The History – and Future – of Infertility

At the recent Fertility Show Africa, Dr Mandy Rodriques, resident clinical psychologist at Medfem Fertility Clinic with 25 years of experience in field of infertility, provided an insightful look at the history of infertility and how the modern world is shaping its future.

As far back as the ancient Greek and Egyptian societies, documented evidence has been found showing that infertility was treated as an illness back then. Unfortunately, in those times, the condition of infertility was called “fruitless womb” and it was presumed to be exclusively a woman’s burden to bear, and was also a societal taboo.

Centuries later in the 18th century, the first indications of an understanding of the link between stress and infertility began to appear. In those days, women were encouraged to “take the water” which meant visiting certain spa towns where they could get into the healing waters and, in effect, relax, so they would fall pregnant.

Later, in the mid-20th century, adoption became regarded as a potential cure for infertility.

So, in some ways, not much has changed!

Infertility is still regarded as a social taboo in many societies, and few couples publicly discuss their fertility challenges. Many couples also share that their silence regarding their fertility challenges is due to receiving advice from family and friends such as “just relax and you will fall pregnant”.

Similarly, infertility is still widely regarded as “women’s problem” and people are often surprised to hear that only in 30% of infertility cases the cause of the infertility lies only with the female partner. In the other 60% of cases, the cause of the fertility is either due to the male partner, or due to factors affecting both partners.

We also still hear stories about many women who are unable to fall pregnant, until they adopt a child – and then they fall pregnant without hassle, perpetuating the idea that adoption can restore fertility.

In other ways, things have changed a great deal.

One clear trend is the how the values of having a child have changed over the years – progressing from plain economic reasons to the “softer” values that are more common these days.

Prior to the Industrial Revolution and during the industrial era, women were basically having children for economic reasons, meaning the more children you had, the more income you could generate by sending them out to work.

Thankfully, as we progressed into the modern world, the values of having children have become more abstract, including concepts like nurturing, companionship and family.

Another change that is clearly evident over time is the substantial drop in the number of children per family. In the 1800s, the number was around six children per family, but by the time we reached the 21st century, it had plummeted to between one and two children per family.

This was not only due to societal influences, but also lifestyle changes.

It was in the 1960s that oral contraceptives were legalized in the USA and this spread around the world over the ensuing years. Sometime later, abortions were also legalized in increasing numbers of countries. All of these changes allowed women to take more control of their own fertility.

The effect of birth rates was further compounded by the societal changes that took place at the same time, including more women pursuing educational opportunities such as post-matric studies and postgraduate studies and greater numbers of women entering the workforce, trends which gained particular momentum in the 1980s.

While women were functioning as well as their male counterparts in the workplace, most experienced an expectation to prove themselves in a highly competitive work environment. It became the norm for women to become ever more driven, working harder and longer than anyone else. And, of course, with that came substantial lifestyle changes.

It led to what can be called a “time urgency perfectionism syndrome” or TUPS society, which was characteristic of the 1990s and beyond. Driven by competitiveness, two-income households became the standard, the age at which women started their families increased significantly and birth rates continued to plummet.

As a result of this and other factors related to the modern stressful lifestyle, such as poor nutrition and substance abuse, an estimated one in six couples worldwide are facing fertility challenges today.

Fortunately, what has also brought significant change is the development of technology and the new insights it delivered.

For example, in 1978 the first baby was conceived using a revolutionary treatment called in vitro fertilization or IVF. Her name is Louise Joy Brown, and since her birth, millions of other children have been born to infertile couples thanks to this amazing treatment. The first birth from a frozen embryo took place when Zoe Leyland was born in Australia in 1984.

Advanced technologies also led to new insights into the causes of infertility. For example, since the first IVF treatment, fertility specialists began to realise that fertility is not “a women’s problem” but that the male partner also has a role to play in infertility and that in many cases, a couple’s infertility was caused by both male and female factors.

These insights also lead to new solutions, such as Intracytoplasmic Sperm Injection (ICSI) treatment which has revolutionised male infertility treatment. It has been regarded as one of the major breakthroughs in the treatment of infertility, because only a few normal sperm are needed for conception using ICSI, which means even men who were previously seen as completely sterile now have an excellent chance to have their own children. Since it was developed in Belgium in 1992, ICSI treatment has been used worldwide, resulting in tens of thousands of babies being born.

Today, infertility is more widely regarded as a medical condition affecting the female partner, or the male partner, or both, and for which a range of safe, proven medical treatments are available.

The World Health Organization now defines infertility is as a “disease of the reproductive system which results in disability” and ranks it as a global public health issue, affecting an estimated 10% of women globally.

Much work is also being done to promote awareness about infertility and the treatments available. The WHO notes that the field of reproductive medicine and endocrinology is growing rapidly ranging from the most simple fertility awareness methods to more advanced innovations.

What about the future?

There are some interesting theories about the future of fertility and fertility treatments. For example, Henry Greeley in his book “The End of Sex and the Future of Human Reproduction” explains the revolutionary biological technologies that dictate the future of infertility and the deep ethical and legal challenges humanity faces as a result. He says that within twenty to forty years most people in developed countries will stop having sex for the purpose of reproduction. Instead, prospective parents will be told as much as they wish to know about the genetic makeup of dozens of embryos, and they will pick one or two for implantation, gestation, and birth. And it will be safe, lawful, and free.

A similar view of the future titled “Frankenlaw” was recently published in Fair Lady magazine, postulating that significant advances in technology have opened up a whole new world of future ethical and legal dilemmas, such as babies conceived after their parents’ death, toddlers inheriting embryos, and snowflake babies referring to ‘leftover’ IVF embryos given up for adoption.

What will stay the same…

What is certain to remain the same as we move into the future is the importance of the expertise of a qualified and experienced fertility specialist.

If you are concerned about your fertility now or in the future, we would like to invite you to meet one of our fertility specialists at Medfem Fertility Clinic.

Simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.

We look forward to meeting you at Medfem Fertility Clinic!


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