I get that in the West we are generally conceiving at a later stage in life than before, and that this does not improve odds of conception. However, with fertility, just as with so many things, we are individualising the problem. Here too the focus is on age. Just get kids when you're younger! What's the big deal.
Let's set aside that there are deeper sociological reasons on why young people start with kids later in life. We are not giving enough weight to all of the pollutants that we are exposed to in society, and how they affect our bodies, health and lives.
I heard Dr. Shanna Swan talk recently about the effects of hormone disrupting chemicals on (male) infertility. It's dire stuff really.
She was on the podcast promoting a recent Netflix documentary called The Plastic Detox in which they intervene in couple's lifestyles to reduce the amount of plastics and the hormone disrupting chemicals (bisphenols, phthalates, etc) they are exposed to. I highly recommend it.
There's over 70 different hormones in the human body regulating all kinds of biological functions. Fertility is only one aspect but think about the adverse effects these chemicals might be having on body weight, our sleep cycle, blood pressure, stress, libido, etc. We are prescribed drugs for related ailments at record rates. Maybe we should take a step back and treat less and prevent more.
You’re correct. All this talk about when people choose to have kids over-intellectualizes that what is a biological function. My wife and I have three kids. I’m not sure you can say any of them resulted from a rigorous analysis. We had our first in law school as a happy surprise. We theoretically planned our second and third, a six year gap after the first. But that the timing coincided with moving from an apartment to a house. We weren’t thinking about more kids when we moved—we wanted to take advantage of good interest rates. But my wife observed later that the availability of more space for kids probably subconsciously influenced our decision to have more.
When talking about hormone disruption, I think people over-focus on how that affects the ability to have kids. But that overlooks how hormones can change behaviors and desires. I don’t see anyone rebutting the fact that testosterone levels in prime-age men have dropped by half compared to the 1960s. Yet nobody seems to be talking about that as a probable cause in the drop in fertility rates. Even if these men are technically able to have kids if they want. Is it possible that the drop in testosterone levels means that men are less interested in having kids, and perhaps less able to persuade women into doing so?
I don’t have kids. We are mid 40s now so chances are nearly zero. Wife does not even want sex for a few years. I have no idea what the problem is. If you know, please let me know!!!
Oh what amazing advice! Never thought to ask her why!
Seriously: she is really good at evading conversations like that. I have done all I could imagine to get her to actually talk about kids and our non existing intimate relationship. She always either gets angry or silent or changes the topic. Without knowing anything about me, some people are always inclined to believe something is wrong with me, not her. That’s so utterly unfair. I always treated her like a princess, work out and try to be healthy and look good, share all chores and take care of the house. Really if something is wrong with me she has never told me. Like I said I have no idea what to do.
I don't have kids, but I think this might be a generational schism where the default view of older generations is that having kids "is just what you do" without much more thought and younger generations see them as a burden. Obviously, generations of people are not a monolith but I think that holds true generally. You might be right that testerone levels have resulted in a declining birth rate, but you also have to consider methods of birth control that are available to women and how atomized society is at the moment (both sexes can do just fine independently)
There are a lot of variables that are hard to control for.
I think that humans just didn't evolve to want so many kids just for the sake of having them.
It's not like fertility rates just started dropping in the 1960s. TFR in the US 200 years ago was over 7. Wealth and fertility are anti-correlated almost universally, at least at the population level.
Why did people centuries or millennia ago have so many children? Partly economic reasons: they can work your farm, and they can support you when you're old. Partly because sex is great and children are a frequent result of it.
The economic reasons fade as wealth grows, and the connection between sex and having children gets decoupled by technology. That leaves innate desire, which just doesn't seem to be that strong. We don't need to posit some recent drop in innate desire to explain the drop in fertility rates. The historical behavior we see fits just fine with innate desire being constant, and just not that high.
> That leaves innate desire, which just doesn't seem to be that strong. We don't need to posit some recent drop in innate desire to explain the drop in fertility rates. The historical behavior we see fits just fine with innate desire being constant, and just not that high.
It varies from person to person; some of that variation is social/cultural influences, some is life experiences/circumstances, some is just randomness-but very likely it has a genetic component.
If certain alleles predispose one to be more likely to desire to have children, then in a society with strong social pressure to have children and limited availability of contraception, the selective pressure in favour of those alleles is going to be limited; in a society where social pressure to have children is low and contraception is readily available, those alleles will significantly increase the odds of having children, likely resulting in their frequency increasing over time, and maybe even (in the very long-run) a rebound in TFR
"Less able to persuade women into doing so" is crazy. IMO the single biggest factor preventing kids right now in the US and other developed countries is the effects of COVID on the global economy along with the most significant period of global economic uncertainty in at least the 21st century. The amount of energy put into fertility is a waste, and by just enabling everyone to afford children the population problem could be solved. I'm also very afraid that all of these "fertility" companies are on a warpath to designer babies and I fear that could absolutely destroy trust and mutual respect in our society globally.
Your theory is easily disproven by looking at other countries with far more volatile economies than the USA. They almost always have much higher fertility rates no matter how bad their economies are. But don’t feel bad: every single theory people have come up to explain decreasing fertility rates in nearly every country on the planet can be shown to not match reality one way or another. Whoever comes up with an explanation that matches reality is going to get a Nobel Prize.
