30 Something and the Clock is Ticking

'Thirty-something and the clock is ticking' by Kasey Edwards http://www.kaseyedwards.com/

I came across this book completely by chance - I had previoulsy ignored an article about it in one of those trashy gossip style magazines dismissing it as 'just another sensationalist IVF story'. But a month later accidentally I bought the book that the article was about ... I say accidentally because I didn't make the connection between the book and the article until after I had bought the book when seeing it randomly on the shelf of a little bookshop.

Anyway, I'll cut to the chase as you aren't interested in how I came to find it.

What's it about?

It is the story of a woman in her early thirties who is told by her gynaecologist that she has a year in which to get pregnant and have a baby or else her 'fertility window' will be gone. In the book, she tells her story: how it made her feel to hear those words, deciding whether she wanted a baby or not, the fact that woman don't realise the facts of their own fertility and that it really is a 'window', and the treatments and path that in her case, led her to a successful pregnancy and the birth of her daughter.

It is a short novel but it is well worth reading as it makes many valid and important points about the challenges of infertility and being a woman on the 21st century - you'll read it and probably think it is no revelation - it says many if not all the things women that have been blogging about for many years now - she tells of the importance of making sure women today are educated correctly as to their own fertility so as to make informed decisions as opposed to being caught out; as well as talking of her own challenges of IVF and those of the people she knows and how there is no guarantee that it will be successful.

The surprising thing is that she was able to convince a publisher to take on such a story and publish it as a book commercially. I think much of her success in convincing folk to print her book relates to how she tells the story - it is very upbeat and ends with a 'happy ending' - in her case she got to give birth to her daughter. There is a sad and unfortunate downside to this though (and it is by no means a criticism of her writing) - as a result, many of the important messages advocating fertility awareness and recounting the abyss that battling with IVF and infertility is, can get lost on the reader. I wonder how much those points will really stick in the mind of a person who has never 'been there'.

It made me sad to read some of the online comments in response to articles in various newspapers talking about this novel a few months ago. Some women posting comments online seemed to attack and criticise Ms Edwards as opposed to being thankful and acknowledging the important message. I guess this comes from a multitude of places and emotions:

It can't help to feel 'lectured' by someone or to see them making money out of it. Did they feel that she was 'tooting her flute' about her own 'happy ending' and so in no place to comment to others?

How do you deal with the sadness or bitterness of the fact that some women can't even meet someone with whom to try for a baby for - this is a very sad reality of being a modern woman today - meeting a guy who you can settle down with or who you would like to be your 'baby-daddy' isn't that easy!

The comments which concerned me the most, however, were the ones who said that they knew all the facts and seemed to feel she was 'teaching them to suck eggs'. You see, there may be some women out there who know about the facts of how fertility declines with age, but I think many think they know more than they really do. Do they really know the statistics about IVF and chances of success resulting in a livebirth? Is this the naivety or arrogance of youth? Or women not really want to hear - and burying their head in the sand. If so, how do you get the message across to a set of men and women who don't really want to listen?

With respect to this last group, there will always be nay-sayers to anyone trying to do the right thing and prevent people from going through the heartache and difficulties that we have suffered; so however disheartening it may be, we have to continue with the push to improve education. Even if it may feel like pushing water uphill. Kasey Edwards got her 'happy ending' of having a baby that is genetically hers via IVF but not every woman doing IVF comes away with a baby at the end of the process if they can't do it on their own. And so we can't rely on IVF as a fall-back option as women to allow us to delay having a baby if that is what young women today think. And they do - I was contacted last week about someone who thought exactly that and was now facing the stark reality that she may not even be a candidate for IVF due to age.

It is hard being a modern women - we 'grow up' and are ready to 'have a family' later than before nowadays but unfortunately fertility hasn't evolved with us. So we have to educate women to realise that if they want to have a baby, they probably can, but unlike men we may not be able to put it off a few years in the same way. Because if you need fertility treatment it is better to be doing this in your more fertile years (i.e. before 35). Harsh as it sounds, sadly this is the case. And yes, it completely sucks that some women haven't met Mr Right at the 'right time' - and oh how I wish we had a magic wand to make that right ....

Update

How do you tell your friends that are struggling with infertility that you are having a baby? I don't know how you do it.... it is as simple as that....

In April I had a baby but I can't tell you how sad it made me that others remain struggling, battling with IVF, to do another round or not, could they afford to do it or not, whether to start adoption, or starting that process.

People may talk about what you 'deserve' but I really don't agree with this concept. Some things in life are not fair; are quite simply a lottery. And fertility is one of those - why can a person with low chances of success get pregnant but not the person who according to the textbook has everything right?

If there is nothing else remember this - as was said to me a few months back - we cannot forget where we came from and the battles with infertility (or more positively put 'the fertility challenges') - and so we must continue with the fight not only to support those who are in that place which feels like you are perpetually 'treading water' but we must also do want we can to inform people, and in particular the young women coming up the ranks, of the challenges that women face with respect to their own fertility and being modern women of our age.

And so after a short hiatus, I am back to continue with the quest to better educate the young women of today. For my next blog I will be discussing the recently published book by Kasey Edwards - '30 something and the clock is ticking' - for now here is the link to her website so you can read into it for yourself .... http://www.kaseyedwards.com/

How late is late? You only know what you know

There has been massive radio silence from me - well there has been. Little time and no internet till a week or two ago - back to full time work, decorating and moving back to my old house in the UK. Anyway, this isn't about me so enough of my wimpering ....

In the last month there has been some excellent articles in the UK press which really deserve to be shared. The links to the articles are below and the headline points are right on the money:

• The best age to have a baby is between 20 and 35
• Don't wait too long for a baby: Women are SIX times more likely to suffer from fertility problems when 35 than at 25
• Doctors have issued the stark warning to couples as more and more women pursue careers and leave parenthood until their late thirties.

Now, of course, not all women leave or wait JUST because of their careers. Many don't meet their other halves until in their thirties so what do you do - we all love the idea of you meet and are married and get pregnant within six months of meeting but even at age 30 plus it doesn't work like that - life isn't the fairytale for all of us and it can take 2 or 3 years before you are settled enough to get married and start to have kids by which point you are out of the optimum period.

To me it highlights the massive challenge that comes with being a woman in the 21st century. They tell you to be financial independent and not to rely on men for financial security (well my dad certainly drummed that one into me and for good reason when he saw the amount of divorces around him and women left struggling to raise children with little money and relying on maintenance - he didn't want that to be me); but the flip side is you get an education and a career first in your twenties when historically and traditional women were having babies.

