Fertility taboos and the cycle of stigma
No one’s talking about it and no one’s asking for help.
When it comes to fertility issues, people often suffer in silence.
A lack of education and societal pressures prevents important conversations around fertility from taking place.
Outdated ideas about fertility, dating back to an age when people started families younger, proliferate, while misconceptions around fertility and gender are also common. These problems are shrouded in silence, with the stigma surrounding the discussion preventing individuals from seeking help, or delaying intervention and by extension diminishing the efficacy of treatments – or reducing treatment options.
Heteronormative pressures still grip society. Natural conception and the nuclear family remain the norm in the minds of many, and the inability to start a family in this way can feel like a failure. This sense of failure, and an individual’s assumption that “there’s something wrong” with them, can obscure the truth: that these issues are common, and solutions exist.
Male infertility now represents half the cases treated by assisted reproduction clinics ¹.
The age of parenthood in the UK has risen steadily between 1975 and 2019 – increasing from 26.4 to 30.7 in mothers, and 29.4 to 33.6 in fathers ².
Approximately 90% of men and women going through fertility treatment reported feeling depressed ³.
Explore the key issues below
Sex education needs an update to reset how we think about fertility
A lot of this stigma starts at school. Many received a sex education curriculum taught through the lens of avoidance: how to avoid pregnancies or access abortion, and how to avoid STIs. Young people are hardwired to believe that we are all fertile and that not using contraception will inevitably result in a baby, instead of being educated in the complex realities of conception: that fertility decreases with age, and one in seven couples in the UK will struggle to conceive.
Assisted reproduction only becomes front of mind when it is needed. For the taboo to lift, a realistic and pragmatic conversation about sexual health and fertility needs to start at a younger age and continue into adulthood. In the UK, The British Fertility Society is leading a task force to bring issues, including future fertility, into the national curriculum – which is an encouraging initiative for the next generation.
Discussions about fertility are still highly stigmatised, reducing the opportunity for conversations, education and support
One environment with access to a significant proportion of adults is the workplace. Yet, employees are often reluctant to talk to their managers about the fertility treatments they are having, let alone ask for help. Many worry this conversation could negatively impact their career prospects and fear they might miss a promotion because of the time commitment associated with attending fertility treatments, pregnancy and having a child.
Individuals may also worry that their personal fertility issues will not be taken seriously or that information about their health may be shared with colleagues without their permission or knowledge.
Some communities have been excluded from the conversation
For LGBTQIA+ families the biological options are more restrictive which places more emphasis on the availability and access to “assisted” options. In the US, it costs on average $120k to have a child via surrogacy, highlighting one of the complex challenges LGBTQIA+ individuals or couples may encounter. There are many other options to start a family but, as the debate around fertility evolves at the same time as broader discussions around diversity, we need to ensure solutions are genuinely inclusive.
The Human Fertilisation and Embryology Authority (HFAE) published a report looking at the variation within IVF cycles by ethnicity in order to understand variations in demand, as well as success rates. The results showed that the IVF success rate across groups varied significantly with up to a 30% variation in outcomes in some measures ⁴. This research also seeded many broader questions about the validity of clinical research where the sample populations had historically been lacking in diversity, and how clinicians should manage and address this going forward.
Bold startups are challenging the status quo
Startups are playing an active role in breaking down fertility and sexual health taboos, triggering a domino effect of societal change.
Disruptive brands tackling taboos and encouraging open conversations
Direct-to-consumer brands, such as Flo, Natural Cycles, Elvie, mojo and Hims & Hers are normalising the discussion of previously taboo topics. It can be extremely difficult to take conversations that typically happen in private and shift them into a more open discussion.
However, in many respects, startups are extremely well placed to do so, as their brands and marketing are naturally designed to be bolder and more disruptive, which is often necessary when trying to challenge a long-standing taboos.
Employee engagement and support
Workplaces are playing an increasing role in encouraging open conversations, for example in the area of improved parent leave policies. But we are now starting to see more difficult issues being acknowledged, with companies like Monzo offering employees additional time off in the event of a miscarriage.
Employers are also enabling employees to engage with trained clinicians. Companies can erode stigma by using external providers, which offer meaningful support around fertility without blurring the personal and professional boundary too far.
New services designed for underserved communities
Startups are building services that promote conversations in underserved communities. LVNDR Health, the digital clinic for the LGBTQIA+ community, is on a mission to change the polarised sexual healthcare landscape, while US-based firm Spora Health is demonstrating that community specific health provision can increase uptake significantly.
IVF success rates vary across different ethnic groups, it will be interesting to see if there is a similar pattern of innovation within fertility.
Menopause and family planning
Menopause occurs when a woman stops having periods and is no longer able to get pregnant naturally (NHS). For more than 80% of women this is accompanied by physical and psychological symptoms.
Typically, the drive to start a family does not coincide with this natural hormonal shift, but it can sometimes occur early with 1% of women in the US experiencing premature menopause. Innovative companies, such as Peppy, are creating ways for women to address menopausal symptoms within employer channels, and research efforts are focusing on ovarian longevity and rejuvenation.
Companies to watch
Mojo is a sexual wellbeing platform for men that provides an entirely digital, medication-free, solution to assist in treating issues such as erectile dysfunction (ED), low libido, and performance anxiety.
LVNDR Health is a sexual and reproductive healthcare app designed specifically for the LGBTQIA+ community.
Parla provides a hub for women covering fertility, mental health and the whole journey to having a baby.
Vira Health offers intelligent and personalised therapeutics, delivering treatment plans to relieve women experiencing menopause of the worst of their symptoms.
Hertility Health is on a mission to make information about female health accessible and affordable.
Peppy connects people with an expert fertility practitioner through their phone, and provides support for women with menopausal symptoms.
Get in touch with our Health team to find out more
Octopus Ventures is the most active health investor in the UK, investing across all stages but with a bias towards the earliest stages (Seed and Series A). We are committed to backing pioneers who are transforming the health industry from digital therapeutics through to biotechnology.