February 3, 2016 • 60 mins
Infertility affects million of women and men around the world, but cultural stigma has kept it in the shadows. Cristen and Caroline talk about the causes of male and female infertility, its psychological impact and why it's often a biological battle waged in silence.
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Speaker 1 (00:03):
Welcome to Stuff Mom Never Told You from how self
works dot Com. Hello, and welcome to the podcast. I'm
Caroline and I'm Kristin. And last time on the podcast,
we talked with Dr Jessica Zucker about miscarriage, which is,
(00:23):
as we established, definitely a taboo topic in our society.
It's really difficult for people to talk about, to acknowledge,
to even reach out and seek help. And in our
conversation about infertility today, it's sort of a continuation of
that theme. Infertility is not uncommon, or struggles with fertility
in general are not uncommon, but as we'll talk about
(00:48):
in this episode and as we saw in our research,
what's so heartbreaking about it is the fact that no
matter who you are, no matter what your background is,
no matter what part of the world you live in
or what time him that you lived, women have experienced
so much shame, both internally and from other people over
(01:09):
the issue of infertility. Yeah, I mean, in all of
these conversations that we've had, not only about a miscarriage
and then today about infertility, but also other times we've
talked about pregnancy and just women's bodies in general, there's
(01:29):
always this theme of the limitations of what we can
and do and feel comfortable talking about UM. So this
is one where it is something that affects so many
of us, but we don't hear about it nearly as
much as we should. And when we do hear about it,
(01:51):
it tends to be from the perspective of a woman's
problem or it's the woman's fault. That's historically what how
this issue has been framed. And as we'll talk about,
this is not a woman's problem. This is this is
everyone's problem. If you are a person who wants to
have children, you very well might be affected by infertility. So,
(02:13):
just to cover the basics of what um infertility is,
it's medically defined as a difficulty conceiving a pregnancy after
a year of unprotected sex. But because as we've talked
about in the podcast before, obviously our fertility declines with age,
So for women over thirty five, doctors recommend checking in
(02:36):
if they've been unsuccessful getting pregnant after six months of trying.
That's right because for perspective, most fertile couples, according to researchers,
do conceive within six cycles when they're using timed intercourse.
Doesn't that sound so sexy and romantic six cycles. Use
your timed intercourse in your in your cycles. They're talking
(02:57):
about menstrual cycles, not yeah, not mons cycles, although I
mean there you go. Still tychnically the same. Yeah, you
could time up by the moon if you wanted, you know,
full moon. Don't come a knocking or no please do
yes well yes, um. And of course related under this
umbrella of infertility is impaired fecundity, which encompasses non surgical sterility,
(03:18):
which is an impossibility to conceive, subfecundity, which is uh,
conception is difficult but not impossible and quote long interval
without conception. So there's a lot of different types of
fertility struggles wrapped up in our conversation today. And basically
this happens. Infertility is said to happen when there's a
(03:41):
breakdown somewhere in the conception process. It could be one place,
that could be multiple places, but you know, brief run
through refresher biology course for you. The conception process starts
with ovulation fertilization. Then the fertilized egg takes a little
swan dive through the fallopian tube towards the uterus and
(04:02):
then has to implant itself successfully in the uterus well,
and because it wasn't until the mid twentieth century that
we really started to understand all of the steps in
this process, humans just made up all sorts of reasons
why infertility would occur, which has only ingrained a lot
(04:24):
of the stigma um that we're going to talk about
that is still very much alive and well today. UM.
But here's the thing. In addition to all of those
steps where things could possibly go awry, just getting pregnant
in and of itself, despite what um absence only sex
education might lead you to believe, getting pregnant is it's
(04:48):
hard to do. I mean, if you think about it,
you have this window in our menstrual cycle during which
conception is even possible. I eat ovulation, and the probability
of inception is only each month. Now, going back to
sex education, if you are listening to this and you're
sexually active, Uh, this is not Christen and Caroline endorsing
(05:10):
you to just go have unprotected sex um. But I
think it's just worth understanding the challenges that can naturally
occur with getting pregnant. Yeah, because it's estimated that ten
of normally fertile couples don't manage to conceive within the
first year, so it's it's not uncommon to struggle with
(05:33):
these issues. And so let's dive into some sex based
stats and facts, and that's biological sex, not literally getting
it on. So, like we said earlier, culturally we tend
to just sort of frame this as the fault of
the woman or the woman's problem. But depending on what
statistics you're looking at, about a third of the time
(05:53):
it's the man's fertility issues causing problems with conception, about
another third of the time it is something going on
in the woman's body. But the remaining third, give or take,
it's either both partners or an unknown cause. So if
we look just at men's fertility um for instance, just
to get a better grasp on that, the two thousand
two National Survey of Family Growth found that seven point
(06:16):
five percent of all sexually experienced men under forty five
I saw a fertility doctor at some point, and within
that group, eighteen percent or diagnosed with a fertility problem.
But that doesn't necessarily account for all of the dudes
who have had fertility issues. That's just people who have
sought out treatment for it. Yeah, and male fertility specific
(06:38):
problems include abnormal sperm production, function, and delivery, and this
can be caused by problems like undescended testicles, genetic disorders
like cystic fibrosis, health issues like diabetes, and also retrograde ejaculation,
which is when semen doesn't go out, it goes into
the bladder instead. I had never heard of that before
me neither, but I create when I read it because
(07:00):
I don't know if it's painful, but it sounds like
it's uncomfortable. So things that can contribute to male fertility
problem that that actually actually right, we should actually actually contribute, uh,
include overexposure to heat. Now I had heard this stuff
like anecdotally about laptops, like I had seen some studies
in the past couple of years about like men, don't
leave your mama's don't let your babies grow up to
(07:23):
put their laptops on their laps because it can affect
your fertility. No, and and this is not funny, but
it's it's true. Uh, Like things like hot tubs and
saunas can affect fertility. And a condition uh that also
affects fertility is when you basically have vericose veins in
your testies. Having those enlarged veins makes your testies warmer
(07:46):
and heat degrades the quality and quantity of sperm. And
also you've got to worry about exposure to overexposure, i
should say, to chemicals like pesticides, radiation, and steroids. So
if we look at what contributes to email fertility, we
have to think again about all of those steps along
the way from ovulation all the way to implantation. So
(08:08):
if we go back to ovulation, you might have disorders
that prevent the ovaries from releasing eggs to begin with,
or something called primary ovarian insufficiency, which is when your
ovaries begin to fail before the age of forty. And
then of course there are hormonal disorders like polycystic ovarian syndrome,
which is the most common cause of female infertility. And
(08:31):
we've talked about PICOS before on the podcast. There's a
stuff I'm Never told you video breaking down how PICOS
works if you're not familiar with it, and um in
a in a very small nutshell, what that leads to
is your body creating a surplus of androgen hormones, which
leads to irregular ovulation. Yeah, and you've also got hormone
(08:53):
issues like your body producing too much testosterone again a
male hormone or prolactin, which we've talked about on the
podcast before, which is actually a hormon that helps you breastfeed.
And of course problems with your thyroid gland, which is
part of your handy dandy endocrine system, and we've talked
about that before on the podcast too. Other major factors
include uterine or cervical abnormalities. You might have issues with
(09:14):
the shape, the opening, or the mucus happening there in
UH fibroids, that's a major issue because it can block
fallopian tubes and distort the uterine cavity, and we've done
a stuff Whenever Told You podcast all about fibroids. If
you're not up on those, that's true. And UH women
also might struggle with pelvic adhesions, which is scar tissue
(09:35):
that binds organs together after surgery. UM Indometriosis is also
a huge factor, as is inflammation of the fallopian tubes.
And to once more promote past stuff on Ever Told
You podcast, you should definitely listen to the one on
endometriosis or watch our video about it because it affects
so many women, and it takes an average of at
(09:57):
least going to five different doctors to get at the
correct diagnosis, and it's a major contributor to infertility as well. Um.
But then they're also other medical issues that can lead
to infertility like celiac, Cushing's disease, sickle cell anemia, diabetes,
and also STDs like gonorrhea or chlamydia, which if left
(10:20):
untreated can cause big trouble in your reproductive tract and
possibly lead to pelvic inflammatory disease. Yeah, oh boy, definitely
definitely practice safe sex. It's just and then that just
means it's one less thing to worry about for so
many reasons. Please please practice safe sex. Um. But a
(10:42):
couple of risk factors regardless of sex include cancer and
its subsequent treatment, radiation and chemotherapy. Age. We mentioned age earlier.
Women's fertility, for instance, starts declining in their thirties, men
in their forties, and this is sort of a growing
issue for people looking to have children because about twenty
percent of women in the United States specifically are having
(11:03):
their first children after age thirty five. So that just
means that age is a growing contributing factor to in
fertility and Among those couples where the woman is over
thirty five, a third report having fertility problems, and then
of course tobacco and alcohol use don't help matters. UM.
(11:24):
Being overweight can lead to fertility issues and can also
affect men's sperm count by the same token. Being underweight
also isn't great for fertility as well, UM, and can
lead to a co occurring issue of a minorrhea, which
can also be sparked by over exercise or excess stress. Yeah.
(11:45):
Stress is always such a culpritive so many things. Yeah,
and we'll touch on the issue of stress here again
in a little bit, because there is also that I
don't know if it's a stereotype or the assumption that
stress makes you unfertile. And it's not quite that black
and white. So how common is this well, um, very common,
(12:05):
to put it in layman's terms. UM. It's important to
remember though that rates are going to differ depending on
factors like the age group of the people included, the
number of people in the surveys and studies. UM. But worldwide,
around two to ten of couples just don't have any
children UM, and ten to cent struggle with what's called
(12:29):
secondary infertility, and that's when you have your first kid,
everything's fine, but then you have a really hard time
getting pregnant the second time around. Yeah, So there was
this huge global meta study in that found that there's
nearly fifty million couples worldwide who were unable to have
(12:49):
a child after five years of trying. They found that
nearly two percent of women forty four years old who
wanted to have kids were unable to have their child.
That's primary infertility, and about ten and a half percent
of women experienced secondary infertility, which is what Kristen just mentioned.
But the thing is they also pointed out that those
(13:10):
rates were similar to what they had been twenty years earlier,
so we're not seeing a ton of advancement in terms
of in terms of sort of stemming that infertility tide basically.
And it is kind of counterintuitive when you look at
those age breakdowns, because for women between twenty and twenty
(13:32):
four years old, primary infertility rates are higher compared to
older women, but that pattern is reversed for secondary infertility,
where if you are younger and you have had that
first successful childbirth, then it's not as hard to get
pregnant a second time. As it is if you are
(13:53):
older and you have a successful first childbirth and then
try to get pregnant a second time. Yeah, And if
we look globally, primary infertility is actually higher in North
Africa and the Middle East when compared to a region
like Latin America or the Caribbean. And secondary infertility in
Sub Saharan Africa specifically affects more than thirty percent of
(14:15):
women between the ages of five and forty nine. And
if we zero in just on the US, six percent
of married women between ages of fifteen and forty four
are infertile. But if you look at all women trying
to get pregnant, regardless of relationship status, twelve percent of
that age group struggles within fertility issues. And I appreciated
(14:37):
that source for making that distinction between or even examining
the distinction between married women and women in any relationship
status trying to get pregnant, because so much of this
data is obviously very heteronormative. UM and you could also
say like sis sexist as well. I don't think that
(14:58):
we saw any studies on like AND's fertility issues at all.
