You are browsing the archive for fertility.

Aging Sperm? Not the End of the World

1:41 pm in Uncategorized by RH Reality Check

Written by Elizabeth Gregory for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Judith Shulevitz’s recent New Republic essay on how later parenthood is “upending American society” claims that delaying kids could lead us down a rabbit hole of genetic decline. The piece gathers much of its energy from new studies suggesting that male sperm quality decays with age.

While female infertility is old news (literally), issues with male fertility create a new cultural frisson. Apparently, genetic errors may be introduced into sperm every time they divide — which is often. So the children of some older men may have issues, cognitive and physical, that the kids of younger men don’t generally face (at least not due to their dad’s contribution to their DNA).

There’s a lot of emphasis on the word “may” in the New Republic piece — since most of the evidence it’s based on is inconclusive. And there’s a strong element of anecdote as well. Fertility catastrophizing is an ongoing sport. For instance, here are some other fertility scaremongering pieces of the past few years which turned out to be not the big problems the headlines suggested: the ovarian reserve scare; the later-parenthood autism scare; the childlessness scare; earlier this month we had the low-birth-rate scare (which turns out to really be about young women delaying kids in order to establish themselves — a time-lag effect).

In the case of new dads over 50, several studies do suggest that their kids may have a higher rate of schizophrenia (about 1 percent) than those of younger dads (about 0.25 percent), and there may be links to other ailments. Time, and more completed studies, will tell. The same is true of studies of the effects of fertility treatments like Clomid on both kids and moms, which the essay also raises as potentially devolutionary. The data is still in the gathering stages.

As there has been all along, there’s reason to ask women and their doctors to think through their fertility options before turning to fertility tech and drugs. Firm data on rates of pregnancy in the late thirties and early forties is scarce, because doctors can’t mandate that a big group of people have unprotected sex constantly for the sake of an experiment. But one study indicates that most women not already known to have an endocrinal disorder or blockage will get pregnant without aid in their late thirties within two years. Many find two years too long a wait before seeking fertility boosters — and certainly it’s reasonable for women to get their hardware checked out early on in their fertility efforts, or even before they’re ready to start trying for kids. But of the 580,000 kids born in 2010 to women over age 35, only about 6 percent of them involved IVF. (We can’t track how many involved Clomid or IUI.) For more on rates of decline click here.

Fertility treatments should be more regulated and tracked than they are. We know little about the long-term effects of the treatments we’re using on a wide scale. But the presentation of data in this essay is questionable. Potential problems should be noted and discussed, but there’s no basis for jumping to end-of-the-world conclusions. We are not falling off a fertility cliff.

Looking at the same question from the positive side, at least such hand wringing does open up discussion of these issues. Suggestions of declining quality of sperm among later dads shares out some of the weight that’s been jammed on the shoulders of later moms in our fertility discourse.

Different from older moms’ situation, however, these male fertility issues can be addressed with relative ease. For women, IVF and egg donation involve injections of high doses of hormones with unknown long-term effects, huge expense for each attempt, and ethical questions over the use of poorer women’s genetic material for the benefit of richer couples.

By comparison, for men worried about potential issues with their aging reproductive materials, arranging for sperm donation is a breeze. The cost is negligible and no risky hormone injections are required. If you want familial DNA connections, there’s the real option for many of using a nephew’s sperm — or that of a younger brother. Or if you don’t have such a handy relative, or it’s not a real option given your family dynamic but you do hope to propagate your own DNA — you can push for further research around generation of new sperm cells from an individual’s adult stem cells or even skin cells. If perfected, such advances could allow men (and, interestingly, women too!) to generate new sperm cells bearing their DNA. These would be free of the genetic errors that older sperm have, because they haven’t divided as often. Some animal experiments along these lines have been successful.

The understanding that spermatic dynamism fades with time may surprise us for a few minutes. But viewed in wider context, it’s not the end of the world, guys. 

