Infertility: a lesson that has to be learned too late

Infertility: the lesson that comes too late
Jemima Lewis, The Sunday Telegraph, 07.06.2008
Translation: GZT.RUGirls are taught how to avoid unwanted pregnancies, but nowadays, when you become a mother at a relatively late age, experts argue whether they should be taught how to get pregnant.

Magazines for girls really decorated my youth, which fell in the 1980s. In them I found advice on all the issues that concern me, from choosing lipstick to kissing passionately. Most of all in these magazines I liked the page where the readers' questions were answered. It illuminated the darkest fears that tormented the soul of a teenage girl. Week after week, the same two questions appeared there: 1) Do I have to go to the end? and 2) Can I get pregnant by sitting on the toilet seat of a public toilet?

In those days, it never occurred to anyone to evaluate the activity of sperm. In our girlish imagination, she was represented as a flame-spewing rocket that scans the horizons in search of unsuspecting female beings. Twenty years later, I was shocked to discover that to get pregnant, it's not enough to enter the same water as a man. It turned out that getting pregnant is not easy at all. By the time you turn the same age as I am now (37), you may need help ranging from voodoo miracles (acupuncture, reflexology, less sex, more sex, headstands after sex) to medical intervention. No matter how painful it is to say, but for some it will be impossible to conceive a child.

According to Lisa Jardine, the new head of the Human Fertilization and Embryology Department (HFEA), young women need to be warned about this.

She believes that children at school should be told about infertility, and this should become part of their sex education. "If every seventh woman in the modern world faces the problem of infertility," she says, "then instead of teaching girls how to prevent pregnancy, it's time to start teaching how to get pregnant, because there are a lot of disappointed people in this area."

Jardine's proposal is supported by Zita West, an expert in the field of fertilization, in whose office on Harley Street, women who are "thirty-something" are always jostling for an appointment. Some are victims of fate or biology, while others, according to her, simply have no idea what to do to conceive a child. Their failures in conceiving a child marked the beginning of an entire infertility industry, the turnover of which in the UK alone is estimated at 500 million pounds.

Complete infertility is the lot of only a few women, but many people experience difficulties with conception. The HFEA website explains that if you regularly have sex and do not protect yourself, you should get pregnant within two years. This happens in 95% of couples. However, women who are over 35 do not want to wait so long. In addition, only women under the age of 39 can apply for in vitro fertilization (IVF) under the British National Health System. The state finances only a quarter of the cost of treatment; most couples seek help from the private sector. Often they receive only basic information about how to get pregnant and carry a healthy baby, nothing more.

When my husband and I decided to seriously engage in the birth of offspring – after more than a year had passed, during which we left everything "to the mercy of fate" – I was ashamed of how little I knew about this topic. I faintly recalled a pair of fallopian tubes drawn on a blackboard and the movement of an egg into the uterus. In addition, it is a complete zero.

Like all truth seekers, I turned to the Internet. There is everything that an amateur who has embarked on the thorny path of childbearing needs to know. A dictionary of abbreviations was immediately opened, because everyone who is going to conceive a child is in a terrible hurry, discussing their efforts online. You can ask for advice on how best to measure BTT (basal body temperature) from others, the same unfortunate PZ (trying to get pregnant), find moral support during 2NO (two weeks of waiting after ovulation and before you can take a pregnancy test), and even a friendly shoulder on which you can cry if you get BJO again (a big fat negative result).

Since all this is available online, is there a need to include information on how to get pregnant in the list of subjects for compulsory study? Professor Jardine says it makes sense to warn young women that being overweight and smoking reduce the chances of getting pregnant.

It would also be useful to talk about the role that chlamydia, a sexually transmitted disease that has flourished among British youth, plays on the ability of both men and women to give birth to a child.

However, there are factors before which we are powerless. Men can hardly do anything about environmental pollution, which reduces the quality of sperm. Besides, motherhood in adulthood is not at all a conscious and selfish step, although many people think so. It's just that our economy needs workers. Most modern families cannot survive without receiving two salaries a month.

