I get that in the West we are generally conceiving at a later stage in life than before, and that this does not improve odds of conception. However, with fertility, just as with so many things, we are individualising the problem. Here too the focus is on age. Just get kids when you're younger! What's the big deal.
Let's set aside that there are deeper sociological reasons on why young people start with kids later in life. We are not giving enough weight to all of the pollutants that we are exposed to in society, and how they affect our bodies, health and lives.
I heard Dr. Shanna Swan talk recently about the effects of hormone disrupting chemicals on (male) infertility. It's dire stuff really.
She was on the podcast promoting a recent Netflix documentary called The Plastic Detox in which they intervene in couple's lifestyles to reduce the amount of plastics and the hormone disrupting chemicals (bisphenols, phthalates, etc) they are exposed to. I highly recommend it.
There's over 70 different hormones in the human body regulating all kinds of biological functions. Fertility is only one aspect but think about the adverse effects these chemicals might be having on body weight, our sleep cycle, blood pressure, stress, libido, etc. We are prescribed drugs for related ailments at record rates. Maybe we should take a step back and treat less and prevent more.
You’re correct. All this talk about when people choose to have kids over-intellectualizes that what is a biological function. My wife and I have three kids. I’m not sure you can say any of them resulted from a rigorous analysis. We had our first in law school as a happy surprise. We theoretically planned our second and third, a six year gap after the first. But that the timing coincided with moving from an apartment to a house. We weren’t thinking about more kids when we moved—we wanted to take advantage of good interest rates. But my wife observed later that the availability of more space for kids probably subconsciously influenced our decision to have more.
When talking about hormone disruption, I think people over-focus on how that affects the ability to have kids. But that overlooks how hormones can change behaviors and desires. I don’t see anyone rebutting the fact that testosterone levels in prime-age men have dropped by half compared to the 1960s. Yet nobody seems to be talking about that as a probable cause in the drop in fertility rates. Even if these men are technically able to have kids if they want. Is it possible that the drop in testosterone levels means that men are less interested in having kids, and perhaps less able to persuade women into doing so?
"Less able to persuade women into doing so" is crazy. IMO the single biggest factor preventing kids right now in the US and other developed countries is the effects of COVID on the global economy along with the most significant period of global economic uncertainty in at least the 21st century. The amount of energy put into fertility is a waste, and by just enabling everyone to afford children the population problem could be solved. I'm also very afraid that all of these "fertility" companies are on a warpath to designer babies and I fear that could absolutely destroy trust and mutual respect in our society globally.
I'm not convinced the economic argument is correct. Anecdotally, two is by far the most common number of kids among other parents I know. They're all pretty well off so I don't think that's the reason. It's definitely not COVID as their kids are some years too old for that. Nor do I think it's age or infertility, as they had plenty of time and there's no wistful talk about wishing they could have another one. As far as I can tell, they stopped at 2 because they wanted to.
Many of my friends have gone through IVF and still I was surprised by some weird parts of the story.
For example: "I was stabbed with 932 needles" and when you tap you find out "because I wanted to improve my odds, I went to 31 acupuncture appointments, where 687 needles pierced my underbelly, legs and head".
It is clearly established that acupuncture is placebo, but beyond whether this placebo might actually improve the odds (highly disputed), it is an elective alternative procedure with unclear benefit, not part of a standard IVF journey.
I understand the story is a very personal one, but it would be good to remember it isn't necessarily representative of most people's experience.
The total number might be a little out there due to her non-medical treatments, but the general sentiment is accurate for IVF. My wife filled up an entire sharps box with the injections she needed to take and that was with success on the first try of the first round (which is very rare).
As someone who is a bit squeamish around needles, I don't know if I could have done what she did.
> that was with success on the first try of the first round (which is very rare).
This very much depends on the patient history (age, cause of infertility, …) and the clinic. Live births per intended retrieval can vary from 10%-60% conditional on the above.
In our case, it was suggested that the first transfer of the first cycle had a 15% chance of success. Whether that's "very rare" is perhaps a matter of perspective. It was low enough we assumed it would be a failure and we were surprised when it succeeded, but to a doctor it's a frequent occurrence.
Actually acupuncture has some studied physiological effects. One is nervous system mediated via the release of endorphins and then a later regulatory rebound which can have an anti inflammatory effect. I think low dose naltrexone has a somewhat similar method of action. I might have the details a bit off but the studies definitely exist if you want to research it. There are even some compounds in coffee (some of the bitter compounds not the caffeine) that have a very mild effect that works in a similar way.
Personally I’m not a fan of acupuncture and I suspect any nervous system benefits from acupuncture would be far outweighed from those of regular exercise. But maybe for people with chronic pain or other issues it could be useful.
