A day in the life of a Centre for Reproduction Research PhD student

My name is Sasha Loyal, and I am one five full-time PhD students undertaking my doctoral research within the Centre for Reproduction Research (CRR). I am currently in the second year of my PhD but I have been a student at De Montfort University for several years as I also completed my BSc in Psychology and MSc in Health Psychology at DMU. My interest in doing a PhD stemmed from the work I did for my masters dissertation which explored men’s experiences of infertility and it was during this time that I was introduced to the work of the CRR. After completing my masters degree I was sure I wanted to continue further study and research in the area of reproduction so after many research topic brain storms, and with the support of my supervisors, I submitted a proposal for a PhD. My proposal was accepted, and I was even able to secure a scholarship to pursue my PhD full time. This scholarship covers my fees, provides me a bursary to cover my living expenses, and even gives me some money to spend each year on research costs and to enable conference attendance.

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My PhD research examines perceptions of reproductive timing within British South Asian Communities and builds on existing strengths within the centre on reproductive timing, ageing and the attitudes towards assisted reproductive technologies held by those of South Asian descent. My research is highly novel because whilst ageing populations and decreasing family sizes in Europe have led to questions in political, public and academic debates around reproductive timing, little is known about how British South Asian women perceive the ‘right’ time for parenthood or how cultural beliefs and values shape these perceptions.

The Centre for Reproduction Research is very multidisciplinary and has researchers working on theoretically grounded and socially relevant research across Sociology, Psychology, Anthropology, Science and Technology Studies, Bioethics, Nursing and Midwifery as well as Biomedical Science. By being a part of the centre I have been introduced to a wide range of research and research perspectives. My project is thus interdisciplinary and draws on theoretical and methodological insights from Psychology and Sociology. In particular, I am using the sociological concept of intersectionality, which is focused on the how a complex range of social identities and psychological attributes overlap to shape an individual’s experience of the social world. Readings such as Cole (2009) has helped me to grasp the value of considering the way in which identities are associated and helps explain why the ‘intersectionality gap’ in psychological research needs to be tackled.

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The day in my life as a PhD student is never really the same especially at the moment as I am currently working as a paid DMU Frontrunner which is kind of like an internship. The Frontrunner placement I am currently undertaking is as a research assistant within the CRR, specifically working on the EDNA Project. This interdisciplinary project is focused on how egg donation is experienced and regulated in the UK, Spain and Belgium. Whilst being in this role, I’ve performed impact related tasks, assisted with participant recruitment and the day to day running of the centre. As well as broadening my knowledge on wider reproductive issues, I’ve also had the opportunity to learn about research ethics, publishing and grant writing. My Frontrunner post has been invaluable in providing me with a real insight in to the job of a research active academic and has helped me develop and further evidence key skills in qualitative research, networking and working in an interdisciplinary research group. I am hopeful that the experience I gain as part of the Frontrunner programme will make me more employable at the end of my PhD by providing me with a clearer understanding of the demands and responsibilities of academic researchers.

I only work one day a week as a Frontrunner and so I am able to spend the rest of my time focused on my PhD. The structure of my PhD working days depend upon my current workload, upcoming deadlines and other research tasks. At the moment I spend a lot of my time at my computer and answering emails which means I can work wherever I choose which is normally at home, university, or in a café. Working in different places gives me a good balance but I tend to be most productive at university.

When I work on campus I try to get to university at around 9am, and normally spend about 30-45 minutes catching up on emails and organising myself for the day ahead. A quick check of my to-do list normally makes my day more manageable and structured. As PhD life is so independent, sometimes planning what to do is overshadowed by ‘what should I actually be doing!?’. This can sometimes really dampen my motivation, especially when the to-do list runs off the page, but keeping in-check with my supervisors and prioritising tasks help me to focus on one thing at a time. Slow and steady wins the PhD race… or so I’ve heard!

Top tip – Coffee (and lots of it throughout the day!)

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At the moment I am in the data collection phase of my PhD. I am currently carrying out interviews so I am busy recruiting and transcribing. Talking to women about their experiences has been the most exciting part of the research so far and I’m looking forward to the next phase where I will be analysing the data. When I’m not carrying out data collection related tasks, I try to spend my time tackling my never-ending reading list and making notes which I use to support my writing.