I'm not convinced the economic argument is correct. Anecdotally, two is by far the most common number of kids among other parents I know. They're all pretty well off so I don't think that's the reason. It's definitely not COVID as their kids are some years too old for that. Nor do I think it's age or infertility, as they had plenty of time and there's no wistful talk about wishing they could have another one. As far as I can tell, they stopped at 2 because they wanted to.
I don't know why you think that would be better than using AI? I asked a specific question and got a detailed answer which (e.g.) differentiated between biological fecundity and achieved fertility.
Many of my friends have gone through IVF and still I was surprised by some weird parts of the story.
For example: "I was stabbed with 932 needles" and when you tap you find out "because I wanted to improve my odds, I went to 31 acupuncture appointments, where 687 needles pierced my underbelly, legs and head".
It is clearly established that acupuncture is placebo, but beyond whether this placebo might actually improve the odds (highly disputed), it is an elective alternative procedure with unclear benefit, not part of a standard IVF journey.
I understand the story is a very personal one, but it would be good to remember it isn't necessarily representative of most people's experience.
It might very well be placebo but it helped me deeply and I can see why women that want to give it their all would try it (and that's why I don't begrudge her counting those jabs).
If it helps anyone - my first cycle was without acupuncture and I barely got 4 eggs out of it. I underwent acupuncture for 3 months before my second cycle and that got me 12 eggs.
When each cycle costs about 30k USD, a lot of women with low amh, egg quality or ovarian reserve would try anything to help tweak the odds!
The "try anything to help" argument drives me batty. How do you know acupuncture doesn't hurt your odds? For every quack treatment somebody is trying to sell you, we could come up with a million other quack treatments (rub cat fur in your eyes twice daily to improve ovulation) that you're not trying. Random unproven nonsense is as likely to hurt as it is to help. Actually, given that it's so much easier to disrupt systems than it is to improve them, random unproven nonsense is far more likely to hurt than it is to help.
Yeah, they are preying on people who a vulnerable and going through a difficult phase...
And always this sentence: I know someone who this worked with! You can always find someone where something "worked". Started smoking? Bet you find someone where it worked.. started drinking alcohol? Bet you find someone where it worked... Etc.
The total number might be a little out there due to her non-medical treatments, but the general sentiment is accurate for IVF. My wife filled up an entire sharps box with the injections she needed to take and that was with success on the first try of the first round (which is very rare).
As someone who is a bit squeamish around needles, I don't know if I could have done what she did.
> that was with success on the first try of the first round (which is very rare).
This very much depends on the patient history (age, cause of infertility, …) and the clinic. Live births per intended retrieval can vary from 10%-60% conditional on the above.
In our case, it was suggested that the first transfer of the first cycle had a 15% chance of success. Whether that's "very rare" is perhaps a matter of perspective. It was low enough we assumed it would be a failure and we were surprised when it succeeded, but to a doctor it's a frequent occurrence.
Actually acupuncture has some studied physiological effects. One is nervous system mediated via the release of endorphins and then a later regulatory rebound which can have an anti inflammatory effect. I think low dose naltrexone has a somewhat similar method of action. I might have the details a bit off but the studies definitely exist if you want to research it. There are even some compounds in coffee (some of the bitter compounds not the caffeine) that have a very mild effect that works in a similar way.
Personally I’m not a fan of acupuncture and I suspect any nervous system benefits from acupuncture would be far outweighed from those of regular exercise. But maybe for people with chronic pain or other issues it could be useful.
For a multiple IVF treatment case (a fancy hospital might have 40% cycle to birth rate remember) it would not be unusual to have ~100 actual injections.
In yet another great cosmic irony, one of the things that is notorious for making it difficult for a woman to get pregnant is the stress of trying to get pregnant.
Placebo or not, anything which reduces the stress of the mother-to-be can be extremely helpful.
Maybe countries could tackle such problems twofold:
- first, implement a nationwide social freezing program, where women in their 20s are offered to freeze their eggs at a young age for free. Such a large-scale program would probably also improve the tech and might make egg collection less intrusive.
- combined with this program, let the women who freeze their eggs opt-in into an egg donation program, where some of their eggs can be used by women with fertility problems
But as with many things fertility, seems that modern states simply do not have the capacity to seriously try anything. Who knows why that is.
They might also look to Israel to see what they're doing that's working so much better than other OECD countries - see my other comment in this post.
But Israel's advantage seems to be partly cultural and I don't see any time-limited elected government willing to expend that much effort to change their nation's culture.
The cure for this is spending an afternoon volunteering in a kindergarden.
> There were the 7 a.m. doctor’s appointments before work; the dozens of days working from home in order to take all my medications; and the many times I reshuffled my travel plans.
Yes I mean just wait until you have kids. It's gonna get tougher.
This is a very well-done piece in a good cause, but it would have been nice for the author to acknowledge the very obvious inspiration from Monument Valley - https://www.monumentvalleygame.com/mv1 - particularly given they're asking for tips.