UM and also a lot operating under the assumption that
all women want to get pregnant, and especially if women
are married. UM. So I think it's those kinds of
contexts are are good to keep in mind as well
(15:19):
to go through this. Sure, and it's not just women
in relationships who want to have children. I mean there
are women who are not in relationships who, for instance,
might be seeking a sperm donor and want to get
pregnant that way and then have struggles with it. So
it I think it is important to kind of break
out of the mindset of like, Okay, we're only going
to research people who are in relationships because well, what
(15:43):
is I mean, that's not the full picture? Then I
would think, yeah, and also only research people who are
in straight relationships too, there's not you don't see a
lot of variation within like the sexual orientation of UM
people in these studies as well. So just a little
background demograph, background on the available data that we're working with, right,
(16:03):
and as we move into talking about treatment, I mean,
I think it's worth mentioning how health in general, but
also access to healthcare and socioeconomics are such a huge factor. UM.
There was a study way back when I was five
years old in h that found that the only group
(16:24):
to suffer a rise in infertility rates since the nineteen
sixties was women under twenty four and that was thanks
to a spike in STDs. That goes back to what
we mentioned about chlamydian gnarrhea, that those conditions are nothing
to laugh at or sniff at. You need to practice
safe sex and then successfully treat these conditions in order
(16:44):
to keep your fertility from suffering. Yeah. I remember when
that study came out and reading about it um in
the New York Times, as I did every day as
a four year old. Baby Kristen Yes, yes, a little
baby glasses well Fisher Price glasses, Yes, yes, baby cup
of coffee, and you were just like, this is this
is such a shame. This is such a shame. Kids
(17:05):
these days need to practice say sex exactly. You took
the words right out of my mouth, right out of
your toddler mouth, just like candy stealing candy from baby Kristen. Um.
And of course, doctors know that overall poor health can
contribute to infertility problems. And this is a huge deal
when you think about and I mean again, I'm speaking
as an American, but this is a huge deal when
you talk about people who don't have access to doctors
(17:28):
or healthcare or insurance. And yes, we have the Affordable
Care Act, but I personally know plenty of people who
still don't have health insurance and therefore still do not
have access to a regular doctor. And then it comes
back to to the cost of fertility treatments, which are
insanely prohibitive. They're definitely not accessible to everyone because they
(17:49):
can run you more than ten grand. Yeah, I mean,
that reminds me of one of the stories that we
were reading about infertility treatments and this couple that had
saved up ever since they got married for their future
children's college fund and had put all this money away,
and they ended up spending all of that money just
(18:13):
trying to get pregnant because those fertility treatments are so expensive,
not to mention all of the travel involved if you
live somewhere that might not have um this kind of
treatments available. So, speaking of which, in two thousand nine,
the World Health Organization classified infertility as a disease, and
(18:33):
part of the motivation for that was paving the way
for more insurers to cover treatments. Because, as of are
the most recent data we found at least only fifteen
states require insurance coverage for fertility treatments, so a lot
of this is like out of pocket costs, right, Yeah,
that which is I mean, that's huge. It's a huge
(18:55):
cost um And treatments can involve assisted reproductive technology gene
this is any treatment in which the egg and sperm
are handled, and of course IVF in vitro fertilization falls
under that. It's the most common type of assisted reproductive technology,
and it involves retrieving multiple eggs, fertilizing them in the lab,
and implanting the embryos in the uterus. And there was
(19:18):
just an article that I just shot over to Kristen
last night that there's apparently a trial starting in the
UK for a controversial IVF technique to allow women thirty
and older And I'm like, oh god, I'm I'm a
thirty and older um to get their eggs quote unquote rejuvenated.
And basically this involves taking mitochondria from immature cells and
(19:42):
sticking them into mature cells to be used egg cells,
that is, to be used for IVF. And this matters
because aging mitochondria, which is like the cell's little powerhouses,
contribute to IVF failure. So if the succeeds, it could potentially,
you know, maybe stave off the repeated costs of going
(20:03):
back over and over again to try IVF. And it
seems like the primary controversy with this is that it's
very unclear at this point that it could even be successful. Yeah,
they're not sure that it could could work. UM. Now,
if we look at treatment for women specifically, there of
course our fertility drugs to stimulate ovulation UM. There's intra
(20:24):
uterine insemination where healthy sperm is placed directly into the uterus,
and there's also surgery to correct uterine problems. And for men,
their treatments for various infections that might affect the reproductive
system as well as sexual dysfunction. You can also undergo
hormone treatments and surgery to correct and obstructed vast deference.
(20:45):
I used to be on a trivia team called Uptown
John and the vast deference UM or that condition that
we talked about earlier, where the enlarged veins and the
testes make them too hot, and of course also the
procedure in the process of hating sperm for that assisted
reproductive technology. But according to research from the CDC, A
(21:07):
majority of infertility treatments fail. Fifty seven percent of IVF
cycles using women's own eggs failed, whereas procedures using donor
eggs do better. They had only a thirty seven percent
fail rate. And not surprisingly, this has psychological side effects
as well. There was a Harvard study that we were
(21:29):
looking at, um finding how women who have difficulty getting
pregnant can be as depressed as those who have major
heart problems or cancer. Yeah, I mean it makes sense, Like,
think of your friends, who all they or maybe it's you.
You know, all you've wanted your whole life is to
have kids. You know. I'm I'm not on that wave length,
but I know many people who um. You know. For instance,
(21:54):
I had a coworker years ago who had pekos and
before she was in gauge, before she was married, she
was with the man she knew she wanted to be
with forever. She's like, let's just start trying because I
might never get pregnant. And I know that, you know,
watching friends struggle with that idea of like, I want
nothing more to than to be a parent, uh, and
(22:15):
to have that be a difficult process. Of course, I
can totally see how it would lead to massive depression
and stress, and it's that stress that can affect weather
and how long people stick it out for for treatment.
Harvard Medical School researchers found that thirty cent of patients
(22:37):
under forty with insurance for at least three IVF cycles
dropped out after only one or two. They also found
that sixty eight percent of patients over forty gave up
before exhausting their insurance coverage for the procedure. And they
write about how this whole thing, it just swallows your
life up. I mean, you become a slave to your
(22:59):
monthly side if you're tracking your ovulation and your periods,
and it's they talk about that that extreme disappointment, like
disappointments to week of a word, when you get your
period the next month, because you've put so much time, energy,
and potentially money into this process. But of course a
(23:20):
doctor is saying, just relax isn't going to help matters.
Those same Harvard researchers did find that lowering anxiety was
linked with improved pregnancy rates, and that patients with psychological
support do feel less distress about treatment and are quicker
to try other options like donor eggs, sperm, or adoption
(23:40):
and this is a big reason why it's important for
us to talk about this even more because, uh, a
lot of times, if you are experiencing infertility, you don't
want to tell anyone about it, and the downside of
that is that you don't have a support system in
that case, which research you know finds can can be really,
(24:01):
really really helpful. Yeah, and we should say again and
emphasize that depression and stress do not cause infertility, but
researchers have found that they are associated that people who
managed to alleviate their anxiety, stress, and depression they put
all of that under the term of distress um have
(24:24):
had in studies more success finally getting pregnant. But the
thing is, as much as we know about the biological
factors that do and don't contribute to male and female infertility,
there are still so many myths surrounding it and so
much moralizing and stigma that go back millennia and and
(24:51):
essentially have been you know, shaming infertility ever since. Yeah,
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You should. And now back to the show, So I
feel like a stuff mom ever told you episode would
almost be remissed if it didn't at some point go
(26:00):
to ancient Egypt. Yeah, we're not laughing, but it's true.
It's true. Um So, Egyptians had a goddess of infertility who,
horrifyingly enough, was also the goddess of funerals and afterlife rituals.
So right off the bat, nothing but the worst connotations
(26:21):
around women who struggle with fertility issues. And they even
had this weird test They would force feed a beer
covered woman dates and if she vomited, she was fertile,
which this of course makes me think of the Last
Crusade where Sala catches the date in his hand and
says bad dates. Sweet I got in today's Indiana Jones
(26:41):
reference Indiana Jones and Monty Python. You're on a roll, girl,
I really am. And we should say too that this
timeline is coming from two sources Bustle, a great in
depth article over at Bustle, and also a timeline from
American radio works. And they also looked at ancient India,
for instance, who thought that perhaps women were possessed by
the goddess of poverty and corruption if she couldn't have
(27:04):
children man um Things didn't get much sunnier over in
China because if a woman was infertile, and I'm assuming
the husband had means, you could just use a concubine instead.
That's fine, Yeah, I just bringing a pinch hitter. Yeah.
And in Rome, just divorce your wife over it. Here,
(27:24):
we'll let you out of this contract pretty easily. But
it's in ancient Greece where we start to see the origins,
maybe not overwhelmingly, but the origins of infertility being thought
of as like a medical condition and not necessarily a
moral failing all the time. Overall, though, the responsibility for
fertility did still lie with the woman and all Hippocrates
(27:47):
had lots of ideas about what led to infertility. Um.
He attributed to things like wait, a tightly closed cervix
or menstrual retention, which Hippocrates come on. So this whole
idea and this idea of measure retention would stick around
for quite some time. Um. They thought that your period
blood would just hang out inside of you. It wouldn't
(28:11):
come out, it would just hang out and prevent you
from being able to have babies slashing around, Yeah, slashing around.
But I mean you could try praying to Asclepius, who's
the god of medicine. There were also all of these
different types of probes, like literally getting things just stuck
(28:31):
up inside of you, trying to like open up that
that reluctant cervix. Uh. And there were also sorts of
weird like herbal cocktails that you could try. I bet
there are still so many herbal cocktails out there for
infertility as well. Um. And in the medieval times, not surprisingly,
things took an even darker turn with the publication of
the Malleus Malfaicarum, which we've talked about before is translated
(28:55):
to the Hammer of the Witches, and this text, as
you might assume from the book's title, blamed infertility on
witches and or the devil, but they also thought that
it could be an indication that you yourself are a witch.
To the witch, there's no winning, there's no winning, Like,
why should a woman who struggles with having children be
(29:17):
considered evil? I it blows my mind, because that's your function, Caroline,
that's true. Well. Other culprits during this time included a
wandering womb, which christ and I. We have that video,
Christian where you and I were looking for crazy, wandering
hysterical uteruses by the train tracks. That's right, and I
ended up finding yours. She gave it to me for christmasing. Yeah,
(29:39):
and if you don't know what we're talking about, listeners,
why are you following us on Instagram? Um? You also
could have a soft womb, which means that it's too
soft and wet to be able to snag that sperm.
It's not vel crowe enough and giveaway. If a woman
had a soft womb, was that she cried all the time.
(30:00):
I hear soft womb, I think of a soft boiled egg.
Come on, I eat boiled eggs for breakfast. Um, sorry
not sorry? Yeah, okay, you you also might They thought
suffered from a suffocated uterus, which was an idea similar
to hippocrates idea of menstrual retention. And in terms though
(30:21):
of this moralizing aspect um, this is going farther back.