You'll read commentaries about how women just want to 'have it all' but that is just nonsense [my opinion]. My dad died many years ago but I am sure that he no more wished for me to have to have struggled with infertility as he did not wish for me to struggle financially because I was financial dependent on a man and left divorced. And that is a man's perspective for his daughter! Not a feminist view.

So what we need to do is make sure we educate women (and men) so that they can try and organise their lives (as best they can) to strive to achieve the two. It is harder for women possibly on this count than for men, I don't think we can argue against that. Women have more of a finite time-line to contend with than our male counterparts. But as women we have two options: to complain it isn't fair, and suffer the consequences; or do something and make sure we keep all young men and women better informed than we were by our predecessors.

I know which one I am picking and I hope you will too - share and educate our young men and women on the challenges of fertility. Awareness is key.

The Links:

http://www.dailymail.co.uk/health/article-1351237/Women-6-times-likely-suffer-fertility-problems-35-25.htmlhttp://www.telegraph.co.uk/health/healthnews/8287719

http://www.telegraph.co.uk/health/healthnews/8287719/Doctors-warn-couples-not-to-leave-it-too-late-to-have-a-baby.html?sms_ss=email&at_xt=4d4ade58d7be4928%2C0

http://www.guardian.co.uk/society/2010/dec/31/pregnancy-mothers-fertility-children

Holiday period & moving back - how people react

We have recently moved back to the UK from living overseas. One of my big concerns was always about falling back in with the old crowd of friends that we know locally, or rather not falling back in. They have all moved on and had babies who are now toddlers or young children. My anticipation was that they wouldn't want to do the same things as us anymore as their focus would be elsewhere. So it was high on my radar that I would probably have to make a big effort to make new friends whose lives perhaps didn't revolve around children - nothing personal to the old crowd - just one of those things. So people may be interested to know what the reality was?

It is exactly that: their socialising now revolves around their children, and so you aren't invited. They either view you as the people who don't want children and assume you don't want to be bothered with such functions, or else when they know of the challenges you have faced, they think it is better to not extend the offer of an invite to you.

No harm is meant, I'm know, but it is very interesting as to how people react. Rather than tell you what is going on and explain why they are being the way they are, or to give you the option to attend, you just don't get invited. Best not hurt your feelings by not telling you; and well, as someone who was already braced for such behaviours it hasn't much bothered me, but it is kind of sad. Things do come to pass as you anticipate, a little.

We're very lucky - old university and school friends are the same as ever and no change, and we have a circle of single or childless friends so we don't feel alone. But I can see how some people could feel a bit like they have been 'banished to Siberia' if they didn't have that wider network.

So if there is any young person reading this, I know having a baby may seem like a long way off to you, even when you are in your twenties, but please bear in mind that one of the challenges of leaving having a child till later is the above - to be fair, this could be the challenge even at a younger age, but the risk is higher the later you leave it. Some of your friends will easily have their children later in life with no problem, and you could be the statistical one in five that has fertility problems. This is a complete lottery - it may not be you, and for your sake I hope it isn't, but as it has to be someone it could be. Just bear that in mind next time when you think of delaying trying for a child, or dealing with any friends of yours who are childless.

Men: often overlooked in the feelings department

There are many articles, discussions and blogs about how fertility challenges (I hate the word infertility) affects women, but men and their feelings are so often overlooked. We tell people when faced with a challenge to "man up" sometimes and perhaps that accidentally points to one of issues - men are expected to be the strong, resilient and unemotional ones. So often times people take the view that they don't need support. To be otherwise is girly and, therefore, perceived as weak.

So let's start right here and now and correct the assumption - men feel the pain of struggling to conceive and stay pregnant too. I am not going to go into degrees of whether it is equal, more or less - in truth I don't know the answer but I suspect that it varies from case to case and that more often than not it is the same more or less. He wants to be a dad as much as the woman wants to be a mom. He doesn't suffer the biological interventions necessarily to the same degree, but he still feels.

I have observed many different approaches and reactions to the male component:

1) men are often less likely to discuss the challenges they are facing or emotions that they are feeling with friends or family: They are more likely to bottle up their feelings. This doesn't mean they don't feel though. The fact that they don't confide in someone can make it harder for them at times, I think. Even if they say it is their 'coping mechanism' they still struggle and suffer deep within. The lack of externalising one's own emotions sometimes can be harmful in the long run - I have seen the stress come out in physical manifestations of all kinds of ailments, such as stomach complaints, which at first blush you might assume are unrelated;

2) people often forget to ask the man how he personally is managing and coping: men often get asked by friends and relatives, particularly male friends and relatives, about how their other half is dealing with it. However, somehow people can be reluctant to ask men how they are feeling. I have no idea why this is. I know it frustrates the living daylights out of me, because to me it feels like not wanting to mention the elephant in the room. But it could also be more a reflection of the person asking in the first place: maybe they assume that because the exterior that they see is all calm and collected, that all is fine; may be they don't know how to deal with the answer they get, be it curt or an unexpected out-pouring of emotion; maybe it is because they feel that the listener will work out that it is implied from their silence?;

3) men are expected to be tough and not feel the impact of the challenge as much as women: I have observed men be told about pregnancies of persons close to them and be told they just have to accept it because 'it is what it is'. And then the person has to hear all about the details of those pregnancies with only rarely, if at all, being asked as to how they are doing, how they are coping, or do they need anything in the way of support. It may well be that the speaker does feel compassion deep within, but it isn't expressed. Being the complex creatures that we are, a man as much as a woman can struggle to interpret the silence and lack of acknowledgment - is it lack of interest, lack of sensitivity or simply that the person doesn't know how to deal with the 'softer' aspects of the situation? Is there an assumption that the man is less affected by the infertility so that he doesn't need the same level of compassion and sensitivity as a woman does?

4) the holiday season can be challenging to men too: parents may elect to visit their children with offspring ahead of their 'infertile' children. The 'infertile' children can be told they will be visited in the New Year. If the 'infertile' child is a male, there can be a habit of delivering the message in a very matter of fact way without any attempt to bolster feelings and self-worth as you would if speaking to a woman. Again, it may be that parents think that men don't need the 'soft language' or cannot deal with it. But you can never assume. It can hurt a man as much as a woman to feel excluded.

People struggle with how to respond or deal with women in this situation, so if there is one take-away, it is don't assume men are necessarily light years away from feeling the same as you might expect of a woman. They may just be better at hiding it. Boys do cry, even if they always don't shed tears or have emotional outbursts in the same way.

