Another day, another report about biological clocks and the fading fertility of women. Today, the news comes from a man called Adam Balen. Balen, who is the chairman of the British Fertility Society (BFS) and professor of reproductive medicine at Leeds University, has told a conference in Helsinki that we should be teaching girls as young as nine about fertility and how it declines when a woman reaches her late twenties – and that message has been dutifully reported by newspapers.
As a 33-year-old woman I hardly need to hear it, and what would be more useful to me are discussions about how we can address the London housing crisis, reports that make clear the fact that statutory maternity leave is pitifully inadequate and promotes sexism, promises to eradicate the low wages a generation have got stuck on post-2008 crash.
As a 33-year-old woman, I hear about my ticking biological clock all the time, people I don’t know literally volunteer facts about it when I speak to them at weddings and parties. I am 100 per cent aware of how fertility fades with age but that doesn’t make it any easier to line up the circumstances – financial and practical and career-related – that would make it sensible to have a child right now.
It is true, that perhaps nine-year-old girls, or even 15-year-old teenagers, don’t know so clearly what their store of unfertilised eggs are up to, but should we disabuse them of the sense of possibility so quickly?
Professor Geeta Nargund, a highly respected fertility expert who has seen first-hand the devastating consequences of “leaving it too late” in her Create Fertility clinic, firmly believes we should. Nargund is committed to teaching girls and young women about the reality of how fertility declines with age, and this year began teaching fertility in schools, kicking off with a series of lessons at St Saviour’s and St Olave’s Church of England school in south London.
I spoke to her about her motivations for the project.
Lynn Enright: Why do you think it’s a good idea to teach fertility in schools?
Geeta Nargund: It’s a good idea because it is very much needed. We need to raise awareness about what factors affect future fertility and how one can protect the natural fertility and prevent infertility. It’s very much a health-education agenda.
What does it entail? What does a class look like?
It’s got different modules… One module we’d have would be about female and male anatomy and how it works and how conception happens. Then about sperm, how sperm are formed, how they mature. Same with eggs: about egg reserve and what factors affect egg reserve, how ovulation happens and how lifestyle factors affect sperm count and quality, and lifestyle factors that affect egg quality and egg reserve, [as well as] the uterus and the fallopian tubes. Then about how implantation happens, how the baby grows inside the uterus.
We talk about causes of miscarriages; the psychological, social and physical effects of fertility problems; what treatments are available. Lately it focused on what factors can affect your fertility when you’re young as well – like lifestyle factors, how smoking can affect a woman’s egg reserve, how smoking can affect sperm quality... alcohol and STIs [affect fertility]. And bodyweight – how being underweight and overweight can both affect infertility in women, and how a family history of early menopause can affect you, as well as any existing medical conditions, if they’re not addressed. So it is a rounded education.
This took place in a girls’ school? Do you intend to teach it to boys?
Yes, absolutely! In fact, it includes both male and female fertility. So it is intended for boys and girls.
OK, but you’ve only taught it to girls so far?
It’s only because whichever schools have opted [in]… It’s like a first-come first-served basis. So, the first school was a girls’ school.
And these girls were aged 14 to 15?
Why do you think it’s important to speak to girls of that age about fertility?
It’s quite relevant at that age because you’re trying to give nuanced messages. Because sex and relationships education is mainly focused on prevention of teenage pregnancies. So what we want to do is make sure we can give that nuanced message about both sides of the coin. On the one side, protecting your fertility, on the other side, preventing pregnancy. They are both sides of the same coin, you know, contraception and conception, and that nuanced message needs to be understood. We worked with headteachers as well as science teachers and PSHE teachers, and the combined opinion was this was an ideal age.
Do your lessons talk about the responsibility that boys have? Because I think that a lot of this fertility chat, it does seem to focus more on girls and women doesn’t it?
No, no, no, it has never been about girls! From the beginning, it has been both boys and girls – both of them are important when it comes to making a baby.
I think in our society, it feels, as a woman, that it does fall more on women. Women get the “biological clock” talk - we talk about that in relation to women, not so much in relation to men.
Nature created gender inequality when it comes to declining fertility – it happens to women much earlier than it happens to men. I suppose that is why the biological clock is spoken about more in the context of women, but there are other reasons for fertility problems as well, and of course it does affect men as well but it just affects [them] a lot later than it affects women.
I suppose what I mean is that I think, in general, our society makes it a woman’s problem.
Look, both men and women are equally responsible and contribute equally when it comes to reproduction and making babies, but because the biological clock ticks faster for women, I suppose society talks about it.
But when it comes to taking responsibility for your own fertility, it is for both men and women, which is why we need to educate both. Why women delay having children is not entirely due to…it’s not entirely her decision. It’s a decision because there is no man on the scene and or there are financial problems or it could be a societal issue or a family issue. So women’s decisions to delay having children are not entirely due to women’s issues sometimes.
