Episode 3: Fertility Education

Transcript

Speakers:

Host - Olivia

Guest – Prof Joyce Harper

 

Olivia Moir  0:02 

Hello everyone and welcome back to it all starts here. This is a podcast focusing on the science communication and education of reproductive science and women's health. And we are here at the Institute for Women's Health, here in London at UCL. I'm your host, Olivia moir, and today we are going to be talking about fertility education. So to discuss this today, I have with me the wonderful professor Joyce Harper, who is a professor of reproductive Science here at the Institute for Women's Health. She has worked in the fields of fertility, genetics, reproductive health and women's health for over 30 years, and is passionate about education and discussion of all aspects of women's health, but especially at three key stages, one of them we're going to talk about today. And these three are the menstrual cycle, the fertile years and the menopause. So I am so excited to be speaking with you today, Joyce, about fertility education and for the wealth of knowledge that you're going to be bringing to this conversation. I know that you've been working in this field for many years now, I think you got into it back in your 20s. And I thought maybe it'd be great to share with everyone kind of what inspired this and how you kind of started down this field and this pathway.

 

Prof Joyce Harper  1:23 

Thank you very much. It's a real pleasure to be here. So after I finished my PhD, I was looking for a job. And this was back in 1919 87. And in those days, we used to look through a magazine called New scientists is still around, but it's all online now. But we had a hard copy. And I was sitting in the library and I saw an advert for a job as a clinical embryologist. So Louise Brown, the world's first IVF baby was born in 1978. So this was not even nine years later. And I was thinking, yeah, that's let's see what this job is. I didn't even really know what it meant. But I thought, let's apply for this exciting sounding job. So I did and I got the job. And the next thing I was learning lots of amazing information about our reproductive health and fertility, things that I really didn't know, I'd done a biochemistry degree and a Biomedicine PhD. And I was learning all this information that I think was really basic and that every woman should have understood. And as I was learning things, I was talking to my friends and telling them about their menstrual cycle and their fertility and all of these things. And they didn't know about it, none of us knew about it. And I thought I need to write a book about this. But I'll come on to that in a moment. But basically, it took me about 30 years to write the book, because it came out a couple of years ago. But that really sparked my love of an urgency that we need to be teaching fertility education to everybody.

 

Olivia Moir  2:54 

Absolutely. Yeah. And, and I think I shared with you, you know, personally, that's kind of where my interests have started it. It's a lot to do with kind of your community and the people that you surround yourself with. And something that I find, as I've said before on this podcast is true is that there's a lot of information out there, but the way that we've presented, it has just been not always the best. And I think you know, like, that's why we're here today to discuss how we can do it better. So talking about fertility education, maybe we can start kind of how the history of it, you know, what has it looked like before? What are some of the issues around this, that you have found gaps that you've found in that area, let's just dive right in to the to the education of it.

 

Prof Joyce Harper  3:41 

Well, back in 87, the only book I could find that really taught a woman anything about her body was a book called our body ourselves. It was a USA book. And that's why I wanted to start writing a book in 1987 to fill that very, very big gap. And I did start it, I read about 40,000 words. But life got in the way. And the next thing I realized, Oh, my friends are now going through the menopause. Jump forward, you know, 20 odd years, we'd had kids and menopause was approaching. And then I realized, okay, I need to write the book, because as you said, there's lots of information out there, and the Internet dispersed thing. So back in 2015, I set up a website called Global women connected, where I was writing blogs about women's health with some other colleagues. And I thought maybe that's the way forward maybe I don't need to write a book. But then I realized it became so disjointed, and I really wanted to write a book that women could dive into. So it covers everything from puberty, past the menopause. So depending on what stage of life they're going through, they can dip in and learn some information. And my passion has always been evidence based information, because there's so much misinformation out there, that myself and many others are spending our entire time debunking the very many myths around reproductive health. So there's been lots and lots of gaps. And I'm not the only one that's been trying to fill it. There's been some fabulous international work of people that have done groundbreaking studies looking at what people know about their fertility and where the gaps are. So a few years ago, back in 2019, I was at a conference in Copenhagen with it was a preconception conference, preconception health conference, but there was a big session on facility education, so many of the world leaders were there. And I said that, look, there's all these pockets of brilliant research going on. I felt we needed to join all this together and join forces, because so many of the people working in this field have very, very different backgrounds. So we've got the health psychologists, we've got the embryologist, we've got the clinicians, we've got the sociologists. There's a really multidisciplinary team of people working on this and I'm, I love uniting people to work together. So back in 2019, we set up a group, we initially called ourselves the international fertility education initiative. But this year, we changed our name to be more inclusive of reproductive health. It's not just about fertility, it's not just about women's health. And it's definitely not just about having babies. There's lots of information that people need to know, such as Polycystic Ovarian Ovary Syndrome, endometriosis, menopause, etc. So this international group, we've now named ourselves the international reproductive health, education, collaboration, that's a very long title. So it's Irek for short, and we have become part of ESHRE. And ESHRE is the European Society of Human Reproduction and embryology. And they are one of the biggest if not the biggest, fertility and reproductive health society in the world. And I've worked with them for for decades, and they were the obvious place for us to sit. And they've been so supportive in helping us do this important work and try and fill in those many, many gaps we have around reproductive health, right from schools, right through to work with companies and beyond.