Maybe countries could tackle such problems twofold:
- first, implement a nationwide social freezing program, where women in their 20s are offered to freeze their eggs at a young age for free. Such a large-scale program would probably also improve the tech and might make egg collection less intrusive.
- combined with this program, let the women who freeze their eggs opt-in into an egg donation program, where some of their eggs can be used by women with fertility problems
But as with many things fertility, seems that modern states simply do not have the capacity to seriously try anything. Who knows why that is.
They might also look to Israel to see what they're doing that's working so much better than other OECD countries - see my other comment in this post.
But Israel's advantage seems to be partly cultural and I don't see any time-limited elected government willing to expend that much effort to change their nation's culture.
I am a husband in an infertile pair which even needs surrogacy, so it is a horrendous journey. We've had 6 unsuccessful transfers so far - on average less than 1 a year (we have been trying since 2019), mostly on behalf of the surrogate mothers deciding to skedaddle randomly during the process. Although Covid didn't help either.
My wife regularly observes that this hell of a journey looks more taxing on me than her. Which is probably true.
This process is hard on the fathers-to-be as well. We do exist, we want to have kids, we are heartbroken each time as well. We also have to be careful not to hurt our wives' feelings when expressing our grief and sorrow.
Amen! As so often in western society, men have no value at best, and are horrible monsters at worst. No one cares about the male part in these situations, which is a shame. But carry on, I will pray that you will succeed!
The cure for this is spending an afternoon volunteering in a kindergarden.
> There were the 7 a.m. doctor’s appointments before work; the dozens of days working from home in order to take all my medications; and the many times I reshuffled my travel plans.
Yes I mean just wait until you have kids. It's gonna get tougher.
This is a very well-done piece in a good cause, but it would have been nice for the author to acknowledge the very obvious inspiration from Monument Valley - https://www.monumentvalleygame.com/mv1 - particularly given they're asking for tips.
Sounds like it might have been added later but it's in the credits now
>The idea for parallel paths and the illustration style developed independently, but the team did take inspiration for the isometric world and user experience mechanics from the game Monument Valley once made aware. If you enjoyed this format, give Monument Valley a play through the Apple or Android app stores.
Super cool site design, I'll have to go back and look at all the other stories.
I didn't realize IVF was such a brutal process. 932 needles sounds like insanity, not to mention everything else. I'll carry a lot more compassion for those going through IVF going forward, and a lot more excitement for those able to concieve naturally.
On a related note, this is becoming a more common issue worldwide. Almost every country, even developing ones, are experiencing below replenishment birthrates. Only a few countries are spared in Central Africa, though not sure how long that will last.
Really beautiful and as others said really heartbreaking how hard it’s been for her.
One thing I’ve thought a lot about as I’ve gone through a similar experience is that a generation ago infertility still happened a lot and was a thing many couples just had to accept. I am wishing all the best for the author
pudding.cool articles are very neat, but the ergonomics of this particular article is really bad. It's been a long day, my wrists and fingers are tired, and i cant be bothered to fight to scroll down.
Beautiful but heart breaking website. I genuinely hope the author will be successful in starting a family.
My partner and I are currently going through a surrogacy process, and it's been a brutal multi year project that has had numerous setbacks. At this point we are just white knuckling our way forward.
I'm glad we as a society have these options available for those that need them, but man is it hard going through these processes.
This is a beautifully designed website. But I also think it's quite... problematic that the child's journey begins with the egg, as if the unfertilized egg is the child — and skips any mention of the sperm and the father.
It feels like this site is almost erasing the father from the IVF process.
Another good look at what IVF is really like, albeit with a really dark tinge that is not likely true in the vast majority of cases, is The Retrievals[0]. I recommend the podcast version.
What I find most incredible about it is the number of women who experienced immensely painful procedures while conscious multiple times, and went back again and again, in order to have a child. And few of them, if any, regret it.
It is simultaneously one of the most impressive feats of modern science, and one of the most unfair burdens put on any section of the populace, that they were able to, and had to.
There's many reasons why this piece wasn't made for me, so I don't want to begrudge anyone, but I wonder how much we can do to alieve this as a society by normalizing childlessness. I never wanted to have kids, but if I did, I doubt I would've been willing to endure what the author did for it. You can (and honestly I think most people should) live a long and fulfilling life without having kids. Myself and so many of my peers were raised in households that really were not good places for children. I'm of course grateful to exist and indebted to my mother for her countless sacrifices, but it pains me to think about how much happier she might have been if she didn't feel compelled to become a mother. I hope someday having children becomes the exception rather than the norm, because it doesn't feel like something that should be taken lightly. I hope that finding out you're infertile can be met with "Oh, okay. I guess I'll do something else then," the same way that folks with imperfect vision can't be pilots or astronauts and those with tremors can't be surgeons. I'm glad IVF is available for people who want to pursue it, I just want to live in a world where no one has kids "by default" without truly accepting the toll it will take.
