How to Make a Family: The Blog

I'm Too Old?! At Least I'm Not Dead or Crazy

A few articles that are out and about right now, for a little watercooler level conversation on the Age & Fertility Conundrum.

What conundrum? 

Well, here's a HuffPo piece about the study in Human Reproduction that catches women in their 40's palm-to-cheek, wide-eyed, mouths open and aghast about their decrepit eggs. Granted, all the survey participants (from only 61 families) had to use IVF to conceive, so the little study's a little skewed. But that doesn't stop us from chattering about it as news.

It's nothing new (is there ANYthing new?) -- for example, here's an NPR story done in late 2011 about the EMD Serono survey of more than 1,000 younger women (25-35 years old and none of whom had given birth or sought fertility treatment) who figure a vegan diet, zealous yoga workouts, and just generally staying physically fit will protect them from normal, age-related infertility later.

That "conundrum"...

Then there's Judith Shulevitz at The New Republic slapping all of us old folks around for pursuing babies beyond the usual societal borders. The "grayest generation" is imposing scary consequences on -- upending, even -- "American Society," Shulevitz says.

Wondered with despondency about the state of the country lately? It's our fault. G'head. Blame us. See if we care. We bet you can't slog through the whole article, anyway.

And anyway, a large Danish study was published recently in Journal of Epidemiology and Community Health that says if you want kids and don't wind up having any, you're likely to die sooner and have psychiatric illness. The study's lead author said in this related article “Parents are less likely to die from accidents, circulatory diseases, cancer, and external causes," suggesting there are related behavioral differences between people with kids and non-parents. I know that I made a point of jumping out of an airplane before pursuing parenthood, and my post-delivery anxieties were part of why I made the career choices I did. Once my son entered my life, the thought of strolling through Crackville as a social worker brought a new element of fear. Choosing to be an at-home copy writer is probably the only thing that kept me from being an eventual gunshot statistic. (do i need to insert j/k here?)

How much of this study information is valuable to regular people? I mean, it's juicy for sociologists and media types who need an attention-getting article topic du jour. But it seems to me the only thing that comes from any of this in terms of real-world daily living is that we are woefully ignorant about reproduction. How it happens, when it happens, why it happens... The real conundrum isn't How Old is Too Old & Isn't It Better To Have Kids At Any Age Than Not? The true mystery is why the heck we don't see the value in sexuality (and family planning) education before it's moot for most people. Now THAT's worth an OMG look.

 

Related articles

Increasingly Older Parents Are Ruining It for Everyone

Delaying Parenthood May Come at a Cost

There's No Perfect Time to Start Having Kids

Childless Until Proven Parenting

Egg-freezing: It's Not Just For Cancer Patients Any More

I had the chance to sit in on a press conference call held by the American Society for Reproductive Medicine this week, just ahead of their annual shindig (which will be in San Diego this year). The call's topic: the removal of the label “experimental” that they adhered years ago to a technique already in use.

Oocyte cryopreservation has only been 'experimental' in name. Reproductive treatment centers have been freezing women's eggs for years now. It's not as if we're talking about Frankenstein-level experimentation.

But in the name of safety and doing no harm, the ASRM approaches the recommendation of various procedures with conservative consideration. That's a good thing, especially here in the Wild West of Reproductive Medicine where just about anything goes, depending on the specialist.

In the press call, the doctors sounded about as old fogey as a doc can get. Still with the line “We can't say it's good for everyone just yet...” The opinion of the group's Practice Committee says even though the largest randomly controlled trial “comparing fresh vs. vitrified donor oocytes in 600 recipients revealed excellent clinical pregnancy rates, no different than in fresh cycles,” – the “data is reassuring” – they want more widespread clinic-specific data on safety and efficacy before universal egg banking can be recommended. 

Sigh.

Their big hangup on not offering egg-freezing to young women as a kind of fertility insurance is based, they say, on balancing (a) the inherent dangers of any kind of medical procedure, and (b) the fact that only a small percentage of young women will actually be infertile and need those frozen eggs later.

