It has been almost two years since Anne-Marie Slaughter’s famous (and in some circles, infamous) declaration that, for most women, ‘having it all’ is a hard and often unrealistic ideal to pursue. Women unquestionably have the right to both an outstanding career and a fulfilled home life, but the reality isn’t so simple. The tensions between career and motherhood cannot be dismissed: they are very real, and juggling them can be crippling for the modern woman.
To date the debate has largely focused on dismaying discrepancies in pay between men and women and the continued existence of the glass ceiling. While these injustices pay a large part in the equality agenda there has been enormous advances in one very important area of women’s lives namely women’s health and in particular reproductive health which eventually may have an impact on improving woman’s equality in other aspects of life. It is often thought that the advent of the contraceptive pill in the 1960’s was a defining moment when women were freed from the burden of unwanted pregnancy. And while this was a breakthrough moment it could not solve one fundamental problem, namely that women who postponed pregnancy still had to confront the different trajectory of fertility between men and women. When it comes to choosing motherhood, the reality of human biology is that a woman’s reproductive clock ticks much faster than a man’s. There is a sharp decline in woman’s fertility after the age of 35, while men, in most cases, can go on reproducing until their 60s or 70s. This places acute strain on the career woman, who may often find that in her most vital and empowering career stage, she is staring down the barrel of declining fertility. But just two years on, and the landscape is already beginning to change – for the better, thanks to scientific advances in fertility treatment.
Thus far the options have seemed clear and stark: either give up on having children or accept that the career ladder must be abandoned. Yet I would argue that the pioneering advances we are now seeing in fertility technology in both IVF and Vitrification for egg freezing provide women with more options – and take us significantly closer to a position when women can -perhaps sooner than we thought – ‘have it all’. These advances will provide broader options that offer women the opportunity to delay, and not simply cancel, the advent of motherhood.
Many women who have postponed pregnancy and faced with declining fertility simply cannot afford to undergo IVF treatment which in most cases is their only chance of conceiving. NHS treatment is restricted and often remains unavailable. However hope is now on the way. I have been privileged to be part of pioneering work in Low Cost IVF technology that, following successful births in Belgium, will be offered initially as a study in London, This technology involves the simplification of the embryo culture process by removing the need for an expensive IVF laboratory, thereby significantly reducing the cost of IVF. Critically, this breakthrough could provide women across a much broader cross-section of society access to IVF treatment.
Further technological advances have also seen IVF become a gentler and safer process for women, thanks to advances in Mild and Natural IVF. Conventional IVF treatment is stressful and can cause serious health risks due to high oestrogen levels. For several years I have championed Mild IVF which uses lower doses of stimulation has fewer health risks, is less costly and results in similar success rates with better long-term health for mother and child. Natural IVF can work for older women even when the drugs do not work. Mild and natural IVF are important steps towards making IVF safer, healthier, and more accessible.
If a woman chooses to delay motherhood in order to progress her career, we should be supporting her decision, not telling her she’s on her own. No longer do women need to go through protracted infertility investigations over many months. Advanced “One-Stop Fertility MOT” can help to assess her fertility potential in one hour. And for those younger women who are unsure where the future may take them, we can help them to preserve their fertility by using the latest vitrification technology for egg freezing. Recent research has shown that frozen eggs stored in a cryobank are equally efficient as fresh eggs in terms of producing a baby. However frozen eggs are no different to fresh eggs in that success rates decline with increasing age of the woman so for optimal success women will have to decide in their early 30’s whether they wish to go along that route. For those in same sex relationship or have no partner and have left it too late to freeze eggs, having a baby using donor sperm is possible as long as “welfare of child” is taken into account.
Of course for women natural conception when they are in their 20’s is the ideal but many women for various reasons are not ready to have a child at this time and for them, there are successful choices available.
Clearly scientific advances alone cannot redress the balance for gender inequality but they are making a difference and empowering women. As a nation, we need to be pro-active about early education to prevent infertility. Ensuring women’s fertility is protected should be central to gender equality in our society. For society to thrive, women must thrive; for women to thrive society must ensure that they have real freedom to make the choices they want to make.
Anne-Marie Slaughter concluded in 2012 that: “I still strongly believe that women can ‘have it all’… but not today”. I believe that ‘today’ is closer, that science and technology are firmly moving us in the right direction – to a point where women may indeed ‘have it all’. But only when gender health equality is understood and embraced will we truly be in a position to declare that day has come.
As part of her pioneering work to improve quality fertility choices and access for women, Professor Geeta Nargund is launching a Centre of Excellence in Natural and Mild IVF in St. Paul’s London in July. This will be one of Europe’s largest fertility clinics. Its central location was chosen with the sole aim of improving access to fertility treatments for professional career women who currently don’t have this care available on their doorstep. As well as increasing London’s IVF capability by 30%, the clinic will focus on informing and educating UK career women on the need to proactively consider their fertility options and make informed choices with regards to motherhood.
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