Fertility problems in the 21st century

[Lyanna Stark]

A recent survey showed that first time mothers in the UK are getting older and older, and recent debate has some "clever" people call for women to have kids earlier. Yet other debaters pointed out that with the job market looking like it does, it is deeply unfair to pressure young women to have babies earlier, before they have a stabile work, some savings and a bit of work experience. It's also still harder for working mothers to be seen as "equal" to working fathers and cultural and financial pressures for the mother to take on the brunt of the childrearing are still strong.

Then there is the obvious conclusion of this, that when mothers get older, fertility problems become more common. Of course, some couples will experience fertility problems anyway, but the likelyhood increases with age as well.

There is a jungle out there of fertility treatments, and with society structured like it is, should UHC systems finance fertility treatments? Should there be a "cut off age" where financing will stop?

People with sufficient financial resources also employ surrogate mothers. (Case in point, Sarah Jessica Parker "had twins", and yes I eyeboggled at the choice of words, by a surrogate mother last week or so.)

In the beginning I was quite horrified by this as I thought it was something deeply wrong with our society when you got another woman to carry your baby, or even to use her eggs and body to create a baby related to the male part of the couple. (I know this is different for homosexual couples, who in turn face slightly different problems.)

Since then, I think I have come to change my mind, since I know it can help women in developing countries a lot financially to become surrogate mothers. It's still not ideal and I am getting slight "Handmaiden's tale" vibes from it, but if it is their own choice and they are happy with it, I can't really say anything.

What are your views? Should fertility treatments be subsidised by the state? Up to a certain age or always? (And I am sure somebody will bring up Octomom here :P ). Fairly recently we had a thread where it seemed at least a couple of people argued that children was something for people who could afford them, i.e. having children, and I assume fertility treatment, would become a privilige for higher earners.

What about surrogate mothers, or egg donors? Since it seems medical science of the 21st century can offer people more options when it comes to having babies, should we even try to stop this, or are there ethical considerations we have missed in the speedy development?

[Galactus]

I think fertility treatment (as well as egg donations, surrogate mothers etc. etc.) should be covered if there is a documented problem with fertility. It should not be provided just because someone wants a child but not to carry it or something like that (which I suspect would be very unusual in the first place)

[Silverstar]

I don't really have answers to your questions, but one thing that has always really bugged me about the debates over fertility problems is this 'call for young women to have babies earlier'. What about men? Yes, there are many women out there who do choose to postpone having children for career reasons, but there are also plenty (in my experience) who would love to have children younger, but the attitude, perpetuated a lot by the media, of the men in their lives is that your twenties and thirties are for having a late adolescence, and that having children means being 'tied down'. I know a number of very broody women my age who just don't have the option of having kids yet, because their partners think that late twenties/early thirties is far too young to be thinking about things like that, and because they have the option of putting off having kids as long as they want, they do so.

Why do these reports never seek to educate men about this kind of thing, and instead just put all the pressure onto women to 'have kids earlier', seemingly forgetting that they can't do this on their own? :/

Now I have my little rant off my chest, please go back to your regularly scheduled programming :)

[Galactus]

It's actually rather simple, men have a longer fertile period than women do. And it's also easier to get sperms donated than eggs.

[Chaldanya]

I actually don't have a problem with surrogacy at all. If that avenue is open to you and all parties are happy then go at it. It's a hard road to travel and not one that I'd necessarily take but different strokes for different folks.

should we even try to stop this, or are there ethical considerations we have missed in the speedy development?

The only problems I have with fertility treatment are:

1) the age at which this allows women to conceive (60+ in a couple of documented cases). a) It's not terribly healthy for a woman past a certain age and b) What are the effects on the child? (This could be me speaking out of my arse, tho).

and

2) Eugenics. The ability to pick and choose certain aspects (i.e. sex) of your child should not be made available at any cost. That way lies all manner of unsavory practices.

[Silverstar]

I know it's simple, but that doesn't mean that women are the only ones who should get pressured to have children earlier. What do these people want - women to just ditch the partners and go to a sperm donation clinic?

[MinDonner]

It's actually rather simple, men have a longer fertile period than women do. And it's also easier to get sperms donated than eggs.

Well, yes, but, um, no. None of that addresses the social incentives for men to have kids later. We have a cultural narrative that says "fellas, once you have kids then your carefree days are over, put it off as long as you can!" while simultaneously trying to persuade women to have kids sooner. While there are some very good biological reasons for this, it does rather give off some rather unpleasant social messages, like "younger women can just marry older guys (fnar fnar)" and "men, your precious freedom is worth a lot more than your risk of having a Down's Syndrome kid"...

[ljkeane]

I don't think there is any obligation for men or women to have children at any age, so trying to encourage men to have children at a younger age isn't the approach I'd take.