But if we look at Christianity and the whole doctrine
of female piety and the Bible and the Old Testament,
there's a story of Hannah who was barren, and she
begged God for a child, and finally, because she was
(30:43):
such a pious woman, God rewarded her with six more children.
And this foster's this whole idea that women without kids
need to work extra hard to prove their piety, and
that infertility is punishment for your sins and is reflected
(31:04):
on women's morality. It probably could be traced back to
two Eave's curse and on and on. Yeah, And much
like the Greeks were like just pray to Asclepius, the
Christians urged women to try praying it away or fasting
it away. And yet it then evolved into a view
of infertile women as promiscuous, masculine and bossy. Yeah, because
(31:31):
I mean, what how more unpious can you be than
if you are both masculine and sleeping around and boss
saying doing it um. And so during a renaissance, we've
got this growing medical and popular acceptance of the idea
that it could also be men's fault. There was this
(31:51):
concern you guys about cold, thin, watery or feeble sperm.
There was a concern over whether you had a short penus,
and also what you were eating. This didn't prevent, though,
Catherine de Medici from being blamed when she and her husband,
King Henry the Second could not have kids, despite the
fact that he apparently had a malformed penis. Catherine was
(32:14):
still blamed. So good for popular culture during this time
where we're finally being like, I wonder if men could
be to blame ever for this, But it did yet
didn't help her. Yeah, I mean, there was still the
belief that it would it would have to be blamed
on the woman's body shape, her cervical shape, womb temperatures,
and that infertility could then lead to mental disturbances. So
(32:39):
we're still living in the whole mentality of the hysterical
uterus and all of the lady brain problems that that
can cause. But finally in the seventeenth century, we start
to learn a little bit about how this works. We
see sperm under a microscope for the first time, and
so this leads to more examination of male fertility, and
(33:01):
by the mid seventeen hundreds, we understood fertilization better and
infertility was slightly less moralized. But now there is just
an idea that your menstruation was unbalanced in some way.
So treatments include stimulating sexual pleasure, which was thought to
be helpful to conception. Yeah, I thought for sure. I
(33:22):
was like, I must have read that wrong, because so
much of what we read and talk about for the
podcast goes back to like, sexual pleasure is super wrong.
Women should never experience sexual pleasure. But it's interesting that
it comes in in terms of fertility, like, well, maybe
it can't work unless somebody's having a good time. You
gotta balance that menstruation somehow. Yeah, I know, I hate
(33:43):
when my menstruation is unbalanced. But by the eighteen hundreds
we see more surgical advancements and the further development of
the idea that infertility is a mechanical problem caused by
cervical disorders or a male position of the uter is.
But you still have ideas about quote unquote luxurious living
(34:05):
and women's misbehavior persisting, and that includes heavy mental activity
that could potentially damage your other organs. Yeah, Basically there
is a longstanding idea that if a woman thinks too much,
then she renders herself infertile because I mean, I guess
her brain heats up our wounds and then that just
(34:26):
ruins everything. Basically, it puts our uterus is in a microwave.
And now I'm picturing like an Industrial Revolution era factory
where like wheels and gears and cogs are just like
working over time, and there's all this steam and like
suddenly the machine just craps out, and that machine is
you womb, if you womb. But in six we do
(34:49):
get a New York doctor who's the first to argue
that husbands GNA rhea infections could be probably potentially maybe
likely causing their wives to be sterile. Yeah, because I
mean with the Industrial Revolution, speaking of which, an urbanization,
you have more men visiting prostitutes and the rise of
STDs with that. But of course probably the blame for
(35:13):
that ultimately would go back to the women and not
inevitably not the men who were paying for their services. Um.
But in the early twentieth century, there are lots of
discoveries around hormones. There's a test developed for blocked fallopian tubes,
and guidelines published for analyzing sperm count for male fertility.
So we're starting to figure some things out in a
(35:35):
real way. And in famed Dr John Rock reports the
first US fertilization of human eggs in a lab dish.
This is in vitro fertilization. And at the same time
the public is demanding fertility treatments. They're like, listen, we
want babies, and we want babies now, and you're gonna
fix this. Isn't it ironic? Then that Dr John Rock
(35:56):
would then go on to be so instrumental in developing
the very first oral contraceptive for women. Oh my god,
the more you know, go back and to stuff Mo'm
never told you dot Com and listen to the episode
The Father of birth Control, Love it Um. And in
the late twentieth century, we see the first in vitro
babies being born in the UK. In the US, we
(36:17):
see sperm injected into the egg for the first time,
the first successful pregnancy from a frozen egg. I believe
that was at a fertility place here in Atlanta and
rising at the same time, though, you've got parallel dialogues
around the desire to wait to have kids because you know,
maybe you're pursuing an education or a career, the desire
(36:38):
to be child free. So you know, more than ever
during this time, women are starting to be like, hey,
maybe I don't want to have kids. But you start
to see almost in response to that, but certainly developing
at the same time, more and more media driven anxieties
about that decision to put off kids and the fact
that you might wind up unable to have them. And Okay,
(37:00):
so I meant to go back and read some of
the media coverage that came out when the first in
betro baby I believe her name was Louise brown Um
was born in the UK to offer some more background
to the media anxiety about not having kids, because if
(37:21):
I remember correctly what I've read about that, there was
a lot of controversy about the so called in betro
babies and people saying back at the time that oh,
we're just now playing god and this is you know,
technology gone awry, and so it seems like regardless of
what's what angle we're looking at reproduction, it's like, no,
(37:43):
this is helping someone have a child that they want
to have. But then if we want to delay having
a child that we may or may not want to
have them, that's not okay either. And this just leads
us into this conversation around the infort to these stigma
and how a lot of times it does seem like
(38:03):
a total catch twenty two where they're, like you said, Caroline,
there's there's kind of no winning. Also because there's this
longstanding misconception that it's it tends to be an issue
with the woman's body, whereas is we noted at the
top of the podcast, it's like a third of the
time it's happening with the penis that there, at the
time it's with the vagina, and the other third of
(38:24):
the time who knows what it is. Yeah, and we
wanted to definitely look globally. We definitely wanted to look
outside of the United States for this conversation because, like
I said at the top of the podcast, no matter
where we are, no matter who you are, shame around
infertility exists. Despite the fact that Christen said that the
fertility issues between men and women are pretty much equal,
(38:47):
and so we were reading these articles. One was from
the World Health Organization, and one was from Newsweek that
focused specifically on stigma in developing countries. However, that being said,
I think despite the fact that these articles focused on
developing countries, these issues can be extrapolated to apply to
women all over the world because women might face everything
(39:09):
from ostracism being considered inauspicious at weddings. Um in some
Muslim regions, women can only go out if they have
children with them, or a or a chaperone of some kind.
But forget running erin solo, ranging all the way to
abandonment and even abuse. And then there's the whole idea
that you are a failure in society because of course
(39:32):
this is the role of women. You know, you have
to have kids. And this was something that Rhea Sambuya,
who's the founder of the Joyce Fertility Support Center in Uganda,
was talking about and she said, quote, our culture demands
that for a woman to be socially acceptable, she should
have at least one biological child. Almost all cultures across
(39:53):
Africa put emphasis on women having children. Marriage without children
is considered a failure of the two individuals. Yeah, and
talking about this, William Ambolet, who works with Gank Institute
for Fertility Technology in Belgium, said that if you're infertile
in some cultures, you're less than a dog. In the
(40:13):
Hindu religion, as one example, when a woman without a child,
particularly a son, can't go to heaven, she needs a
son to perform burial ritual rituals, and similar attitudes persist
in China and Vietnam, where some believe childless folks souls
can't rest for eternity. And in China, again, children are
seen as gifts from God, so people who are childless
(40:37):
can be viewed as unworthy or as sinners, which makes
it even harder to seek treatment, even if you can
afford it, even if you have the money to go
seek treatment, just that stigma of needing help prevents people
from doing so. And then there's a whole angle of well,
if you're infertile, you are a socio economic burden. And
this was something uh that World Health Organization Productive Health
(41:00):
and Research Department head Dr Cheryl Vanderpoolt was talking about, saying,
how uh, you know, if you don't have kids who
can then grow up to take care of you and
also have kids who can do household chores and also
contribute to local economies. Then you're just gonna be a
drain not only on your community, but also to your
(41:21):
wider family, who becomes deeply disappointed for the loss of
what she calls continuity of the family, as well as
again the contribution to the community. So this only intensifies
feelings of guilt and shame. Yeah, and the the idea
that your failure in your marriage. I mean, the World
Health Organization article quoted a Ugandan woman who said, women
(41:43):
like me often have to bear the extra marital relationships
that our husbands tend to have. I have overheard other
women talking about us as being cursed. There's an idea,
especially in polygamous cultures, that it's completely acceptable for a
man to either divorce his wife or take another your
wife if that culture permits polygamy, simply in the effort
to have biological children. There was one example talking about
(42:07):
a particular ethnic group in Mozambique, where it's common for
women to commit adultery in an attempt to get pregnant
rather than face exclusion from traditional ceremonies and social activities.
But if you are living in a society where it
is acceptable for the husband to leave you and father
children with other women. In the case of infertility, then
(42:30):
he's going to be likely unlikely excuse me, to support
your efforts to seek fertility treatments, or probably support you
at all. And with all of this potential extramarital sex
having going on, this can also lead to STDs. I mean,
if you look at the developing nation in general, there
(42:51):
are of course issues regardless of fertility with untreated STDs,
if you have condom taboos, um, and just the cost
of condoms and contraceptives being too high, and also infections
from female genital mutilation. Yeah, and similarly, uh, there are
many women across the developing world who face infections and
(43:12):
complications from either births or abortions in unsanitary hospitals. And
you know, we mentioned earlier that sperm count and quality
can be affected by overexposure to certain chemicals. You've got
to worry about toxins like lead, which is high in
places like Mexico City and Cairo, or the chemical dioxin
which is sprayed on crops. But if you get to
(43:32):
the point to where you know that you could benefit
from treatment, there are still cultural hurdles that you would
have to cross because of course, some cultures consider masturbation evil,
but of course if you need sperm for an IVF treatment,
masturbation is required. Um. In some Muslim cultures, as the
(43:53):
w h O pointed out, um there against egg and
sperm donation because children must have what they call known parents.
