#YouAreNotAlone

Fertility Week 2019: #FertilityAtWork

image courtesy IVF@work

image courtesy IVF@work

This week is UK Fertility Week and today the theme is #FertilityAtWork

I've written about this at length in previous blog posts, which you can check out here:

Nov 18: Fertility At Work

Feb 19: Fertility In The Workplace

Everything I wrote in those posts is (sadly) still just as valid several months on, so please do check them out for more detailed info and insight into the impact of fertility issues in the workplace.

This year I wanted to highlight some new research findings and initiatives that show how this issue is more salient than ever.

Support needs to come at an organisational level

We can only get the support we need from employers if we actually let them know that we're going through fertility issues in the first place.

But if (worst case) we worry that we'll be discriminated against and (best case) that they won't know how to support us - how likely are we to say anything?

New research from LinkedIn found that almost two thirds of workers wouldn’t discuss fertility issues with their employers - but a similar number would be more likely to have a conversation with their employer about fertility if they had training/guidance on how to deal with the conversation.

This fantastic infographic from Dr Uracha Chatrakul Na Ayudhya at Middlesex University highlights the scale of the problem.

 

Advocating for this change

HR professionals are starting to acknowledge that offering fertility support to employees would make them more competitive in attracting and retaining talent, and that happier employees would be more productive employees.

Which is great. More awareness is good.

But we need more than conversation. We need action.

Much of the coverage in the media about fertility benefits has been around coverage for fertility treatment provided by global corporations. But there's so much more that every company can do - from the small business right up to the multinational.

Claire Ingle is an HR professional and fertility patient who's written about why IVF should be higher on HR's agenda and is speaking out as an activist for change. She is speaking to organisations about the support networks/polices and procedures they have in place (and the most common response is that they simply 'don't') and advocating for change - do check out her IVF@work blog and follow her on Twitter and Instagram

Middlesex University is at the forefront of getting this issue on the agenda, which they described in a recent workshop on 'Contemporary reproduction, work and working life' as 'a neglected but growing form of workplace diversity".

image courtesy IVF@work

image courtesy IVF@work

Middlesex have collaborated with Fertility Network UK since 2016, leading to the launch of Fertility Network UK's Fertility In the Workplace initiative - offering employers training sessions and policy consultations to help them develop and implement their own fertility policies, as outlined in their Workplace Webinar

The More to Life Webinar Series covers a vast range of issues and subjects for those dealing being childlessnot by choice. We have selected a fantastic group of experts to host this series bringing you information, support and inspiration to help you as you journey through a life unexpected.

Channel 4 recently hit the headlines for their (brilliant) recently launched menopause policy for employees - I hope by this time next year we can see stories about employers launching formal fertility policies in the headlines too...

Surviving Mother's Day

Anyone who’s experienced fertility problems will be only too aware of the many grief landmines scattered throughout the year.

There’s the sporadic ones — such as christenings, baby showers, family get togethers. Then there’s the seasonal ones — such as Christmas, or even back to school day or world book day (when social media becomes wall-to-wall proud parents sharing photos of their gorgeous children). Then there’s the big one. The whopper. THE DAY.

I’m talking, of course, about Mother’s Day.

Image by Maria Andrew

A day you so desperately want to be able to celebrate, but fear you never will.

A day that reminds you that you’re excluded from the parents’ club, pressed up against the window peering in from the outside, longing to join in.

A day that reminds you of what you’re missing out on — if that cycle had worked, or you hadn’t miscarried, you’d have a something-year-old child by now, and Mother’s Day would be a day of celebration, not mourning

A day that can be a double whammy for some people — if, like me, you’ve lost your mother, it can feel like the cruellest day of the year, with grief seemingly coming at you from all angles.

3 years ago I was pregnant when Mother’s Day rolled around, and I remember hoping with every fibre of my being that the following year I’d be a card-carrying member of the mummy club.

Sadly, that wasn’t to be — as we found out the following day that our baby had died. I’m still waiting for that membership card to arrive.

#SurvivingMothersDay

It’s really, really shit.

There’s no magic solution for how utterly, horribly shitty it feels.

But for what it’s worth, here’s a few tips that I hope may help to navigate this shittiest of shitty days.

 

Feel all the feels

It’s OK to feel angry. It’s OK to feel jealous of others. It’s OK to feel sorry for yourself. You are not a bad person if you feel like this. You’re human. It’s hard enough already without beating yourself up as well.


Do whatever you need to do

Do whatever you need to do to get through the day. Be kind to yourself.

Indulge in some radical self care.
 
Treat yourself to something self-indulgent. Get a massage, go for a really boozy lunch (preferably somewhere likely to be child free), go away for the weekend.

Or if you want to hide away, and sit in your tracksuit bottoms on the sofa with chocolate and Netflix, that’s totally OK too.