I've commented on this before, I do agree with some of the other sentiments that we are individualizing the problem. It's up-to each person (or couple) to navigate it themselves. For example, in Canada, the federal government announced a tax credit (up to 25%) for spending related to fertility treatments. For my partner and I, it took a professional accountant (with related costs) to navigate that system.
IVF and IUI (and now, IVM) treatment cycles are largely handled by private clinics that receive funding from provincial governments and, by extension, federal. Even with first-class health insurance, from employers, and government grants (paid to the doctors) there are out-of-pocket costs (ex., vitamins, supplements, missed work time, medications, genetic testing, sperm washing...). In our case, after multiple years, our health insurance coverage has dried-up (~30,000 CAD) and our lifetime grant eligibility for IVF (one treatment cycle) has finished. We could have easily exhausted our financial resources, (ex., investments, pensions, re-mortgage, lines-of-credit...), but with less chance to conceive daily, it's a race of diminishing biology. The opportunity to conceive a healthy child has been erased by time.
This added to the emotional and social costs of not being able to have a child. In my field, I find colleagues to be judgmental of working adults without children. As if having a child of your own gives you this magical insight into working with children that childless adults do not posses. I've started answered the question: "Do you have kids?" by saying, "Not by my own choice." This hopefully communicates that I've tried, but at a certain point a decision had to be made about whether to continue.
My spouse has taken all of the physical toll of the treatments. The male's job is to provide a sample, see their doctor, and sign the paperwork. By contrast, my wife has had early morning or lunchtime appointments (in an effort to not miss work) 3-4 times per week during certain monitoring or pre-proceedure periods. She has been subjected to blood testing, hormone therapy, daily injections, invasive ultrasounds, bruising, repeated pharmacy trips. All this in addition to phone-calls to remind staff at our clinic what the doctor recommended or asking the clinic reception for confirmation of a certain prescription or guideline. Of course, she undertook all of these responsibilities while internalizing the trauma of our familial reality.
My partner is strong, resilient, and beautiful. I owe her more grace and more appreciation than I can ever give.
My daily reminder to myself is to remember that my partner are I are already a family. Our commitment to one another has not changed. Although our lives may look differently then we may have imagined, it will not be any less meaningful.
66 comments
Let's set aside that there are deeper sociological reasons on why young people start with kids later in life. We are not giving enough weight to all of the pollutants that we are exposed to in society, and how they affect our bodies, health and lives.
I heard Dr. Shanna Swan talk recently about the effects of hormone disrupting chemicals on (male) infertility. It's dire stuff really.
She was on the podcast promoting a recent Netflix documentary called The Plastic Detox in which they intervene in couple's lifestyles to reduce the amount of plastics and the hormone disrupting chemicals (bisphenols, phthalates, etc) they are exposed to. I highly recommend it.
There's over 70 different hormones in the human body regulating all kinds of biological functions. Fertility is only one aspect but think about the adverse effects these chemicals might be having on body weight, our sleep cycle, blood pressure, stress, libido, etc. We are prescribed drugs for related ailments at record rates. Maybe we should take a step back and treat less and prevent more.
When talking about hormone disruption, I think people over-focus on how that affects the ability to have kids. But that overlooks how hormones can change behaviors and desires. I don’t see anyone rebutting the fact that testosterone levels in prime-age men have dropped by half compared to the 1960s. Yet nobody seems to be talking about that as a probable cause in the drop in fertility rates. Even if these men are technically able to have kids if they want. Is it possible that the drop in testosterone levels means that men are less interested in having kids, and perhaps less able to persuade women into doing so?
Many of my friends have gone through IVF and still I was surprised by some weird parts of the story.
For example: "I was stabbed with 932 needles" and when you tap you find out "because I wanted to improve my odds, I went to 31 acupuncture appointments, where 687 needles pierced my underbelly, legs and head".
It is clearly established that acupuncture is placebo, but beyond whether this placebo might actually improve the odds (highly disputed), it is an elective alternative procedure with unclear benefit, not part of a standard IVF journey.
I understand the story is a very personal one, but it would be good to remember it isn't necessarily representative of most people's experience.
As someone who is a bit squeamish around needles, I don't know if I could have done what she did.
> that was with success on the first try of the first round (which is very rare).
This very much depends on the patient history (age, cause of infertility, …) and the clinic. Live births per intended retrieval can vary from 10%-60% conditional on the above.
Personally I’m not a fan of acupuncture and I suspect any nervous system benefits from acupuncture would be far outweighed from those of regular exercise. But maybe for people with chronic pain or other issues it could be useful.