 

 

Olivia Moir  7:05 

That's amazing. And touches on so many of the points that I think are so important, like, namely, the collaboration between the different fields that people work in. And I think that's something that, you know, through my time, here at UCL, has become increasingly important, like something that I've become aware of more so since being here is just that having the different perspectives is really important, because at the end of the day, people feel differently about so many different things. And so when you're making different you know, if you're trying to educate on a topic, it's important to take different opinions into consideration so that, you know, what you're educating about is kind of more well rounded. And, you know, as you mentioned, briefly, beginning with schools, right, from the very beginning, I think, I mean, with my background, my I mean, I don't even think I had anything to do with fertility education back when I was in school. Until I started studying in my bachelor's. I think, obviously, in high school, they teach you a little bit about it, and the concepts, but the understanding that there are so many different things that can stem, you know, outside of just the actual pregnancy, but to do with fertility. I mean, people don't even think about that, like, What do you mean that I can't get pregnant? Of course, I can't. I'm a woman. But it's like, no, not necessarily. So I think, you know, what, what do you think would be important in terms of fertility education? If you're trying to integrate this into a school with students that are of younger years? I mean, I guess it's hard to navigate that. What do you tell them? How do you tell them? What do you think is important in that setting?

 

 

Prof Joyce Harper  8:50 

Well, about six years ago, I went to my local school with a list of topics that I thought should be included in high school education. And I said, I was talking to a biology teacher and said to her, Tell me what you teach. And she said, you're going to be very upset Joyce, she said, we really don't teach hardly any of this. So then the research began. So we've published a couple of papers, looking at the UK curriculum. And for sure, lots of the topics that were on my list are not included in the curriculum. But then in 2019, the Department for Education have now included in the curriculum that we should teach about reproductive health, pre pregnancy, health, and fertility and menopause within schools. So that's really got the ball rolling for me. We did a survey of UK school kids up to age 16 to 18. And it's also been repeated in Belgium and in Greece, and we asked schoolkids many things it was about their attitudes and their knowledge of reproductive health and fertility, but we also asked them to tell us

 

Watch which of the topics on my list they had learned in school and which they looked for information outside school. So really interesting things like menopause. 10% learn something in school, but 50% of teenagers had looked for information outside school. Now we've got things like PCRs, I mentioned earlier, polycystic ovary syndrome, endometriosis, less than 5% of teenagers had been taught any of this in school. And these are both disorders that affect one in 10 women, so very common diseases, but we haven't even told the school kids about them. So they have learned about puberty, a bit about the menstrual cycle, they've done, sexually transmitted infections, and contraception. So the message that has been taught in schools is how not to get pregnant. But there hasn't been any education on how to have a healthy pregnancy when you're ready to. And one thing I asked when I go into schools is how many of you want to have children and about 60%? Say they do want to have children? There's quite a few that are not sure. So it's important. But as I said, it's not just fertility. When I started giving the school talks, I was talking about fertility education, and then realized that what I think of as fertility, my book is called your fertile years. And it's certainly not just about having children. My view of fertility is all of reproductive health. But that's why the international group, we changed our name to reproductive health, because in the population in the public, that's what they understand more that reproductive health, even for me, reproductive health means you're reproducing, but reproductive health does sit better with the public rather than fertility, which has the connotation of definitely wanting to have a child.