Many women have to find a compromise between their ability to earn money and their ability to conceive a child. In adolescence and early youth, they may feel that the advantages are on their side. But, whatever the shortcomings of the sex education system in the UK, most women are aware that they do not have much time. Apart from pregnancy, fear of infertility is the most common reason for going to the doctor among women aged 20-45. In addition, we have boundless optimism about the possibilities of modern reproductive medicine.

Professor Siladitya Bhattacharya, who heads the obstetrics and gynecology unit at Maternity Hospital in Aberdeen, said last week that women are overestimating the possibilities of "in vitro fertilization" as a way to turn back the biological clock.

"Some women believe that in vitro fertilization is a solution that solves the problem of the natural extinction of the ability to conceive a child. But they just don't know how the mother's age affects the results of IVF," he explains. – In 30-year-old women, only 30% of conception outside the mother's body are successful, and at the age of 44 – 0.8%. Women need to know what the reality is."

My friend Katie was one of those optimists. "It seemed to me that this was the solution," she says. "I was afraid it would be too late to have a baby, but I thought that, as a last resort, I could always do IVF."

Katie has been trying to get pregnant since she turned 36. She's 42 now. After four completed procedures IVF – three full cycles and another procedure during which she was implanted with a frozen embryo – she is still afraid to face the truth.

"From a physical point of view, I am perfectly healthy," she says. "But I'm too old now. That's my problem– I only have a few eggs left. When you get old, you realize that statistical probability is not on your side, but again you hope that this time you will be lucky."

Katie has to live with the bitter thought that one day she missed the opportunity to become a mom: "I got pregnant when I was 30, but it wasn't that guy. He didn't want me to have a baby. If I had known then how difficult it would be for me to get pregnant again, I think I would have kept it. I regret what I did. Although our relationship did not suit me, I could have kept the child."

Although Katie, like me, doubts that school lessons about age-related changes and infertility will benefit ("All teenagers think they are immortal, and even 35–year-old age is perceived by them ridiculously distant"), she still believes that young women should know the facts.

The media should be the source of information, but currently journalists take a contradictory position in relation to motherhood at an age. On the one hand, they are happy to pour a whole bucket of gloomy prophecies on the head of any woman if she is naive enough to assume that she can have everything in this life. On the other hand, they are happy to write about the birth of children of aging Hollywood actresses, without mentioning that many have resorted to donor eggs.

"Girls look at pictures in popular magazines and think it's OK to have a baby at 40," says another friend who still managed to get pregnant after in vitro fertilization. "However, the magazines don't tell you what you have to go through, physically and mentally. Nor do they write there that half of these women have given birth to a child who is not genetically theirs at all," she bitterly concludes.

If the lessons, where they will talk about infertility, can help solve this problem, arming the next generation with the facts that are needed to make a reasonable choice, that will be fine. The danger is that these same lessons can make a woman even more nervous and feel guilty that she is in a situation that is not always her handiwork. In reality, our choice is often dictated by circumstances: school class, social pressure, concern about money, difficulties with finding the right person at the right time.

I realize that I am very lucky. I was able to become a mom at the last moment. Sometimes I regret that at an earlier age I did not have children, because then I would not have been in such a hurry with brothers and sisters for my son.

Maybe I would have behaved differently if my biology teacher had been less interested in the drawings on the blackboard and more worried about my biological clock? If so, which of the romantic hobbies of my youth would be suitable for the role of the father of the family? A maniac suffering from depression? Married? A cocaine-addled toy boy?

Maybe I would be more picky about love if I were shown all the dangers of age-related infertility in advance. But I am romantic enough to think that the man who became my husband is the best–and the only–possible father for my children. However, I am practical enough to understand that meeting him is just luck, not a reward for a wise decision I made.

In the question of the birth of children, as in love stories, everything depends on the ability to correctly assess the past. I made a bet on conceiving a child and I can look back without regrets. Katie is (so far) out of luck. Fate can be cruel – but is it possible to teach this lesson?

Portal "Eternal youth" www.vechnayamolodost.ru16.06.2008