Sounds like it might have been added later but it's in the credits now
>The idea for parallel paths and the illustration style developed independently, but the team did take inspiration for the isometric world and user experience mechanics from the game Monument Valley once made aware. If you enjoyed this format, give Monument Valley a play through the Apple or Android app stores.
How far back do you want to take this? Like why aren't they giving credit to the person who invented the pen? C'mon, this is a much more direct copy of Monument Valley than Escher.
Monument Valley is a copy of Escher so I’m not sure your point. Or maybe it’s an order thing? Then Monument Valley is a copy of the Escher scenes from the movie Labyrinth or maybe it’s a copy of a-ha’s Take me on music video?
Super cool site design, I'll have to go back and look at all the other stories.
I didn't realize IVF was such a brutal process. 932 needles sounds like insanity, not to mention everything else. I'll carry a lot more compassion for those going through IVF going forward, and a lot more excitement for those able to concieve naturally.
Really beautiful and as others said really heartbreaking how hard it’s been for her.
One thing I’ve thought a lot about as I’ve gone through a similar experience is that a generation ago infertility still happened a lot and was a thing many couples just had to accept. I am wishing all the best for the author
pudding.cool articles are very neat, but the ergonomics of this particular article is really bad. It's been a long day, my wrists and fingers are tired, and i cant be bothered to fight to scroll down.
Beautiful but heart breaking website. I genuinely hope the author will be successful in starting a family.
My partner and I are currently going through a surrogacy process, and it's been a brutal multi year project that has had numerous setbacks. At this point we are just white knuckling our way forward.
I'm glad we as a society have these options available for those that need them, but man is it hard going through these processes.
This is a beautifully designed website. But I also think it's quite... problematic that the child's journey begins with the egg, as if the unfertilized egg is the child — and skips any mention of the sperm and the father.
It feels like this site is almost erasing the father from the IVF process.
I am a husband in an infertile pair which even needs surrogacy, so it is a horrendous journey. We've had 6 unsuccessful transfers so far - on average less than 1 a year (we have been trying since 2019), mostly on behalf of the surrogate mothers deciding to skedaddle randomly during the process. Although Covid didn't help either.
My wife regularly observes that this hell of a journey looks more taxing on me than her. Which is probably true.
This process is hard on the fathers-to-be as well. We do exist, we want to have kids, we are heartbroken each time as well. We also have to be careful not to hurt our wives' feelings when expressing our grief and sorrow.
Amen! As so often in western society, men have no value at best, and are horrible monsters at worst. No one cares about the male part in these situations, which is a shame. But carry on, I will pray that you will succeed!
Another good look at what IVF is really like, albeit with a really dark tinge that is not likely true in the vast majority of cases, is The Retrievals[0]. I recommend the podcast version.
What I find most incredible about it is the number of women who experienced immensely painful procedures while conscious multiple times, and went back again and again, in order to have a child. And few of them, if any, regret it.
It is simultaneously one of the most impressive feats of modern science, and one of the most unfair burdens put on any section of the populace, that they were able to, and had to.
There's many reasons why this piece wasn't made for me, so I don't want to begrudge anyone, but I wonder how much we can do to alieve this as a society by normalizing childlessness. I never wanted to have kids, but if I did, I doubt I would've been willing to endure what the author did for it. You can (and honestly I think most people should) live a long and fulfilling life without having kids. Myself and so many of my peers were raised in households that really were not good places for children. I'm of course grateful to exist and indebted to my mother for her countless sacrifices, but it pains me to think about how much happier she might have been if she didn't feel compelled to become a mother. I hope someday having children becomes the exception rather than the norm, because it doesn't feel like something that should be taken lightly. I hope that finding out you're infertile can be met with "Oh, okay. I guess I'll do something else then," the same way that folks with imperfect vision can't be pilots or astronauts and those with tremors can't be surgeons. I'm glad IVF is available for people who want to pursue it, I just want to live in a world where no one has kids "by default" without truly accepting the toll it will take.
Another quick thought - so long as we live in a world where children in need of adoption exist, I hope we can make adopting more normal too. If you're in a position to become a parent, why on Earth would adoption not be the default? It seems much better for everyone involved. The fixation on breeding and having children whose genetics perfectly match your own is strange and mildly alarming to me.
Adoption is incredibly, incredibly hard. Especially in Western countries, there are actually more people who want to adopt than there are kids to adopt. When you add in overseas adoption, it gets even harder and more expensive.
In short, adoption is incredibly expensive, stressful, and not a sure thing.
> hope someday having children becomes the exception rather than the norm, because it doesn't feel like something that should be taken lightly.
Doesn't this seem extremely selfish?
The fewer mothers there are, the more children each mother will have to give birth to.
If one in two women decide to become mothers, then each mother needs to have four children. If one in four become mothers, then it means each mother needs to give birth to eight children.
Since you are depending on those children to work for you during retirement, you're essentially leeching off other people's children.
No wonder mothers no longer think they are sacrificing themselves for their children, but rather for a capitalist machine that requires more bodies.
I've commented on this before, I do agree with some of the other sentiments that we are individualizing the problem. It's up-to each person (or couple) to navigate it themselves. For example, in Canada, the federal government announced a tax credit (up to 25%) for spending related to fertility treatments. For my partner and I, it took a professional accountant (with related costs) to navigate that system.
