A Shot in the Dark - Preventive Measures Against Infertility

Reading quite a few infertility-themed blogs this week for ICLW, I had a bit of a light bulb moment. One thing that many bloggers, including myself, had in common was no warning of their infertility before they began trying to conceive (TTC). That unfortunate timing and the delay it caused in our parenting plans was something I already knew, but the flash of light was whether we could change that. Some women have an idea that their reproductive health is going to be problematic because they may have symptoms of an underlying condition such as PCOS or endometriosis, for which they are already being treated. However, for the rest, infertility can come as a terrible shock that rips away the pretty, pastel-coloured dream of "baby makes three."

What if we could change all that?  In my children's primary school, the 5th grade gets sex education lessons in the Summer Term.  My daughter is in Year 5 and at 10 years old, she is one of the oldest in the class. If it's anything like my own Sex Ed class in Junior High School, it will focus on physiology; a map of the the girl's and boy's reproductive organs and what they take to function and produce babies, in a A + B = C fashion.  They may tie this in to a limited discussion of sexual responsibility; don't do anything you aren't ready for.  After that, I guess they are expected to find out what they need to know on their own or from their parents.

What if children were given an update in 9th and 12th grades (some schools may already do this) each time altered to fit with their levels of maturity, sexual activity and need-to-know? For instance, accurate, biological names for organs are more appropriate for younger children of 9 or 10, who still call a urethra a "wee-wee" and a bowel movement a "poo" or "doodoo." By the time those children reach 9th grade and 13 years old, they will have heard, if not used, more street names for both bodily organs, digestive and reproductive functions and sexual acts.  They need to be spoken to by a teacher who carries more credibility, who is completely comfortable with this type of conversation.  At 18 and about to leave school for their gap year, first job or university, it's an entirely different story. Many will already be engaging in sex by then. Many will leave their parents' home and set up life elsewhere. Before they do that could be the best opportunity for us to reach them.

Many women I know did not visit a gynaecologist for a well-woman check or birth control until they were at university.  Their first visit would have coincided roughly with the beginning of sexual activity and/or their first urinary tract infection.  Those that chose the birth control pill probably had to return every 6 months for a new examination in order to get a new 6-month prescription.  I doubt that most young men ever went to the doctor for an examination of his genitals or his reproductive function except if he came down with a funny rash. Neither girls nor boys of this age were interested in becoming parents in the very near future. It is likely that none of them thought in terms of their sexual and reproductive organs as anything but their vagina or penis.

These days, girls of about 14 years old can have the injection for human papilloma virus(HPV), a sexually transmitted disease. There are many forms of HPV; some go away on their own, some cause genital warts and others can become cancer of the cervix. One would hope that parents would take this opportunity to have an in-depth conversation (it's definitely not the birds and the bees anymore) with their daughters about sex and reproductive health at the same time. I could be wrong, but I wouldn't like to place any money on it. I have already opened the door to any questions from either of my children, answering them in terms appropriate to their respective ages.

What do they need to know?  For starters, both young men and women need to know exactly how their bodies work. This would dispel any of those unbelievably ridiculous myths that girls can't get pregnant from their first experience with sexual intercourse. They also need to know what sexually transmitted diseases are: what they look like, which ones have no external signs, that some, like herpes, are controllable but can last forever, and that HIV is still incurable. Then, the education should include truths v. myths of fertility.  These can include:

• ovaries produce an egg each cycle (myth) v. a girl is born with all the eggs she will ever have and her ovaries release an egg each cycle (truth);
• birth control is also an adequate protection against sexually-transmitted diseases (myth) v. only condoms can doubly protect in this way (truth);
• a "macho" or very masculine guy has an endless supply of sperm (myth) v. any guy can have seminal fluid that has reduced or no sperm, or "slow swimmers" (truth);
• a woman who gets a menstrual period every month is fertile (myth) v. there are many causes of infertility and they may not have anything to do with menstruation or ovulation (truth);
• it's usually the woman in the relationship who is infertile (myth) v. male infertility is nearly as, if not equally, common as female infertility (truth);
• Sexually transmitted diseases (STDs) are cleared up with antibiotics and have no lasting effects (myth) v. STDs can cause infertility; and
• If a couple has a child already, they are always going to be fertile (myth) v. couples can fail to conceive again after a birth, known as secondary infertility (truth)
• (I'd like to add your suggestions to this list, so please feel free to post in the Comments)

Now, here's the shot in the dark that I promised.  If every man and woman of 18 years old could be:

1. educated about reproductive health with an emphasis on male and female infertility and recurrent miscarriage;
2. given an opportunity to have their fertility medically checked, this would allow them to make decisions as young people about protecting their desire to have a family in the future; and
3. They could be given options for treatment before that time, to safeguard their ability to conceive with a future partner. 

In certain situations they could decide if drug therapy, surgery or long-term freezing of eggs or sperm at that point would be appropriate or necessary. Just think of the heartache that would be eliminated when couples follow the dream of love, marriage, home, baby carriage.