Modern fertility is changing at lightning speed, and along with it the stratification of tasks based on gender. Many of our old-world assumptions are being upended. But for women, men, families, and society, the new options introduced by control of fertility are largely positive and open the way to ongoing positive cultural evolution.

To the Religious Right, I Am No Longer a Woman

7:17 am in Uncategorized by RH Reality Check

Written by Robin Marty for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

A mother nurses her infant

A woman's only purpose? (Photo: See-Ming Lee / Flickr)

In just the last seven years, I have experienced nearly every biological joy and trial that comes with being a woman. I’ve been on hormonal contraception. I’ve struggled with unexplained infertility. I’ve had a miscarriage. I’ve attempted vaginal birth. I’ve had an emergency c-section. I’ve had planned c-sections. I’ve used natural family planning to try to conceive. I’ve used natural family planning to try to not conceive. And, as a result of that, I became a woman with an unplanned pregnancy.

Currently, I am enjoying a state that I have never been in before–one where I don’t have to think at all about my reproduction, fertility, trying to get pregnant, trying to avoid pregnancy or being in a state of pregnancy. It’s a huge and welcome relief, frankly. Between miscarriage and two fairly closely-spaced births, I’ve spent well over two of the last three years having enough HCG in my bloodstream to be able to produce a positive pee test if I was so inclined. The seven months that have passed since I have had my last (and I do mean last) child is the longest I have been unencumbered by pregnancy hormones since 2009.

So it’s with a bit of irony that I read the incessant assertions from the religious right that I am in fact not a true woman anymore, simply because I have chosen to remove myself from the baby game. I already had one strike against me, obviously, just for advocating that women should be allowed to decide when or if they want to have children, and for believing that sex can be meaningful even if there isn’t some potential for conception to occur during the process. I’ve had sex to try and create children, and honestly, it can be a very stressful, non-magical endeavor. As much as I can guarantee that all of my children were conceived equally in love, I can’t say the same about the… um… enthusiasm.

Since the birth of my son (and, nearly as importantly, the snipping and cauterizing of my fallopian tubes) I’ve had the chance to relearn both emotional and physical intimacy, two items that are often lost among couples with a houseful of small children or an empty house two partners are trying desperately to fill. It’s a task that is much more emotionally charged now that sex is for us alone, and without a worry about the “consequences” of sex that the religious right seems so focused on making a part of the bargain. We don’t need potential consequences. Our family is complete. After all, they already outnumber us. I’d hate to get even further behind.

But to them, I am no longer a woman.

Women around the world have swallowed a detestable lie that a person’s identity can somehow be separated from his or her biological body… Women like [Sandra] Fluke who accept this detestable lie, have thereby rejected the glorious beauty and radiant splendor of what is really at the core of a woman’s being, namely her profound ability to procreate, to form a new life, to carry that life within her for nine months, to birth that new life into the world, and to nourish that life until it reaches independence.

The life-creating potential and nurturing capacities that belong to a woman’s very nature are most marvelous. But in the name of so-called freedom, Fluke and others want to elect a president who will support them in rendering their feminine bodies sterile and who will aid them in killing their offspring when their sterility strategy fails.

Have I lost all “beauty and splendor” now that I am permanently out of the baby-making business?  Do I no longer get to have an “identity” now that my “profound ability to procreate” has come to an irreversible end?

For those willing to allow me to keep a sliver of womanhood, even if I have lost my ability to create and birth tiny human beings, I am still at the very least “corrupt.

Abortion strikes clear to the core of a woman because a woman’s God-given nature is to create, sustain, nurture, and protect new life.  Whether a woman ever gives birth is irrelevant.  It is still a woman’s essential make-up to bring forth new life into the world.  God designed us that way.

Just to believe that a woman should have the right to control how many (or even no) children she should bring into the world is a “corruption” of our very natures, according to those who are the most extreme.  Whether a woman gives birth or not, she is a “mother,” according to them, just by being female. Much like the state of “pre-conception” that Jessica Valenti discusses in her new book Why Have Kids? all girls and women of reproductive age are in a state of “mommy-to-be” whether she cares to be or not.