- first, implement a nationwide social freezing program, where women in their 20s are offered to freeze their eggs at a young age for free. Such a large-scale program would probably also improve the tech and might make egg collection less intrusive.
- combined with this program, let the women who freeze their eggs opt-in into an egg donation program, where some of their eggs can be used by women with fertility problems
But as with many things fertility, seems that modern states simply do not have the capacity to seriously try anything. Who knows why that is.
But Israel's advantage seems to be partly cultural and I don't see any time-limited elected government willing to expend that much effort to change their nation's culture.
Now you're suggesting every young and healthy woman should get these injections and have eggs scraped out of her ovaries?
This honestly feels so backwards. Create a broken society and then fix it in post with med tech.
My wife regularly observes that this hell of a journey looks more taxing on me than her. Which is probably true.
This process is hard on the fathers-to-be as well. We do exist, we want to have kids, we are heartbroken each time as well. We also have to be careful not to hurt our wives' feelings when expressing our grief and sorrow.
> There were the 7 a.m. doctor’s appointments before work; the dozens of days working from home in order to take all my medications; and the many times I reshuffled my travel plans.
Yes I mean just wait until you have kids. It's gonna get tougher.
>The idea for parallel paths and the illustration style developed independently, but the team did take inspiration for the isometric world and user experience mechanics from the game Monument Valley once made aware. If you enjoyed this format, give Monument Valley a play through the Apple or Android app stores.
I didn't realize IVF was such a brutal process. 932 needles sounds like insanity, not to mention everything else. I'll carry a lot more compassion for those going through IVF going forward, and a lot more excitement for those able to concieve naturally.
https://www.imf.org/en/publications/fandd/issues/series/anal...
https://www.ssa.gov/policy/docs/ssb/v66n4/v66n4p37.html
https://www.newsweek.com/americas-population-time-bomb-18987...
IVF is also no longer something that's only for older women. Younger couples from both sexes are starting to need it.
https://tulipivf.com/news/detail/397
https://thehill.com/opinion/healthcare/4727738-people-need-i...
My partner and I are currently going through a surrogacy process, and it's been a brutal multi year project that has had numerous setbacks. At this point we are just white knuckling our way forward.
I'm glad we as a society have these options available for those that need them, but man is it hard going through these processes.
It feels like this site is almost erasing the father from the IVF process.
Dont have any kids. They reduce your freedom. I need to emphasize this.
To be fair, once I stopped having freedom, we went hard obviously.
If you already have 1, might as well go wild.
What I find most incredible about it is the number of women who experienced immensely painful procedures while conscious multiple times, and went back again and again, in order to have a child. And few of them, if any, regret it.
It is simultaneously one of the most impressive feats of modern science, and one of the most unfair burdens put on any section of the populace, that they were able to, and had to.
[0] https://www.nytimes.com/column/the-retrievals
IVF and IUI (and now, IVM) treatment cycles are largely handled by private clinics that receive funding from provincial governments and, by extension, federal. Even with first-class health insurance, from employers, and government grants (paid to the doctors) there are out-of-pocket costs (ex., vitamins, supplements, missed work time, medications, genetic testing, sperm washing...). In our case, after multiple years, our health insurance coverage has dried-up (~30,000 CAD) and our lifetime grant eligibility for IVF (one treatment cycle) has finished. We could have easily exhausted our financial resources, (ex., investments, pensions, re-mortgage, lines-of-credit...), but with less chance to conceive daily, it's a race of diminishing biology. The opportunity to conceive a healthy child has been erased by time.
This added to the emotional and social costs of not being able to have a child. In my field, I find colleagues to be judgmental of working adults without children. As if having a child of your own gives you this magical insight into working with children that childless adults do not posses. I've started answered the question: "Do you have kids?" by saying, "Not by my own choice." This hopefully communicates that I've tried, but at a certain point a decision had to be made about whether to continue.
My spouse has taken all of the physical toll of the treatments. The male's job is to provide a sample, see their doctor, and sign the paperwork. By contrast, my wife has had early morning or lunchtime appointments (in an effort to not miss work) 3-4 times per week during certain monitoring or pre-proceedure periods. She has been subjected to blood testing, hormone therapy, daily injections, invasive ultrasounds, bruising, repeated pharmacy trips. All this in addition to phone-calls to remind staff at our clinic what the doctor recommended or asking the clinic reception for confirmation of a certain prescription or guideline. Of course, she undertook all of these responsibilities while internalizing the trauma of our familial reality.
My partner is strong, resilient, and beautiful. I owe her more grace and more appreciation than I can ever give.
My daily reminder to myself is to remember that my partner are I are already a family. Our commitment to one another has not changed. Although our lives may look differently then we may have imagined, it will not be any less meaningful.