Whilst the completion of a PhD can very much be a solitary and individual task, I welcome breaks and opportunities to talk to other PhD students and researchers in my area at the monthly CRR reading groups, PhD student writing groups and CRR seminars. These meetings are a great opportunity to discuss or listen to reproduction related research and it’s always enjoyable to catch up with my CRR friends. The CRR seminars always host researchers working on really interesting topics such as Kinneret Lahad who this summer gave a fascinating talk based on her recently published book ‘A Table for one: A Critical Reading of Singlehood, Gender and Time’. I often leave these seminars re-invigorated with lots of motivation, ideas and notebook scribbles.

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After picking up some lunch from the university cafe, I’ll normally take this back to my desk to crack on with the rest of my day with occasional catch-ups with other students. If I find that I’m losing concentration, a change of scenery always helps me to stay focused. There are great places on campus to park up with my laptop or books including the library and lounge spaces specifically for postgraduate students.

The PhD journey is really independent and flexible, but I try to stick to a 9-5 workday to ensure that I’m progressing whilst having time to relax outside work. After I leave campus a quick session at the gym usually gets me moving after a day at my desk and I spend the rest of the evening with my family or friends.

Whilst intellectually challenging, I have so far enjoyed my PhD studies at the Centre for Reproduction Research and I would recommend the centre to students and researchers working in the field of reproduction as it always feels like there is something going on to be involved in. I feel lucky to have secured a bursary to undertake my PhD and I look forward to completing my research and sharing the research findings with the academic community and wider public so ‘watch this space!’.

Written by Sasha Loyal, PhD Student.

References:
Cole, E. R. (2009). Intersectionality and research in psychology. American
Psychologist, 64(3), 170-180. doi: 10.1037/a0014564

Popularity of apps like Natural Cycles highlights serious issues with contraceptives today

Natural Cycles

Many women have made a dramatic change in their use of contraceptives of late. Specifically, use of “contraceptive apps” such as Natural Cycles, a smartphone app that predicts the days on which a woman is fertile and can be used for contraception (as well as planning pregnancy), is on the rise. By closely tracking a woman’s cycle and temperature, such apps designate unprotected sex safe or unsafe each day. When unsafe, the use of barrier methods of protection is advised.

Natural Cycles was developed by CERN scientist Elina Berglund and her husband, Raoul Scherwitzl, whose scientific background has lent the app a certain kudos. And as “the only app certified for contraception” in Europe and, as of August 10, the US, women who might otherwise be suspicious of the method, which is at the end of the day simply jazzed up natural family planning, have taken the plunge.

The fact that many women are spurning more “medical” kinds of contraception, such as the pill or IUD, in favour of such apps, along with discussion in some cases of their failures, are once again drawing public attention to the hazards of being a pre-menopausal, heterosexual, sexually active woman. The risks of contraceptives range from milder side effects to rare but potentially serious complications. These, of course, come alongside the ever present risk of unintended pregnancy through contraceptive failure.

Many women report side effects with the contraceptive pill, but often aren’t listened to.
Suriyachan/Shutterstock

Understated side effects

When choosing a method of contraception, women routinely have to balance the impacts of each method against its likely effectiveness. Most of the evidence suggests that it is common for women to choose the least bad option in terms of side effects, rather than something they are really comfortable with. Consequently, it’s not surprising that a technology that promises to overcome many of these difficulties would prove to be popular.

Being able to control fertility is essential for women’s equality, yet the means to do this are currently all imperfect. Side effects are a common experience and are a major cause of women stopping using particular birth control methods. In contraceptive consultations, the frequency and severity of side effects and other more serious health risks are often understated.

Research suggests that health professionals seek to avoid mentioning issues they believe would cause undue concerns. This reluctance to disclose may be linked to historic ideas that women are not fully capable of rational decision making. The assumption that women are not to be trusted with contraception is most clearly seen in the promotion of long-acting reversible contraception (LARC): the injection, implant, and hormonal and copper coils. The evidence shows that some women who encounter difficulties sometimes struggle to get health professionals to remove their LARC. Women are expected to put up with side effects rather than taking a bigger risk of unintended pregnancy.