I realize that you can't absolutely project what a person's reproductive health will be at 35, compared to their 18 year old self.  I understand that hormone levels will fluctuate throughout a person's life and that it might not be worthwhile to test every person for things like "sticky blood."  However, I do think that the medical community can estimate how many people would be helped by testing certain conditions at a young adult age. The NHS and insurance companies already make their policies based upon statistics; they could just change the focus and timing.

I don't know how much this type of national program would cost, so perhaps I am suggesting something that is prohibitive, however; I think not, when compared to the billions that are spent on advertising, tests, drugs, treatment, procedures, egg donor and sperm donor banks and any other assisted conception.  I also know that the UK is not very supportive of preventive medicine, in comparison with the United States. It would reduce, if not eliminate, the need to cut women off from NHS-funded IVF at 39 years old. It follows that age would not make much diference if a man or woman had taken protective measures against infertility when they were younger.  I'm getting excited now!!!

Someone in the medical field or fertility-related industry might read this and think I'm an innocent do-gooder who doesn't know squat, but I don't care. If ideas don't get voiced, nothing gets done.  I would like to know if anyone has an answer to the thoughts I have posed here.

I would like to start a conversation about this, getting your input. Please Comment with your opinions, suggestions and experiences. Tell me if you think I'm wrong.  Better still, tell me if I have something here.

Comments

[Abi]

I agree that people are misinformed about fertility - having spent the best part of 20 years petrified of getting pregnant, imagine my horror to find out that there's only actually a very short period of time in which you even stand a chance each month of getting pregnant, and that's if you're lucky! I'm not sure if telling kids the truth about that would make them take more risks with contraception - possibly it would. But it would certainly help them plan their longer-term goals better.

[C]

I'm actually one of the few who has long suspected I might have reproductive troubles, simply because my mom did. But there was no overt reason for concern; I've always had textbook perfect cycles and no underlying health issues. However, my issues - and the manifestation of them - are different from my mom's. She had trouble conceiving. I have trouble remaining pregnant. But all the same, while I was on a certain level wary of having trouble conceiving, nothing in any way prepared me to miscarry again and again. If infertility is a medical and social redheaded stepchild, RPL is the redheaded, clubfoot, cross-eyed stepchild.

I absolutely support comprehensive, honest, early and often sex ed. And I do think that school is the place for it. Science should be taught by scientists. I think sex ed should be comprehensive, with a focus on how to prevent STDs, and both how to prevent unwanted pregnancy and how to achieve a wanted pregnancy. With, of course, is naturally taught as sex ed is taught, but I don't think there's enough emphasis on the time factor. Sure, age isn't an absolute either way (trust me, this I know. I am 28 and am DOR/POF, and my cousin's wife is almost 40 and pregnant with #3 in 4 years) But even though age isn't an absolute guarantee of anything, it is still the most universal factor for women.

I think a big part of the difficulty about teaching too much about infertility or pregnancy loss is simply time constraints. Perhaps this is the argument then for sex ed to be done yearly and incrementally, instead of in one or two fell swoops. But think about it. When I open up to someone new about my miscarriages, the inevitable question is "Why does this keep happening?" Which I know the answer to. But holy crap, to try to explain it to someone in under an hour....Infertility and loss are just such huge, wide open subjects, full of tons of information, that it's extremely daunting to teach. And I don't really know that it's really a good idea to pare it down and give partial information. BUt honestly, what more important topic is there in biology than how our own human bodies work? Learning about the human body is so much more useful than dissecting frog eyes.

I do think you have a valid point, that giving this info up front and letting people get tested will prevent a lot of the back-end costs associated with ART. When i asked my doctor if a female child would have a high likelihood of the same problems I have, his answer was a very breezy, "Yes, that is likely. So we'd test her ovarian reserve early, and if there was a problem, we'd freeze her eggs." Oh. Okay, then.

I hope this long and rambling comment is of some use to you :-)

[C]

And thank god your post was so long, it makes my comment look not quite so absurdly long by comparison.

[Lisa Marsh]

There's nothing wrong with long when you have something to say. Thank you for taking the time to give me your point of view, which gives me and others something to think about.

I'm glad to hear that you have been so proactive in seeking the correct information about your own fertility health and the possible repercussions for your future children. As I know from personal experience, it is terribly confusing, frustrating and depressing to have little or no explanation why your body doesn't work the way you have been led to believe that it should. Then there is the added dimension of the emotional pain of each loss you suffer.

However, I do believe that a little information goes a long way. Knowing how inefficient the human reproductive system can be, helps us understand that our bodies are not machines that are programmed with a faultless sequence of processes. There are things we can do to help our chances of conceiving and carrying a healthy pregnancy, and there are some things that are beyond us. We need to continue to learn from each experience and keep trying to move forward.

Thanks again for visiting and commenting. Lisa