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Just why has the expectation of infertility become normal?

There is a kind of casual banter that involves the casual damnation of humanity, society and life ("Oh people are awful!" "Sure the world is going to the dogs!").

News doesn't help. There's no story in the teenagers who went to Magaluf, had a moderate amount of alcohol, no drugs, did not get involved in any sex games and got home safe and sound just peeling slightly because they missed a patch with the sun cream.

Good news is no news. If we are willing to casually agree that yes, we belong to an intrinsically morally-dubious species and society, surely we're willing to believe anything?

A friend undergoing fertility treatment was told in the clinic that at the rate at which fertility is currently falling, within 20 years people will be having sex only for recreation.

The remark has been repeated in different situations to different people many times over. And astonishingly, the announcement that a fertility professional believes human reproduction as we know it is coming to a swift and permanent end in a matter of decades is never greeted with incredulity.

No one says "What the…?" or "That can't be true." It's usually more along the lines of casual resignation.

We're so used to believing bad news is the only news and that everything is coming to a sad end that it seems no stretch to believe fertility is a major issue too.

From news stories and anecdotal evidence it would be easy to believe that fertility is declining, that more and more people are having trouble conceiving and, indeed, that in a few decades sex will no longer have a reproductive function.

Except, the world's population is trotting towards 7.2 billion, more than double what it was in 1960. It's hard to read "fertility decline" in those figures. Yet for those affected it is one of the great stressors in life, a source of ongoing grief.

In the western world there are some statistics that suggest infertility is increasing.

In Ireland it's estimated that one in six couples faces infertility. In the US, according to the Centre for Disease Control, an estimated 12pc of Americans - some 7.3 million people of reproductive age - are infertile. But statistics always bear careful analysis.

As it stands, only 2pc of children in the western world are born through IVF. That's expected to rise, and there are other fertility interventions, but it's important to look at both the reasons for the statistics as well as those for the apparent infertility before we write off our reproductive organs for good.

Specialists in reproductive health agree that attitudes to infertility have changed. It is better known and more talked about, which, while good news for many, also means that the more of a problem it is deemed to be, the more likely people are to diagnose themselves it. Where people once might have been trying to conceive for several years before they sought help, now they seek help after just months. The expectation of infertility is certainly growing.

There are, as there have always been, fertility issues with clear medical reasons. Figures vary, but broadly speaking 25pc of infertility is caused by ovulation issues, 25pc by sperm issues and 20pc by physical blocks to conception such as endometriosis or damage from infections such as chlamydia.

The most noticeable change has been to the quality of sperm. The average sperm count has dropped by more than 50pc in the last 50 years.

In the 1970s there was a theory that was attributable to tight trousers that overheated the testes, but there has also been a decline in the quality of sperm, with increasing numbers of abnormalities being produced.

This has been ascribed to increased levels of female hormone oestrogen in the water system from hormonal contraceptives, hormones given to the animals that enter our food chain and the chemicals in plastics, detergents, electronics and pesticides that mimic the action of oestrogen.

Weight is also a factor: obesity decreases fertility for both sexes while being underweight adversely affects a woman's chance of conceiving. And there's the elephant in the room - age, maternal and paternal, which is a bigger factor than we care to admit.

We live in a society where the prevailing logic is that women who wish to have a career should delay motherhood.

Kirstie Allsopp got in trouble for saying that if she had a daughter she'd tell her to have children before (not instead of) her career but her comments bear consideration.

Like it or not, for the vast majority of couples having children affects the woman's career more than the man's. The prevailing logic tacitly acknowledges this by suggesting that women should get as much career under their belts as possible before having kids.

But who says there's any real benefit to slowing down halfway up a ladder? And how logical is it to spend prime child-bearing years making progress in a career before slowing down then spending your 50s doing a job you've been at for 30 years while juggling kids and teenagers?

logic

However, part of the package with that prevailing logic is the idea that it is easy to have children well into your 40s. Look at Gwen Stefani, Madonna, Mariah Carey.

In reality, a lot of people are hitting fertility speed bumps in their 30s because that is the more common biological truth. Very often, especially if people do not look or feel their age, they assume their fertility will be equally time-defying.

But eggs age even if your face doesn't. As a woman ages, the overall likelihood of pregnancy per cycle decreases.

So yes, there are issues around fertility, but to what extent is it becoming self-perpetuating? Statistics vary widely, but between 19pc and 28pc of infertility is considered unexplained - there is simply no detectable physical reason why conception does not occur.

Which is no less difficult for the couple. There are many documented cases of people who have struggled for years to conceive, giving up, adopting and suddenly having a natural conception. The same has happened following IVF.

Other people swear by acupuncture and still more by the power of positive thinking or prayer. The mind does seem to play an important but unfathomable role, so the more we believe fertility will be an issue, the more it is likely to become one.

Fertility is big business. According to Rollercoaster.ie, in Ireland the average cost of a round of IVF is €5,000 - up to €10,000 with donor eggs - and the average number of treatments per couple is four.

A healthy 40-year-old woman might have only a 5pc chance per cycle of conceiving naturally, but with IVF the chances are still only 10pc.

People who are having difficulty conceiving are sometimes resentful of exhortations for them to think positively.

Following several years of trying to conceive and lots of examinations and expense, 'Sarah' opted first for ICI treatment (where sperm is injected high into the cervix) which is much less invasive and cheaper than IVF.

"The fertility problem was with my partner, but the ICI wasn't working and after a while I felt it was my fault. I was getting more and more anxious. Before you know it you're 39 instead of 36 and instead of the three kids you thought you'd have by now you have none," she said.

"It's all I thought about in the end. You get envious of people you love, and you're ashamed of that and how you feel about people who can pop out kids on welfare.

"My friend was into positive thinking and she meant well when she said it was important to stay positive and not to think my eggs into a funk but it started annoying me because it was like she was blaming me, like she was saying 'If only you could think the right way it would all be sorted'. We fell out over it."

turmoil

'Sarah' has subsequently had one child through her first attempt at IVF and was astonished by a second, unassisted pregnancy three months after the first baby was born.

After two miscarriages, both without fertility treatment, she decided to get a coil.

"That felt like a very strange decision after all the turmoil we went through to get our first baby, but I was in my 40s with toddlers - the body can only take so much."

Whether through hormone production or body memory, many women who have fertility treatment for a first pregnancy conceive naturally afterwards. 'Sarah' thinks there's something to that, though she adds: "I am also aware that after I had my first baby was the first time in about eight or nine years that I wasn't obsessing over getting pregnant. And I got pregnant.

"I don't think it is that simple, and even if it were, I don't know how someone who wants a baby and can't have one can stop focussing on that absence. But I think there is something to the power of the mind in fertility."


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