The fertility blame game


I realise I am writing this the day after International Women's Day which, to me, adds poignancy to the subject in hand because what I want to write about is a wider women's issue.  This has been a long-brewing blog, brought to a head when reading 'No, Millenial Women are Not Failing at Fertility' in the Huffington Post this morning.  It's not supposed to be a rant (although it may come across like one!) but a contemplation on the situation of hundreds of women who come through our clinic.

When I attend fertility conferences or read fertility-related articles it strikes me, over and over, how often women are blamed for the status of sub-fertility or infertility in couples.  When the (usually, but not exclusively male) consultant stands up and says "Women are choosing to leave it later to start trying to conceive", I really want to shout out and question their use of the word 'choice'.  Because, having worked with couples over the last 18 years for fertility-related issues, I know that most women in their late 30's and early 40's would have far rather have chosen to try to conceive earlier if a) they'd had a willing partner and 2) they had financial and employer support to do so.

Blaming women for making the 'wrong' choice is neither useful nor beneficial.  First of all, women shouldn't have to make a choice at all, between fulfilling employment and child-care.  The excellent author, Caitlin Moran, has a simple measuring tool for assessing life/style choices (wearing make-up, high shoes, worrying about our weight, being 'nice' etc etc) and that is, ask yourself, "are men doing it?". The answer is usually "no". Certainly no one is standing up at fertility conferences and saying "men are leaving it too late to settle down and have children".  The onus, as always, falls on the women's shoulders.   

But this isn't an 'anti-man' article and it's not just consultants and statisticians who are doing the blaming.  I am very aware, because I see it all the time, that women find it easier to take responsibility for low fertility or infertility on themselves, even when the cause is decisively Male Factor.  Fertility is a male and female issue equally but women assume the burden of blame readily and often without questioning. 

Currently I have a female patient whose male partner is opting not to complete a semen analysis.  This is not uncommon.  He is not being 'blamed' for his choice.  Instead, she is finding all sorts of ways to make it easier for him: choosing with great care the time to bring up the subject. She is taking on the responsibility for their fertility problems.  Would a frank calling out of the subject with her partner help more?  I don't know.  She has endometriosis so is seeing it as 'her' problem and yet a semen analysis is still vital to the cause and if he wants children, which he says he does, then surely one small pain-free test (though admittedly one fraught with potential for embarrassment) isn't too big an ordeal?

There is so much that could be done to change this culture of blame, starting with improved fertility education. It is incredible  how little people know about falling fertility rates associated with age and believe that IVF will solve all issues.  We regularly see couples in their 40's expecting conception to occur easily and quickly, disappointed when nothing has happened after 3 months.  Maybe if both and men and women had a more realistic idea about the fragility of human fertility we would be in a better position to make earlier decisions and encounter fewer problems. 

Instead of blaming women for 'choosing' their jobs over childbearing, governments could be supporting women to have children earlier.  Because, let's face it, it is an either or. The difficulties of trying to work and look after more than one child quickly becomes obvious and it's usually (but not always, I know) the woman who jacks in her job.

Instead of making women & couples more dependent on medical intervention later in life, let's put funds into affordable child-care and legislate so that women aren't penalised economically for being the ones who do the child-bearing and most of the subsequent child care (most men in the UK still don't use their allotted paternity leave allowance).  

But most of all, let's stop the use of blame as a shaming tool.  Women are up against it where fertility is concerned.  Our bodies are built to conceive and carry a pregnancy much earlier than society allows.  'Early' pregnancies are frowned upon and life is hard enough as a working mother, let alone as an older working mother.  Whether it's your GP, your partner, your consultant or friends who imply that it's a woman's fault when things don't go to plan, fertility is a human issue, not just a woman's issue and we need to start calling this out. 

So next time I'm at a conference and a fertility consultant glibly apportions blame to women and, specifically, older women, I am going to speak up instead of sitting in the audience fuming to myself but staying silent.  Women have incredible bodies and strong minds, we are resilient and resourceful, let's not let that be taken away from us.