A perfect woman

Culturally speaking, unintended pregnancies are usually frowned upon. This is particularly the case for younger women and those in marginalised circumstances. This denigration links to ideas about irresponsibility more generally. Popular stereotypes of “feckless” families who have babies for benefits are commonplace, but are rarely accurate. In the US for example, the idea of the “welfare queen” has been shown to be false.

In the UK, it is government policy to limit the number of children claimants can receive benefits for. As in-work poverty means increasing numbers of families are reliant on benefits, more and more women will have their fertility judged.

Stereotypes of who would be or not be a “good” mother can be seen in healthcare providers’ assumptions of who would particularly benefit from LARC. It is also important to remember that the stigma surrounding abortion builds on assumptions of irresponsible women failing to successfully control their fertility. This is despite the evidence that contraceptive failure is a significant reason for needing abortion.

Failed contraceptives are a major cause of unwanted pregnancy.
Vadim Zakharishchev/Shutterstock

The cultural notions that women fail, rather than the fault being with contraceptive technologies, has even become standardised within health information. Many contraceptive information pages have institutionalised notions of women’s irresponsibility by including statistics on effectiveness reporting “perfect” and “typical” use. Given that “perfect” use for some methods is actually beyond women’s control (for example, the impact of a stomach upset on the pill), just showing “typical” use would ensure women were informed properly but without being judgemental.

Although women are largely held responsible for failure, that does not necessarily mean they are seen as responsible enough to make decisions over which birth control method to use. Although in other parts of the world, emergency hormonal contraception is available in supermarkets or even vending machines, in the UK and Australia, women wanting access need to have a consultation, even if this just takes place in a pharmacy. This is not necessarily to access them medically, but so they can be “advised” to avoid future “mistakes”.

Gendered inequality

In an age where relationships are supposed to be equal partnerships, contraception raises equality issues. To date, the “male pill” still has not materialised, leaving men with few options. Condoms are often not seen as “proper” contraception for ongoing relationships. The protection they provide against sexually transmitted infections means that they are associated with casual partners.

Condoms tend not to be used by those in ongoing relationships.
BORIMAT PRAOKAEW / Shutterstock.com

Meanwhile the idea of vasectomy (which should obviously only be undertaken if a decision of no future children is made) is popular with women for equality reasons. It allows couples to take turns over contraceptive responsibility over time. But many men do not seem to be that keen.

It’s also important to remember that pregnancy carries some risks for women alone. Even if they are supportive partners, men do not face the same biological issues of either continuing or ending a pregnancy. While there are now challenges to the expectations that women should always be the primary carer of children, changes in attitude cannot overcome this biological reality of pregnancy.

So it’s unsurprising that such apps are popular. Avoiding the health difficulties that many women experience with other contraceptive methods is appealing. But women are still waiting for better contraceptive solutions. In the meantime, reducing the stigma and costs of unintended pregnancy and abortion would an extremely useful step in recalibrating the understanding of the difficult balance women make between embodied impacts and the effectiveness of the current options.

Pam Lowe, Senior Lecturer in Sociology, Aston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Social egg freezing: balancing hope and hype

The topic of social egg freezing once again hit the headlines last week (8th August) with the release of a statement from the Royal College of Obstetricians and Gynaecologists (RCOG) which called for caution over the technology and greater recognition of its limitations. Drawing on my research on this topic, I was pleased to provide various comments on this statement live on Sky News, Radio Four, and BBC News throughout the day.

Dr Kylie Baldwin live on Sky News (08/08/2018)

The statement from the RCOG came following the release of two papers published in the British Journal of Obstetrics and Gynaecology on social egg freezing, and offered guidance and advice to women who are considering freezing their eggs. This advice is much overdue and is the first to come from an official UK body in almost 10 years (Cutting et al, 2009). The lack of such easily accessible advice thus far is surprising, if not concerning, not only because the numbers of egg freezing cycles being performed has risen by over 400% in the last eight years (HFEA, 2018), but also because several authors have raised questions about the quality and limitations of the reporting of the technology on clinic websites as well as in the popular media (Avraham et al, 2014; Mayes et al 2017; Wilkinson et al 2017).