That biological relationship is important, it's necessary, and there's even
hurdles to getting help. This is what's talked about in
a couple of the articles we read where Westerners, for instance,
(44:14):
have little sympathy for countries or cultures that they view
very in a very self centered way as being overpopulated. Anyway,
this is something that Dr Mammud Fatala talked about in
the WHO article. He said, if couples are urged to
postpone or widely spaced pregnancies, it's imperative that they should
be helped to achieve pregnancy when they do decide in
(44:35):
the more limited time that they have available. And basically
this goes back to what um one O B g
I N in South Africa described as a fertility paradox
where you have both high fertility rates and high infertility rates,
and those fertility rates really depend on again the use
and desire to use family planning services, what your preferences
(44:58):
are for family size. For instance, East Africa has a
much higher rate of family planning and contraception use, whereas
West Africans still tend to prefer the larger families. But
then those high infertility rates come from everything we've been
talking about, the health issues, the untreated STDs, and when
you talk to infertility treatment proponents who are over into
(45:21):
these developing countries, they note that, hey, guys, IVF does
not contribute to overpopulation anymore than saving lives with vaccination does,
and both alleviate suffering. So why would we not try
to help establish whether clinics in general or fertility treatment
specialists specifically. But the thing is, you know, we've just
(45:44):
been talking for the past few minutes about these situations
happening in areas where you might not be able to
access clean drinking water, much less an IVF treatment. But
that suffering and this psychological um, guilt, shame, and also
social stigma and taboo around this is almost universal because
(46:07):
if we look back in the US, where IVF and
infertility treatments at large might be far more accessible, it's
still often such a silent battle um There was an
end up article that we read actually in Self magazine
was reported on a survey finding that six of the
infertility patients they talked to hid their struggle to get
(46:30):
pregnant from both friends and family, and more than half
of those people reported that it was easier to tell
folks that they didn't intend to build a family rather
than share their troubles. And that's I hate that. Oh God,
I couldn't believe that when I read that that it
was it's easier just to say, but I mean, I
(46:51):
can I can believe it, but I can't. Uh. They
talked to psychologists Linda Applegarth, who says that having difficulty
getting pregnant can causes much grief as losing a loved one,
but it's different. She writes, it's chronic and elusive. There's
a fear that life will be eternally empty. Some feel
a sense of damage and brokenness, and it goes to
(47:12):
the heart of who they are. And she writes about
the sense of dread and shame that she sees even
in her own waiting room from women who won't even
make eye contact with each other, and how it's different
when you look in the waiting room for people, uh,
male or female seeking treatment for cancer, for instance, where
patients will maybe trade stories, will maybe ask each other
(47:32):
how they're doing. She's like, there's a distinct difference in
a fertility waiting room because it's almost like these these
men and women don't want to acknowledge that they're having
these struggles. And even when psychological resources are available and
fertility patients often don't use them. Um. Apple Garth noted
that only about five percent of patients in her clinic
(47:57):
take advantage of the psychological support service. Says, uh that
it offers despite data showing how helpful that it might be.
I mean, we talked a while back now, um about
the kind of that mind body interaction between anxiety, depression
and difficulty getting pregnant as well, and a University of
(48:17):
Michigan studies zeroed in on black women specifically in this
country because they're less likely to seek medical helps, so
their struggles end up overlooked. I mean, this is already
an issue where people aren't talking about it, feel they
can't talk about it, but when when it comes to
African American women, even fewer are vocalizing their struggle. Of
(48:38):
the women that this study talked to reported feeling isolated
and lonely during their efforts to get pregnant, and many
felt that they needed to take on the burden all
by themselves. And it's because of this web of reasons.
It's personal shame that we've talked about, but it's also
cultural barriers like stigma against talking about your personal business
(49:00):
or the expectation that Black women should be strong and
resilient enough to handle their problems on their own. There's
also this feeling that from the women that they talked
to of abnormality for not being able to get pregnant,
and this goes back to what the authors discussed as
the internalization of stereotypes about African American women's hyper fertility
(49:22):
or belief in a black fertility mandate. So a lot
of women of whatever race, age background report feeling pressure
of the motherhood mandate that you're a woman, you should
have babies, have lots of babies, go forth and be
multiply and be fruitful. And this was also the case
for these UH University of Michigan research participants that they
(49:43):
felt like, well, um, you know, I'm a an African
American woman, I'm a black woman. I'm supposed to have
lots of children or that's common in this culture, or
it's expected of me. It should be easy for me
to get pregnant, exactly, And so a lot of them
hold the researchers that infertility is not something that's supposed
(50:04):
to happen to me. It's something that happens to rich
white people who can, you know, pay all this money
to have treatments done well. And speaking of you know,
the the wealth factor, I mean that absolutely is one
of the reasons why women of color are less likely
to seek treatment. But there's also the issue of having
tense relationships with doctors. I mean, this is something that
(50:26):
if you start looking in medical studies about like patient
doctor interactions, Um, things do shift when uh, it is
a white person sitting on the exam table versus people
of color. But regardless of race, women dealing with that
motherhood mandate that you described, Caroline, that every woman should
(50:47):
have kids, or that if you don't have kids then
you're somehow less valuable or a less than woman. Um,
that is a really powerful myth that I think is
really easy for us to believe because it's seen as
just this basic feminine act. It's just something that's inevitable.
(51:07):
You know, we take birth control in order to not
get pregnant. All we're taught a lot of times in
at least American sex education classes is that you know,
if we have sex, then automatically we're going to get pregnant.
So it's no surprise then that we have so many
misconceptions about a how challenging it can be to get pregnant,
and how common infertility is. And I think that this
(51:30):
is part of what should be considered comprehensive sex education,
ongoing sex education. Yeah, and what all this spoils down to,
basically is that this constant shame and overwhelming stigma contributes
to women not talking about their experiences, women and men
not sharing their experiences, which then translates into a lack
(51:53):
of advocacy on a governmental level. I mean, if people
aren't talking about it the same way that they talk
about breast cancer, for instance, there's not as much of
a push for research dollars or for answers and solutions.
Um Barbara Clura, who's the executive director of Resolve, the
National Infertility Association based in Virginia, so as we can
(52:14):
only get a handful of our own volunteers to speak
out because of the shame and because we have some
little patient advocacy, we have so little progress. And I
highly recommend that if you are someone you know struggles
with this issue, you go over to Resolve the website.
It's a very comprehensive resource. It talks about everything from
the actual infertility struggle, to mental health issues to talking
(52:37):
about issues of insurance coverage. Um so it's definitely a
great resource. But this is yet another women's health issue
where we see so much, so much shame and internalization
of of something that your body is doing and or
your partner's body is doing. And we can all benefit
from having a wider, more, a wider and louder conversation
(52:59):
about it. Yeah. Mean, and it's a women's health issue,
but it's also a men's health issue as well. And
I'm glad you mentioned you know, men's silence around it too,
because one of the studies we looked at evaluated the
psychological impacts of infertility for both men and women, and
while women in the study were likelier to experience negative
(53:20):
psychological repercussions, many of the men did as well. So
as with our conversation about say, miscarriage. It's definitely something Um,
I mean, and again we were now talking more in
straight couple of context, but it's still something that men
need to feel more welcome and comfortable talking about as well,
(53:42):
because you know, a third of the time it could
be their bodies which might be causing the issue. But Caroline,
before we wrap up, I did want to ask your
opinion on something that came up in our research about
infertility being considered or a disability, which some think would
(54:03):
be helpful for getting more insurance coverage for infertility treatments.
But when I read that, I my my instinct was
to not entirely agree because it seems like classifying infertility
as a disability only reinforces the idea that it's women's
(54:26):
role and purpose to reproduce. Yeah, I mean, I think
that that's a conversation that literally happens anytime anything is
classified as a disability, because it almost makes it sound
like this defines you, and you know, what your body
does does not define you. Your your more than your body. UM.
(54:47):
That being said, you know someone who doesn't struggle with
these issues. It's it's hard for me to weigh in
other than to say if something is classified a certain
way according to the government. It helps you get insurance coverage.
I see that as a positive. Um it's I think
it's less so in our conversations that we had around
(55:10):
pregnancy and the way that like maternity leave and paid
family leave happens. But as far as language goes, I
think it's a shame that it has to be called
a disability for that very important coverage to happen. Yeah,
I mean, because I just wonder, um and and listeners,
I really hope that some of you can fill us
in on this. I wonder about people who find out
(55:33):
that they are infertile and they're okay with it, and
whether that leads to conflicted feelings as well, because there
is an assumption that if you are inferrald that it
is a shameful and sad tragedy. But I have a
feeling that there there are people who are are totally
fine and live perfectly happy live. So I mean, again,
(55:54):
this is just I mean, I'm just I'm I'm genuinely
curious to hear from people what these experien rances are
because I don't know at all. Um So, listeners, we
definitely want to hear from you on this issue, because again,
this is something that we don't talk about nearly enough.
Mom Stuff at how stuff works dot Com is where
you can email us. You can also tweet us at
(56:15):
Mom's Stuff podcast or messages on Facebook, and we've got
a couple of messages to share with you right now.
I have a letter here from April in response to
our knitting episode. She says. Let me start by saying,
how much to enjoy your podcast. Thank you, April. We
enjoy having you listen. She says, as I was listening
(56:38):
to the podcast on knitting this evening, you mentioned knitting
during the World Wars was propaganda. This could not be
further from the truth. From the Civil War to World
War One and World War Two, the knitting of socks
was very important. Foot rot was a constant battle. Soldiers
could not march and walk long distances without good socks
that helped keep the moisture away. Can you imagine trying
(56:59):
to walk in mill military boots with wet holy socks,
or even without socks altogether. Soldiers had blisters and would
develop infections. Their feet would literally wrought. The knitting of
socks was as important as the recycling of metal or
the rationing of sugar. It was not just a way
to keep the women and children busy or make them
feel like they were part of the war effort. It
was an important part of the war effort. I am
(57:21):
a knitter and a feminist in the age of forty one.
I am currently working on my dissertation for my PhD
in history. My focus is women's history, and my dissertation
is actually focused around women and the crafts that bring
them together, things such as knitting and sewing. I also
am an adjoinct history teacher at a local junior college
and I teach a women's history class I put together.
In this class, we have a section on women and
(57:43):
the war effort, and we talked about knitting as a
big part of the lives of those at home. Thank
you for all the hard work you do. I just
don't think you overlooked this one important thing, So thank
you for filling us in April. Well, I have a
delightful letter here also about our knitting episode, and it's
from Elias, who writes, I'm eighteen years old and I
actually just started listening to your podcast in December. I'm
(58:04):
a big fan of stuff you should know, so I
thought i'd give another house Stuff Works podcast to try.
By the title, I thought I'd learned about all kinds
of interesting secret things my mom never told me. So
I was a bit surprised when it turned out to
be a podcast about feminism, but I'm so glad I
decided to keep listening. While before I only had a
vague understanding of what feminism really means, after just a
(58:25):
handful of episodes, I already feel so much more educated
on the social topic and have a much better grasp
on its scope and importance. Thanks for being such informative,
friendly and charming podcasters. Well, thank you, Elias. And I
think I might be mispronouncing your name, so I apologize
um if I am. But anyway, getting on to knitting,
Elliots wrote, anyway, the real reason I wanted to email
(58:47):
you is because I'm a guy who knows how to knit.
You see, a few summers ago, when I was fourteen,
I went to a family camp with my extended family,
and one day we were surprised to find that the
arts and craft staff would be teaching knitting to anyone
who'd like to learn. Two of my aunts and I
thought it sounded like a fun idea, so We gave
it try, but as you were both saying, it's very
difficult to learn. The steps were so precise and hard
(59:08):
to remember, and I made so many mistakes that my
script first scarf turned out to be more like a
scratchy rainbow shaped cloth. Still, it was fun and a
little addicting, So when I got home, I looked at
the steps on YouTube to really get them down, bought
some fresh yard, and tried again. After a few days,
I finally got it. Now I have an awesome black
and blue scarf as proof of my dedicated work. So
(59:31):
word to everyone, no matter how old or what gender
you are, anyone can love to knit. Well. Thank you
so much for that story and for listening, and thanks
to all of you for your letters. Keep them coming
to mom stuff at how stuffworks dot com and brilling
all of our social media as well as all of
our blogs, videos and podcasts with our sources so you
(59:52):
can learn more about infertility and other topics. Head on
over to stuff Mom Never Told You dot com For
more on this and thousands of other topics. Visit how
staff works dot com.