I see women and couples every day of my life, and many many women don’t know how fast that it can decline.When you look at the detail, when you look at the reality, there are gaps in knowledge
Yeah, I completely agree. I think most of the time the reasons for people postponing parenthood are not really to do with biology and health, they’re more to do with issues of society and personal situations. Why do you think education can address that? Isn’t it that workplaces need to be more flexible or jobs need to pay better or we need to tackle the housing crisis?
Yes, absolutely. But in my day-to-day work I have realised there are so many women – educated women – who have not been made aware of how fast fertility can decline after the age of 35, and many times they say “If only I knew earlier, I could’ve done something about it, I would’ve taken action.” So there’s not only a need for raising awareness about that for women themselves, but also there are other factors I suggested before: talking about smoking and lifestyle from much earlier on and how STIs affect the fallopian tubes. I’m not saying fertility education is going to say “Oh well, there are no inequality issues when it comes to society and employment.” If we give fertility education that doesn’t mean that we don’t give equal pay, maternity leave or better childcare – absolutely not. They have to go hand in hand, but what is important is both need to be addressed. Knowledge is power, education powers people, so it is extremely important that we as a society educate our teenagers so that we have done our bit when it comes to preventing future infertility and allowing boys and girls to protect their future fertility.
Thank you for joining The Pool
FOR ME AND MY GENERATION, I FEEL LIKE, WE ARE VERY AWARE OF FERTILITY DECLINING WITH AGE. I DON’T FEEL LIKE THAT’S A SURPRISE TO US, BUT I FEEL LIKE WE’RE STRUGGLING TO FIGURE OUT HOW TO MAKE IT WORK IN OUR LIVES, FROM A FINANCIAL AND PRACTICAL POINT OF VIEW – YOU KNOW THIS GENERATION WHO LIVE IN LONDON ESPECIALLY. IT FEELS LIKE WE ALREADY KNOW BUT WE JUST DON’T KNOW WHAT TO DO ABOUT IT, IF THAT MAKES SENSE.
I see women and couples every day of my life, and many many women don’t know how fast that it can decline. When you look at the detail, when you look at the reality, there are gaps in knowledge. When you fill them, that helps. So there is that aspect of wanting to raise awareness and building those gaps in knowledge, and the other aspect is of course addressing for women to thrive in society. We have to ensure that addressing fertility is gender-equal.
IS THAT WHAT YOU’RE PUSHING FOR?
Yes, addressing women’s fertility needs has to be part of [a] gender-equality agenda. Fertility is not just a Department of Health issue, it does need to come under [the] women and equality department as well.
WHAT DO YOU THINK ABOUT THE EFFICACY OF EGG-FREEZING?
Egg-freezing is here to stay with the modern vitrification, which is the fast-freezing method. The success of egg-freezing has gone up, and if you use that method when you’re younger, your success with fresh eggs and frozen eggs can be the same. Technologically, we are making it not only more successful but also safer for women. So we need to use the technological advantage to help women who have to delay having children, but it needs to be done early, we need to make it affordable, and women should be asked to check their fertility and if they have to postpone having children until late their late thirties or forties because of good reasons, then clearly egg-freezing is something that they need to be told about, they need to be given information about, so that they can make an informed, honest decision.
DO YOU THINK WOMEN IN THEIR THIRTIES SHOULD HAVE A FERTILITY TEST TO SEE HOW MUCH TIME THEY HAVE LEFT? IS THAT WHAT YOU WOULD SUGGEST?
With the National Health Service, I think it is going to be difficult for us with the current funding issues to actually offer everybody a fertility screening, but for those who are concerned, and this is what fertility education is all about – when I use the word “concerned” either the clock is ticking faster because they are over 30, getting close to 35. Or there’s a family issue: her mother had an early menopause, or she has smoked or is smoking. Or she has some other medical condition like a thyroid condition, or she’s had ovarian operation, or she’s got weight problems. Any of these issues where her fertility is more likely to be adversely affected, it’s worth getting a fertility MOT done.
HOW DO YOU GET YOUR INFORMATION ACROSS WITHOUT MAKING PEOPLE FEEL EVEN MORE UNDER PRESSURE – MAKING WOMEN FEEL EVEN MORE UNDER PRESSURE?
Education is never about pressure or anxiety, education is to relieve anxiety. That is the bottom line. I don’t think anybody could convince me or argue with me about “if you educate, you’re going to create anxiety”. In fact what is desperately needed is to educate and give girls and women that very balanced, up-to-date, evidence-based scientific information in a language they understand.
IS YOUR HOPE THAT EVERY TEENAGE GIRL AND BOY IS TAUGHT ABOUT FERTILITY AT SCHOOL?
My hope is to bring this into the national curriculum, so that the information and education is given to everybody, not [just] those schools who opt for it. If we want to achieve equality, we need to achieve equality in education as well.