Fertility – it's more complicated than you'd think

Fertility is so much more than the simple joining of egg and sperm leading, nine months later, to a happy, healthy baby. As this month's profiles illustrate, achieving a healthy pregnancy and birth can be challenging.

There are risks to fertility, risks that aren't intrinsic to our ability to have children but that arise because of things like cancer treatment. The treatment can be successful, but the resulting infertility can put an end to dreams of a family. It's particularly difficult when those dreams haven't even begun, but decisions have to be made regardless. Peter Chan is seeking a way to help young boys, who don't yet have sperm to freeze, protect their future fertility.

There are internal risks to fertility, too, when our bodies just don't cooperate with our desire to have children. Sometimes, it can be tiny genetic mutations that lead to early miscarriages, as Evica Rajcan-Separovic is investigating. Other times, there are factors that prevent an embryo from implanting in its mother's uterus, because they interfere with effective communication between the embryo and uterus, as Daniel Dufort tells us.

In these latter cases, many people turn to assisted reproductive technologies (ARTs) such as in vitro fertilization or embryo selection to help them have their own biological children. Other people turn to ARTs because their fertility has declined with age. Changing social conditions, including longer years of education, more debt as a result of that education, greater workforce participation by women, even high housing costs mean that many couples are delaying having children. When they are ready for children, though, their bodies may have passed the point of maximum fertility, making becoming pregnant more difficult.

But ARTs are not a panacea and, in fact, just as our fertility declines with age, so does the ability of ARTs to result in pregnancy and birth. As Judith Daniluk has found, however, many people are making decisions about their fertility in the absence of information about the real ability of ARTs to help them overcome age-related infertility.

Research advances are already helping many people become parents. As we learn more about the exquisitely intricate process called fertility through research like that profiled here, our ability to help people achieve that dream is improving. But it will never be perfect and, as Dr. Daniluk points out, it's important to know what's possible – and what isn't.

Dr. Michael Kramer
Scientific Director
CIHR Institute of Human Development, Child and Youth Health

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