Once upon a time, in those far off days before the Pill reigned supreme, any sexually active young woman would always have the fear at the back of her mind of "falling" pregnant. (It's a verb that has always intrigued me in this context but I suppose "fallen" woman explains it.) In fact, if we're truthful, it probably added a frisson of excitement to those early, rather inexpert, couplings. Even with "precautions", nothing was ever foolproof. We were human after all.
Today, though, the fear of pregnancy is being supplanted by another fear altogether, albeit one not yet widely understood in our community - that of not being able to have a baby when we decide the time has come.
It's a fear that's now eroding the happiness of an increasing number of couples in Australia, with one in six struggling with infertility. Women delaying the decision to have a child to their late 30s is certainly a factor, but the problem is now affecting younger women as well.
In their new book Infertility: the hidden causes Dr Sandra Cabot and naturopath Margaret Jasinska raise a compelling argument that our nation's increasing rate of infertility is a sign of underlying health problems. As they state unequivocally in their opening paragraph: "Infertility is a sign that something is not right with you or your partner's health. A healthy body is a fertile body. Our bodies are cleverly designed to, and when that doesn't happen, there is always an explanation."
I'm sure we all know young couples who desperately want a baby but whose dreams are being dashed; endometriosis and polycystic ovarian syndrome (PCOS) are familiar terms even if we don't really understand what they mean; IVF (Invitro Fertilisation) use has skyrocketed (one in 29 Australian children is now conceived by some assisted technology); young men now face the reality that their sperm might not be up to the task when finally asked to perform (sperm counts of healthy males have more than halved in the last 50 years).
Dr Cabot, well known as a long term advocate of holistic health and natural medicine, has brought her own extensive background in obstetrics to bear in compiling this book as a detailed guide to couples seeking to conceive. As well as exploring some of the more obvious causes such as endometriosis, PCOS, ovarian cysts, fibroids, blocked fallopian tubes and infections in both women and men, it covers new ground in examining more subtle causes.
"Our book's about so called unexplained infertility," she tells me.
Even if a couple has gone to the effort of "cleaning up their act" in preparation for the happy event, they may carry an unsuspected legacy from previous ill health.
"Let's say a woman has had a pelvic infection in the past but she's overcome it and is now in good health. But in the past she wasn't and that can explain the problem."
Her colleague and co-author, naturopath Margaret Jasinska adds, "It's often very subtle health problems that people will never think to link to their reproductive tract. Commonly, people think their reproductive organs are like an island - separate from the rest of their body.
"There are things like being overweight or having allergies or nutrient deficiencies that people would never suspect would affect their fertility.
"We just wanted to make people aware of that and so often those sorts of problems are relatively easy and inexpensive to fix compared to IVF, for example."
The rush to IVF is a trend that clearly disturbs both women and receives several mentions in the book as the "go to" solution for "any and every case of infertility, often without properly investigating the underlying cause of the problem." They pose what seems an eminently reasonable question: "Don't you think it's essential to rule out every known possible and treatable cause of infertility before resorting to IVF?" Says Margaret, "IVF does nothing to make the couple healthier."
So what is behind this alarming statistic that one in six couples struggles with infertility in Australia?
Dr Cabot is firmly of the view that being overweight is the most important factor, together with an increasing incidence of insulin resistance.
"Just being overweight can shut off the pituitary gland or at least the FSHLH (follicle stimulating hormone and luteinising hormone) cycle so that it's out of balance and you don't get proper ovulation and then you get progesterone deficiency. In turn, that causes an inhospitable terrain in the uterus and then the feedback to the pituitary is wrong. And so the whole situation compounds itself.
"It's a cascading effect that starts with a woman being overweight."
Insulin resistance brings with it a greatly added risk of polycystic ovarian syndrome and women with the increasingly common syndrome don't ovulate regularly or at all.
But even without PCOS, we learn that an overweight woman often fails to ovulate. Even young obese women with regular menstrual cycles usually take longer to conceive than slim women. The newfound saviour of IVF is also far less successful when a woman is carrying excess weight.
But it's not all doom and gloom because, say Cabot and Jasinska, "Losing weight if overweight is one of the fastest ways to achieve a pregnancy."
It's hard to escape the conclusion that our society's inadequate diet with everything skewed to convenience with prepared, highly processed food taking the place of natural, home cooked meals is leading to a multiplicity of health problems - and now it seems they include rapidly declining fertility.
"It's interesting," Dr Cabot continues, "that we see a lot of women in our clinic and if you took a dietary history from them you'd think that's pretty good. And these are women who are trying to be healthy.