 

Olivia Moir  11:47 

Right. Yeah, that makes sense. And I think I mean, I think definitely some of the arguments against having that education in school would just be that, you know, maybe it's something that they they don't need, it's something that's so far down the line. And, you know, even on the other side, it's like, well, maybe giving this information could cause unwanted pregnancies and so forth and so forth. But I mean, I think I would argue against that. And I think also, what's important is, as you said, and that same holds true, I think, no matter what age you are, when you're in a school setting, I think a lot of the time you feel maybe uncomfortable, or you feel like it's not the place to be asking questions, particularly related to reproductive health. But something that's really interesting is okay, like, let's say, we're not giving this education and at school, you maybe see your GP once a year. Outside of that, where, where's this information coming from, like a Google search that can get so misleading, I mean, we've all been down that route before where you Google something, and then all of a sudden, you find out that you're actually dying in that moment, according to Google. So I think going forwards it would be so important really, to reconsider the fact that our education is no is coming from, you know, largely outside of a school when, you know, having the important and write messages. There's such a, there's such a way for them to be communicated properly to you. Maybe not just in a more standard way, and more accessible way.

 

Prof Joyce Harper  13:18 

In an article survey, we asked teenagers, where would you like to learn about this information and school, in all the surveys we've done even with that, with adults, they've all said school needs to be the basis. So we're working on that the International Group, we've set up a teaching guide to teach reproductive health, all the things I've spoken about, and post menopause. And it's just been out for consultation just finished a couple of days ago. So now I'm working my way all our committee are working our way through all the questions and comments people gave, which I'm really glad they did. It's really important with any resource for the public, any education resource for the public, or for teachers to co design this with the group that it's for. So we've had been doing this with students with teachers, and anything we prepare for the public we do we co design with the public. So we are now going to embark on a project in September, where we're going to work with a small number of schools, and now help the teachers and work with the teachers to see how they use our teaching guide. What do they want more of what do they want less of? How else can we help them as an international group of multidisciplinary experts? How can we help them deliver this because they're the ones delivering this to the students and also finding out if the change in education, hopefully the improvement in education has actually had an impact? So we're doing a big study with a small number of schools starting in the UK and then we're going to do this in different countries. Different countries have very different thoughts about this. So for example, my colleagues in Belgium they do not have menopause on their curriculum. So there are menopause slides in our tea. Just resource. But they said our teachers won't even touch those because it's not in the curriculum, they won't teach anything extra. So it's a really big project to try and support schools and give them the information that they need, that we can provide them with to deliver the stuff and make it easy for them. But as you said, it is wider than that people will Google things. So our international group, we have a website where we're putting various resources. In the next few months, we're going to have some recordings of people telling their real stories about their fertility journeys and their reproductive health journeys. And we're also writing some information leaflets, we're co designing these again, with a public, we're setting up a public focus group that we're going to work with over a few months to develop these information leaflets. And there's lots lots more we can do there, we're just sort of starting off, it's been four years since we formed, but there's still so much to do, to try to make this as comprehensive as possible. We need to work with companies, we need to work with the public, we need to work with schools, and really try and tackle this from all sides. But our website will be an evidence based place for people to get correct information about reproductive health.

 

Olivia Moir  16:15 

And yeah, as you said, evidence base is so important. And I think you know, something that I really harp on, too, you know, you something that we talked about in other episodes, you know, science communication, the importance of having those pieces and those bits there to backup, what you're saying, and kind of extending out of that, in terms of fertility, like what do you think are important bits of information for women to know what or what or or just anyone to know that I was curious about fertility? What are pieces that really seem to matter? What are things that maybe don't seem to matter as much that we maybe focus on too much? What are you what are your thoughts,

 

Prof Joyce Harper  16:59 

I'll start with the fact that we do focus on women too much. And I would do the same way you said women and they change. And I'm the same, I still sometimes do it. So we've got to stop thinking that these things are women's issues. They're everyone's issues, whether directly or indirectly, they can affect everybody and again, whether you want children or not, but if we're looking at fertility, the key information is about male and female fertility decline. So when I started this, I was always talking about female fertility decline. But we have a large amount of data now showing that male fertility does decline not to the extent of women's which women when they are postmenopausal will be totally infertile men do not lose their fertility like we do, but it does decrease, and it does have an effect on the chance of getting a pregnancy. So that's the main issue of female fertility decline really starts in a woman's 30s. By the age of 35, it can become really quite significant. And many women see we all see celebrities getting pregnant at 45, or 50. And we think that's the norm. But it's really not the norm. And the trouble is that now we talk about 40 being the new 20 and 60 being the new 40. And we're all feeling healthier and fitter than we were before. But unfortunately, our fertility hasn't quite caught up with evolution. So we still lose our fertility in our mid 30s. By the time we get to 40 majority of women will be infertile and find it very hard or impossible to get pregnant. And by age 45 Almost everyone, every woman will have lost her fertility. So we have to be aware of that. That's the main point. And doesn't matter if you're doing yoga and eating healthy diet, that will still happen. So menopause is the end of our fertility and menopause will happen. Anywhere really, at any age, menopause is gonna happen, but more commonly between 45 and 55. And we lose our fertility quite a few years before that.

