge.

Treats

Even though DH and I were nearly 30 when we met, we could still have had kids younger but he was studying part-time for a degree whilst working full-time, so a baby wasn't really compatible with that, and then we had a couple of years just enjoying making the most of holidays and time together before kids came along.

As it happens, my mam started the menopause at 37, although she only told me this after I had dc1. She hadn't wanted to worry me but was worried herself that I'd leave it too late. However, knowing that meant we knew we couldn't risk waiting too long to have dc2 and only left it as long as we did (2.9 age gap) as we couldn't afford the nursery fees if we had no2 before no1 got the 15 hours free!

Having friends and family who have struggled to conceive I appreciate that we got extremely lucky and it could so easily have been a very different story.

Of course it is the GP's role to give this advice. As GPs we're not just there to dole out any pills/ potions our patients want. We also have a duty to educate and inform our patients, and try to actively prevent health problems. For example it has been shown that a 'brief intervention' by a GP on the subject of smoking [eg "How much do you smoke? If you'd like to stop we can help."] is very effective in helping people stop.

It might be a bit inappropriate for a GP to bring up declining fertility to a childless women there to discuss her ingrowing toenail or her chest infection (probably), but when she is actually there for contraception, it is clearly a most appropriate occasion to give this kind of advice.

And for those who think their GP is trying to make them have a coil; actually we are required to talk about LARC (long acting reversible contraception) at every appointment for contraception (minimally annually for all women on oral contraceptives), to ensure every woman is able to make a properly informed choice each time, and knows about the more reliable/ possibly more suitable methods available to her. We are doing it FOR YOU; not because we have some hidden reason to want everyone to have a mirena...!