IVF and IUI (and now, IVM) treatment cycles are largely handled by private clinics that receive funding from provincial governments and, by extension, federal. Even with first-class health insurance, from employers, and government grants (paid to the doctors) there are out-of-pocket costs (ex., vitamins, supplements, missed work time, medications, genetic testing, sperm washing...). In our case, after multiple years, our health insurance coverage has dried-up (~30,000 CAD) and our lifetime grant eligibility for IVF (one treatment cycle) has finished. We could have easily exhausted our financial resources, (ex., investments, pensions, re-mortgage, lines-of-credit...), but with less chance to conceive daily, it's a race of diminishing biology. The opportunity to conceive a healthy child has been erased by time.
This added to the emotional and social costs of not being able to have a child. In my field, I find colleagues to be judgmental of working adults without children. As if having a child of your own gives you this magical insight into working with children that childless adults do not posses. I've started answered the question: "Do you have kids?" by saying, "Not by my own choice." This hopefully communicates that I've tried, but at a certain point a decision had to be made about whether to continue.
My spouse has taken all of the physical toll of the treatments. The male's job is to provide a sample, see their doctor, and sign the paperwork. By contrast, my wife has had early morning or lunchtime appointments (in an effort to not miss work) 3-4 times per week during certain monitoring or pre-proceedure periods. She has been subjected to blood testing, hormone therapy, daily injections, invasive ultrasounds, bruising, repeated pharmacy trips. All this in addition to phone-calls to remind staff at our clinic what the doctor recommended or asking the clinic reception for confirmation of a certain prescription or guideline. Of course, she undertook all of these responsibilities while internalizing the trauma of our familial reality.
My partner is strong, resilient, and beautiful. I owe her more grace and more appreciation than I can ever give.
My daily reminder to myself is to remember that my partner are I are already a family. Our commitment to one another has not changed. Although our lives may look differently then we may have imagined, it will not be any less meaningful.
I should add that we do not actually know whether or not we could have conceived naturally with better odds 5, 10, or 15 year ago. At this point in our testing and treatments, the doctors cannot tell us with any certainty why we are having trouble conceiving. They can only speculate and give their professional opinions based on completed trials of studies and previous research in the field of infertility.
Of course, each person and couple is different and the reasoning behind the difficulty of a successful implantation will differ.
A few reasons I can think of, having been through IVF twice now:
- Capability. Many couples are perfectly capable of carrying a pregnancy, they’re just having trouble conceiving.
- Cost. Surrogacy in a lot of countries is very expensive compared to IVF. Where I live in the UK, IVF is free on the NHS, or ~£8,000-£10,000 a round privately. Surrogacy can be £20,000 to £100,000 (or more), depending on the arrangement.
- Legal issues. In the UK, for example, the surrogate mother is the legal mother of the child at birth.
- Availability. Finding a surrogate can be very hard, especially in countries where commercial surrogacy is illegal. People go use surrogates abroad instead, which has its own range of issues (read up on orphaned surrogate kids in Ukraine).
- Ethical barriers. Using a surrogate involves issues of bodily autonomy. You can’t stop your surrogate smoking or drinking while pregnant, for example.
- Emotional barriers. Emotionally, motherhood starts at conception. Most mothers do not want to skip those 9 months of bonding they have with their baby prior to it being born.
On a related note, this is becoming a more common issue worldwide. Almost every country, even developing ones, are experiencing below replenishment birthrates. Only a few countries are spared in Central Africa, though not sure how long that will last.
A click-bait article I read mentioned that Israel's culture is more child-rearing friendly than others, like the United States, where kid-friendly gathering places are not encouraged.
the article at https://www.taubcenter.org.il/en/research/why-are-there-so-m... mentions several possible reasons for the increased fertility, at least compared to OECD countries - Israel's birth rate is similar to its neighbours, Egypt and Syria, according to the article.
I get that in the West we are generally conceiving at a later stage in life than before, and that this does not improve odds of conception. However, with fertility, just as with so many things, we are individualising the problem. Here too the focus is on age. Just get kids when you're younger! What's the big deal.
Let's set aside that there are deeper sociological reasons on why young people start with kids later in life. We are not giving enough weight to all of the pollutants that we are exposed to in society, and how they affect our bodies, health and lives.
I heard Dr. Shanna Swan talk recently about the effects of hormone disrupting chemicals on (male) infertility. It's dire stuff really.
She was on the podcast promoting a recent Netflix documentary called The Plastic Detox in which they intervene in couple's lifestyles to reduce the amount of plastics and the hormone disrupting chemicals (bisphenols, phthalates, etc) they are exposed to. I highly recommend it.
There's over 70 different hormones in the human body regulating all kinds of biological functions. Fertility is only one aspect but think about the adverse effects these chemicals might be having on body weight, our sleep cycle, blood pressure, stress, libido, etc. We are prescribed drugs for related ailments at record rates. Maybe we should take a step back and treat less and prevent more.