With regard to fertility treatment, I'd be in favour of state funded fertility treatment for those that have fertility problems. Having said that I'd be in favour of some limits on age and probably priority being given to those that are in the optimal child bearing age bracket and having difficulties.

While women don't have any obligation to have children at a younger age they should be made aware of the risks that waiting longer represent if they do want to have children, I'm sure this is probably already the case.

[Ser Scot A Ellison]

It's interesting that Lyanna started this thread today. I just read a movie review for "My Sister's Keeper". It's about a family who's oldest daughter is suffering from Lukemia and there are no compatable marrow donors, so, her parents have another daughter "enginered" to provide the tissue that may save their older daughter's life. As the younger daughter pushes into her teens she resents the repeated medical procedures she's forced to undergo by her parents, hires an attorney, and sues to require the procedures to end even though her sister is still very sick.

I think this film throws into stark relief some of the ethical debates creatied by our ability to produce children at will and for particular purposes (I believe the film is at least based on the true story of older parents seeking fertility treatments to have a child to help another child suffering from Lukemia).

I understand the desire to have children of your own. My daughter was born when I was 32. That's not aged but I wasn't a young parent either. I don't want to deny people the opportunty to become parents via extra-ordinary means, but, I do think, at a minimum, that to receive the treatments there should be a cutoff age and a proven need. The rational for the choice to use fertility treatments should also be explored.

[Chaldanya]

off-topic

(I believe the film is at least based on the true story of older parents seeking fertility treatments to have a child to help another child suffering from Lukemia).

The film is actually based on a book by Jodi Picoult.

N

[Ser Scot A Ellison]

Chaldanya,

off-topic

(I believe the film is at least based on the true story of older parents seeking fertility treatments to have a child to help another child suffering from Lukemia).

The film is actually based on a book by Jodi Picoult.

N

Which was likely inspired by the situation I mention in parenthesis. Here's a link.

From the article:

Parents who have children who are ill with leukaemia or anemia are going to reproductive genetic clinics in order to better conceive siblings as stem cell donors.

This approach is attracting criticism from some people. Ethicists say there is not enough information about the impact this has on these kids.

Clinics screen embryos that were created by IVF. They find out if the tissues of these embryos match those of the sick child.

The problem for parents who try to conceive naturally is that there is only a 25% chance the sibling will be a perfect match for the sick child. This means you may need to have four extra children to find the match. With IVF, multiple births are more common so you can find the match more quickly and only implant into the mother's uterus those embryos that are a match for the sibling.

In the reproductive genetic clinics they only transfer the embryos that are a perfect match into the uterus of the mother. The umbilical cord of the new matching sibling can be used to treat the sick child.

To show this isn't just a recent development here's another link.

From the article:

More Babies Being Born to Be Donors of Tissue

By GINA KOLATA

Published: Tuesday, June 4, 1991

At about 8 o'clock this morning, doctors at the City of Hope Medical Center in Duarte, Calif., plan to transplant bone marrow into Anissa Ayala, a 19-year-old girl who is dying of leukemia.

The marrow will come from her baby sister, Marissa. Their parents say they conceived Marissa to provide bone marrow to save Anissa's life.

Doctors and ethicists say this is the first time a family has publicly admitted conceiving a child to serve as an organ donor. But many others have done so privately. Parents have had babies to provide bone marrow for siblings and relatives or even, in one case, a kidney. Some parents have sought prenatal diagnosis to insure that the fetus had genetically compatible tissues necessary to serve as a donor, intending to abort it if not.

[Datepalm]

I was talking aboutt his just an hour or so ago - my dad reports seeing sign all over Kiev reading "We should be 52 million. Love."

I'm extrmely uninvested in the idea of having children at this point in my life, so I feel like maybe i'm failing to to really understand the perspective of people who go to great length to have kids, but here at least you cannot go wrong with desire for a child. No measure is too extreme, nothing is not worth it, no public or medical criticism is worth anything against the power of more babies.

I do think the health care system should have some sort of sensible medical cutoff in terms of what it will fund - by risks to the woman or child and refusal to fund fertility treatments for people who already have kids, for example, and I have a hard time wrapping my head around surrogacy - but if theres a significant amount of people who want these things, no legislation is going to stop it, just drive it underground, so it comes back down to the way socity is built and what sort of things it drives people to do.

I think we might still be in a transitional sort of stage though where all these issues of age and number of kids and under what circumstances are fluctuating quite a bit and might settle down eventually. They might settle down to women having 2.4 kids startign age 32 rather than 23, which is probably not going to be that big a problem, but if it settles into couple not having kids until they're in their 40s and a wide reliace on increasingly complex and technological fertility treatments...well, that strikes me as unsustainable.

