Guest post: "Young adults need to understand the facts about fertility"

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Conversations about fertility usually take place when there's a problem. They focus on treatment, rather than prevention. But with one in seven couples having difficulty conceiving, effective education could help to stop those numbers from rising.

As we live longer, have children later, and often build our careers before settling down - we're facing a fertility time-bomb in Britain. Having children in our late 30s and 40s is not always straightforward, and both age and lifestyle choices can have an incredible impact on our ability to conceive. Yet, even though we are aware of this, the widespread disconnect between social and biological reality means that the extent of such impacts isn't always known.

So how do we tackle the misconceptions around fertility? For me the solution is clear, and that is encouraging the next generation to be as informed and educated as possible on this subject.

I know this is both a sensitive and emotive issue, and I am aware of the argument that most young people are already aware of their biological clock, and that adding to this pressure is damaging. Yet it is my opinion that such a view is short-sighted. By providing reliable medical facts we are looking to remove fear and anxiety, rather than create it. It is a simple fact that we cannot turn back the biological clock once it is too late, and we should be giving young people the information they need to make informed decisions about their lifestyle and future.

We need to be informing teenagers and young men and women of the possible effects of their lifestyle choices. There isn't enough awareness about the impact low or high body weight, smoking, alcohol, drugs, STIs and thyroid problems can have on fertility.

We have already been successful in reducing teenage pregnancy through Sex and Relationship Education (SRE). Contraception and conception are two sides of the same coin. Last year I wrote a letter to Nicky Morgan MP, calling for the government to include fertility education as part of SRE in the secondary school curriculum. I am working with South London Schools to develop a pilot scheme in which secondary school children are provided with clear information as part of SRE on both the male and female fertility timeline and the effects of lifestyle.

At the most basic level, young men and women need to understand the fundamental facts about their fertility. A harsh biological reality is that female fertility declines much faster than that of men, decreasing significantly from the age of 35. Women are born with a finite number of eggs, and the decline in fertility comes from a reduction in the number and quality of eggs as women age. This decline can be measured by testing to indicate how many active egg sacs a woman still has. Sperm quantity and quality also decline with age - but at a much more gradual rate.

When it comes to reproductive ageing, nature has created a 'gender inequality'. Family history of early menopause also plays a part, and I encourage young women to speak to their mothers and female relatives openly. Education is crucial to ensuring that women who wish to have children don't miss out on the chance of motherhood due to misinformation.

Without effective education, the number of people facing fertility problems is only set to rise. But by passing on accurate and responsible information we can empower informed adult decisions. We need to shift the fertility paradigm from treatment to prevention - education can help us do this.

the problem with career vs children is that we're still stuck in an old-fashioned idea that the time when you should be putting the hours in and moving up the career ladder is your 20s and early 30s, which is fine if you're a man living in a time when one income can cover the cost of living, but not in the modern world. we also have the daft notion that ambition and commitment to a career is demonstrated through long hours and single-minded focus on the job, and pretending that you don't have commitments outside work. All this at the same period of life that women are fertile, and yes there is also the issue that most women understandably want to have children with the right partner, who may not appear until your late 30s. We as a society need to have a far more holistic and long term view of higher education, careers and childrearing. Educating people about fertility won't achieve this - believe me the message is out there

I see your point Marilyn and I agree to an extent, of course you shouldn't jump into having children with the first feckless eejit that comes along just because you don't want to be an 'old mum'.

But neither is it a good idea assuming you are in the right relationship are already around 30-35, to deliberately keep putting it off TTC year in year out until you are pushing 40 or over 40. If you have no immediate practical or financial issues to overcome first then it's foolish to keep putting it off.

The more I think about this, the more I think if any additional moral pressure should be exerted anywhere it's on young men. Of course there are exceptions, but the young men who are happy to have children in their early or mid twenties are more likely to be the 'baby daddy' variety that any woman looking for a long-term co-parent will reject out of hand. The kind of men who generally make responsible long-term partners and co-parents are generally older than that. So should we all be looking for older partners? If we got together with a man in our twenties, should we ditch them for a broodier model if he's still not interested in babies when we're pushing 30?