You’re correct. All this talk about when people choose to have kids over-intellectualizes that what is a biological function. My wife and I have three kids. I’m not sure you can say any of them resulted from a rigorous analysis. We had our first in law school as a happy surprise. We theoretically planned our second and third, a six year gap after the first. But that the timing coincided with moving from an apartment to a house. We weren’t thinking about more kids when we moved—we wanted to take advantage of good interest rates. But my wife observed later that the availability of more space for kids probably subconsciously influenced our decision to have more.
When talking about hormone disruption, I think people over-focus on how that affects the ability to have kids. But that overlooks how hormones can change behaviors and desires. I don’t see anyone rebutting the fact that testosterone levels in prime-age men have dropped by half compared to the 1960s. Yet nobody seems to be talking about that as a probable cause in the drop in fertility rates. Even if these men are technically able to have kids if they want. Is it possible that the drop in testosterone levels means that men are less interested in having kids, and perhaps less able to persuade women into doing so?
I don’t have kids. We are mid 40s now so chances are nearly zero. Wife does not even want sex for a few years. I have no idea what the problem is. If you know, please let me know!!!
> Wife does not even want sex for a few years. I have no idea what the problem is. If you know, please let me know!!!
Have you talked to her about what the problem is? It doesn’t sound like you have. In which case, that almost certainly is at least part of the problem
Oh what amazing advice! Never thought to ask her why!
Seriously: she is really good at evading conversations like that. I have done all I could imagine to get her to actually talk about kids and our non existing intimate relationship. She always either gets angry or silent or changes the topic. Without knowing anything about me, some people are always inclined to believe something is wrong with me, not her. That’s so utterly unfair. I always treated her like a princess, work out and try to be healthy and look good, share all chores and take care of the house. Really if something is wrong with me she has never told me. Like I said I have no idea what to do.
You don’t sound happy. If you don’t have kids, why stay together?
I don't have kids, but I think this might be a generational schism where the default view of older generations is that having kids "is just what you do" without much more thought and younger generations see them as a burden. Obviously, generations of people are not a monolith but I think that holds true generally. You might be right that testerone levels have resulted in a declining birth rate, but you also have to consider methods of birth control that are available to women and how atomized society is at the moment (both sexes can do just fine independently)
There are a lot of variables that are hard to control for.
I think that humans just didn't evolve to want so many kids just for the sake of having them.
It's not like fertility rates just started dropping in the 1960s. TFR in the US 200 years ago was over 7. Wealth and fertility are anti-correlated almost universally, at least at the population level.
Why did people centuries or millennia ago have so many children? Partly economic reasons: they can work your farm, and they can support you when you're old. Partly because sex is great and children are a frequent result of it.
The economic reasons fade as wealth grows, and the connection between sex and having children gets decoupled by technology. That leaves innate desire, which just doesn't seem to be that strong. We don't need to posit some recent drop in innate desire to explain the drop in fertility rates. The historical behavior we see fits just fine with innate desire being constant, and just not that high.
> That leaves innate desire, which just doesn't seem to be that strong. We don't need to posit some recent drop in innate desire to explain the drop in fertility rates. The historical behavior we see fits just fine with innate desire being constant, and just not that high.
It varies from person to person; some of that variation is social/cultural influences, some is life experiences/circumstances, some is just randomness-but very likely it has a genetic component.
If certain alleles predispose one to be more likely to desire to have children, then in a society with strong social pressure to have children and limited availability of contraception, the selective pressure in favour of those alleles is going to be limited; in a society where social pressure to have children is low and contraception is readily available, those alleles will significantly increase the odds of having children, likely resulting in their frequency increasing over time, and maybe even (in the very long-run) a rebound in TFR
"Less able to persuade women into doing so" is crazy. IMO the single biggest factor preventing kids right now in the US and other developed countries is the effects of COVID on the global economy along with the most significant period of global economic uncertainty in at least the 21st century. The amount of energy put into fertility is a waste, and by just enabling everyone to afford children the population problem could be solved. I'm also very afraid that all of these "fertility" companies are on a warpath to designer babies and I fear that could absolutely destroy trust and mutual respect in our society globally.
Your theory is easily disproven by looking at other countries with far more volatile economies than the USA. They almost always have much higher fertility rates no matter how bad their economies are. But don’t feel bad: every single theory people have come up to explain decreasing fertility rates in nearly every country on the planet can be shown to not match reality one way or another. Whoever comes up with an explanation that matches reality is going to get a Nobel Prize.
I'm not convinced the economic argument is correct. Anecdotally, two is by far the most common number of kids among other parents I know. They're all pretty well off so I don't think that's the reason. It's definitely not COVID as their kids are some years too old for that. Nor do I think it's age or infertility, as they had plenty of time and there's no wistful talk about wishing they could have another one. As far as I can tell, they stopped at 2 because they wanted to.
[dead]
The biggest fertility distributor is probably sugar by a country mile. Being fat screws with your hormones.
[flagged]
Don't post generated comments or AI-edited comments. HN is for conversation between humans.
From https://news.ycombinator.com/newsguidelines.html
Why don't you just Google "fertility microplastic", read a bit and then decide for yourself
I don't know why you think that would be better than using AI? I asked a specific question and got a detailed answer which (e.g.) differentiated between biological fecundity and achieved fertility.
does your language model cite sources, or generate them too?
Yes it does. I looked at several of the individual sources. If you want, I can post a link to the full response.