Now to finish here is the ultimate piece of irony, and one to dispel all stereotypes and generalisations that I/we may ever make about men! Along our journey of challenges so far, it has been a man who has been the best at managing the right balance of level-headed 'it is what it is' approach with compassion and support. The fact that they were expecting a child was relayed to us at the same time as everyone else, and the excitement and nerves wasn't hidden from us and yet at the same time, there was never a conversation where a portion of it wasn't dedicated to being supportive, offering help to us and asking how we were doing. It was recognising the bitter-sweet nature of the situation but with equal respect to each. We felt respected for the honesty and not being treated as social lepers and also respected and appreciated for not being forgotten in our times of challenge - and very appreciative that the person still found the time to think of us even when consumed with his own busy life.

Painkillers in pregnancy and male babies

http://theafa.typepad.com/theafablog/2010/11/painkillers-in-pregnancy-and-male-babies.html - Link to AFA posting

In the written press as well as on the internet these last couple of weeks, particularly in Europe, articles have started to appear, stating that common painkillers could be linked to male reproductive disorders. It was reported that scientists had found a link between the use of mild painkillers in pregnancy and the risk of giving birth to a son with undescended testicals with the possible consequences of having both poor sperm quality, as well as the potential for the emergence of testicular germ cell cancer in later life.

The study was done by researchers from the University of Copenhagen as well as other academic and medical institutions in Denmark, Finland and France.

The study featured both an analysis of pregnant women’s medication use and also data on animal research studies which analyzed testes development in rats; one potential outcome of the study indicated that the timing and duration of the mild painkiller use during pregnancy was linked to the risk of undescended testes in male babies. The research also suggests that ibuprofen, aspirin, and other nonsteroidal anti-inflammatory painkillers act as hormonal "endocrine disruptors" thus interfereingwith normal male sexual development. The greatest window of risk appears to be in the second trimester of pregnancy in humans.

To anyone reading the headlines these articles might be worrying at first blush. For example, it seems to suggest that even paracetemol (acetaminophen) may increase the risk in male babies (to a lesser degree).

In addition, there are many women presently being prescribed low dose aspirin during pregnancy to address cases of miscarriage risk or blood-clotting disorders (it is important to note that low dose aspirin is only a quarter of the regular, standard dose). Women in this situation may feel in a conundrum about what to do when managing the relative risks of both taking, and not taking, this medication. First up the advice to anyone pregnant that has taken such painkillers and is concerned about these findings is clear: consult with your doctor.

The British NHS Choices website states: "It is preliminary but important evidence, although at the moment, it is unlikely to change the current recommendations to pregnant women. These are to: avoid medications in general and to use paracetamol rather than ibuprofen or aspirin if painkillers are needed. However, advice should always be sought from a GP or midwife before taking medication." And if your doctor has recommended that you take medication, such as low dose aspirin, consult with him or her as to what to do, if anything.

Some believe that there are shortcomings to the research, for example, small sample sizes and the number of analyses involved reducing the certainty of its finding. The direct causal link has not firmly been proven. Nor does it examine the case of women who have been taking low dose aspirin (quarter the standard dose). Also, there are many other studies which show the benefits and upsides of taking the low dose for miscarriage risk/blood clotting issues on doctor's recommendation. Therefore the reports do need to be read with caution. What is clear is that this is an important area which needs more urgent research. While the rates of undescended testes seen in the study were still relatively low, it seems, as unfortunately happens with reporting in the press, the risk factors quoted can vary from article to article and some of the headlines can be alarmist, suggesting a 'global sperm decline'.

The NHS Choices website concludes: "Overall, this study does not prove a link between use of painkillers in pregnancy and this reproductive disorder in boys but it does suggest an important avenue for more research." Let's hope this research and investigation happens swiftly. As always, it is better to be informed than ignorant, however, information such as this may put a lot of pressure on the reader to think critically as a result - which is easier said than done if it affects you personally.

No matter how level-headed you are normally, to anyone who has suffered or is suffering from primary or secondary infertility, reading such an article could prove to be quite unsettling. Whatever your situation, it is essential to consult with your doctor if you are or have been taking mild painkillers and are worried in order to address any concerns you may have.

A thought .....

Following on from the work and efforts of Dr. Mary Herbert as mentioned in the last blog entry, here's a suggestion:

How about each of us try and have a word with our nurse and/or doctor the next time we visit them to see if they will get information evenings and leaflets running in their practice on the topic of raising fertility awareness to our young men and women? In particular to raise awareness to those in their 20's and 30's who are in the age range who need the information the most.

We have a wonderful example to refer to now.

Thanks!

Bravo Dr Mary Herbert of Newcastle University

http://www.independent.co.uk/life-style/health-and-families/health-news/revealed-why-risk-of-infertility-and-birth-defects-rises-with-age-2069229.html

Back in September this year Dr Mary Herbert of Newcastle University in the UK, reader in Reproductive Biology at the Institute of Ageing and Health, led a team whose research showed that declining levels of proteins called cohesins, which act like a glue holding chromosomes together, are the key to reproductive ageing, and why infertility and birth defects rise with age.

As part of the article on her research (see link above) it was reported that obstetricians have warned that the "bio-panic" women used to suffer on their 30th birthday has moved to their 40th. It further went on to say that some experts have predicted that a fertility time bomb hangs over Britain over the coming decades as women delay childbearing. One in seven couples have problems conceiving, and this could rise to as many as one in three if present trends continue.

With respect to her research and this issue, Dr. Herbert stated that:

• "We are at the stage of saying how the engine works and what is broken. The next stage is answering the question: can it be fixed? Could you add cohesin that would do the job [of holding the chromosomes together]? A lot of effort is going into answering that."
  


• However, no solution to infertility was imminent. "The main message is for women not to delay childbirth. The best way for women to avoid the problem is to have their children earlier. If there are social reasons why they are delaying then we should look at these and make it easier for them."
  

I wrote to Dr. Herbert saying how much I had enjoyed reading about her study and in particular her conclusion about clearly messaging to women to not delay childbirth, and highlighted that the message she advocated sadly is not conveyed in any way properly or sufficiently to women so that they know the risks, and working women are particularly at risk. I asked for any support or guidance that she could provide in order to raise awareness on this topic, and I would just like to share with you all the wonderful response I received from her today.

As part of my letter to Dr Herbert, I raised her attention to this blog and mentioned that in it suggestions are made for improved education and awareness as well as referenced the study in Canada where it warns women could risk being unintentionally childless due to their lack of awareness of how fertility declines with age. I also pointed out the poor success to date in my attempts to raise awareness at the levels that have the authority and gravitas to make a change: I highlighted the letters I had written to the UK's Department of Health, the Department of Education, HFEA, the Royal College of GPs and the Royal College of Obstetricians on the need for improved education and the disappointing response - either a plain vanilla 'we are looking into it and aware of the issue' or else no real acknowledgement as in the case of the RCOGPs who simply said it was already on their curriculum but did not acknowledge that GPs and nurses weren't having the conversations with patients on the topic at pill checks and pap smears. And I pointed the the young women's magazines that I contacted to see if they would be interested in covering the topic and explained that I also had had no response from these.