Welcome to Stuff Mom Never Told You from how self
works dot Com. Hello, and welcome to the podcast. I'm
Caroline and I'm Kristin. And last time on the podcast,
we talked with Dr Jessica Zucker about miscarriage, which is,
(00:23):
as we established, definitely a taboo topic in our society.
It's really difficult for people to talk about, to acknowledge,
to even reach out and seek help. And in our
conversation about infertility today, it's sort of a continuation of
that theme. Infertility is not uncommon, or struggles with fertility
in general are not uncommon, but as we'll talk about
(00:48):
in this episode and as we saw in our research,
what's so heartbreaking about it is the fact that no
matter who you are, no matter what your background is,
no matter what part of the world you live in
or what time him that you lived, women have experienced
so much shame, both internally and from other people over
(01:09):
the issue of infertility. Yeah, I mean, in all of
these conversations that we've had, not only about a miscarriage
and then today about infertility, but also other times we've
talked about pregnancy and just women's bodies in general, there's
(01:29):
always this theme of the limitations of what we can
and do and feel comfortable talking about UM. So this
is one where it is something that affects so many
of us, but we don't hear about it nearly as
much as we should. And when we do hear about it,
(01:51):
it tends to be from the perspective of a woman's
problem or it's the woman's fault. That's historically what how
this issue has been framed. And as we'll talk about,
this is not a woman's problem. This is this is
everyone's problem. If you are a person who wants to
have children, you very well might be affected by infertility. So,
(02:13):
just to cover the basics of what um infertility is,
it's medically defined as a difficulty conceiving a pregnancy after
a year of unprotected sex. But because as we've talked
about in the podcast before, obviously our fertility declines with age,
So for women over thirty five, doctors recommend checking in
(02:36):
if they've been unsuccessful getting pregnant after six months of trying.
That's right because for perspective, most fertile couples, according to researchers,
do conceive within six cycles when they're using timed intercourse.
Doesn't that sound so sexy and romantic six cycles. Use
your timed intercourse in your in your cycles. They're talking
(02:57):
about menstrual cycles, not yeah, not mons cycles, although I
mean there you go. Still tychnically the same. Yeah, you
could time up by the moon if you wanted, you know,
full moon. Don't come a knocking or no please do
yes well yes, um. And of course related under this
umbrella of infertility is impaired fecundity, which encompasses non surgical sterility,
(03:18):
which is an impossibility to conceive, subfecundity, which is uh,
conception is difficult but not impossible and quote long interval
without conception. So there's a lot of different types of
fertility struggles wrapped up in our conversation today. And basically
this happens. Infertility is said to happen when there's a
(03:41):
breakdown somewhere in the conception process. It could be one place,
that could be multiple places, but you know, brief run
through refresher biology course for you. The conception process starts
with ovulation fertilization. Then the fertilized egg takes a little
swan dive through the fallopian tube towards the uterus and
(04:02):
then has to implant itself successfully in the uterus well,
and because it wasn't until the mid twentieth century that
we really started to understand all of the steps in
this process, humans just made up all sorts of reasons
why infertility would occur, which has only ingrained a lot
(04:24):
of the stigma um that we're going to talk about
that is still very much alive and well today. UM.
But here's the thing. In addition to all of those
steps where things could possibly go awry, just getting pregnant
in and of itself, despite what um absence only sex
education might lead you to believe, getting pregnant is it's
(04:48):
hard to do. I mean, if you think about it,
you have this window in our menstrual cycle during which
conception is even possible. I eat ovulation, and the probability
of inception is only each month. Now, going back to
sex education, if you are listening to this and you're
sexually active, Uh, this is not Christen and Caroline endorsing
(05:10):
you to just go have unprotected sex um. But I
think it's just worth understanding the challenges that can naturally
occur with getting pregnant. Yeah, because it's estimated that ten
of normally fertile couples don't manage to conceive within the
first year, so it's it's not uncommon to struggle with
(05:33):
these issues. And so let's dive into some sex based
stats and facts, and that's biological sex, not literally getting
it on. So, like we said earlier, culturally we tend
to just sort of frame this as the fault of
the woman or the woman's problem. But depending on what
statistics you're looking at, about a third of the time
(05:53):
it's the man's fertility issues causing problems with conception, about
another third of the time it is something going on
in the woman's body. But the remaining third, give or take,
it's either both partners or an unknown cause. So if
we look just at men's fertility um for instance, just
to get a better grasp on that, the two thousand
two National Survey of Family Growth found that seven point
(06:16):
five percent of all sexually experienced men under forty five
I saw a fertility doctor at some point, and within
that group, eighteen percent or diagnosed with a fertility problem.
But that doesn't necessarily account for all of the dudes
who have had fertility issues. That's just people who have
sought out treatment for it. Yeah, and male fertility specific
(06:38):
problems include abnormal sperm production, function, and delivery, and this
can be caused by problems like undescended testicles, genetic disorders
like cystic fibrosis, health issues like diabetes, and also retrograde ejaculation,
which is when semen doesn't go out, it goes into
the bladder instead. I had never heard of that before
me neither, but I create when I read it because
(07:00):
I don't know if it's painful, but it sounds like
it's uncomfortable. So things that can contribute to male fertility
problem that that actually actually right, we should actually actually contribute, uh,
include overexposure to heat. Now I had heard this stuff
like anecdotally about laptops, like I had seen some studies
in the past couple of years about like men, don't
leave your mama's don't let your babies grow up to
(07:23):
put their laptops on their laps because it can affect
your fertility. No, and and this is not funny, but
it's it's true. Uh, Like things like hot tubs and
saunas can affect fertility. And a condition uh that also
affects fertility is when you basically have vericose veins in
your testies. Having those enlarged veins makes your testies warmer
(07:46):
and heat degrades the quality and quantity of sperm. And
also you've got to worry about exposure to overexposure, i
should say, to chemicals like pesticides, radiation, and steroids. So
if we look at what contributes to email fertility, we
have to think again about all of those steps along
the way from ovulation all the way to implantation. So
(08:08):
if we go back to ovulation, you might have disorders
that prevent the ovaries from releasing eggs to begin with,
or something called primary ovarian insufficiency, which is when your
ovaries begin to fail before the age of forty. And
then of course there are hormonal disorders like polycystic ovarian syndrome,
which is the most common cause of female infertility. And
(08:31):
we've talked about PICOS before on the podcast. There's a
stuff I'm Never told you video breaking down how PICOS
works if you're not familiar with it, and um in
a in a very small nutshell, what that leads to
is your body creating a surplus of androgen hormones, which
leads to irregular ovulation. Yeah, and you've also got hormone
(08:53):
issues like your body producing too much testosterone again a
male hormone or prolactin, which we've talked about on the
podcast before, which is actually a hormon that helps you breastfeed.
And of course problems with your thyroid gland, which is
part of your handy dandy endocrine system, and we've talked
about that before on the podcast too. Other major factors
include uterine or cervical abnormalities. You might have issues with
(09:14):
the shape, the opening, or the mucus happening there in
UH fibroids, that's a major issue because it can block
fallopian tubes and distort the uterine cavity, and we've done
a stuff Whenever Told You podcast all about fibroids. If
you're not up on those, that's true. And UH women
also might struggle with pelvic adhesions, which is scar tissue
(09:35):
that binds organs together after surgery. UM Indometriosis is also
a huge factor, as is inflammation of the fallopian tubes.
And to once more promote past stuff on Ever Told
You podcast, you should definitely listen to the one on
endometriosis or watch our video about it because it affects
so many women, and it takes an average of at
(09:57):
least going to five different doctors to get at the
correct diagnosis, and it's a major contributor to infertility as well. Um.
But then they're also other medical issues that can lead
to infertility like celiac, Cushing's disease, sickle cell anemia, diabetes,
and also STDs like gonorrhea or chlamydia, which if left
(10:20):
untreated can cause big trouble in your reproductive tract and
possibly lead to pelvic inflammatory disease. Yeah, oh boy, definitely
definitely practice safe sex. It's just and then that just
means it's one less thing to worry about for so
many reasons. Please please practice safe sex. Um. But a
(10:42):
couple of risk factors regardless of sex include cancer and
its subsequent treatment, radiation and chemotherapy. Age. We mentioned age earlier.
Women's fertility, for instance, starts declining in their thirties, men
in their forties, and this is sort of a growing
issue for people looking to have children because about twenty
percent of women in the United States specifically are having
(11:03):
their first children after age thirty five. So that just
means that age is a growing contributing factor to in
fertility and Among those couples where the woman is over
thirty five, a third report having fertility problems, and then
of course tobacco and alcohol use don't help matters. UM.
(11:24):
Being overweight can lead to fertility issues and can also
affect men's sperm count by the same token. Being underweight
also isn't great for fertility as well, UM, and can
lead to a co occurring issue of a minorrhea, which
can also be sparked by over exercise or excess stress. Yeah.
(11:45):
Stress is always such a culpritive so many things. Yeah,
and we'll touch on the issue of stress here again
in a little bit, because there is also that I
don't know if it's a stereotype or the assumption that
stress makes you unfertile. And it's not quite that black
and white. So how common is this well, um, very common,
(12:05):
to put it in layman's terms. UM. It's important to
remember though that rates are going to differ depending on
factors like the age group of the people included, the
number of people in the surveys and studies. UM. But worldwide,
around two to ten of couples just don't have any
children UM, and ten to cent struggle with what's called
(12:29):
secondary infertility, and that's when you have your first kid,
everything's fine, but then you have a really hard time
getting pregnant the second time around. Yeah, So there was
this huge global meta study in that found that there's
nearly fifty million couples worldwide who were unable to have
(12:49):
a child after five years of trying. They found that
nearly two percent of women forty four years old who
wanted to have kids were unable to have their child.
That's primary infertility, and about ten and a half percent
of women experienced secondary infertility, which is what Kristen just mentioned.
But the thing is they also pointed out that those
(13:10):
rates were similar to what they had been twenty years earlier,
so we're not seeing a ton of advancement in terms
of in terms of sort of stemming that infertility tide basically.
And it is kind of counterintuitive when you look at
those age breakdowns, because for women between twenty and twenty
(13:32):
four years old, primary infertility rates are higher compared to
older women, but that pattern is reversed for secondary infertility,
where if you are younger and you have had that
first successful childbirth, then it's not as hard to get
pregnant a second time. As it is if you are
(13:53):
older and you have a successful first childbirth and then
try to get pregnant a second time. Yeah, And if
we look globally, primary infertility is actually higher in North
Africa and the Middle East when compared to a region
like Latin America or the Caribbean. And secondary infertility in
Sub Saharan Africa specifically affects more than thirty percent of
(14:15):
women between the ages of five and forty nine. And
if we zero in just on the US, six percent
of married women between ages of fifteen and forty four
are infertile. But if you look at all women trying
to get pregnant, regardless of relationship status, twelve percent of
that age group struggles within fertility issues. And I appreciated
(14:37):
that source for making that distinction between or even examining
the distinction between married women and women in any relationship
status trying to get pregnant, because so much of this
data is obviously very heteronormative. UM and you could also
say like sis sexist as well. I don't think that
(14:58):
we saw any studies on like AND's fertility issues at all.