The website is great!
Many of my friends have gone through IVF and still I was surprised by some weird parts of the story.
For example: "I was stabbed with 932 needles" and when you tap you find out "because I wanted to improve my odds, I went to 31 acupuncture appointments, where 687 needles pierced my underbelly, legs and head".
It is clearly established that acupuncture is placebo, but beyond whether this placebo might actually improve the odds (highly disputed), it is an elective alternative procedure with unclear benefit, not part of a standard IVF journey.
I understand the story is a very personal one, but it would be good to remember it isn't necessarily representative of most people's experience.
It might very well be placebo but it helped me deeply and I can see why women that want to give it their all would try it (and that's why I don't begrudge her counting those jabs). If it helps anyone - my first cycle was without acupuncture and I barely got 4 eggs out of it. I underwent acupuncture for 3 months before my second cycle and that got me 12 eggs.
When each cycle costs about 30k USD, a lot of women with low amh, egg quality or ovarian reserve would try anything to help tweak the odds!
Yeah, including weird teas, minerals, oils etc etc.
Source: my wife, every YouTube video was with something new which "totally" change your odds. Pinky promise.
God, how I hate those people.
The "try anything to help" argument drives me batty. How do you know acupuncture doesn't hurt your odds? For every quack treatment somebody is trying to sell you, we could come up with a million other quack treatments (rub cat fur in your eyes twice daily to improve ovulation) that you're not trying. Random unproven nonsense is as likely to hurt as it is to help. Actually, given that it's so much easier to disrupt systems than it is to improve them, random unproven nonsense is far more likely to hurt than it is to help.
Yeah, they are preying on people who a vulnerable and going through a difficult phase...
And always this sentence: I know someone who this worked with! You can always find someone where something "worked". Started smoking? Bet you find someone where it worked.. started drinking alcohol? Bet you find someone where it worked... Etc.
Mfer.
Excuse my English
The total number might be a little out there due to her non-medical treatments, but the general sentiment is accurate for IVF. My wife filled up an entire sharps box with the injections she needed to take and that was with success on the first try of the first round (which is very rare).
As someone who is a bit squeamish around needles, I don't know if I could have done what she did.
> that was with success on the first try of the first round (which is very rare).
This very much depends on the patient history (age, cause of infertility, …) and the clinic. Live births per intended retrieval can vary from 10%-60% conditional on the above.
In our case, it was suggested that the first transfer of the first cycle had a 15% chance of success. Whether that's "very rare" is perhaps a matter of perspective. It was low enough we assumed it would be a failure and we were surprised when it succeeded, but to a doctor it's a frequent occurrence.
Actually acupuncture has some studied physiological effects. One is nervous system mediated via the release of endorphins and then a later regulatory rebound which can have an anti inflammatory effect. I think low dose naltrexone has a somewhat similar method of action. I might have the details a bit off but the studies definitely exist if you want to research it. There are even some compounds in coffee (some of the bitter compounds not the caffeine) that have a very mild effect that works in a similar way.
Personally I’m not a fan of acupuncture and I suspect any nervous system benefits from acupuncture would be far outweighed from those of regular exercise. But maybe for people with chronic pain or other issues it could be useful.
For a multiple IVF treatment case (a fancy hospital might have 40% cycle to birth rate remember) it would not be unusual to have ~100 actual injections.
In yet another great cosmic irony, one of the things that is notorious for making it difficult for a woman to get pregnant is the stress of trying to get pregnant.
Placebo or not, anything which reduces the stress of the mother-to-be can be extremely helpful.
Maybe countries could tackle such problems twofold:
- first, implement a nationwide social freezing program, where women in their 20s are offered to freeze their eggs at a young age for free. Such a large-scale program would probably also improve the tech and might make egg collection less intrusive.
- combined with this program, let the women who freeze their eggs opt-in into an egg donation program, where some of their eggs can be used by women with fertility problems
But as with many things fertility, seems that modern states simply do not have the capacity to seriously try anything. Who knows why that is.
They might also look to Israel to see what they're doing that's working so much better than other OECD countries - see my other comment in this post.
But Israel's advantage seems to be partly cultural and I don't see any time-limited elected government willing to expend that much effort to change their nation's culture.
Didn't you see the amount of injections you need for IVF?
Now you're suggesting every young and healthy woman should get these injections and have eggs scraped out of her ovaries?
This honestly feels so backwards. Create a broken society and then fix it in post with med tech.
The cure for this is spending an afternoon volunteering in a kindergarden.
> There were the 7 a.m. doctor’s appointments before work; the dozens of days working from home in order to take all my medications; and the many times I reshuffled my travel plans.
Yes I mean just wait until you have kids. It's gonna get tougher.
This is a very well-done piece in a good cause, but it would have been nice for the author to acknowledge the very obvious inspiration from Monument Valley - https://www.monumentvalleygame.com/mv1 - particularly given they're asking for tips.
Sounds like it might have been added later but it's in the credits now
>The idea for parallel paths and the illustration style developed independently, but the team did take inspiration for the isometric world and user experience mechanics from the game Monument Valley once made aware. If you enjoyed this format, give Monument Valley a play through the Apple or Android app stores.