To them, there is no society of men or women, but men and “potential mothers.”  Once you remove yourself from the motherhood game, whether it occurs before or after you have children, you have denied your right to lay claim to womanhood.

Yet somehow, I don’t feel corrupt.  I don’t feel a lack of “splendor.” In fact, I feel exactly as much a woman as I did before I had my tubes tied, or before I gave birth or even, shockingly enough, before I was pregnant. I feel the same as I did about my gender, my beliefs, my true nature, and my potential.

Most of all, I feel relief. Relief that regardless of what happens in the future, there will never be a point where I will be forced to add onto my family due to lack of access to birth control or abortion. My family is complete. And I am complete, even if I’m missing a small part of my tubes that the religious right claims is the most important part of me.

Egg Freezing: Risks to Women and Children Unknown

9:48 am in Uncategorized by RH Reality Check

Written by Marcy Darnovsky for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Originally published by the Center for Genetics & Society. Published here with permission of the author.

To its credit, the fertility industry’s professional organization – the American Society of Reproductive Medicine (ASRM) – has said plainly that freezing women’s eggs remains an experimental procedure that should not be “marketed or offered as a means to defer reproductive aging.” To its discredit, ASRM does little to see that even its own members adhere to its conclusion. (If this sounds familiar, you may be thinking of the similar disregard in which fertility clinics hold ASRM guidelines on the number of embryos they should put in women’s wombs, and on the use of embryo screening for sex selection.)

In fact, hundreds of American fertility clinics now offer “social egg freezing,” and there are thousands of online ads promising women they can “extend their fertility” by putting their eggs on ice. This disjuncture is examined in an article in this week’s Nature titled “Growth of egg freezing blurs ‘experimental’ label” [registration required].

Science writer Alison Motluk points out that chemicals used in the freezing process are toxic to embryos, though no one knows how much the eggs absorb; that there have been no systematic follow-up studies either of children born from frozen eggs (fewer than 2000 worldwide) or of success rates, especially for women in their late thirties who are the primary users; and that the procedure is very expensive. She notes that several other widely used assisted reproduction techniques, including pre-implantation genetic diagnosis and injecting sperm directly into eggs, were also rushed from lab to patients with next to nothing in the way of animal studies or clinical trials.

Ironically, proponents of social egg freezing offer this record of untested techniques as an argument in favor of removing the procedure’s experimental label. Though the commercial throttle is already wide open, these promoters are probably right in thinking that ASRM’s designation dissuades some women, dampening the growth of what is clearly a lucrative new market for the fertility industry. In an April article in Vogue, fertility doctor Geoffrey Sher, an active and early proponent of egg freezing, says that there “is already the potential for eight times the demand for egg freezing as there is for IVF procedures, just based on population numbers.” Sher and others believe that women should be encouraged to undergo the procedure in their late 20s or early 30s, when their eggs are higher quality.

Though the tone of the recent Nature article is more sober than that of many media accounts, neither it nor the other media stories published over the past several months – the Vogue piececoverage by National Public Radio, and a first-person account on Huffington Post – even mention the non-trivial short-term risks (side effects ranging from mild to – rarely – life-threatening, with plenty of debilitating territory in between) and still uncertain long-term risks of egg retrieval for women.

In most of the media coverage, the take-away message is that egg freezing is an unproblematic boon. NPR’s article, for example, carries the conclusive title, “Egg Freezing Puts The Biological Clock On Hold” and reports that fertility doctors “envision a time when society considers freezing eggs an act not of desperation but of empowerment.” The Vogue piece declares, “Stopping the biological clock through egg freezing has long been the ultimate feminist fantasy.”

There have indeed been, and probably still are, some feminists who fantasize thus. The most notorious is Shulamith Firestone, who back in 1970 envisioned gender equality enabled by artificial wombs. Myself, I’ll forgo the fantasy techno-fixes. Give me the kind of feminism that assesses the real-world effects of a practice like egg freezing – as do, for example, Our Bodies Ourselves and the National Women’s Health Network.