UM and also a lot operating under the assumption that
all women want to get pregnant, and especially if women
are married. UM. So I think it's those kinds of
contexts are are good to keep in mind as well
(15:19):
to go through this. Sure, and it's not just women
in relationships who want to have children. I mean there
are women who are not in relationships who, for instance,
might be seeking a sperm donor and want to get
pregnant that way and then have struggles with it. So
it I think it is important to kind of break
out of the mindset of like, Okay, we're only going
to research people who are in relationships because well, what
(15:43):
is I mean, that's not the full picture? Then I
would think, yeah, and also only research people who are
in straight relationships too, there's not you don't see a
lot of variation within like the sexual orientation of UM
people in these studies as well. So just a little
background demograph, background on the available data that we're working with, right,
(16:03):
and as we move into talking about treatment, I mean,
I think it's worth mentioning how health in general, but
also access to healthcare and socioeconomics are such a huge factor. UM.
There was a study way back when I was five
years old in h that found that the only group
(16:24):
to suffer a rise in infertility rates since the nineteen
sixties was women under twenty four and that was thanks
to a spike in STDs. That goes back to what
we mentioned about chlamydian gnarrhea, that those conditions are nothing
to laugh at or sniff at. You need to practice
safe sex and then successfully treat these conditions in order
(16:44):
to keep your fertility from suffering. Yeah. I remember when
that study came out and reading about it um in
the New York Times, as I did every day as
a four year old. Baby Kristen Yes, yes, a little
baby glasses well Fisher Price glasses, Yes, yes, baby cup
of coffee, and you were just like, this is this
is such a shame. This is such a shame. Kids
(17:05):
these days need to practice say sex exactly. You took
the words right out of my mouth, right out of
your toddler mouth, just like candy stealing candy from baby Kristen. Um.
And of course, doctors know that overall poor health can
contribute to infertility problems. And this is a huge deal
when you think about and I mean again, I'm speaking
as an American, but this is a huge deal when
you talk about people who don't have access to doctors
(17:28):
or healthcare or insurance. And yes, we have the Affordable
Care Act, but I personally know plenty of people who
still don't have health insurance and therefore still do not
have access to a regular doctor. And then it comes
back to to the cost of fertility treatments, which are
insanely prohibitive. They're definitely not accessible to everyone because they
(17:49):
can run you more than ten grand. Yeah, I mean,
that reminds me of one of the stories that we
were reading about infertility treatments and this couple that had
saved up ever since they got married for their future
children's college fund and had put all this money away,
and they ended up spending all of that money just
(18:13):
trying to get pregnant because those fertility treatments are so expensive,
not to mention all of the travel involved if you
live somewhere that might not have um this kind of
treatments available. So, speaking of which, in two thousand nine,
the World Health Organization classified infertility as a disease, and
(18:33):
part of the motivation for that was paving the way
for more insurers to cover treatments. Because, as of are
the most recent data we found at least only fifteen
states require insurance coverage for fertility treatments, so a lot
of this is like out of pocket costs, right, Yeah,
that which is I mean, that's huge. It's a huge
(18:55):
cost um And treatments can involve assisted reproductive technology gene
this is any treatment in which the egg and sperm
are handled, and of course IVF in vitro fertilization falls
under that. It's the most common type of assisted reproductive technology,
and it involves retrieving multiple eggs, fertilizing them in the lab,
and implanting the embryos in the uterus. And there was
(19:18):
just an article that I just shot over to Kristen
last night that there's apparently a trial starting in the
UK for a controversial IVF technique to allow women thirty
and older And I'm like, oh god, I'm I'm a
thirty and older um to get their eggs quote unquote rejuvenated.
And basically this involves taking mitochondria from immature cells and
(19:42):
sticking them into mature cells to be used egg cells,
that is, to be used for IVF. And this matters
because aging mitochondria, which is like the cell's little powerhouses,
contribute to IVF failure. So if the succeeds, it could potentially,
you know, maybe stave off the repeated costs of going
(20:03):
back over and over again to try IVF. And it
seems like the primary controversy with this is that it's
very unclear at this point that it could even be successful. Yeah,
they're not sure that it could could work. UM. Now,
if we look at treatment for women specifically, there of
course our fertility drugs to stimulate ovulation UM. There's intra
(20:24):
uterine insemination where healthy sperm is placed directly into the uterus,
and there's also surgery to correct uterine problems. And for men,
their treatments for various infections that might affect the reproductive
system as well as sexual dysfunction. You can also undergo
hormone treatments and surgery to correct and obstructed vast deference.
(20:45):
I used to be on a trivia team called Uptown
John and the vast deference UM or that condition that
we talked about earlier, where the enlarged veins and the
testes make them too hot, and of course also the
procedure in the process of hating sperm for that assisted
reproductive technology. But according to research from the CDC, A
(21:07):
majority of infertility treatments fail. Fifty seven percent of IVF
cycles using women's own eggs failed, whereas procedures using donor
eggs do better. They had only a thirty seven percent
fail rate. And not surprisingly, this has psychological side effects
as well. There was a Harvard study that we were
(21:29):
looking at, um finding how women who have difficulty getting
pregnant can be as depressed as those who have major
heart problems or cancer. Yeah, I mean it makes sense, Like,
think of your friends, who all they or maybe it's you.
You know, all you've wanted your whole life is to
have kids. You know. I'm I'm not on that wave length,
but I know many people who um. You know. For instance,
(21:54):
I had a coworker years ago who had pekos and
before she was in gauge, before she was married, she
was with the man she knew she wanted to be
with forever. She's like, let's just start trying because I
might never get pregnant. And I know that, you know,
watching friends struggle with that idea of like, I want
nothing more to than to be a parent, uh, and
(22:15):
to have that be a difficult process. Of course, I
can totally see how it would lead to massive depression
and stress, and it's that stress that can affect weather
and how long people stick it out for for treatment.
Harvard Medical School researchers found that thirty cent of patients
(22:37):
under forty with insurance for at least three IVF cycles
dropped out after only one or two. They also found
that sixty eight percent of patients over forty gave up
before exhausting their insurance coverage for the procedure. And they
write about how this whole thing, it just swallows your
life up. I mean, you become a slave to your
(22:59):
monthly side if you're tracking your ovulation and your periods,
and it's they talk about that that extreme disappointment, like
disappointments to week of a word, when you get your
period the next month, because you've put so much time, energy,
and potentially money into this process. But of course a
(23:20):
doctor is saying, just relax isn't going to help matters.
Those same Harvard researchers did find that lowering anxiety was
linked with improved pregnancy rates, and that patients with psychological
support do feel less distress about treatment and are quicker
to try other options like donor eggs, sperm, or adoption
(23:40):
and this is a big reason why it's important for
us to talk about this even more because, uh, a
lot of times, if you are experiencing infertility, you don't
want to tell anyone about it, and the downside of
that is that you don't have a support system in
that case, which research you know finds can can be really,
(24:01):
really really helpful. Yeah, and we should say again and
emphasize that depression and stress do not cause infertility, but
researchers have found that they are associated that people who
managed to alleviate their anxiety, stress, and depression they put
all of that under the term of distress um have
(24:24):
had in studies more success finally getting pregnant. But the
thing is, as much as we know about the biological
factors that do and don't contribute to male and female infertility,
there are still so many myths surrounding it and so
much moralizing and stigma that go back millennia and and
(24:51):
essentially have been you know, shaming infertility ever since. Yeah,
and we'll talk about that after a quick break. These days,
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You should. And now back to the show, So I
feel like a stuff mom ever told you episode would
almost be remissed if it didn't at some point go
(26:00):
to ancient Egypt. Yeah, we're not laughing, but it's true.
It's true. Um So, Egyptians had a goddess of infertility who,
horrifyingly enough, was also the goddess of funerals and afterlife rituals.
So right off the bat, nothing but the worst connotations
(26:21):
around women who struggle with fertility issues. And they even
had this weird test They would force feed a beer
covered woman dates and if she vomited, she was fertile,
which this of course makes me think of the Last
Crusade where Sala catches the date in his hand and
says bad dates. Sweet I got in today's Indiana Jones
(26:41):
reference Indiana Jones and Monty Python. You're on a roll, girl,
I really am. And we should say too that this
timeline is coming from two sources Bustle, a great in
depth article over at Bustle, and also a timeline from
American radio works. And they also looked at ancient India,
for instance, who thought that perhaps women were possessed by
the goddess of poverty and corruption if she couldn't have
(27:04):
children man um Things didn't get much sunnier over in
China because if a woman was infertile, and I'm assuming
the husband had means, you could just use a concubine instead.
That's fine, Yeah, I just bringing a pinch hitter. Yeah.
And in Rome, just divorce your wife over it. Here,
(27:24):
we'll let you out of this contract pretty easily. But
it's in ancient Greece where we start to see the origins,
maybe not overwhelmingly, but the origins of infertility being thought
of as like a medical condition and not necessarily a
moral failing all the time. Overall, though, the responsibility for
fertility did still lie with the woman and all Hippocrates
(27:47):
had lots of ideas about what led to infertility. Um.
He attributed to things like wait, a tightly closed cervix
or menstrual retention, which Hippocrates come on. So this whole
idea and this idea of measure retention would stick around
for quite some time. Um. They thought that your period
blood would just hang out inside of you. It wouldn't
(28:11):
come out, it would just hang out and prevent you
from being able to have babies slashing around, Yeah, slashing around.
But I mean you could try praying to Asclepius, who's
the god of medicine. There were also all of these
different types of probes, like literally getting things just stuck
(28:31):
up inside of you, trying to like open up that
that reluctant cervix. Uh. And there were also sorts of
weird like herbal cocktails that you could try. I bet
there are still so many herbal cocktails out there for
infertility as well. Um. And in the medieval times, not surprisingly,
things took an even darker turn with the publication of
the Malleus Malfaicarum, which we've talked about before is translated
(28:55):
to the Hammer of the Witches, and this text, as
you might assume from the book's title, blamed infertility on
witches and or the devil, but they also thought that
it could be an indication that you yourself are a witch.
To the witch, there's no winning, there's no winning, Like,
why should a woman who struggles with having children be
(29:17):
considered evil? I it blows my mind, because that's your function, Caroline,
that's true. Well. Other culprits during this time included a
wandering womb, which christ and I. We have that video,
Christian where you and I were looking for crazy, wandering
hysterical uteruses by the train tracks. That's right, and I
ended up finding yours. She gave it to me for christmasing. Yeah,
(29:39):
and if you don't know what we're talking about, listeners,
why are you following us on Instagram? Um? You also
could have a soft womb, which means that it's too
soft and wet to be able to snag that sperm.
It's not vel crowe enough and giveaway. If a woman
had a soft womb, was that she cried all the time.
(30:00):
I hear soft womb, I think of a soft boiled egg.
Come on, I eat boiled eggs for breakfast. Um, sorry
not sorry? Yeah, okay, you you also might They thought
suffered from a suffocated uterus, which was an idea similar
to hippocrates idea of menstrual retention. And in terms though
(30:21):
of this moralizing aspect um, this is going farther back.
But if we look at Christianity and the whole doctrine
of female piety and the Bible and the Old Testament,
there's a story of Hannah who was barren, and she
begged God for a child, and finally, because she was
(30:43):
such a pious woman, God rewarded her with six more children.