Is there more to the inspiration than "3d isometric with a lot of staircases"?
More like MC Escher, Monument Valley isn’t an original idea.
How far back do you want to take this? Like why aren't they giving credit to the person who invented the pen? C'mon, this is a much more direct copy of Monument Valley than Escher.
Monument Valley is a copy of Escher so I’m not sure your point. Or maybe it’s an order thing? Then Monument Valley is a copy of the Escher scenes from the movie Labyrinth or maybe it’s a copy of a-ha’s Take me on music video?
Super cool site design, I'll have to go back and look at all the other stories.
I didn't realize IVF was such a brutal process. 932 needles sounds like insanity, not to mention everything else. I'll carry a lot more compassion for those going through IVF going forward, and a lot more excitement for those able to concieve naturally.
687 of those are acupuncture, a form of alternative medicine. So it might help on a psychological level, but certainly not a requirement for IVF.
That said, 245 is still a big number. 79 blood samples and 166 hormone injections.
Really beautiful and as others said really heartbreaking how hard it’s been for her. One thing I’ve thought a lot about as I’ve gone through a similar experience is that a generation ago infertility still happened a lot and was a thing many couples just had to accept. I am wishing all the best for the author
pudding.cool articles are very neat, but the ergonomics of this particular article is really bad. It's been a long day, my wrists and fingers are tired, and i cant be bothered to fight to scroll down.
Beautiful but heart breaking website. I genuinely hope the author will be successful in starting a family.
My partner and I are currently going through a surrogacy process, and it's been a brutal multi year project that has had numerous setbacks. At this point we are just white knuckling our way forward.
I'm glad we as a society have these options available for those that need them, but man is it hard going through these processes.
The website looks like copied from Monument Valley games
This is a beautifully designed website. But I also think it's quite... problematic that the child's journey begins with the egg, as if the unfertilized egg is the child — and skips any mention of the sperm and the father.
It feels like this site is almost erasing the father from the IVF process.
Perhaps it was a sperm donor? There doesn’t necessarily have to be a traditional father.
I am a husband in an infertile pair which even needs surrogacy, so it is a horrendous journey. We've had 6 unsuccessful transfers so far - on average less than 1 a year (we have been trying since 2019), mostly on behalf of the surrogate mothers deciding to skedaddle randomly during the process. Although Covid didn't help either.
My wife regularly observes that this hell of a journey looks more taxing on me than her. Which is probably true.
This process is hard on the fathers-to-be as well. We do exist, we want to have kids, we are heartbroken each time as well. We also have to be careful not to hurt our wives' feelings when expressing our grief and sorrow.
Amen! As so often in western society, men have no value at best, and are horrible monsters at worst. No one cares about the male part in these situations, which is a shame. But carry on, I will pray that you will succeed!
Another good look at what IVF is really like, albeit with a really dark tinge that is not likely true in the vast majority of cases, is The Retrievals[0]. I recommend the podcast version.
What I find most incredible about it is the number of women who experienced immensely painful procedures while conscious multiple times, and went back again and again, in order to have a child. And few of them, if any, regret it.
It is simultaneously one of the most impressive feats of modern science, and one of the most unfair burdens put on any section of the populace, that they were able to, and had to.
[0] https://www.nytimes.com/column/the-retrievals
There's many reasons why this piece wasn't made for me, so I don't want to begrudge anyone, but I wonder how much we can do to alieve this as a society by normalizing childlessness. I never wanted to have kids, but if I did, I doubt I would've been willing to endure what the author did for it. You can (and honestly I think most people should) live a long and fulfilling life without having kids. Myself and so many of my peers were raised in households that really were not good places for children. I'm of course grateful to exist and indebted to my mother for her countless sacrifices, but it pains me to think about how much happier she might have been if she didn't feel compelled to become a mother. I hope someday having children becomes the exception rather than the norm, because it doesn't feel like something that should be taken lightly. I hope that finding out you're infertile can be met with "Oh, okay. I guess I'll do something else then," the same way that folks with imperfect vision can't be pilots or astronauts and those with tremors can't be surgeons. I'm glad IVF is available for people who want to pursue it, I just want to live in a world where no one has kids "by default" without truly accepting the toll it will take.
Another quick thought - so long as we live in a world where children in need of adoption exist, I hope we can make adopting more normal too. If you're in a position to become a parent, why on Earth would adoption not be the default? It seems much better for everyone involved. The fixation on breeding and having children whose genetics perfectly match your own is strange and mildly alarming to me.
Adoption is incredibly, incredibly hard. Especially in Western countries, there are actually more people who want to adopt than there are kids to adopt. When you add in overseas adoption, it gets even harder and more expensive.
In short, adoption is incredibly expensive, stressful, and not a sure thing.
> hope someday having children becomes the exception rather than the norm, because it doesn't feel like something that should be taken lightly.
Doesn't this seem extremely selfish?
The fewer mothers there are, the more children each mother will have to give birth to.
If one in two women decide to become mothers, then each mother needs to have four children. If one in four become mothers, then it means each mother needs to give birth to eight children.
Since you are depending on those children to work for you during retirement, you're essentially leeching off other people's children.