Dr Herbert responded to me today and I am over the moon with her support:

After consulting with her colleagues about the problem of getting the reproductive ageing message to the family planing practitioners, she indicated that the general feeling is that targeting the practice nurses might be the most effective way to raise awareness. And that the Royal College of Nurses ('RCN") might be a good place to go.

She had also spoken with the head of nursing here at Newcastle Fertility Centre about the possibility of organising information days and/or leaflets for GP practice nurses who was enthusiastic about the idea and therefore hopefully something would begin to happen in that direction.

I will follow this up with the RCN but I would just like to say here and now a massive thank you to Dr. Herbert for her efforts here - this really is the wonderful type of support that will make a change and make for a better informed set of twenty and thirty somethings for the future. And hopefully avoid the 'fertility time-bomb' that some experts warn about.

The assumptions we make of those with fertility challenges

One life lesson that I always seem to never quite learn is that you should never make assumptions about others, because you can realise how wrong you are if you do so without asking any questions or getting the facts. I was very recently reminded of this all over again.

We were talking about someone that we actually don't know, who we had heard was having fertility challenges, and who we were told had said did not want to do IVF. The assumption made was that the person had investigated this with fertility specialists before coming to that conclusion. But it then transpired we may be wrong and I felt very bad.

Here's the thing - even those of us that battle with fertility issues can forget that everyone's experience is different. We shouldn't assume anything. We cannot assume to have an idea of what that person's feelings and thoughts are, and we shouldn't even for a nanosecond pretend to try and second guess. This whole situation certainly made me think a little more about the issue of fertility challenges.

• It can cause a great deal of anxiety and we all react to it in a different way. In someone like me who is such a 'do-er', it translates into wanting to do all the investigation and steps I can to work out what I can do to increase the chances of a successful pregnancy. In others that anxiety can have a paralyzing effect. And there are others who are very relaxed about their chances of success and feel that there is nothing which they need to do. Some of us may need help however, to relax, some of us may need someone to lend us a hand to help us out of our 'mind fog' and some of us may need nothing more than a friend or someone to be there. The biggest challenge is for the person themselves to work out which type they are and for others to help them in this process - this sounds easy but it can be very hard.
  
  
• There is an assumption that the cure to all fertility issues is IVF. Because it is so popular nowadays, we take for granted that this is the only way to go in order to deal with fertility issues but actually that is not the case. There are some fertility specialists who are of the view that people move on too quickly to IVF before trying other things first. And if someone feels that IVF is not for them, for whatever reason, they really shouldn't feel there is nothing they can do. There are certainly lots of things people can try besides IVF which can be helpful and many promote natural fertility remedies.
  
  My personal view is that the two can be complementary - you can pursue traditional medicine and also do natural things like reduce toxins, for example eat organically and do acupuncture to maximize your chances; but you should be open with your practitioners as to what you are doing to be sure the two do not clash with each other. And we should never criticize someone if they don't want to do IVF - it is a personal choice, we should remember to be supportive to alternative things they may wish to try. In my opinion, people can sometimes be too quick to dismiss natural and alternative remedies.
  
  
• We should never forget to stretch out a hand to others - you can never make someone come to you for help, but you can extend a hand and say you are there if they need to speak or point them in the direction of someone who can help. Even if you don't know the person, be there for them, particularly if you know what it is like to be there yourself.
  
  
• I realized how lucky folks in the US actually are. There are many wonderful organizations such as The AFA that are there to help support folks through their family building experience. These organizations are truly active, enthusiastic and progressive. Speaking with counterparts back in the UK, I realize how much more the help and support in that country is ad hoc and just not on the same level - it is changing and getting there, but not quite yet. (If any UK person is reading this and doesn't agree I apologize - this is just my personal view.)
  
  

So where does this all take me? Well probably not very far. But if nothing else it underlines to me how difficult and challenging dealing with fertility issues is. Nobody should ever underestimate this and assume that everyone reacts the same way. Stretch out a hand and seek to understand the person. This isn't about you - it is about them.

Posting on the AFA website: http://theafa.typepad.com/theafablog/2010/11/the-assumptions-we-can-make-of-those-with-fertility-challenges.html

Blastocyst Chromosome Screening - new test trials

Article in UK press:

http://uk.news.yahoo.com/4/20101102/tuk-women-due-to-give-birth-in-new-ivf-t-dba1618.html

CCRM randomised control trial:

http://www.colocrm.com/NewsEvents/10-02-12/Randomized_Control_Trial_for_Blastocyst_Comprehensive_Chromosome_Screening.aspx

Blastocyst Chromosome Screening (BCS) can spot chromosomal mistakes in outwardly normal-looking embryos that may prevent pregnancies or lead to miscarriages. It is still in the trial stage but if successful, it could help increase the IVF success rates as it will help doctors to pick out the 'best' embryos. The trials run so far have focused on the female age bracket 35 to 45 it seems (late thirties in the UK and 38 to 45 in the US).

There is one thing to be said about IVF and it is that innovation trail blazes on. I had never heard of BCS and I thought that my research on IVF was fairly thorough - clearly not! ;) I picked up on this new technology recently in the UK press referring to the first trials in Europe but it is already being done in the US as part of a trial at CCRM - see the second link above.

Back in February of this year, CCRM as part of its notice calling for people to take part in a randomised control trial said that preliminary results from their initial phase trials indicated higher implantation rates, lower miscarriage rates and higher live birth rates following BCS.

I don't know where the UK press take their following statement from, "evidence from the US suggests the procedure can boost the chances of a viable pregnancy after In-Vitro Fertilisation from around 35 to 75 per cent" but if true it is not insignificant.

So what is my lesson learnt? Well, the very institutions themselves will not always tell you about these trials they are running - I am not sure why - but having done an IVF at a CCRM sister clinic I do wonder why they did not tell us about this trial; perhaps we did not fulfil all the criteria? What I would say to anyone out there in the 35 to 40 age bracket is to ask about this! I do not know if it is the answer to your prayers but it is worth asking the doctors about.

Cougars and APS

I was sad to read the story of David Arquette and Courtney Cox splitting up. This is always a bitter-sweet event, as you hope it is a decision that they have taken for a happier future, yet you always feel a sadness too.

In their case, this is even more the case when you factor in the troubles they went through to get their little girl Coco - rounds of IVF and finally a diagnosis of antiphospholipid syndrome (an autoimmune disease associated with thrombosis and pregnancy complications).