In their statement the RCOG recognised the potential of egg vitrification in enabling women to have children later on in life, but also provided a warranted word of warning to women considering freezing their eggs noting the high cost of the technology and low rates of success. Research shows that women are currently on average 37 years of age at the time of freezing their eggs, and in 2016 less than a third of the egg freezing cycles performed were done with women aged 35 years or below (HFEA, 2018). This is significant given that a woman’s age the time of undergoing the procedure and the number of eggs frozen are recognised as the most important predictors of a future live birth (Doyle et al, 2016). Offering further comment from the RCOG, Adam Balen Professor of Reproductive Medicine, suggested that women who are considering the procedure should freeze their eggs as early as their 20s and certainly before the current average age of 37. However, women are only able to store frozen eggs for 10 years unless they can prove that they have become prematurely infertile in which case an extension to the storage period can be obtained up to 55 years. As I have described elsewhere this means that if a woman freezes eggs at 28 years of age she must use them by the time she is 38 or they will be destroyed leaving her without a fertility ‘back up’ plan right when she may need it the most. It is for this reason why myself and colleagues have launched a campaign to see the storage time limit extended.

Echoing other professional guidelines, the RCOG noted how clinics have a responsibility to provide women with a realistic idea of the likelihood of a live birth with their eggs relevant to their age at time of freezing. However, my research interviewing users of this technology found that women struggled to elicit age-specific and clinic-specific success rates about their chance of a future live birth and instead had to rely on limited published data from other centres that often did not reflect, or were not specific to, their age at time of freezing. This is most likely because unlike the success rates of IVF treatment which are published on the HFEA website, it is much more difficult to obtain success rates of IVF using previously frozen eggs as currently only small numbers of women have returned to use their eggs to attempt conception. This lack of clear data about their chance of a future live birth was troubling for some of my participants, yet women often suggested that by undergoing the procedure they would always be improving their chance of motherhood in the future. However, the problem facing these women as well as prospective users of egg freezing now, is that it is difficult to estimate to what extent they will be improving their chances. I suggest that a vague notion that egg freezing may increase the chance of a live birth in the future could lead a woman to spend the £5,000 plus required to freeze eggs. However, if the same woman was provided a more evidenced-based estimate that the chance of success may only be 5-15% she may feel under less pressure to undergo the procedure ‘just in case’ due to the low rate of success she may encounter. This is significant as my research found that a fear of future regret, of not making use of the technology and suffering unwanted childlessness in the future, was a key factor motivating many women to engage with the technology. Thus, if women are provided with information which clearly articulates the limitations of egg freezing they may feel under less pressure to engage with the technology and may feel less blame and guilt about their non-motherhood status both in the present as well as the future.

Whilst the RCOG provided some useful information to prospective users of egg freezing it was not able to offer insights in to what it is like to undergo the procedure. As such we were pleased to learn that on the same day of the release of the RCOG statement a paper by myself and Professor Lorraine Culley examining women’s experiences of social egg freezing was accepted for publication in the journal ‘Human Fertility’. In this paper we discuss how the process of egg freezing poses a different set of challenges for women compared to those experienced by individuals undergoing IVF to conceive. In particular, the women in our research often reported feeling lonely and isolated when undergoing the procedure, in part due to the fact that they were doing so without a partner. They also described a degree of stigma and embarrassment about making use of egg freezing and for ‘still being single’ at a stage in the lifecourse when normative expectations often included marriage and motherhood (Becker, 1997). As such, in many cases the most challenging aspect of undergoing the procedure for our participants was doing so alone and at a time where they would have preferred to have been pursuing motherhood naturally with a partner.

The participants in our research were generally satisfied with the care they received from the clinic, however they believed that clinics could improve their support of women undergoing egg freezing. This included by ensuring better awareness among clinic staff that women might be at the clinic to freeze eggs and not to attempt conception; by providing more time in consultations for women attending alone; and by displaying greater sensitivity and understanding of the reasons behind women’s use of egg freezing.