But when it comes to all things fertility, women have been taking huge risks – financially, physically, and emotionally – of all kinds for eons. Why? Because there is nothing that any woman can do that has more impact on her entire life than getting pregnant. (Now there's an opinion that I could get hammered on, but I'll stand firm.) So we (women) already do crazy things, like take daily pills that haven't truly stood the test of time and rigorous scientific investigation just to avoid pregnancy, or hitch our wagons to myriad wrong men because our ovaries are commanding us to procreate. The list of wacky pregnancy-related behavior – as women can attest – goes on and on. Trust us: We know how big a deal it is to get pregnant. 

So in my opinion (here we go again), worrying about a young woman's ability to make an informed choice about her reproductive capacity and future is, well, patriarchal and archaic.

I, too, think that the fertility industry has had a hand in steering perfectly fertile people into costly treatment. But some members of the same industry have been trying their damnedest to bring home the message that early detection equals early treatment equals greater take-home baby success. The ASRM got hit hard years ago by some women's groups when their public service program dared tell us that one of the keys to fertility was to stop putting off having babies so far into our future that our eggs were useless.

Unfortunately, except for at the church my son attends (where children are offered comprehensive sexuality and relationship classes that start in Kindergarten and are taught by parents), I have yet to see the American culture pick up the ball on the details of conception education, since most people are sadly mired in the fearful mindset that If You Teach It, They Will Do It.

There was a time when the idea of women having complete control over their reproductive ability was blasphemy. Later on, it wasn't so much heretical as it was just unbelievable. After all, what would women do if they weren't having and raising babies? (As I write this, I keep having visions of big, white men patting little pig-tailed girls on their wide-eyed heads.)

As far as I'm concerned, the unleashing of egg freezing as an option, now declared NOT experimental and actually quite successful, could very well be similar in terms of societal bend as was the birth control pill. Do I envision a Gattaca-like world in the future? No. But then could any of our ancestors imagine our world today?

There's a time for concern and worry and protecting the ignorant. Then there's a time to let go and have a little faith – in nature, in deities, in common sense, in whatever gets you through the night.

I say let 'er rip.

Crazy Rant Idea Time: How would infertility patients teach reproductive health?

Here's a crazy idea: What if all kids, boys and girls, were required to learn about reproductive health?

If your ears automatically translated “reproductive health” to “sex,” then I suggest you fall in line with the class, too.

Everyone knows that “SEX EDUCATION” is a hot topic of public and political debate. I'm not talking about teaching kids about sex. They get plenty of that now from the media. I'm suggesting we step up whatever they call it nowadays in some places – hygiene? Health class? – so that girls learn about more than menstruation and boys learn about more than... whatever it is they learn about in those classes (nocturnal emissions?) And that those classes need to be more than a one-shot attempt at vaccinating our children against unplanned pregnancy.

Okay, Junior High happened for me well before the Internet, I'll give you that. But from my work in infertility, it seems to me that either reproductive health classes aren't happening at all or classes that are supposed to be covering that topic are failing woefully. If young women are seeing the same shtick that I did in the 1970's, then they're getting an eye-full of how to handle your period with the right name-brand products plus a fleeting mention of how the menstrual cycle is related to getting pregnant. That's not reproductive health education, folks.

Most cases of female infertility (and some of the male-factor cases, too) that are seen in specialists' clinics today started off as preventable conditions. And just like every other thing in this fix-it-now society of ours, the focus has been so intensely on getting those folks pregnant after the fact, that most attempts at prevention education have been half-hearted at best.

Hold up, you're saying – this is old news. True, and there are already a lot of existing organizations and services with the goal of “reproductive health”, but you and I both know that most of that is focused on contraception. Nothing wrong with that. It's good, even. But zeroing in on contraception is either short-sighted or not connecting the dots to the bigger picture. I know that big NGOs and smaller agencies have their hands full with the relateds – HIV & other STD prevention, the legal and social rights related to gender, sexuality, and healthcare, and contraception, contraception, contraception. But take a look at this little post on the International Planned Parenthood Federation website and you might get an idea of how education about fertility (or infertility) gets lost in the shuffle.

So what, you say – isn't it more important to prevent pregnancy than to promote it, overall? No way could I address that directly without a firestorm ensuing. But I will add this to that: The Fertility Industry is a several-billion dollar industry of elective medicine. (I know that “elective” sounds caustic to some fertility patients' ears, but let's be honest here – you won't die or even be physically debilitated if your infertility is left untreated.) That a handful of physicians and their staff and all the people swirling around their energy are able to make a very good living off of helping people get pregnant is not wrong, in and of itself. What is wrong is our seeming disinterest in taking the cart and putting it behind the horse again. It's not just a bass-ackward waste of energy to put all of our focus on how well the cart wheels turn; the horse that's supposed to pull it is not only behind the cart, it's practically starving to death.