I have two (unrelated) points to make:

1. watching Good Morning America discuss the whole Arquette/Cox story on 13 October 2010, the issue of 'cougars' arose and a psychologist professional listed fertility treatments for one of the reasons there were now more 'cougar' women and why the older woman was not scared to 'go it alone' if necessary. I found this very frustrating - I think that it is only a handful of women who feel that fertility treatments mean they can settle down with a younger man at a later stage in her own life - in other words, encourage her to become a 'cougar'. To make such a statement is to over-simplify things.
   
   It may be that fertility treatments as reported in the press given the impression that IVF is the holy grail to allow you to have a baby late into your child-bearing years, but as anyone who reads this blog will know, yes fertility treatments are great, but there is also a lot of misrepresentation in the press about IVF and how it affects female fertility. Basically a woman in her fifties cannot have a child using her own eggs (unless she froze them much earlier), even though the press would have you believe so!! And even freezing your eggs isn't a guarantee to success - it is still early days in that territory.
   
   
2. antiphospholipid syndrome is still one of those tests which you only get most times after having had problems conceiving for a long time, or a few miscarriages. It does not feature in the standard fertility tests that they do right at the beginning. And some doctors still poo poo the whole auto-immune system issue of how it can affect fertility. So it is worth educating people on this and Courtney Cox did a wonderful job at that! Getting it known in the main stream so that people know what questions to ask if they are ever in the unlucky position of having to sit in a fertility specialist's office.

So may be when the dust has settled, and the hype over cougars has calmed, an element of realism will settle back in. But I doubt it - so in the meantime I just sigh when I see comments made flippantly on television about fertility treatments (even if it was only 2 or 3 seconds of the story), and I contemplate writing in to GMA too to tell them my opinion. I question if this is over-reacting, being too sensitive, I'm sure the woman on the show didn't mean to cause offence or trivialise fertility treatments, but then again there is a part of me that says 'no' - if we don't speak up people will continue to only hear the crazy hypotheses put other there sometimes such as - fertility treatments lead to more cougars. We need to avoid the general public taking away the wrong impression of fertility treatments - as the majority of the women suffering fertility issues and battling with fertility treatments are not 'cougars' or 'wannabe cougars'.

Is the message starting to get through?

In recent times, two mainstream young women's magazines have run articles on fertility - Marie Claire in the UK and Cosmopolitan in the US. Hooray!

I ran down the list of fertility articles published by Marie Claire in the last couple of years and this is the first of its kind - up until now it has been far more focused on IVF treatments and how it is a wonderful tool to delay motherhood.

So let's hope this is a sign of shifting sands - that people are now starting to talk the honest nuts and bolts about all things fertility to make sure we make informed decisions at the right points in our lives.

But we still have a long way to go. Seemingly the press is still embarrassed to run articles that discuss things like 'vaginas' but it is okay to discuss 'sperm' - what a wonky crazy world we live in. Until we get over these hang-ups, which are self-created, we are never going to really be in a world where we have open and honest discussions about the things that matter - and one of these are how babies are made and our own sexual health.

Anyway, one step at a time I guess. So for now - well done Cosmopolitan and Marie Claire! But dear magazines, this is just the first step - don't think you have discharged your duty to mankind with this one feature - keep at it, and keep spreading the word with more features like this please....

Who is Lisa Faulkner?

http://www.mirror.co.uk/celebs/news/2010/05/03/adopting-billie-is-the-best-thing-that-s-ever-happened-to-us-115875-22229855/

Who is Lisa Faulkner you may ask? I certainly did. Having been out of the UK for many years, and even when I was there not a massive TV viewer, I had no idea who this television actress was.

Yet someone pointed her out to me recently as an exemplary woman who showed the 'other side' of infertility/subfertility - where IVF doesn't work and you have to think of something else. For some this is adoption and for others it is a decision to lead a child-free life. Each is a completely valid life-choice. This 'side' is so under-represented in the press.

The press rarely reports the cases where IVF doesn't work because (a) people like to hear success stories, not sad ones; and (b) individuals are probably less willing to put themselves out there if they fear they will be viewed as a 'failure' - so it is great that there is the occasional story like this to change public perception. We need more honest accounts like this one.

There is nothing but positive from her story. In her case, they opted for adoption and there are some wonderful points that jump out from her story:

• the path to motherhood can be via a different route - adoption;
• you are no less a 'woman' if you adopt this route and you can hold your head up in public and say 'look at me!';
• how emotionally and financially draining IVF can be, not to say cruel;
• that the adoption process is not easy and requires determination; it took them two years to be approved given the vigorous review process they undertake of prospective parents;
• adoption can be so rewarding - they have looked every minute of having their little girl Billie. She says, "adopting is such an incredible thing to do. I really can't imagine what our lives would be like without Billie."

It also highlights what a difference having a supportive husband or partner will make. He spoke of his desire to adopt if IVF didn't work, was supportive and had a great sense of humour through it all. She was very lucky and I am sure that made a massive difference. They were on the same page with respect to how they wanted to create their family unit and got through it together. Not every couple is so fortunate on this front, and it can create a whole new set of challenges to work through when you have already gone through so much.

So I would like to congratulate Lisa for her honesty and for being a real woman. She tells it to us like it was for her. She doesn't hide the fact that IVF doesn't always work. Even the miracle doctor in the UK Dr Taranissi of ARGC in London wasn't able to make it work for them (he is the doctor credited in the press recently for helping Penny Lancaster get pregnant via IVF). But that was okay, as with the wonderful support of her husband, they were able to create a family via adoption.

AFA Blog Link: http://theafa.typepad.com/theafablog/2010/09/who-is-lisa-faulkner.html

PCOS Awareness Week in the UK - 20 to 27 November 2010

http://www.verity-pcos.org.uk/events/pcos_awareness_week

Above is the link for the very first PCOS Awareness Week that is taking place in the UK from the 20th to the 27th November 2010.

This is very exciting as this a condition that affects so many women, and it is good to show support to each other, and educate each other. So often women are unaware that they have the condition until they go to see the doctor or start to try to conceive.

So get involved!

During PCOS Awareness Week, they are planning at least one activity every single day. These will be activities run by the PCOS Charity Verity but also by women with PCOS and businesses that support the work Verity does, (can you do something in your local area?)

The activities they have instore so far for PCOS Awareness Week include:

Evaluation of how the NHS is supporting women with PCOS
Shouting about PCOS at Speakers Corner in Hyde Park
A knit-your-own PCOS Snood for winter
A PCOS calendar
PCOS conference with sessions on emotion, excess hair, alopecia, fertility, weight loss, being slim with PCOS and all about your menstrual cycle

PCOS Awareness Week needs your support if it's to be successful now in the future. Get involved!