Arm the defences

Short of not leaving the house (tempting), it’s impossible to avoid seeing & hearing about Mother’s Day seemingly every -bloody-where But there are a few tactics that can help to turn down the volume:


Digital detox
Social media. Just don’t go there. Nothing good will come of going on social media on The Day.

Reading joyful #feelingblessed posts of seemingly idyllic Mother’s Day homemade cards & breakfast in bed will not help

Reading posts from mums recounting how they’ve had a crap Mother’s Day & feel unappreciated will not help.

Just switch off & unplug until the coast is clear.


Emails
When it comes to the flurry of Mother’s Day emails (from mailing lists that despite endless GDPR emails you somehow still seem to be subscribed to) promoting gift ideas & discounts, some brands have recognised that this can be a really difficult time of year for many, and given subscribers the chance to opt out of any Mothers Day specific communications

Big shout out to brands like Bloom & Wild and Superdrug

 

(And check out #notomothersdaypr for a great initiative from Berenice @ Walk In Our Shoes to encourage more brands to do the same!)

In the mean time, setting up an email filter to send any message with the word ‘Mother’s Day’ in the subject to Spam can be highly effective!

#YouAreNotAlone

I wish I had words of comfort, but all I can say is to remember that you are not alone — and this too shall pass. If nothing else, once it’s over, you don’t have to worry about it for another 12 months…

Metro: Why treatment for male infertility is failing both men and women

Men matter too

My second article for Metro’s Fertility Month series examines how treatment for male infertility is failing both men and women

Men are massively overlooked in the fertility experience more generally: but the inadequate care for male infertility - inadequate diagnosis, meaning inadequate treatment - is also harming women, as ICSI treatment bypasses the male problem to treat the issue in the woman’s body.

Normally I rail against articles which focus on the miracle baby success stories, but in this instance these examples - real examples, from real couples - were pretty critical for the overall argument (spoiler alert: that if treatable problems were diagnosed and treated, this might increase the chances of success, or eliminate the need for invasive ICSI altogether.) These stories are used to demonstrate tangible examples where proper care has made a tangible difference to the outcome. Which I hope will spark discussion and debate!

It’s an issue that’s woefully ignored in both public discourse and within the fertility industry itself - so I hope that this article will help to encourage more open conversations about this issue.

“Male infertility is a growing problem on a global scale — so when are clinicians going to start taking it more seriously?”
 

Have your say

I’m writing a book that challenges the fantasy infertility narrative of endless positivity and happy endings, by sharing real women’s (and men’s) stories about what it’s really like to struggle with infertility and pregnancy loss. My goal is to represent as many different perspectives as possible — including the male perspective.

If as a couple you’ve experienced infertility or pregnancy loss (regardless of which partner has received the infertility diagnosis, if any)— whether your journey is current or past, whether successful or not — I’d be honoured if you’d consider sharing your story anonymously.

There are questionnaires for both the female and male perspective — and I’d particularly love to hear more from the guys!

#FertilityFellas: a brief history of male infertility

spermracing-10-ways-to-increase-male-fertility-by-healthista.com_-1.jpg

This week is UK Fertility Week — and today’s theme is #FertilityFellas.

Fertility is not solely a female issue — men are half the fertility equation too, but are often ignored. To understand a bit more about how we got to this point, I thought it would be interesting to take a trip down memory lane, and have a look at some highlights in the history of male factor infertility.

Let’s jump back a few hundred years…

Don’t be silly, of course men don’t have fertility issues — it’s the woman who’s barren

barren woman.jpg

Fertility and virility have historically been central to masculinity —so to be impotent or infertile was to be a failure as a man. So it’s not surprising that in years gone by, any inability to conceive was blamed on the woman — as long as the man wasn’t impotent, he was assumed to be fertile.

Daniel Sennert summed this up in his 1664 page-turner Practical Physick; The Fourth Book:

Hence we may gather, that Barrenness is oftner from a fault in the women then the men: for in men there is nothing required but fruitful Seed spent into a fruitful womb.


Jolly good — so as long as he got his rocks off, job done. If babies didn’t immediately spring forth it was definitely his barren wife’s fault.

Unsurprisingly, blokes were pretty happy with this theory, so it becomes a bit of a recurrent theme…

No doubt for James McMath in his 1694 banger The Expert Mid-wife: A Treatise of the Diseases of Women with Child:

‘the vile Imputation of Barrenness, rests almost, solely upon them [i.e. women]’

Or William Salmon in his 1686 blockbuster Systema Medicinale, A Compleat System of Physick, Theoretical and Practical :

‘Here we shall only examine Barrenness, so far as it concerns a Woman alone.’