Our upcoming paper will reiterate the comments made by the RCOG and suggests that to ensure egg freezing is not oversold as a way to ‘stop the biological clock’ it is imperative that women are given as much individualised information as possible about the likelihood of having a live birth with frozen eggs or at the very least, are clearly informed of the limitations of current evidence. Furthermore, we suggest that it is important to make clear to all women, men and couples that the postponement of childbearing always lowers the chances of becoming a parent, even if they have access to IVF, and that IVF and ICSI have limitations and risks as does pregnancy in later life (Bewley et al, 2005)

By Dr Kylie Baldwin

References

AVRAHAM, S., MACHTINGER, R., CAHAN, T., SOKOLOV, A., RACOWSKY, C. AND SEIDMAN, D.S., (2014) What is the quality of information on social oocyte cryopreservation provided by websites of Society for Assisted Reproductive Technology member fertility clinics?. Fertility and Sterility, 101(1), pp.222-226.

CUTTING, R. et al. (2009) Human oocyte cryopreservation: evidence for practice. Human Fertility, 12 (3), pp. 125-136.

MAYES, C., WILLIAMS, J. AND LIPWORTH, W., (2017) Conflicted hope: social egg freezing and clinical conflicts of interest. Health Sociology Review, 27(1), pp.45-59.

WILKINSON, J., VAIL, A., & ROBERTS, S. A. (2017). Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites. BMJ open, 7(1), e012218.

Human Fertilisation and Embryology Authority (2018) Fertility Treatment 2014-2015 Trends and figures. HFEA Available at https://www.hfea.gov.uk/media/2563/hfea-fertility-trends-and-figures-2017-v2.pdf Accessed 14/08/2018

DOYLE, J.O., RICHTER, K.S., LIM, J., STILLMAN, R.J., GRAHAM, J.R. AND TUCKER, M.J., (2016) Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval. Fertility and Sterility, 105(2), pp.459-466.

BECKER, G. (1997). Disrupted lives: How people create meaning in a chaotic world. Univ of California Press.

BEWLEY ET AL (2005) Which career first? The most secure age for childbearing remains 20 – 35. British Medical Journal, 17, pp. 588-589.

 

Considering motherhood, ‘Eggistentialism’ and the gendered inequalities of parenting.

The upcoming fertility-fest organised by Jessica Hepburn has the CRR buzzing with excitement, the wide variety of speakers and exhibits on topics which many of us have spent several years researching is a rare treat for us as academics. I was however recently lucky enough to get something of a sneak peek at one of the acts presenting at the festival; the stage play by Joanne Ryan called ‘Eggistentialism’.

Conceived during an ice breaker at a theatre development scheme, and reflecting the thoughts and feelings of many women in their 30s, the play sees Ryan share her ambivalences about the possible role which motherhood may one-day play in her life. Musing on her own reproductive future the play examines the sexual as well as social politics of contemporary motherhood and through the use of an animated slide slow, maps key moments in the history of Ireland between 1916 and 2017. With a focus on the politics of the family, reproduction and sexual relationships, the play examines emotive and distressing topics such as the forcible removal of babies from unmarried mothers, poor access to reproductive and sex education for young people, repressive legal barriers to contraceptive technologies, and the denial of access to safe and legal abortions for tens of thousands of women in Ireland which still continues today.

In the play Ryan draws a comparison between the reproductive and mothering experiences of the older women in her family and herself. In doing so, she notes how the comparatively liberal experiences of her generation who had access to reliable contraception and seemingly egalitarian relationships with intimate partners, has meant that she is now part of the first generation of women for whom the experience of motherhood is not considered a simple inevitability, but a ‘choice’ which she is able, but also required, to make for herself.