Reply from the Ministry of Education

The reply from the Ministry of Education arrived on 9th September, so I am sharing it with you all here. Scroll to the end of this piece for their reply. I am starting to learn that politicians reply with a guarded and non-committal standard-form answer which at first blush can dishearten, I am sure. But of utmost importance is that the message was sent, and one hopes, not only will be read but digested and acted upon by someone with the power to change policy. I have asked them to indicate to me where I can follow the policy considerations that the Government is said to be taking.

I could continue to sigh at certain responses I get from people to the work I am doing to raise awareness - only today after my previous blog article, I received the following comment from someone:

The person acknowledged reading all the information circulated and to being able to see what we were working so hard to change, and so hoped it made a difference. And we were wished all the love and luck in the world.

Now don't get me wrong, I value the support that is expressed a great deal, but if I were of a less determined and optimistic spirit I would be saddened at the fact that it feels as if a key point continues to be lost a little, however clearly I think I articulate it; it feels as if people still view from the sidelines to an extent.

So at the risk of sounding repetitious I will say it again. We are each of us a vessel and conduit for better communication and change. Every thing we do or say, however little it may seem to us at the time, can have a positive impact. We just need to try. It isn't all up to someone else or me, to make a change. So here is my reply to anyone and everyone who still doesn't feel the need or is worried about being pro-active:

"I hope that my work empowers you to have the conversations that have been so sadly lacking - you too can make a difference!"

Good luck everyone!

REPLY FROM MINISTRY OF EDUCATION (9 SEPTEMBER 2010):

"Thank you for your email of 10 August addressed to Ministers about improving sex education and awareness of fertility issues. On this occasion I have been asked to reply.

Following the instatement of the Coalition Government, Ministers are considering their position of a number of policies, including SRE. They do believe it is important that all children should have high quality SRE in school in order to make the right decisions in later life. However, they recognise that there are a wide range of views on SRE and want to ensure that they are adopting the best approach. They will announce their intentions in due course.

Thank you for taking the time to write and I hope you are reassured that this issue is very much on the Government's agenda.

Yours sincerely

Leona Smith
Public Communications Unit
www.education.gov.uk"

Raising Fertility Awareness - it can be frustrating but hang in there

http://theafa.typepad.com/theafablog/2010/09/raising-fertility-awareness-it-can-be-frustrating-but-hang-in-there.html - also on AFA site

I have been writing and lobbying for about six months now to improve fertility and infertility awareness. There is one word which sums up how it has felt: frustrating.

My lobbying has extended to a blog, writing pieces which are posted on sites such as the AFA site, emailing friends and family and writing to government bodies, politicians and fertility specialists - all with a call for increased awareness. The frustration, however, comes from the responses received.

In the case of some family members, the response has been silence. What do this mean? That they don't approve? That they feel embarrassed? Are they in some sort of denial? Do they think that they do not have a role in raising awareness and being supportive to others? And this silence has extended to family members who themselves suffered from infertility, which is difficult to fathom.

Other family and friends have expressed admiration for my efforts, but in some of the responses I still detect that while they make encouraging noises, they don't seem to appreciate that they are actually a conduit themselves for improved awareness: they themselves have the ability to talk to people about (in)fertility issues, or even lobby for awareness. An example of this was from my mother who when asked for a reaction to my pieces said, 'let me know if anybody does anything about it'. It continued to be, in her eyes, somebody else's job to do, and not hers.

This sort of response is not limited to friends and family, however; the same sort of sentiment is expressed by the medical profession themselves. On the recommendation of the Human Fertilisation and Embrylogy Association, a letter was sent to the Royal College of General Practitioners ("RCGP") regarding the need for more pro-activity from the medical profession to inform patients wanting a family one day about the fertility challenges that can arise and how fertility declines with age. The Honorary Secretary of the RCGP did reply promptly but here is what she said,

'The College does have these issues in our curriculum and we appreciate their importance'.

There was no acknowledgement of the fact that while it is 'in the curriculum' that the point was that general practitioners are not always having the conversations with their patients at pill checks and other well-women checks as they should. I felt compelled to reply to the Honorary Secretary and highlight that, as a patient, I could inform her that the information was not being passed on as she might expect or anticipate, and that I recommended that they issue memoranda to GPS as reminders to the importance of their pro-activity in these areas and to reinforce it also as part of their continuing professional development.

So what can we do about this? To encourage people to be more responsible and to look out for each other in terms of raising awareness and being supportive of those with infertility.

For one, the key is to not loose hope, energy and determination. It is going to be a long and slow road to raise awareness, but it can be done. Rome wasn't built in a day so we shouldn't expect this to be an overnight change either. But with perserverance we can slowly chip away at the prejudices and help people to face the realities of fertility issues.

We should not feel that our efforts are in vain: in the memoirs of an emminent criminal defence barrister (attorney) in the United Kingdom, he states that what he has observed over his long career is that progress is brought about by the extraordinary efforts of ordinary groups of people who fight for what is right and change; you cannot rely on politicians. This gives me the hope that change is possible with a little effort from us all.

Teach people 'how' to have the conversation with the people they meet to raise fertility awareness. It has struck me just how much people don't know how to discuss the topic. Their own embarrassment to raise it prevents them from doing it. They may not stay silent out of malice, but their own insecurities can stop them from doing an act of kindness.

People fear sometimes that they will come across as nagging, or that they may get a bad reply from the person if they raise the topic, or do not know how to handle the reply if it is not what they had anticipated. They, therefore, hide behind statements such as 'you are a very private couple' or 'you are an adult' to defend their own fears of raising the topic.

So may be it would be good to have some way of teaching people how to have the confidence to have the conversation on fertility awareness. To feel equipped with a set reply when someone cuts them off briskly saying they don't want to discuss or they do not get the reception they had hoped for. What follows are my own thoughts and opinions, and not those of any professional in the fertility field - but it would be wonderful to see it developed by professionals to help friends and family have the conversations which can save people from uneccessarily difficult times.

Some people are not even comfortable asking a person if they would like children, but I personally see no issue with this. It is one of the steps in life which many, many people take. If they say they do, or say that they think they may one day, this gives you an opening to have more of a conversation. The key is to not come across as nagging, to not make the person feel belittled or stupid for any decisions or lack of information that they have had up to that point. And, of course, you never know if they are already battling with infertility issues privately and just have not told you. So as the initiator, you have to be prepared for an unexpected response possibly - but whatever the responses here is the most important thing to come out of your conversation: for the person to feel that you are non-judgmental and supportive whatever they decide, and that you are there to speak more if they would ever like to. And for those who have yet to start trying to conceive, to plant the seed of thought in the person's mind with a pointer as to where to get more information on the topic if they would like it - for example, a conversation with their doctor, or even better, a gynaecologist, or to websites such as the American Fertility Association.