[kungtotte]

I don't like fertility treatments or alternatives such as surrogacy, because there are so very many orphaned children in the world that could be adopted as opposed to cranking out a new strain on the Earth's already limited resources. At six billion people we are already living above our means, and they are projecting that we stabilise somewhere around nine billion. Is biological parenthood really what's important, or do you want to be a mother or father? Siring children is a far cry from being a parent, and a biological connection to the child won't really affect your ability to be a mother or father.

You don't have any sort of right to beget children, so I don't understand quite why it should be covered by UHC. In most cases, society will eventually benefit from any child being born, they becoming productive members of society and whatnot, but a society would also reap those benefits if the child was adopted rather than born to those particular parents. I would much rather see adoption sponsored by the state than I would fertility treatments.

[MinDonner]

I think we might still be in a transitional sort of stage though where all these issues of age and number of kids and under what circumstances are fluctuating quite a bit and might settle down eventually. They might settle down to women having 2.4 kids startign age 32 rather than 23, which is probably not going to be that big a problem, but if it settles into couple not having kids until they're in their 40s and a wide reliace on increasingly complex and technological fertility treatments...well, that strikes me as unsustainable.

Yes. One of the problems at the moment is that the working world is still pretty much set up to accommodate the "traditional" family structure, where Husband works a 35-40 hour week and is looked after by lower-earning/non-working Wife, who has to sacrifice her career to raise the kids, and all the efforts to change this have just involved tinkering with the original model rather than trying to overhaul the whole thing. So there's maternity leave but no (or not much) paternity leave; the long work-week is still standard; taking early career breaks is frowned upon, etc etc. This all despite the fact that a) most households now require two incomes in order to live comfortably and b) many women do not want to give up their careers at a crucial time even if it means reducing their future chances of having kids.

All this "encouraging" women to reproduce earlier is useless unless some of the underlying obstacles are addressed.

[Ashaman]

are there not a huge problem of declining sperm quality, i watched a documentary about a danish resercher that had documented a 50% decline in sperm quality over the last 50 years.

and that he suspected that the corse of this where the use of syntecised chemicals in nearly every thing we come inn tuch whit, had a property that where simmilare to the female hormone austrogen (sp?).

and that becours of this boy babies where subjected to exstra amount of the female hormone while in development inn side the womb.

all this leading to porer sperm quality and an increas in numbers of testicle canser over the last 50 or so years.

[Lyanna Stark]

All this "encouraging" women to reproduce earlier is useless unless some of the underlying obstacles are addressed.

I agree, and I think because of this we will see the age where women have children to keep being pushed towards higher ages, due to purely financial/practical concerns.

Re Ashaman's comment about male fertility, yes I have seen similar reports that male fertility is in decline in general due to diet, pollutants and other things. Also, recent research seems to indicate that older fathers may produce less intelligent offspring. Hence eventually, the onus may not only be on the woman to "produce" a child earlier.

Is biological parenthood really what's important, or do you want to be a mother or father?

I think this varies a lot. Some I am sure have this ideal of The Family and children need to be a part of their life. To me, it's different. I don't feel I need a child to fulfill my life, and if I couldn't have conceived, I don't think adoption would have interested me. Parenthood in itself has not been something I have been after, as I don't consider it imperative.

However, I am now extremely excited about getting to meet MY daughter in a couple of months. Having a child is still not the end all and be all for me, and I know in the past people have been adamant they want a large family and would never even date somebody who could not have children. This thinking is totally alien to me. Sure, if my SO had been infertile I might always have wondered what it would be like, but I am sure our lives would have been fine anyway.

[ljkeane]

All this "encouraging" women to reproduce earlier is useless unless some of the underlying obstacles are addressed.

I don't think it's really about encouraging women to have children earlier it's just about making sure women realise that if they want to have children it's far easier to do so at a younger age. That isn't really an issue for society it's an issue for women who want to have children.

[Ser Scot A Ellison]

Lyanna,

Laura and I both have commented that having two young children would have been easier in our twenties simply based upon our energy levels as compaired to our children. That, I acknowledge, is completely anicdotal.

[Lyanna Stark]

I don't think it's really about encouraging women to have children earlier it's just about making sure women realise that if they want to have children it's far easier to do so at a younger age. That isn't really an issue for society it's an issue for women who want to have children.

What do you mean with "far easier"? It doesn't matter if biologically it is far easier, when financially/practically it is either impossible or very, very hard.

In general, women already know this, but what can we do about it? £117 a week is not something you can happily live on (that's the maternity leave money in the UK btw.)

Ser Scot,

I am sure it is, but most people don't really have the material/financial resources to do that, nor are they so inclined for various reasons.

[Silverstar]

I don't think it's really about encouraging women to have children earlier it's just about making sure women realise that if they want to have children it's far easier to do so at a younger age. That isn't really an issue for society it's an issue for women who want to have children.

I think most women are very well aware of this fact. The simple fact is that society is set up to make it much harder for women to do this, and the media encouragement to men not to have children earlier again adds yet more difficulties into the mix.