And this foster's this whole idea that women without kids
need to work extra hard to prove their piety, and
that infertility is punishment for your sins and is reflected
(31:04):
on women's morality. It probably could be traced back to
two Eave's curse and on and on. Yeah, And much
like the Greeks were like just pray to Asclepius, the
Christians urged women to try praying it away or fasting
it away. And yet it then evolved into a view
of infertile women as promiscuous, masculine and bossy. Yeah, because
(31:31):
I mean, what how more unpious can you be than
if you are both masculine and sleeping around and boss
saying doing it um. And so during a renaissance, we've
got this growing medical and popular acceptance of the idea
that it could also be men's fault. There was this
(31:51):
concern you guys about cold, thin, watery or feeble sperm.
There was a concern over whether you had a short penus,
and also what you were eating. This didn't prevent, though,
Catherine de Medici from being blamed when she and her husband,
King Henry the Second could not have kids, despite the
fact that he apparently had a malformed penis. Catherine was
(32:14):
still blamed. So good for popular culture during this time
where we're finally being like, I wonder if men could
be to blame ever for this, But it did yet
didn't help her. Yeah, I mean, there was still the
belief that it would it would have to be blamed
on the woman's body shape, her cervical shape, womb temperatures,
and that infertility could then lead to mental disturbances. So
(32:39):
we're still living in the whole mentality of the hysterical
uterus and all of the lady brain problems that that
can cause. But finally in the seventeenth century, we start
to learn a little bit about how this works. We
see sperm under a microscope for the first time, and
so this leads to more examination of male fertility, and
(33:01):
by the mid seventeen hundreds, we understood fertilization better and
infertility was slightly less moralized. But now there is just
an idea that your menstruation was unbalanced in some way.
So treatments include stimulating sexual pleasure, which was thought to
be helpful to conception. Yeah, I thought for sure. I
(33:22):
was like, I must have read that wrong, because so
much of what we read and talk about for the
podcast goes back to like, sexual pleasure is super wrong.
Women should never experience sexual pleasure. But it's interesting that
it comes in in terms of fertility, like, well, maybe
it can't work unless somebody's having a good time. You
gotta balance that menstruation somehow. Yeah, I know, I hate
(33:43):
when my menstruation is unbalanced. But by the eighteen hundreds
we see more surgical advancements and the further development of
the idea that infertility is a mechanical problem caused by
cervical disorders or a male position of the uter is.
But you still have ideas about quote unquote luxurious living
(34:05):
and women's misbehavior persisting, and that includes heavy mental activity
that could potentially damage your other organs. Yeah, Basically there
is a longstanding idea that if a woman thinks too much,
then she renders herself infertile because I mean, I guess
her brain heats up our wounds and then that just
(34:26):
ruins everything. Basically, it puts our uterus is in a microwave.
And now I'm picturing like an Industrial Revolution era factory
where like wheels and gears and cogs are just like
working over time, and there's all this steam and like
suddenly the machine just craps out, and that machine is
you womb, if you womb. But in six we do
(34:49):
get a New York doctor who's the first to argue
that husbands GNA rhea infections could be probably potentially maybe
likely causing their wives to be sterile. Yeah, because I
mean with the Industrial Revolution, speaking of which, an urbanization,
you have more men visiting prostitutes and the rise of
STDs with that. But of course probably the blame for
(35:13):
that ultimately would go back to the women and not
inevitably not the men who were paying for their services. Um.
But in the early twentieth century, there are lots of
discoveries around hormones. There's a test developed for blocked fallopian tubes,
and guidelines published for analyzing sperm count for male fertility.
So we're starting to figure some things out in a
(35:35):
real way. And in famed Dr John Rock reports the
first US fertilization of human eggs in a lab dish.
This is in vitro fertilization. And at the same time
the public is demanding fertility treatments. They're like, listen, we
want babies, and we want babies now, and you're gonna
fix this. Isn't it ironic? Then that Dr John Rock
(35:56):
would then go on to be so instrumental in developing
the very first oral contraceptive for women. Oh my god,
the more you know, go back and to stuff Mo'm
never told you dot Com and listen to the episode
The Father of birth Control, Love it Um. And in
the late twentieth century, we see the first in vitro
babies being born in the UK. In the US, we
(36:17):
see sperm injected into the egg for the first time,
the first successful pregnancy from a frozen egg. I believe
that was at a fertility place here in Atlanta and
rising at the same time, though, you've got parallel dialogues
around the desire to wait to have kids because you know,
maybe you're pursuing an education or a career, the desire
(36:38):
to be child free. So you know, more than ever
during this time, women are starting to be like, hey,
maybe I don't want to have kids. But you start
to see almost in response to that, but certainly developing
at the same time, more and more media driven anxieties
about that decision to put off kids and the fact
that you might wind up unable to have them. And Okay,
(37:00):
so I meant to go back and read some of
the media coverage that came out when the first in
betro baby I believe her name was Louise brown Um
was born in the UK to offer some more background
to the media anxiety about not having kids, because if
(37:21):
I remember correctly what I've read about that, there was
a lot of controversy about the so called in betro
babies and people saying back at the time that oh,
we're just now playing god and this is you know,
technology gone awry, and so it seems like regardless of
what's what angle we're looking at reproduction, it's like, no,
(37:43):
this is helping someone have a child that they want
to have. But then if we want to delay having
a child that we may or may not want to
have them, that's not okay either. And this just leads
us into this conversation around the infort to these stigma
and how a lot of times it does seem like
(38:03):
a total catch twenty two where they're, like you said, Caroline,
there's there's kind of no winning. Also because there's this
longstanding misconception that it's it tends to be an issue
with the woman's body, whereas is we noted at the
top of the podcast, it's like a third of the
time it's happening with the penis that there, at the
time it's with the vagina, and the other third of
(38:24):
the time who knows what it is. Yeah, and we
wanted to definitely look globally. We definitely wanted to look
outside of the United States for this conversation because, like
I said at the top of the podcast, no matter
where we are, no matter who you are, shame around
infertility exists. Despite the fact that Christen said that the
fertility issues between men and women are pretty much equal,
(38:47):
and so we were reading these articles. One was from
the World Health Organization, and one was from Newsweek that
focused specifically on stigma in developing countries. However, that being said,
I think despite the fact that these articles focused on
developing countries, these issues can be extrapolated to apply to
women all over the world because women might face everything
(39:09):
from ostracism being considered inauspicious at weddings. Um in some
Muslim regions, women can only go out if they have
children with them, or a or a chaperone of some kind.
But forget running erin solo, ranging all the way to
abandonment and even abuse. And then there's the whole idea
that you are a failure in society because of course
(39:32):
this is the role of women. You know, you have
to have kids. And this was something that Rhea Sambuya,
who's the founder of the Joyce Fertility Support Center in Uganda,
was talking about and she said, quote, our culture demands
that for a woman to be socially acceptable, she should
have at least one biological child. Almost all cultures across
(39:53):
Africa put emphasis on women having children. Marriage without children
is considered a failure of the two individuals. Yeah, and
talking about this, William Ambolet, who works with Gank Institute
for Fertility Technology in Belgium, said that if you're infertile
in some cultures, you're less than a dog. In the
(40:13):
Hindu religion, as one example, when a woman without a child,
particularly a son, can't go to heaven, she needs a
son to perform burial ritual rituals, and similar attitudes persist
in China and Vietnam, where some believe childless folks souls
can't rest for eternity. And in China, again, children are
seen as gifts from God, so people who are childless
(40:37):
can be viewed as unworthy or as sinners, which makes
it even harder to seek treatment, even if you can
afford it, even if you have the money to go
seek treatment, just that stigma of needing help prevents people
from doing so. And then there's a whole angle of well,
if you're infertile, you are a socio economic burden. And
this was something uh that World Health Organization Productive Health
(41:00):
and Research Department head Dr Cheryl Vanderpoolt was talking about, saying,
how uh, you know, if you don't have kids who
can then grow up to take care of you and
also have kids who can do household chores and also
contribute to local economies. Then you're just gonna be a
drain not only on your community, but also to your
(41:21):
wider family, who becomes deeply disappointed for the loss of
what she calls continuity of the family, as well as
again the contribution to the community. So this only intensifies
feelings of guilt and shame. Yeah, and the the idea
that your failure in your marriage. I mean, the World
Health Organization article quoted a Ugandan woman who said, women
(41:43):
like me often have to bear the extra marital relationships
that our husbands tend to have. I have overheard other
women talking about us as being cursed. There's an idea,
especially in polygamous cultures, that it's completely acceptable for a
man to either divorce his wife or take another your
wife if that culture permits polygamy, simply in the effort
to have biological children. There was one example talking about
(42:07):
a particular ethnic group in Mozambique, where it's common for
women to commit adultery in an attempt to get pregnant
rather than face exclusion from traditional ceremonies and social activities.
But if you are living in a society where it
is acceptable for the husband to leave you and father
children with other women. In the case of infertility, then
(42:30):
he's going to be likely unlikely excuse me, to support
your efforts to seek fertility treatments, or probably support you
at all. And with all of this potential extramarital sex
having going on, this can also lead to STDs. I mean,
if you look at the developing nation in general, there
(42:51):
are of course issues regardless of fertility with untreated STDs,
if you have condom taboos, um, and just the cost
of condoms and contraceptives being too high, and also infections
from female genital mutilation. Yeah, and similarly, uh, there are
many women across the developing world who face infections and
(43:12):
complications from either births or abortions in unsanitary hospitals. And
you know, we mentioned earlier that sperm count and quality
can be affected by overexposure to certain chemicals. You've got
to worry about toxins like lead, which is high in
places like Mexico City and Cairo, or the chemical dioxin
which is sprayed on crops. But if you get to
(43:32):
the point to where you know that you could benefit
from treatment, there are still cultural hurdles that you would
have to cross because of course, some cultures consider masturbation evil,
but of course if you need sperm for an IVF treatment,
masturbation is required. Um. In some Muslim cultures, as the
(43:53):
w h O pointed out, um there against egg and
sperm donation because children must have what they call known parents.