The play begins with Ryan waking up on her 35^th birthday with the hangover from hell, the type of hangover which makes you question your life choices, and the decision about whether she wants to become a mother rests firmly at the forefront of her mind. Aware of her advancing age, and fearful that she may not have ‘enough eggs left over to make an omelette’, like many women before her she takes to the internet for advice about her fertility and possibility of motherhood in the future. What results is a particularly funny skit which sees Joanne’s computer screen quickly overrun by alarmist media headlines about fertility decline and older motherhood which cascade before the audiences’ eyes to the rumbling overture of Carl Orff’s Carmina Burana. Finding that the decision about whether or not to become a mother has not yet been made for her by ‘Mother Nature’, Ryan decides to undergo an ovarian reserve test to assess the state of her fertility and is told that she is still within the normal range for a woman of her age. With no moment of clarity provided by the results of these tests, Ryan ponders what her life would look like should she remain childfree. She concludes that she wouldn’t need to have a child in order to experience fulfilment and happiness but remains anxious about the thought of entering old age without building a ‘legacy’ and a family who could care for her should she become unwell or infirm. She also notes how despite growing numbers of women coming to the end of their fertile lives without becoming a mother, the language used to describe such women often remains derogatory (selfish, shallow, bitter, self-absorbed) with connotations of incompleteness and lacking in essential qualities of femininity; such a fact troubles Ryan.

However, Ryan’s personal ambivalence about motherhood appears to centre on what she perceives as the pressures of modern day motherhood, remarking that during her grandmother’s lifetime keeping a child alive, well fed, and warm appeared to be the extent of a woman’s mothering responsibilities. By contrast she notes how contemporary motherhood is characterised by what she describes as an ‘endless triage of difficult decisions a woman is constantly judged for’. Evoking the notion of the ‘mummy wars’, it appears that Ryan’s ambivalence about motherhood is at least in part shaped by her anticipation of engaging in, or being required to engage in, a process of intensive mothering (Hays, 1998; Baldwin, 2017). This expectation of mothering intensively leads Ryan to note how becoming a mother would almost certainly see the end of her much beloved ‘city breaks’ as the demands of motherhood would require not only a complete reorganisation and reorientation of her life, but would also entail a high degree of personal sacrifice and altruism in putting the needs of her child before her own. The perceived demands of motherhood also lead Ryan to worry about ‘losing herself’ in the process of becoming a mother.  Most significantly however Ryan notes how the transition to motherhood would change her life completely as the burdens of raising a child would more than likely fall disproportionately on her shoulders, by comparison she notes that for her partner Rob, it would be ‘business as usual’.

The fear that the burden of parenting, and other associated domestic tasks, would fall disproportionately to her is perhaps not unwarranted given the context in which she makes her decision. After all, it was only in 2016 that men in Ireland were first able to take state mandated paternity leave (with shared parental leave still not available), and whilst maternity leave is accessible for many women, it is often only paid at a statutory rate with employers not required to top up women’s income as seen in England. Ryan also cites statistics which paint a depressing picture of the low rate of Irish men’s involvement in domestic tasks and in the delivery of unpaid care. This leads her to fear that should she and Rob decide to become parents, the egalitarian relationship which they have enjoyed thus far would be disrupted with Rob being applauded for ‘babysitting’ his own child whilst she faces her career being side-lined and independence marginalised. In raising these issues Ryan recognises the deep gendered inequalities parenting can bring to a previously equal intimate relationship which Ryan is perhaps the first in her family to enjoy.

I am not going to spoil the ending of the play for you by divulging what Ryan eventually decides, you will have to attend the Fertility Fest to see for yourself, but I can thoroughly recommend the play as a wonderful mix of both a hilarious stand-up routine and a personal monologue which is emotionally honest, intelligent but also highly engaging and entertaining.

‘Existentialism’ is running at the Bush Theatre on Friday 11^th and Saturday 12^th May, for more details see https://www.fertilityfest.com/ or follow @eggsplay on Twitter.

References

HAYS, S. (1998) The cultural contradictions of motherhood: Yale University Press.

BALDWIN, K. (2017) ‘I suppose I think to myself, that’s the best way to be a mother’: how ideologies of parenthood shape women’s reproductive intentions and their use of social egg freezing.  Sociological Research Online 22 (2), 1-15

 By Dr Kylie Baldwin, Senior Lecturer