The right to fertility education is a topic I have been discussing for some time (1), and which has seen intense discussion from both sides of the fence. However in looking to focus on scientific fact, not only is fertility greatly affected by the lifestyle choices we make, but for women the harsh biological reality is that fertility declines much faster than that of men.
As an IVF clinician, every day I meet with women and couples facing the challenge of infertility, many of whom are shocked to learn that their difficulty to conceive is due to age related reduction in quantity and quality of eggs. As more and more women wish to concentrate on building their careers before settling down, many mistakenly believe that having children in their late thirties and forties is straightforward. It is this disconnect between knowledge and physical reality which we must address if we are to reduce the number of women and couples facing fertility problems.
In the UK about one in seven couples may have difficulty conceiving, yet fertility issues are all too readily swept under the carpet – a societal attitude that further entrenches the problem. It is this, which led me to write a letter to Nicky Morgan MP last year, calling for the Government to add Fertility as part of Sex and Relationship education to the secondary school curriculum.
Following this, I have met with head teachers and local government leaders to discuss the inclusion of fertility education within the curriculum, and I am this month launching the first set of lessons at a London school. These will not only cover scientific facts about the fertility timeline, but also ensure pupils are aware how lifestyle choices such as smoking can affect their fertility, and how they can work to protect their fertility until they are ready to consider becoming a parent.
The fall in egg number and quality with age has been documented by histological examination, ultrasound follicle counting, and the measurement of hormones such as AMH (Anti-Mullerian Hormone), as well as epidemiological studies. They all tell the same story: that there is a steep fall in egg reserve from 35 years onwards. Of course in some women this fall in egg reserve will be less steep than others, which is why we hear anecdotal stories of successful pregnancies from women in their mid-forties. However by encouraging those who wish to postpone trying to have a baby to take the sensible step of checking their egg reserve through a fertility test before their fertility starts to decline, we can ensure that simply by waiting they don't forfeit their chance to have a genetically related child.
As well as age, there are a number of factors such as smoking, excessive alcohol consumption, recreational drugs, body weight, STIs, thyroid conditions and the mother's age of menopause that can have both short and long term effects on fertility. These are issues that many teenagers and young men and women may not connect to fertility, but which may be treated with early detection. It is our duty to inform the next generation of the effect their present lifestyle choices may have further down the line.
The ultimate aim of fertility advice is to have a healthy mother and a healthy full-term baby without any future health risks and, if possible, without the need for fertility treatment. We have been successful in reducing teenage pregnancies through education on contraception. Conception and contraception are two sides of the same coin. We need to empower our young people with education on fertility, so that they are able to make informed choices and stand a better chance of falling pregnant when they choose to.
The next generation also has a right to up-to-date, accurate, unbiased information on the technology available. This should cover 'one-stop' fertility testing, safer IVF methods and the latest egg freezing technique, vitrification, which has improved success rates of IVF with frozen eggs and is now giving women the option of preserving their fertility if they need to delay motherhood for medical and social reasons.
The bottom line is that complete reproductive education, including regarding fertility issues, is the right of all our young people. I have worked as a school governor in primary and secondary schools for many years and have given ad hoc lectures in schools. Through my charities, we conduct public fertility education programmes, but such initiatives are not enough to prevent infertility in the long-term, which is why I am now working with schools to permanently build this into curriculum.
We need to shift the paradigm from treatment of infertility to protection of fertility. This may take up to a generation to achieve, and so we must start now if we are to ensure our children have the choices they deserve.
The Progress Educational Trust's free-to-attend public debate about about sex education, schools and (in)fertility - 'The Birds, the Bees and Fertility Treatment: A Sting in the Tale?' - is taking place in central London on the evening of Wednesday 13 April.