That biological relationship is important, it's necessary, and there's even
hurdles to getting help. This is what's talked about in
a couple of the articles we read where Westerners, for instance,
(44:14):
have little sympathy for countries or cultures that they view
very in a very self centered way as being overpopulated. Anyway,
this is something that Dr Mammud Fatala talked about in
the WHO article. He said, if couples are urged to
postpone or widely spaced pregnancies, it's imperative that they should
be helped to achieve pregnancy when they do decide in
(44:35):
the more limited time that they have available. And basically
this goes back to what um one O B g
I N in South Africa described as a fertility paradox
where you have both high fertility rates and high infertility rates,
and those fertility rates really depend on again the use
and desire to use family planning services, what your preferences
(44:58):
are for family size. For instance, East Africa has a
much higher rate of family planning and contraception use, whereas
West Africans still tend to prefer the larger families. But
then those high infertility rates come from everything we've been
talking about, the health issues, the untreated STDs, and when
you talk to infertility treatment proponents who are over into
(45:21):
these developing countries, they note that, hey, guys, IVF does
not contribute to overpopulation anymore than saving lives with vaccination does,
and both alleviate suffering. So why would we not try
to help establish whether clinics in general or fertility treatment
specialists specifically. But the thing is, you know, we've just
(45:44):
been talking for the past few minutes about these situations
happening in areas where you might not be able to
access clean drinking water, much less an IVF treatment. But
that suffering and this psychological um, guilt, shame, and also
social stigma and taboo around this is almost universal because
(46:07):
if we look back in the US, where IVF and
infertility treatments at large might be far more accessible, it's
still often such a silent battle um There was an
end up article that we read actually in Self magazine
was reported on a survey finding that six of the
infertility patients they talked to hid their struggle to get
(46:30):
pregnant from both friends and family, and more than half
of those people reported that it was easier to tell
folks that they didn't intend to build a family rather
than share their troubles. And that's I hate that. Oh God,
I couldn't believe that when I read that that it
was it's easier just to say, but I mean, I
(46:51):
can I can believe it, but I can't. Uh. They
talked to psychologists Linda Applegarth, who says that having difficulty
getting pregnant can causes much grief as losing a loved one,
but it's different. She writes, it's chronic and elusive. There's
a fear that life will be eternally empty. Some feel
a sense of damage and brokenness, and it goes to
(47:12):
the heart of who they are. And she writes about
the sense of dread and shame that she sees even
in her own waiting room from women who won't even
make eye contact with each other, and how it's different
when you look in the waiting room for people, uh,
male or female seeking treatment for cancer, for instance, where
patients will maybe trade stories, will maybe ask each other
(47:32):
how they're doing. She's like, there's a distinct difference in
a fertility waiting room because it's almost like these these
men and women don't want to acknowledge that they're having
these struggles. And even when psychological resources are available and
fertility patients often don't use them. Um. Apple Garth noted
that only about five percent of patients in her clinic
(47:57):
take advantage of the psychological support service. Says, uh that
it offers despite data showing how helpful that it might be.
I mean, we talked a while back now, um about
the kind of that mind body interaction between anxiety, depression
and difficulty getting pregnant as well, and a University of
(48:17):
Michigan studies zeroed in on black women specifically in this
country because they're less likely to seek medical helps, so
their struggles end up overlooked. I mean, this is already
an issue where people aren't talking about it, feel they
can't talk about it, but when when it comes to
African American women, even fewer are vocalizing their struggle. Of
(48:38):
the women that this study talked to reported feeling isolated
and lonely during their efforts to get pregnant, and many
felt that they needed to take on the burden all
by themselves. And it's because of this web of reasons.
It's personal shame that we've talked about, but it's also
cultural barriers like stigma against talking about your personal business
(49:00):
or the expectation that Black women should be strong and
resilient enough to handle their problems on their own. There's
also this feeling that from the women that they talked
to of abnormality for not being able to get pregnant,
and this goes back to what the authors discussed as
the internalization of stereotypes about African American women's hyper fertility
(49:22):
or belief in a black fertility mandate. So a lot
of women of whatever race, age background report feeling pressure
of the motherhood mandate that you're a woman, you should
have babies, have lots of babies, go forth and be
multiply and be fruitful. And this was also the case
for these UH University of Michigan research participants that they
(49:43):
felt like, well, um, you know, I'm a an African
American woman, I'm a black woman. I'm supposed to have
lots of children or that's common in this culture, or
it's expected of me. It should be easy for me
to get pregnant, exactly, And so a lot of them
hold the researchers that infertility is not something that's supposed
(50:04):
to happen to me. It's something that happens to rich
white people who can, you know, pay all this money
to have treatments done well. And speaking of you know,
the the wealth factor, I mean that absolutely is one
of the reasons why women of color are less likely
to seek treatment. But there's also the issue of having
tense relationships with doctors. I mean, this is something that
(50:26):
if you start looking in medical studies about like patient
doctor interactions, Um, things do shift when uh, it is
a white person sitting on the exam table versus people
of color. But regardless of race, women dealing with that
motherhood mandate that you described, Caroline, that every woman should
(50:47):
have kids, or that if you don't have kids then
you're somehow less valuable or a less than woman. Um,
that is a really powerful myth that I think is
really easy for us to believe because it's seen as
just this basic feminine act. It's just something that's inevitable.
(51:07):
You know, we take birth control in order to not
get pregnant. All we're taught a lot of times in
at least American sex education classes is that you know,
if we have sex, then automatically we're going to get pregnant.
So it's no surprise then that we have so many
misconceptions about a how challenging it can be to get pregnant,
and how common infertility is. And I think that this
(51:30):
is part of what should be considered comprehensive sex education,
ongoing sex education. Yeah, and what all this spoils down to,
basically is that this constant shame and overwhelming stigma contributes
to women not talking about their experiences, women and men
not sharing their experiences, which then translates into a lack
(51:53):
of advocacy on a governmental level. I mean, if people
aren't talking about it the same way that they talk
about breast cancer, for instance, there's not as much of
a push for research dollars or for answers and solutions.
Um Barbara Clura, who's the executive director of Resolve, the
National Infertility Association based in Virginia, so as we can
(52:14):
only get a handful of our own volunteers to speak
out because of the shame and because we have some
little patient advocacy, we have so little progress. And I
highly recommend that if you are someone you know struggles
with this issue, you go over to Resolve the website.
It's a very comprehensive resource. It talks about everything from
the actual infertility struggle, to mental health issues to talking
(52:37):
about issues of insurance coverage. Um so it's definitely a
great resource. But this is yet another women's health issue
where we see so much, so much shame and internalization
of of something that your body is doing and or
your partner's body is doing. And we can all benefit
from having a wider, more, a wider and louder conversation
(52:59):
about it. Yeah. Mean, and it's a women's health issue,
but it's also a men's health issue as well. And
I'm glad you mentioned you know, men's silence around it too,
because one of the studies we looked at evaluated the
psychological impacts of infertility for both men and women, and
while women in the study were likelier to experience negative
(53:20):
psychological repercussions, many of the men did as well. So
as with our conversation about say, miscarriage. It's definitely something Um,
I mean, and again we were now talking more in
straight couple of context, but it's still something that men
need to feel more welcome and comfortable talking about as well,
(53:42):
because you know, a third of the time it could
be their bodies which might be causing the issue. But Caroline,
before we wrap up, I did want to ask your
opinion on something that came up in our research about
infertility being considered or a disability, which some think would
(54:03):
be helpful for getting more insurance coverage for infertility treatments.
But when I read that, I my my instinct was
to not entirely agree because it seems like classifying infertility
as a disability only reinforces the idea that it's women's
(54:26):
role and purpose to reproduce. Yeah, I mean, I think
that that's a conversation that literally happens anytime anything is
classified as a disability, because it almost makes it sound
like this defines you, and you know, what your body
does does not define you. Your your more than your body. UM.
(54:47):
That being said, you know someone who doesn't struggle with
these issues. It's it's hard for me to weigh in
other than to say if something is classified a certain
way according to the government. It helps you get insurance coverage.
I see that as a positive. Um it's I think
it's less so in our conversations that we had around
(55:10):
pregnancy and the way that like maternity leave and paid
family leave happens. But as far as language goes, I
think it's a shame that it has to be called
a disability for that very important coverage to happen. Yeah,
I mean, because I just wonder, um and and listeners,
I really hope that some of you can fill us
in on this. I wonder about people who find out
(55:33):
that they are infertile and they're okay with it, and
whether that leads to conflicted feelings as well, because there
is an assumption that if you are inferrald that it
is a shameful and sad tragedy. But I have a
feeling that there there are people who are are totally
fine and live perfectly happy live. So I mean, again,
(55:54):
this is just I mean, I'm just I'm I'm genuinely
curious to hear from people what these experien rances are
because I don't know at all. Um So, listeners, we
definitely want to hear from you on this issue, because again,
this is something that we don't talk about nearly enough.
Mom Stuff at how stuff works dot Com is where
you can email us. You can also tweet us at
(56:15):
Mom's Stuff podcast or messages on Facebook, and we've got
a couple of messages to share with you right now.
I have a letter here from April in response to
our knitting episode. She says. Let me start by saying,
how much to enjoy your podcast. Thank you, April. We
enjoy having you listen. She says, as I was listening
(56:38):
to the podcast on knitting this evening, you mentioned knitting
during the World Wars was propaganda. This could not be
further from the truth. From the Civil War to World
War One and World War Two, the knitting of socks
was very important. Foot rot was a constant battle. Soldiers
could not march and walk long distances without good socks
that helped keep the moisture away. Can you imagine trying
(56:59):
to walk in mill military boots with wet holy socks,
or even without socks altogether. Soldiers had blisters and would
develop infections. Their feet would literally wrought. The knitting of
socks was as important as the recycling of metal or
the rationing of sugar. It was not just a way
to keep the women and children busy or make them
feel like they were part of the war effort. It
was an important part of the war effort. I am
(57:21):
a knitter and a feminist in the age of forty one.
I am currently working on my dissertation for my PhD
in history. My focus is women's history, and my dissertation
is actually focused around women and the crafts that bring
them together, things such as knitting and sewing. I also
am an adjoinct history teacher at a local junior college
and I teach a women's history class I put together.
In this class, we have a section on women and
(57:43):
the war effort, and we talked about knitting as a
big part of the lives of those at home. Thank
you for all the hard work you do. I just
don't think you overlooked this one important thing, So thank
you for filling us in April. Well, I have a
delightful letter here also about our knitting episode, and it's
from Elias, who writes, I'm eighteen years old and I
actually just started listening to your podcast in December. I'm
(58:04):
a big fan of stuff you should know, so I
thought i'd give another house Stuff Works podcast to try.
By the title, I thought I'd learned about all kinds
of interesting secret things my mom never told me. So
I was a bit surprised when it turned out to
be a podcast about feminism, but I'm so glad I
decided to keep listening. While before I only had a
vague understanding of what feminism really means, after just a
(58:25):
handful of episodes, I already feel so much more educated
on the social topic and have a much better grasp
on its scope and importance. Thanks for being such informative,
friendly and charming podcasters. Well, thank you, Elias. And I
think I might be mispronouncing your name, so I apologize
um if I am. But anyway, getting on to knitting,
Elliots wrote, anyway, the real reason I wanted to email
(58:47):
you is because I'm a guy who knows how to knit.
You see, a few summers ago, when I was fourteen,
I went to a family camp with my extended family,
and one day we were surprised to find that the
arts and craft staff would be teaching knitting to anyone
who'd like to learn. Two of my aunts and I
thought it sounded like a fun idea, so We gave
it try, but as you were both saying, it's very
difficult to learn. The steps were so precise and hard
(59:08):
to remember, and I made so many mistakes that my
script first scarf turned out to be more like a
scratchy rainbow shaped cloth. Still, it was fun and a
little addicting, So when I got home, I looked at
the steps on YouTube to really get them down, bought
some fresh yard, and tried again. After a few days,
I finally got it. Now I have an awesome black
and blue scarf as proof of my dedicated work. So
(59:31):
word to everyone, no matter how old or what gender
you are, anyone can love to knit. Well. Thank you
so much for that story and for listening, and thanks
to all of you for your letters. Keep them coming
to mom stuff at how stuffworks dot com and brilling
all of our social media as well as all of
our blogs, videos and podcasts with our sources so you
(59:52):
can learn more about infertility and other topics. Head on
over to stuff Mom Never Told You dot com For
more on this and thousands of other topics. Visit how
staff works dot com.
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