by Edgar Mocanu, on Nov 15 2019

"Prevention is better than cure" Erasmus 

Medicine has long promoted smoking cessation to prevent lung cancer. Blood pressure and cholesterol control, as well as, healthy diets and exercise for heart disease and stroke prevention.  Gender-specific interventions like cervical screening for cervical cancer prevention.  Colonoscopy for bowel cancer screening and breast checks or mammograms for early detection of breast cancer have been around for many years.  Similarly, prostate regular exams and PSA measurements help in early diagnosis or prevention of prostate cancer.  These conditions are far more prevalent that infertility, it is true.   Yet, the emotional impact of being told you will never have a family has been shown to be equivalent to that of being diagnosed with cancer.

At present, Reproductive Medicine practice is focusing too much on cures, many of them with pitiful results, and too little on prevention.  Many young adults have no idea of the finite ability to procreate.  Who will be responsible for the negligence of a system that ignores fertility planning at the expense of contraceptive advice only?  Both contraception and the reproductive ability of men and women should be part of the general education of all adolescents. 

It is clear that many individuals are becoming victims of a failing education and societal system.  By omitting to teach them about the importance of both timely contraception and the fertility opportunity window, very different for men and women.  By not providing the support for couples to consider a family when the likelihood of conception is at its best.

Is it not ironic that large companies are offering egg freezing?  I would challenge these companies to instead support their employees in establishing relationships and offer appropriate maternity and paternity cover and familial support when their employees become pregnant or have a child.  Not to push naive females in believing that having undergone egg freezing a baby is guaranteed and that exercising their “right” to become a mother very late in life is as safe as when you get pregnant in your 20's or 30's.  

How many women and men, dedicated to their career or under the false impression that medicine can always offer them a family, find themselves one day with no partner, too few or no eggs in their ovaries, poor sperm?  And with the realisation that even the costly and emotionally challenging procedures like IVF will not offer them a realistic chance of conception, at best a mere 50%?  Do we truly believe that the social and printed media present the reality?  That female fertility finishes at 51, that women rarely conceive after 45 years of age?  Certainly not, only the exceptional sells!   

Time has come for adolescents of both genders to realise that their reproductive life is a matter of extreme importance.  One that is their responsibility to think about, discuss and plan.  That medicine remains many times helpless when confronted with the irreversible reproductive changes that occur as age advances.  That many past events, medical or surgical interventions including previous treatments, can have a definitive and irreversible effect upon their ability to have children.  

Avoiding the disappointment of a childless life is a personal responsibility and not a matter for society or the medical professionals.  A balanced education for adolescents should facilitate mutual understanding of reproductive desires and the ability to plan a child at peak of reproductive potential, a true preventive measure and far more realistic than any future promised cure.