 

Olivia Moir  19:04 

It's yeah, it's really important, I think, to stress that and highlight that just because you see a celebrity online, doing one thing doesn't mean that that is applicable to the population. And absolutely. I know that you are an avid coldwater swimmer. So I guess I was what I mean, I know you've talked about the, you know, you have a community of women and people that you talk to, and how their experience through different stages of their fertility and the menopause. How that's been helpful. I mean, I've mainly heard about the the benefits from you regarding the menopause, but what do you think, you know, there's some application of this sort of temperature cold water swimming to fertility itself?

 

Prof Joyce Harper  19:52 

I certainly think it is for menstrual health. We did a survey last year asking women if they felt cold water swimming Help them or how it affected their menstrual and menopausal symptoms. We didn't want to put the idea in their head, we said how does it have an impact, positive or negative, and absolutely very, very positive, cold water swimming as well as being in as you said, in a community, you're outside in nature. All of those things just on their own would make you feel much happier and supported. But also the effects of the cold water. It's very euphoric. It can reduce cramps at the exercise, if you feel up to it can help through that premenstrual and menstrual time. And it can help reduce migraines. And this is what the the women had been telling us that they felt that it did. So all of those things are just tick, tick, tick, tick, tick. And it's, it also makes you feel very, very strong. So I'm an avid exerciser exercise almost every day. But as you get older you if anything, you slow down a little bit, you can't run quite so fast, you can't lift so many weights, but coldwater swimming, no matter what your shape, size, age, you will adapt, your body adapts very quickly. So that was one of the bonuses that I found. Besides all those other benefits. I said, the fact that I get I got better and better every time I did it. So you know, I can stay in cold water now for much longer than I could the year before. I did start for a few months with a wetsuit and want to wet suit for years. And the clothes get less and less as the time goes on. So you know, when I took my very fit 17 year old son's swimming recently, and he stayed in for about two minutes. And I stayed in between see, you know, I was like yes, look at me, you know, I can do something that my fit kid can't do. So I think that's very empowering. And feeling physically strong is really good. But yeah, the benefits are really amazing, but it is dangerous. I strongly suggest reading up everything you can about it before. That's what I did. And the motto I always use is swim your own swim, don't do what the person next to you is doing. We're all very different. And so I have started my own podcasts recently, and I've had a few quite a few of my guests have been avid cold water swimmers. And I've also interviewed Heather Massey who, she I read everything she did. She all her research, research on extreme sports. So she was one of my go to people before I started swimming. And she gives some really helpful hints then about how to be safe.

 

Olivia Moir  22:34 

Yeah, I think that's great. And I, I really, really liked that point that you said about how it can be empowering, because I think that's a lot of this field outside of just the actual kind of education, bit of fertility and the communication of it. I mean, behind all of that is people who feel empowered to do that. So I think anything that supports that is really important. And back to your podcast. So I mean, I know it's called Why didn't anyone told me this? And I love it. I listened to I think all of the episodes now. And I think pertaining to fertility education. I mean, you've touched a little bit about this before. But I guess in the conversations you've had with your friends in the different communities that you're a part of, what do you find particularly about fertility? Where you're like, Why? Why did I not know this? Why did someone not tell me this? What? You know, what do you wish your 20 year old self had no known about fertility?

 

Prof Joyce Harper  23:38 

Yeah, so I didn't start my job times 25. So it's harder for me to think what I would have told myself actually also on my podcast, I do ask everybody, what would what advice would they give their younger self and the very first episode is me. What I talked about then was about well being. So I says that I've always exercised right from a really young age, I did ballet and tap when I was three or four years old. So I really felt very empowered by exercise. I am very, very good at sleeping. People say it's my superpower. Sleeping is really important. Exercise is really important. But for me the two parts of my wellbeing I think that I didn't do when I was younger, which and these are related to reproductive health. One is being still and we are much more thinking about meditation and mindfulness nowadays, but I think I think I rush I'm very manic because I rush around a lot. And I wish I spent time now being still I wish I'd spent time when I was younger. Just being still doesn't come naturally to me. But the main one for me is my nutrition. I'm pretty good with my nutrition, but I've always struggled with my weight. I have a sugar addiction. And, and when I go into schools, I talk about these four pillars of well being so nutrition, exercise, sleep, and mental health that for me, it was the stillness. So I think those four are key through our whole reproductive life. And, and beyond just for our general health anyway, they're obviously really important. But when we're trying to deal with our menstrual cycle, those four pillars of well being are really, really important. When we're trying to get pregnant, they're really important when we're pregnant, or before we get pregnant, when we're pregnant, they're really important. post pregnancy important. And then when we hit the menopause, those are the four areas that the doctors would advise women to think about first, are they looking after those four pillars? So I think those are essential for our reproductive health. I wish someone had wrapped it up in that way. For me, when I was younger. I wish I thought more about things like my mental health, more about my sugar addiction, and had prepared myself more, I haven't had any, I had years of infertility, which I went through years of IVF treatment, and my kids are IVF kids. But yeah, I wish I'd balanced those a little bit more, I think they're really important for our reproductive health. And my podcast is aimed at reproductive health, but it does have an overview of health, because all of those feed into our long term health. So risk of dementia, Alzheimer's, heart disease, cancer, etc, hugely affected by those four pillars of well being. So when I go into schools, I end my talk talking about that. And I really think that kids need to do more on that relating to reproductive health and our general health overall, really, really important.