No wonder mothers no longer think they are sacrificing themselves for their children, but rather for a capitalist machine that requires more bodies.
Your hope is deeply dysfunctional.
I've commented on this before, I do agree with some of the other sentiments that we are individualizing the problem. It's up-to each person (or couple) to navigate it themselves. For example, in Canada, the federal government announced a tax credit (up to 25%) for spending related to fertility treatments. For my partner and I, it took a professional accountant (with related costs) to navigate that system.
IVF and IUI (and now, IVM) treatment cycles are largely handled by private clinics that receive funding from provincial governments and, by extension, federal. Even with first-class health insurance, from employers, and government grants (paid to the doctors) there are out-of-pocket costs (ex., vitamins, supplements, missed work time, medications, genetic testing, sperm washing...). In our case, after multiple years, our health insurance coverage has dried-up (~30,000 CAD) and our lifetime grant eligibility for IVF (one treatment cycle) has finished. We could have easily exhausted our financial resources, (ex., investments, pensions, re-mortgage, lines-of-credit...), but with less chance to conceive daily, it's a race of diminishing biology. The opportunity to conceive a healthy child has been erased by time.
This added to the emotional and social costs of not being able to have a child. In my field, I find colleagues to be judgmental of working adults without children. As if having a child of your own gives you this magical insight into working with children that childless adults do not posses. I've started answered the question: "Do you have kids?" by saying, "Not by my own choice." This hopefully communicates that I've tried, but at a certain point a decision had to be made about whether to continue.
My spouse has taken all of the physical toll of the treatments. The male's job is to provide a sample, see their doctor, and sign the paperwork. By contrast, my wife has had early morning or lunchtime appointments (in an effort to not miss work) 3-4 times per week during certain monitoring or pre-proceedure periods. She has been subjected to blood testing, hormone therapy, daily injections, invasive ultrasounds, bruising, repeated pharmacy trips. All this in addition to phone-calls to remind staff at our clinic what the doctor recommended or asking the clinic reception for confirmation of a certain prescription or guideline. Of course, she undertook all of these responsibilities while internalizing the trauma of our familial reality.
My partner is strong, resilient, and beautiful. I owe her more grace and more appreciation than I can ever give.
My daily reminder to myself is to remember that my partner are I are already a family. Our commitment to one another has not changed. Although our lives may look differently then we may have imagined, it will not be any less meaningful.
I should add that we do not actually know whether or not we could have conceived naturally with better odds 5, 10, or 15 year ago. At this point in our testing and treatments, the doctors cannot tell us with any certainty why we are having trouble conceiving. They can only speculate and give their professional opinions based on completed trials of studies and previous research in the field of infertility.
Of course, each person and couple is different and the reasoning behind the difficulty of a successful implantation will differ.
As someone with 6 kids:
Dont have any kids. They reduce your freedom. I need to emphasize this.
To be fair, once I stopped having freedom, we went hard obviously.
If you already have 1, might as well go wild.
Why not just use a surrogate instead? That's what every one of my friends who faced infertility, did.
A few reasons I can think of, having been through IVF twice now:
- Capability. Many couples are perfectly capable of carrying a pregnancy, they’re just having trouble conceiving.
- Cost. Surrogacy in a lot of countries is very expensive compared to IVF. Where I live in the UK, IVF is free on the NHS, or ~£8,000-£10,000 a round privately. Surrogacy can be £20,000 to £100,000 (or more), depending on the arrangement.
- Legal issues. In the UK, for example, the surrogate mother is the legal mother of the child at birth.
- Availability. Finding a surrogate can be very hard, especially in countries where commercial surrogacy is illegal. People go use surrogates abroad instead, which has its own range of issues (read up on orphaned surrogate kids in Ukraine).
- Ethical barriers. Using a surrogate involves issues of bodily autonomy. You can’t stop your surrogate smoking or drinking while pregnant, for example.
- Emotional barriers. Emotionally, motherhood starts at conception. Most mothers do not want to skip those 9 months of bonding they have with their baby prior to it being born.
On a related note, this is becoming a more common issue worldwide. Almost every country, even developing ones, are experiencing below replenishment birthrates. Only a few countries are spared in Central Africa, though not sure how long that will last.
https://www.imf.org/en/publications/fandd/issues/series/anal...
https://www.ssa.gov/policy/docs/ssb/v66n4/v66n4p37.html
https://www.newsweek.com/americas-population-time-bomb-18987...
IVF is also no longer something that's only for older women. Younger couples from both sexes are starting to need it.
https://tulipivf.com/news/detail/397
https://thehill.com/opinion/healthcare/4727738-people-need-i...
You don't mention the outlier - Israel stands out in the OECD fertility rate race - 2.89 in 2023 (if I'm reading https://www.oecd.org/en/data/indicators/fertility-rates.html correctly) while the next highest is France at 1.91.
A click-bait article I read mentioned that Israel's culture is more child-rearing friendly than others, like the United States, where kid-friendly gathering places are not encouraged.
the article at https://www.taubcenter.org.il/en/research/why-are-there-so-m... mentions several possible reasons for the increased fertility, at least compared to OECD countries - Israel's birth rate is similar to its neighbours, Egypt and Syria, according to the article.
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