If they say they do not want children, then I do think you can wrap up the conversation in a relatively quick fashion but in a manner that, again, leaves them feeling that you are non-judgmental and supportive whatever the case and which leaves the door open for more dialogue if they would like. They do not want your opinion on the correctness of their decision so make clear your respect but do tell them that if they ever have questions or feel they may change their mind, that you are happy to chat, or if you or they aren't comfortable to have the conversation, to speak with their doctor. People are complex creatures and they sometimes use this as a standard answer to avoid having a conversation on a topic that they havent quite sorted out in their head yet, and so aren't comfortable discussing. But they may be in a few months' time. Or again, they may use this response as a smoke screen to hide fertilty issues which they are struggling with privately. And, of course, there are those people who truly do not want children.

I have emailed friends and family members of child bearing age or with relatives of child-bearing age, articles regarding how fertility changes with age with a line saying, in case you would might like children one day otherwise feel to ignore. People have either been silent or expressed gratitude, but nobody has been rude. Sometimes it just needs a little courage and sensitivity to the issue, to stretch out a supportive hand to a friend or family member.

So yes, it may be frustrating but the key is to not give up, even if people don't seem to want to 'get with the program' with the positivity that you would expect. I am convinced that good does come of good. So spreading the word will eventually have a positive effect on somebody's life, even if you aren't aware of it. And if only just one couple is spared the challenges of (in)fertility because of your little attempt at advocacy, it will have been worth it.

Is infertility an illness? A perspective and call for increased advocacy for awareness

Link to the blog on the AFA: http://theafa.typepad.com/theafablog/2010/08/is-infertility-an-illness-a-personal-perspective-and-call-for-increased-advocacy-for-awareness.html

I was recently told that infertility was not an illness. In the speaker’s mind, infertility therefore did not merit emotional support in the same way as if the person was suffering from an illness.

This gave pause for thought. I hadn’t actually thought about it in those terms. Admittedly, it is not like having a life-threatening condition such as cancer. Without a doubt, however, it is a medical condition, and one which can have far-reaching consequences on the person suffering from it.

What analogies could you use to express what infertility feels like? Could you say that it is like having a tumor on your arm which you don’t know if can be controlled with treatments, or if they will have to cut off your arm? I was told that this could be a bit melodramatic. But I don’t think it is, as emotionally it evokes how a person suffering from infertility can feel - as if a part of them could potentially always be missing. There is a sense of grief. Infertility can also lead in some cases to mental illness – this is a well known fact from time immemorial.

If people are suffering, shouldn’t we be understanding and sympathetic? If the up-and-coming athlete suddenly has a fatal injury that means he can’t run in the Olympics, we would feel for that person and not tell them to ‘just get over it’. While we can’t all have the ambition of running in the Olympics, it is very natural for the majority of us to have the ambition of having a family of our own one day. Therefore, being potentially denied something which is taken as one of the natural and defining events in life, will affect a person to their core.

A dismissive reaction to infertility, however, can be very typical of many people in society.

Religious arguments are sometimes put forward. Religious thinking such as the Catholic Church sees any form of intervention, be it even for the creation of life, as a sin, as they view infertility as a sign from God that the person should look to an alternative in their lives.

Political and financial considerations can influence a person’s thinking on the topic: In the United Kingdom where there is a National Health Service (‘NHS’) (there is a monthly deduction from salaries to contribute to the national healthcare pot), there have been many objections along similar lines to those in the USA saying that insurance companies should not cover fertility treatments because it is not an illness. People react negatively because they do not want to see their monies being spent against fertility treatments when they would rather see it spent against saving lives which they consider more relevant to them. In economic terms what is the opportunity cost of spending on infertility? This is a very subjective evaluation.

There is a general lack of awareness of infertility as an issue: A large amount of the reaction that the man in the street has to infertility comes from the fact that it is not something that people talk about openly. Therefore the man in the street may not actually know what it actually feels like. Or be aware of how common it is. One in eight people in the USA is dealing with infertility. Infertility comes in many forms – PCOS, endometriosis, advancing age, low sperm count, sperm antibodies, miscarriages etc. These are all debilitating to a couple trying to start a family, and sadly conditions that they generally only learn about when they join the infertility world, and not before. So the person who has never been affected by fertility issues, or known someone affected by it, is definitely not going to know about it.

Even if the man in the street knows someone with fertility issues, it is a difficult topic to grapple with emotionally, and it is easier to turn the other cheek or to think of something else. Although it is time to change and bring discussing fertility issues out of the closet.

Human nature cannot be under-estimated: It is human nature for people to make quick judgments on a topic without questioning further as to whether they have all the information, considered all the angles and the legitimacy of the sources. This is even more the case in today’s world which is very much driven by people focusing on the headline and punch-line in a fast paced media environment.

A good example of this is when you read the online comments section on newspaper articles. You will see comments telling people going through infertility treatment to stop being selfish and to just adopt one of the needy children in the world. What people, however, do not realize is what struggles those people have gone through already and what the entire adoption process entails – it is not easy. The numbers of children available for local adoption, happily, are far less than they used to be. International adoption can be an expensive process. The adoption process is long and intrusive. In some cases you are required to maintain contact with the birth relatives (it can be direct or indirect contact). These are all things which the individuals have to come to terms with. Until you walk in another man’s shoes, it is easy to make off the cuff comments.

What would these people say if you told them that instead of having a second or third child, they should adopt and play back their own arguments to them – feed an existing needy or hungry child as opposed to bring another into the world? From an environmental footprint perspective it is said that families should seek to have less children. May be they should have had one less child or even have elected to have no biological children.

It is a different world today to before: My mother recently told me that she had a conversation with my aunt along the lines of ‘what is wrong with the world? Why is there so much more of this today than before?’ This was a very interesting comment. For one, people probably didn’t go to the doctor in those days for such things and just got on with life and accepted their fate as there was nothing to be done. So it was not considered something relevant to discuss, or was swept under the carpet. If we could go back in time with the knowledge we have today I think we would be surprised, for example, at the level of miscarriages occurring.

In today’s world it is a fact that your son or daughter is likely to have children later in life than before. The delayed timing of the child rearing years isn’t necessarily out of choice.

In today’s world it can take many years to meet Mr. or Mrs. Right.