Frankly there are enough people hectoring women about fertility already. You'd have to be living under a stone with earplugs in to be a woman and unaware that fertility declines after 35. If anything it's men's attitudes (lad culture, extended adolescence) that need to change in favour of long-term relationships and parental responsibility at a younger age.

You'd have to be living under a stone with earplugs in to be a woman and unaware that fertility declines after 35.

Agreed!

Has she met any actual teenagers?

I'm laughing at the thought of telling teenagers their lifestyle choices can affect their fertility - choices that they make despite the effect they can have on their own immediate health, but yeah, telling them it might stop then having children that they're not currently planning on having, that'll make a difference...

I think it is a good idea since so many other mothers are likely to have miscarriages and are at higher risk of having babies with birth defects

It's not being ageist it's just scientific facts and educating teenagers will make it stick in their head. Even if most don't pay attention, some will

It's like educating about safe sex, it always stuck in the back of my mind

On a personal note I suffered from secondary infertility for years before I had my baby naturally and currently pregnant again at 29

I wouldn't want to risk leaving it longer as ttc is heartbreaking

Giving people facts and information isn't 'pressuring' or 'lecturing' them. This is just an emotional subject that everyone brings their own insecurities to.

How can anyone possibly believe that women are somehow not already aware of this? In my experience it's the men who don't want the responsibility of a family - most women are acutely aware that their fertility is likely to decline but until someone invents a fucking "decent man" tree, there is not an awful lot they can do about it. Good business for sperm banks I suppose...

Just to give the other side of the 'dooooooom' argument. I am 40 and pregnant after a single round of IVF. I was not suffering from infertility, but I wanted to avoid passing on a genetic problem so I had PIGD. At the grand old age of 39, I was told that my ovarian reserve was better than most 25 year olds. This after 6 months of chemo which I was told might leave me infertile. It's about SO MUCH MORE THAN JUST AGE!

Would you have fallen pregnant if it wasn't for Ivf?

The nhs is under strain

Ivf most likely won't available for free to today's teenagers in 20 years time!

It's really not about age. It's about educating teenagers on medical facts

Everyone is commenting about when they were 20/30 something but not about what they knew about infertility when they were a teenager... which is the target audience

When I was a teenager I'd never even heard of ttc and I imagined that adoption would be easy lol

I think this is a good thing to teach our children

2under I would have thought that the reference in my post to my very high ovarian reserve and the other bit where I point out that i was not suffering from infertility would have made it blindingly obvious that yes, I would undoubtedly have fallen pregnant without IVF.

Which I paid for privately btw.

There are many more important things to teach in school than this scaremongering nonsense. Reading comprehension, for example.

Those are already taught in schools. The risks of infertility are not.. Yet but thankfully will be

Were you aware that fertility decreases rapidly at 35 when you where a teenager? I wasn't

the chances of falling pregnant naturally at 40 for anyone are slim.

Why argue with the facts?

Of course there are exceptions but you had ivf so you weren't one of those who conceived naturally over 35 so your egg supply is irrelevant

Not only are you at higher risk of birth defects but you will be old when your child is going to university

I can't imagine many 58 year olds keeping up with an 18 year old and being able to play sports or do fun things like jet skiing with them.

Why not advise teenagers to plan ahead. They are also implementing financial advice for teenagers about credit cards and credit scoring

Knowledge is power after all.

I'd never heard of secondary infertility until it happened to me. It's not something we talk about openly in society so why not make teenagers aware of the risks of waiting to have children

Or is 58 not old
Haha

I'm generally in agreement with others here that material factors are probably more significant than women's ignorance here. I firmly believe that cheaper decent housing will have much more impact than continually telling women to make better 'choices'.

