Approximately one in every six people experience infertility in their lifetime. In this episode of The Why Wait Agenda podcast we discuss the main causes of infertility – a disease of the reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse – with Karin Hammarberg, an Australian fertility expert and Senior Research Fellow at Monash University.

«Infertility, no matter if primary or secondary, is pretty devastating» says  Hammarberg, a registered nurse with twenty years of experience as clinical co-ordinator of in vitro fertilisation programs: «Sometimes people with secondary infertility feel guilty about wanting to have another child, when people might tell them "well, you're lucky, you've got one child – or two children – already". But if you actually had a real hope of having two or three children and you only have one, the grief you feel is pretty profound, and I'm not so sure it's even helpful to try and compare the two».

As Hammerberg stated in an article about late pregnancy storylines in tv dramas, previously featured in the Why Wait Agenda – "Mothers over 40: it seems easy enough on TV, but what about real life?" – the chance of pregnancy is lower for women in their late thirties and forties. «Infertility has a range of causes, but one cause often under-reported is what we call age-related infertility» stresses Hammarberg: «It's becoming a more and more common cause, unfortunately».

Hammerberg doesn't think that people know enough about infertility – nor about fertility, for that matter. That's why her «strong passion in life» is to work on «what people can do to actually promote and protect their own fertility, and to make sure they give themselves the best chance of conceiving without having infertility treatments».  And that's precisely what she's doing by collaborating with the website Yourfertility.org.au, a national public education program managed by the Fertility Coalition and funded by the Australian Government's Department of Health and the Victorian Government's Department of Health.

«Often infertility is presumed to be a women's problem, but in fact one in three cases of infertility is because of a male factor» points out Hammarberg, who's also Deputy chair of the International Reproductive Health Education Collaboration and a member of the scientific committee of the European Fertility Society: «I hope that with more and more advocacy and information and awareness raising, we can reach a point where everybody understands that it's no one's fault. It's just sometimes biology, sometimes a disease, but it's not a personal responsibility – and no one should be blamed or shamed» fo it.

What have Constitutions got to do with people’s decision to have babies or not? Well, for example, the Italian constitution has an article that states: «Working conditions shall allow women to fulfil their essential role in the family», placing working women in a subordinate position to working men, who are free to work without being forced to fulfil any «essential role».  And an unequal household division of labour and attitudes about egalitarian roles can influence the timing of first births, according to the paper “Why do people postpone parenthood?” by professor Melinda Mills (also a guest of our podcast, twice!) amongst others.

«Working conditions shall allow women to fulfil their essential role in the family», then. It wasn’t all that shocking seventy years ago, when the Italian Constitution was written. But it's quite different now.

The guest of this episode is Carla Bassu, one of the youngest full professors of Comparative Public Law in Italy, and an ambassador for egalitarian roles. For years she fought – and recently won – a major battle: the one to empower both parents to give their surname to their children in Italy.

«We need to consider the contest [our Constitution] has been formulated in»  professor Bassu says, «It reflects the historical and cultural background: in 1948, when our Constitution came into effect, most people found it hard to recognise a position for women away from domestic work». So, being an historical document as all Constitutions are, the Italian Constitution simply reflects the spirit of the time.

But a lot can be done now, Bassu explains, «by interpretation» of the said Constitution, and «through education» of the younger generations towards gender equality and equal parenting. Because, even if it's probably a bit of a stretch to blame the Italian Constitution for the fertility gap – the imbalance between how many children people would like to have and how many children they actually end up having – it's fair to say that it certainly hasn’t helped.

Becoming a parent is first and foremost a decision to make. A choice. But what happens when our mind and our heart long for a baby, and our body simply does not cooperate? When it comes to fertility, wanting is not enough – choosing is not enough:  only 85% of couples will conceive naturally within a year of regular unprotected sex. No less than 25 million citizens are affected by infertility just in the European Union.

This episode's guest is Jessica Hepburn, the author of the memoir "The Pursuit of Motherhood" and of “21 Miles: swimming in search of the meaning of motherhood”. Her books focuses on the need to talk openly about the stigma of infertility and unsuccessful IVF, that Hepburn experienced firsthand going through multiple rounds of in vitro fertilisation, suffering miscarriages and even an ectopic pregnancy.

There was no happy ending for her: that's why her voice is different, maybe less sugar-coated than your typical fertility ambassador, but honest. Jessica Hepburn has come to represent the people who have not and will not be able to conceive, even with all the medical aid currently available. And she's living proof that infertility can be overcome not just in the obvious way – by having a baby – but also by finding other ways to fill that void.

Hepburn is now a fertility activist and ambassador: she has been a trustee of the charity Fertility Network UK; a patient adviser to the HFEA, the UK’s independent regulator of fertility treatment; and a member of the Fertility Education Initiative. In this episode of the podcast she discusses with Eleonora Voltolina, founder of The Why Wait Agenda, the huge effect of infertility on relationships, the difficulties of sex after a round of failed fertility treatment, the secrecy and shame that still surrounds infertility, and the need to raise awareness about this topic.