We have created a society where many people spend much of their young lives in secondary and tertiary education in order to gain access to an average to decent job. In years gone by, often that same level job would not have required today’s level of advance study. This, therefore, involves personal debt and more years before young people are able to afford a home for a family.

The cost of housing is expensive and takes a far greater percentage of a person’s salary than it used to, so it can take people many more years to get on the property ladder and be able to put a roof to put over their children’s heads, as they feel responsible parents should do.

Parents today often want to live their own lives once their children are grown up. This means that even if they can, they may be less likely to offer to help their children financially or with childcare. Children know they need to find a way to pay their way on their own, which translates into a delay in child-rearing years. There are those parents, of course, who would love to be able to help their children but cannot do so financially, or due to poor health. And even if parents are willing to help with childcare, they may live far away from their children because their children have had to move to where the work was.

Take even only one of these factors, and you have the lives of many young adults today delaying when they start to try for a family, not out of choice but because it has taken them longer to find their ‘mate’ and build their ‘nest’. And consequently these couples end up with an increased risk of infertility issues. Which can come as an even harder blow to them when they see all their efforts into building that ‘nest’ could be redundant in terms of having biological children.

We need to remind people that we have a collective responsibility for the type of society that we live in today, and the fertility challenges that those of child-bearing age experience today. It isn’t all of somebody else’s making, and nothing to do with them. The person suffering infertility could well be themselves or their son or daughter.

Fertility may not be an illness as we understand the word ordinarily. It isn’t going to kill you physically necessarily. But it is, without doubt, a medical condition with a much higher level of incidence today than it should have and one which people should be supportive of. It can have a very serious and permanent effect on people mentally, made worse by the complications of growing up in today’s world. In November 2009, the World Health Organization in Geneva defined infertility as a disease, which is a great step in allowing people to validate the suffering that many are experiencing and people are ignoring. And people are starting to stand up and make a voice for their message to be heard – two good recent examples are the What IF: A portrait of infertility Video which won an award for promoting fertility awareness with a call for grassroots advocacy and the SELF Magazine Article on Breaking the Silence on Infertility. The man in the street should understand that the increased incidence of infertility is a modern day phenomenon not to be ignored. If people want to see less of this ‘medical condition’, they need to stop being critical or unsupportive. They need to start doing, taking part, speaking to their children and family about this important topic and helping to change society so that we are more supportive and encouraging to young couples. They need to support research aimed at reducing infertility, and funding to help those who need assistance.

Medical condition or not, without doubt, it is an ‘illness’ of our modern world. And it is in our hands whether to change this or not in an enlightened way. Not anybody else’s.

Royal College of General Practitioners - their reply to letter

Below is the response from the Royal College of General Practitioners who were similarly approached for improved education on the topic of fertility awareness.

Truth be told I find it frustrating that they take this 'we are aware and have it under control' approach to the issue, when clearly they do not. See my reply to their response below also:

--------------------------------------------------------------------------------
From: Hon. Sec
Sent: Tue, 24 August, 2010 5:39:52
Subject: RE: Letter to Royal College of General Practitioners


Thank you for your letter sent to the Royal College of General Practitioners on 18th August 2010, the content of which has been duly noted. The College does have these issues in our MRCGP curriculum and we appreciate their importance.

Yours sincerely,


Professor Amanda Howe
Honorary Secretary
Royal College of General Practitioners

THE REPLY BACK SAME DAY:

Dear Professor Howe,


Thank you for your reply. While I see that you say that these issues are on the MRCGP curriculum, which is encouraging, from experience as a patient I am able to tell you that the information is not being passed on by GPs in the manner that perhaps you expect or anticipate.

Therefore, my recommendation to you would be to re-visit the teaching of those modules and to issue memoranda to practising general practitioners as to the importance of their pro-activity in this area. Reinforcement of the point as part of GP's continuing professional development training would also be recommended.

NHS Choices - reply from the NHS information website

In reply to the letter to the NHS Choices Team in the UK, here is what was received on 18 August 2010:

Thanks for your recent email on NHS Choices fertility content. We aim with this content to provide a balanced and useful introduction to fertility and issues around it.

The fertility content in Live Well is due to be reviewed soon, and I certainly will be mindful of your view that we could do more to highlight the fact that fertility declines with age.

It is not, however, in the power of us at NHS Choices to tell GPs how to practice, so we won't be able to ensure that GPs talk to women about this issue when prescribing the pill.

Thanks for reading NHS Choices.

Kind Regards

NHS Choices Team

AND THE REPLY TO THEM:

Thank you for the reply. Yes the point is to advice people as to how fertility declines with age, but also of the issues affecting fertility that can arise - e.g. endometriosis, polyps, PCOS etc - these can occur earlier and women are very unaware that such conditions exist unless they have had problems or start to try for a family.

Education of all fertility issues is key. Not just addressing infertility when it is already a problem but upfront prevention and detection. Early awareness is key to mitigating the risk and managing problems in an effective manner.

Reply from MPs to Department of Health

Below is the reply from the MPs to the Department of Health.

First up, it is disappointing in that they seem to miss the point that it is also about fertility awareness - they focus on the infertility aspect which makes me fear they continue to miss the point. The reply in other respects is very plain vanilla standard. Non-committal and a simple acknowledgement of the communication.

Is there more that can be done? Yes. We need to continue lobbying. Which is where you all come in. Watch out for the petition which will be circulating shortly. And for right now, a response will be sent to make clear that the point is not just dealing with infertility but fertility awareness - making us more aware of our own biology in advance, so we are properly informed and be pro-active in the steps we take to mitigate the risk.

Bottom-line, the situation is not going to improve - only worsen - with more and more cuts. And with headlines such as this, saying that in the UK if you are unhealthy (e.g. a smoker, or overweight) that you may be denied healthcare in the future, the point becomes all the more relevant. http://uk.news.yahoo.com/4/20100816/tuk-unhealthy-brits-could-be-denied-free-dba1618.html.

Therefore, doing nothing is not an option.

REPLY FROM DEPARTMENT OF HEALTH

Thank you for your emails of 16 July and 22 July to Andrew Lansley, Simon Burns, Paul Burstow and Anne Milton about infertility. I have been asked to reply.

I should explain that, due to the quantity of correspondence received by the Department, it is not possible for Ministers to reply to all letters and emails personally.

In addition to my colleague's previous replies, I can confirm that the Department was interested to read your suggestions and that policy officials are aware of them. However, while the Department is grateful for any submissions from members of the public, it is not possible to guarantee that policy officials will be in a position to enter into dialogue regarding such submissions.

I hope this reply is helpful.

Yours sincerely,

Jonathan Tringham
Customer Service Centre
Department of Health