In short, people reach reproductive age without a clue as to how their own bodies work, let alone how those bodies function when they are sexually active with a partner. The result is not just unplanned pregnancy. The result is plainly growing numbers of inability to achieve pregnancy even when it is very thoroughly planned. And both are preventable with comprehensive reproductive health education.

So, you ask: what the heck made your coffee bitter this morning? It might seem unrelated, but you know me... all roads seem to lead to this industry. Here's what set me off today: a report issued by the CDC that reveals one percent of pregnant women binge drink, i.e. have 4 or more drinks on one occasion.

Um. Infertility... pregnant women drinking... um...

Okay, here's my mind today: I saw the report and immediately raced to “Other than maybe someone with alcoholism, seems to me I cannot imagine a single woman I've ever known who went through infertility later binge drinking during her kid's gestation period.”

From there, it was just a quick step to “What we should try is having infertility patients – current and past – teaching young people about reproductive health! That might add some emphasis to self-care before and during pregnancy!”

And that's how a rant is born. But you have to admit, I have a point.

 

From the Isn't There A Magic Pill Dept: There's More to Happy Kids Than Dinner

This could also be subtitled "Duh"... So raise your hand if you were even the least little bit excited back when all those studies about the positive impact of The Family Dinner Table were being bandied about.

"Awesome!" you thought, "All I have to do is make my kids sit down to eat dinner a lot, and we are GOOD to go! None of that sturm und drang adolescent crap for my family!"

Okay, now raise your hand if, when you heard all those talking heads on TV and Twitter and Facebook telling you with an expensive grin that Kids Who Eat Dinner At The Table With Family Turn Out Better, you thought, "wut?"

Looks like you, that tiny little group out there whose hands I can barely see, won!

A study by Cornell's Kelly Musick and U of Minnesota's Ann Meier being published in June's Journal of Marriage and Family Therapy says that while, yeah, there are some good things about eating dinner with your kids at the table regularly, the associations between all the study variables don't quite add up to the happy-happy-dinner-table-as-therapy-prophylaxis as the media spewed.

Here's a link to the paper (the link may stop working once the publication comes out...) If you're not keen on reading research analyses, you can head straight for the "Discussion" section near the bottom. Some snippets:

"What, then, does our study say about the “magic” (Gibbs, 2006) of the family meal?  We end on a cautionary note to parents and policy makers eager to find ways to improve family  functioning and the fortunes of children... Family dinners may be part and parcel of a broader package of practices, routines, and rituals that reflect parenting beliefs and priorities.  Interventions aimed at increasing the frequency of family meals may be successful only if they can change the family habits that tend to go along with eating as a family."

As Musick is quoted in the pre-pub press release, "... it’s unclear how well family dinners would work unbundled from the rest of that [broader] package [of practices, routines, and rituals...]"

SO, you're saying that if some other parts of our relational lives at home aren't optimal, that simply eating together won't fix everybody?? Damn.

Just a few more Magic Pills to flush down the toilet.

Oh, but do keep feeding your kids. (But if your tendency is to slap them upside the head now and then in between fork-fulls, y'all feel free to eat in separate rooms again.)

One Big Happy Circle. Don't Ignore Infertility. But Remember Other Stuff More.

This is National Infertility Awareness Week®. It's an annual thing, and this year's theme by RESOLVE (the folks who trademarked the name), is "Don't Ignore Infertility." Some of my friends and other folks don't know that writing about fertility & reproductive medicine has been 90% of my livelihood for 15 years. Now you know.

Here's my requisite nod to NIAW. It features a woman whom I admire and respect a lot. And it alludes to my perspective that people experiencing infertility have a lot more to ponder than just how to get pregnant. 

And the awesome photo, featuring Jason Songhurst (aka The Roomie) and a big thunderboomer cloud, was taken a year ago off a highway that runs down the middle of a west Texas oil field. Proof that you just never know how things from yesterday and today and "tomorrow" will connect in this thing we call life.

And THAT is my NIAW message.