One of my favourite examples of the ‘nope, definitely not the man, it’s absolutely, definitely the woman who’s got the problem’ assumption is US President George Washington. He and his wife Martha were happily married but “mystified why, year after year, he and Martha could produce no Washington heir”. Obviously as the leader of a great nation, there couldn’t possibly be any question of his virility, so the issue evidently had to lie with Martha.

Except that Martha was a widow, and had given birth to 4 children with her late husband before she married George.

So, er, yeah, the woman with 4 kids is definitely the infertile one…

Alright, maybe the male partner might be worth checking out, just to be sure

male-inf.jpg

Whilst the barren women assumption dominated, the notion that the problem might lie with the male partner wasn’t totally inconceivable (no pun intended).

In his study of barrenness in The Hidden Treasures of the Art of Physick (1659) surgeon John Tanner stated that there might be merit in considering male infertility

Before you try these uncertain conclusions upon the Woman, examine the man, and see if the fault be not in him.


The 1668 edition of Lazarus Riverius’s Practice of Physick went further by acknowledging that failure to consider the possibility of male factor could inflict unnecessary treatments on the female partner:

‘diligently consider and inquire, whether Conception and Generation be not hindered by fault of the Man, or any deficiency in him. For in such a Case, It were vainly done to torment the Woman with a multitude of Medicines.


The contribution of sperm quantity and quality to successful conception was recognised even in 1662:

‘the mans Seed, when it is not sufficient in quantity, or fit for Generation; and though a Woman receives it, either there is no Procreation, or its in vain’


And varicoceles had been identified as a possible root cause of male factor infertility as early as 1687

They who have their Testicles varicous are barren, because the Spirits of Generation pass to the Varices, and so leave the Seed unfruitful, being deprived of Spirits’


It’s clear that there was in fact a relatively sophisticated level of understanding of male factor infertility, even in the 17th century — but that there was little appetite to attribute any blame to the male.

OK, so how can we test for male factor?

If a man was willing to have his virility challenged, there were a couple of ways of investigating male infertility:


Male vs female fertility blame game

In 1545 one handy midwifery guide advised that both partners should pee into a pot that had been planted with barley, and whichever seed sprouted first demonstrated the fertility of the person who had watered it.

Or for a more rapid-turnaround test result: both parties would pee on a lettuce leaf, and the person whose urine evaporated from the leaf first was thought to be infertile.

Urine + horticulture — they both sound pretty bulletproof fertility tests, no?

Solo male testing (strap in for this one)

image by Matt Hoffman on Unsplash

image by Matt Hoffman on Unsplash

But wait, there’s even a fertility test for the blokes in their own right.

Instead of knocking one out in a clinic masturbatorium, yep, you’ve guessed it — it’s pee-in-a-pot time again.

But be prepared, it’s a doozy.

In his 1605 smash hit, The General Practise of Physicke, Christopher Wirtzung suggested this approach to determining a man’s fertility:

‘let him pisse in a pot, and let the urine stand awhile, if wormes grow therein, then is that urine barren’


WTF?!!

Leave your warm piss in a cup and see if any worms start growing? If worms grow in your piss then I think you’ve got more than subfertility going on to worry about!

And let’s face it, the likelihood of worms magically emerging seems somewhat slim (at least, you’d hope so). Therefore the man was guaranteed to pass with flying colours regardless.

Bonus male fertility top tip

image by Sam Truong Dan on Unsplash

image by Sam Truong Dan on Unsplash

Whilst reading up on the history of male infertility, I ended up down some pretty freaky rabbit holes, discovering certain stuff I can never un-see.

And now I’m going to share this delightful fertility sex tip with you too.

Jane Jackson’s recipe book included a fertility enhancing remedy that had to be applied to the male genitalia:

‘Take the braine of a crane and medle it with ganders grease and fox greaseand keepe it in a vessell of silver or of gould and at what time thou wold have knowledge annoynt therewith thy yard and shee shall conceave’.


Right, so kill a crane, mix up its brain with some goose and fox grease, smush it together and smear it on your cock, BOOM. Up the duff.

Suddenly those fertility lubes like Pre-Seed are looking remarkably appealing in comparison…

We’ve invented semen analysis! But nah, let’s not bother with it, it’s probably a waste of time

image by Ousa Chea on Unsplash

image by Ousa Chea on Unsplash

So in the 1860s, American gynaecologist James Marion Sims is investigating ‘sterile marriages’ and decides to have a quick look at a semen sample under the microscope. And, wait for it…..he can now see ACTUAL sperm with his own eyes! Voila, the semen analysis is born. Examination of sperm count, motility and morphology is now possible. No more peeing on lettuce leaves.

Zoom forward a few years: in 1945 the Family Planning Association (FPA) opens a dedicated seminological centre — Britain’s first purpose-built laboratory for investigating semen samples.

It was established in part specifically to help women, by sparing them from ‘unnecessary operative procedures’ — when it was the husband who was ‘partly or even wholly responsible’ for the couple’s infertility.