"But in 50% of these cases who, to a dietician would seem to have a good diet, we find they are deficient in iodine and Vitamin D."
Thyroid problems, particularly an underactive thyroid gland, are "incredibly common in women" and a common cause of infertility in both women and men. Vitamin D, the "sunshine vitamin", is only now being recognised as being seriously deficient in our society which has learned to fear the sun; a deficiency of this hormone precursor aggravates hormone disorders.
Dr Cabot continues: "80% of Aussies are low in selenium and that acts synergistically with low Vitamin D, low iodine and low progesterone and stress and they all magnify each other. So that seemingly simple problems become quite profound when they're all put together."
Although often called the pregnancy hormone, the importance of progesterone in promoting fertility is poorly understood by women and doctors, too, she suggests.
It performs a balancing role with oestrogen to prepare the lining of the uterus for the fertilised egg, to maintain the pregnancy and boost the immune system.
Oestrogen dominance and the corresponding fall in progesterone is yet another of our modern world's emerging patterns - and once again, it's most commonly caused by a high carbohydrate diet, excess body weight, nutrient deficiencies, ageing, and stress.
"Doctors are not trained to be aware of the implications of progesterone deficiency. And they're not trained to use the natural progesterone. It's something that is considered complementary and also drug companies aren't interested in doing clinical research because it's natural," says Dr Cabot.
"But what we're talking about is preventing women having to go to the stress of IVF by making them aware of progesterone so they can use it to regulate their own cycles."
Men are also given the once over in this very detailed fertility "manual" - we learn that males are currently responsible for 40% of infertility with most cases relating to sperm quantity and quality. And while we learn some seriously concerning details about what's happening to males worldwide - a Danish study in 1992 demonstrated that sperm counts in healthy men had dropped by more than half in 50 years - with rapid cell division in sperm making them vulnerable to chemicals in the environment, especially endocrine disruptors, there is hope at hand! New sperm are produced every three months, so changes in diet and lifestyle can lead to dramatic improvements. Cabot and Jasinska are, as ever, firm in their advice that any man wanting to have a child needs to clean up his diet and strive to achieve optimum health at least three months before trying to conceive.
While infertility, both explained and unexplained, is placed under the microscope, the authors are determined to empower couples who take up their challenge to do it naturally.
They include a "fertility diet" with its promise of "getting pregnant fast". Top of the list is to increase your vegetable intake along with adequate protein, plenty of good fats(omega 3 fats from fish oil, in particular, and not omega 6 oils from processed foods, plus beneficial monosaturated oils found in olive oil, avocados and macadamia nuts), nuts and seeds, herbs and spices, and plenty of healthy fluids like purified water, herbal and green teas.
Lifestyle habits are also important for any hopeful couple with the authors suggesting exercise and seven to eight hours sleep a night are essential. Managing stress (one sure way is to improve time management), limiting stimulants and excess alcohol and even just making time for your favourite activities or friends can all help tip the balance in your favour.
Exposure to chemicals in the environment is one of the greatest challenges to fertility and health generally, with endocrine disruptors the main culprit. While they are impossible to escape - 80,000 manmade synthetic chemicals have been released into the environment in the past 60 years - once again the authors suggest it's possible to minimise your exposure.
Avoiding plastic in contact with food or liquid is an important step, particularly when food is heated, install a water filter and store water in glass bottles, minimise your intake of canned foods as many contain bisphenol A in the white resin lining, use natural and organic cosmetics and personal care products, avoid air freshener and instead make your home smell sweet with pure essential oils.
In talking to Dr Sandra Cabot and naturopath Margaret Jasinska, it seems to me the choice is becoming more clear cut in how we go about managing our health. We can either embrace the medical model that is there to "help" us at every opportunity - in the case of childbearing, from IVF all the way to an elective Caesarean because we've become increasingly disconnected from our bodies - or we can empower ourselves by understanding how our body functions holistically.
Says Dr Cabot: "Medicine is very compartmentalised. If someone has a thyroid problem, they're not necessarily going to be looked at for a progesterone deficiency and vice versa.
"So I think the message is educate yourself because you will really need to work with your doctor. And also understand holistic medicine.
"If men and women understood how much power they could have over their future health by understanding themselves holistically, and through getting regular checkups and self education, then they would have a much better quality of life. In this particular case, you'll get better results in your fertility and in our children's health as well."
Infertility: the hidden causes , subtitled How to overcome them naturally is a great start to that empowering process, both for couples wanting a baby and for anyone wanting to improve their health through greater knowledge.
Margaret Evans has a background in teaching, journalism and publishing. She is the editor of NOVA Holistic Journal.