There are sometimes other factors. I delayed having children because I thought for a long time it wasn't fair to give them a lesbian mother - social attitudes have changed on that really, really recently. in fact, when I was trying to get pregnant with dd1 (now 10) and I thought I might be undergoing early menopause, the local NHS refused to give me a blood test on the grounds that that would be abetting a lesbian pregnancy.

But still, knowledge is power and of course young people should understand about fertility. So the two important questions for me are:

1. WHY are so many women giving birth in their 40s? Is it because they cavalierly put off having children, or because they didn't get the right partner at the right time, or because we can't access decent places to live and career structures don't allow for early motherhood?

1. Is teaching schoolchildren about declining fertility effective? So many people imagine that everything you might ever need to know in life can be squashed into the national curriculum, but I'm not convinced that young people are necessarily open to considering or retaining that information in their teens, but I may be wrong. Subsidiary questions: what is the most effective way of teaching this information? And: do we know that most schools don't include it in SRE already?

If Dr Nargund could write another blog addressing these two questions, I'd be very interested to read it.

2under2

ODFOD.

I did not choose IVF. I was busy dealing with cancer at the age when most are starting a family. I did not postpone starting a family for my career or for any reason other than not knowing I was going to fucking survive my illness. If I will be "old" when my kid goes to university so what? I am bloody lucky to be here and even luckier to be a mother.

I sincerely hope you raise your kids with more compassion and less judgment.

Shitty attitudes like yours are precisely why women should not judge each others' choices and why we should NOT be putting the fear of God into young women - they have enough struggles over things they can actually control.

Dear me, am I suddenly going to become incredibly infirm over the next five years? Will I stop running 5k four times a week, and find myself hobbling behind my teenagers?

No idea if 58 is 'old' but I am not anticipating sudden collapse....

I also thought that the "declining rapidly after 35" was based on very specific cohorts and wasn't necessarily a good indicator for the general population. Obvious fertility declines with age but of those I know who had problems TTC all already knew they potentially would have problems (already diagnosed with PCOS, endometriosis, fibroids). There didn't seem to be a significant difference pre- and post-35 for the rest including those who didn't start TTC for the first time until after 35.

My friend (with PCOS) has just had her third, she'll be 44 in a couple of weeks. She isn't fazed by the idea of being 58 with a 15 year old but she's way fitter than me so probably will be in much better shape then than I will be at 51 when DC2 is 15.

PCOS friend fell pregnant naturally at 43. She appreciates she was very lucky but it does happen.

I'm infertile. I would have been just as infertile at 22 as I was at 32 but I'd have had ten extra years to feel shit about it.

reading comprehension, for example.

2under2 I can't believe there is an adult woman in this country that doesn't know that fertility declines as we get older. It doesn't fall off a cliff though. The fastest growing cohort of women seeking abortions are the over 40's who thought they were infertile. As many people have said here, it still makes no difference, because if men aren't ready or you are renting a room in a shared house in your '20's or you want to be able to financially support your child through having a good job, more haranguing of women is just going to make them feel shit about themselves.

Agree with most of the pps

Plus

I have teenagers.

I seriously believe that nearly ALL of them give no fucks about infertility if anything its fertility they're worried about

If you have phse sessions on this you'll have rows of blank faces

It is sooooo far off in their futures as to be nearly completely irrelevant imo.

Mental note after reading: don't use create fertility services for future ivf cycles.

EDUCATE THE YOUNG MEN NOT THE YOUNG WOMEN.

Women know all this already. We would be happy to settle down earlier. It's the men who don't want to be "tied down" or who "aren't ready" at 32 that are the issue!!

And it's in capitals because I am SO fed up of this completely inaccurate "women are making the wrong choices" rhetoric.

teenagers will not be interested in hearing this. To them infertility is something that happens to other people not them. But like talking about pensions and writing a will at that age!!

increase in women having babies in their 40s? Because they can; because the social stigma about being an old mum has gone. Because we are you get and healthier now at 40 then we have ever been. It isn't just women delaying motherhood and infact I bet the stats for those women are very low. I also dont believe that older women are more likely to have disabled children. Just that the numbers of women having children is fewer.