Awesome! Finally infertility is treated as a couple’s issue!

Er, not quite.

One medical journal reports the case of a couple who were struggling to conceive, and over the course of 2 years, the woman underwent:

  • 2 D&C operations

  • a tubal insufflation

  • a salpingogram

  • an endometrial biopsy

  • a host of tablets, injections and vaginal douches

Only after all this invasive treatment was unsuccessful did someone suggest that perhaps her husband’s fertility should be tested.

One simple semen analysis later & the verdict is in.

Not a single sperm was found in the sample. Not one.

Neither in any of the subsequent repeat tests.

Every single procedure the woman endured was thus totally pointless — all because male factor simply wasn’t a priority.

Let’s deliberately avoid diagnosing a male factor issue so we don’t hurt the man’s feelings

image by Sydney Sims on Unsplash

image by Sydney Sims on Unsplash

Although in theory the new concept of ‘infertile marriage’ gave equal weight to women and men, in practice few English doctors paid the same amount of attention to both partners.

Some men felt so threatened by the prospect of having to take a semen test, that they attempted suicide. Therefore one doctor argued that the risks of upsetting a sensitive man by asking him to undergo a semen test far outweighed those of unwarranted surgery on his wife.

Sometimes it was even the wife who objected to the test ‘either because she is afraid of the effect the knowledge of his infertility may have on their relationship, or because she believes that male infertility cannot be treated successfully and she prefers to live in hope rather than know the truth.’

How much progress have we actually made?

Male infertility is a really, really important issue — that simply doesn’t get enough recognition

It’s now the most common reason for couples in the UK to have IVF, according to the latest HFEA data.

And we really, really should be paying more attention.

Last year, an apocalyptic study by the Hebrew University of Jerusalem found that sperm counts in the West have more than halved over the past four decades, and are continuing to decline — but we don’t really understand why, or what to do about it.

Despite so many cutting edge advances in assisted reproductive technology, the way we approach male infertility isn’t really that dissimilar to 150 years ago.

Women are routinely undergoing IVF — even if there’s nothing wrong with their own fertility — because their infertile partners are being ignored by the medical profession.

Leading fertility expert Prof Sheena Lewis — chairwoman of the British Andrology Society — says the lack of focus on male infertility within the health system is an “urgent” problem:

Men are not being looked after properly, not diagnosed, and not cared for.

The woman actually acts as the therapy for the man’s problem. We are giving an invasive procedure to a person who doesn’t need it, in order to treat another person. That doesn’t happen in any other branch of medicine.


A couple with a male factor infertility diagnosis will be referred to a fertility clinic, where they will be treated by a gynaecologist. It’s the male partner who has the medical issue — but yet they’re sent to a specialist in women’s reproductive health.


Dr Jonathan Ramsay, a consultant urologist specialising in male fertility sees many couples who’ve undergone multiple rounds of failed IVF, where the underlying pathology was never identified and treated — rendering the treatment utterly futile.

Which sounds rather like the 1945 case mentioned above, where no one had bothered to look at the man’s sperm until 2 years of harrowing treatment down the line.

Dr Ramsay says:

What gynaecologists don’t do is look at the bloke and say, let’s do some old fashioned doctoring with you. Let’s do a few more tests. A physical examination could reveal a varicocele, for example: a varicose vein in the testicle that can overheat the sperm, yet be eliminated by a quick operation under local anaesthetic.

Or it could be that he’s obese and drinking too much. If that guy loses weight, stops drinking and just does sensible exercise, he may well get over the threshold where she gets pregnant. We need to treat the man and the sperm, ignoring half of the picture is just not sensible.


We saw above that varicoceles had been identified as a cause of male factor infertility in a medical text from 1687 — and yet in 2018 a couple may be referred for ICSI without anyone even bothering to examine the man to see if this might be a treatable issue?

How much unnecessary time, money and heartache might be saved if men were actually acknowledged as more than the sperm donor?

They deserve better. Their partners deserve better. We might have moved on from peeing on lettuce leaves in 2018, but in many ways we haven’t really moved on at all.

How you can help & have your say

Thanks so much for reading — all and any feedback is very gratefully received.

I’m currently trying to write a book that challenges the fantasy infertility narrative of endless positivity and happy endings, by sharing real women’s and men’s stories about what it’s really like to struggle with infertility and pregnancy loss. It’s a club that no-one wants to join: but knowing that you’re not alone can provide solace and support in the darkest times.


My goal is to represent as many different perspectives as possible — including the male perspective. If as a couple you’ve experienced infertility or pregnancy loss (regardless of which partner has received the infertility diagnosis, if any)— whether your journey is current or past, whether successful or not — I’d be honoured if you’d consider sharing your story anonymously. There are questionnaires for both the female and male perspective — and I’d love to hear more from the guys!