 

Olivia Moir  26:47 

So important, I completely agree. And I think, you know, maybe it's a topic for another day, because I know that we could both talk about this for hours. But, you know, just infertility as well. Like, I mean, something that has become really true for me through this is we had a class and it was talking about pregnancy and childbirth and the things that can go wrong. And one of the students said, oh, you know, what, we're only talking about the really extreme end of cases and when things go wrong, but there's also so much that goes, right, and I think, you know, the topic, and the title of this podcast is fertility education. But I think what's so important about that isn't when it goes right, no one's asking questions when it's going, right. Everyone wants to know, you know, when it's going wrong. And I think, you know, it's so important to focus on that, just because it's better for the community. And you don't you never want someone to feel alone in that. So I think, on that note, kind of going forward in the space of fertility education, what do you think will be what do you look forward to seeing? What do you think will be the changes? And and, you know, what do you hope for this field.

 

Prof Joyce Harper  27:54 

So one of the aims of our international group is to prevent some infertility. And to keep people out of the fertility unit, some of the people in our group work in fertility units, but we we want to ideally see people, more people have children naturally if they want to have children. So having been on the other side of the table, and going through seven years of fertility treatment, I have my kids, I know how distressing and stressful and traumatizing it is. And I've know people that have not had a baby and those that have a baby, it doesn't matter. It's really, really traumatic for people to go through. So I would like to see less people going through fertility treatment, and to do that we need to educate them. And we need to give them the information so they can make their informed decision about how they want to deal with this. So in our studies, most people have said most women for sure men are slightly older, but most women who said they want kids around the age of 30, which is really interesting, because that's the age I wanted kids when I was 30, which is 30 years ago. So I thought that people would have pushed that a bit later by now, but they haven't they said age 30. And that's a good age, because as I just said, in our mid 30s, we'll start to lose our fertility. But the age that women are actually having their children in the UK in every country that's been examined worldwide is going up and up and is beyond that. Now. In many, many countries. It's closer to age 3435 In many countries, so we've got to be sure they've got the education but thinking of the future. What I do worry about is technologies such as egg freezing, and infertility treatment in general. That will we see more people now ending up in the IVF unit? Because for example, the woman's 30 Her partner is not ready or she's not got a partner. She's ready but she hasn't got anyone to have children with so she goes to freeze her eggs or the younger woman finishes her degree age 21. And decides, Okay, I'm going to go and do this particular career, I really need a good 1015 years to establish myself. So I'm going to freeze my eggs. So with egg freezing, which we are seeing increase, globally, it's not a guarantee you're going to have a baby, it's very expensive, you need to go through the harsh fertility treatment I mentioned. And it just concerns me that it's going to become much more common to that putting people in the fertility clinic, whereas we wanted to keep people out of the fertility clinic. So I have concerns about where the future will go. I would I would like to see people having more natural pregnancies with without having to go through fertility treatment, but I think it's going to go the other way.

 

Olivia Moir 30:52

It’s interesting, I mean I guess we will find out. On the topic of egg freezing which I hope to talk about in the next episode with Dr. Zeynep Gurtin, it’s going to be interesting to unpack that and the psychological side of that and the role it will play in society. I mean, it’s an interesting topic but at the end of the day it comes down to the fact that having knowledge is power, and ensuring everyone, not just women, having knowledge about fertility is very important to stress now and going forwards.

 

Olivia Moir 31:41

It’s been so lovely having you here today, Joyce, to talk about Fertility education, thank you so much for joining me today.

 

Joyce 31:50

It’s been a real pleasure, thank you.