In the last few years, the zeitgeist has shifted from "look at all those successful women having their first babies in their forties" to "all those high-achievers who have waited to have a baby are in big trouble." In her controversial 2002 book, Creating a Life: Professional Women and the Quest for Children, Sylvia Ann Hewlett showed ambitious 40- or 50-something women who'd pursued the dream of "having it all" as facing the devastation of a nest that would never be filled. Some questioned Hewlett’s dark scenario, but her book touched off a "Baby Panic," as a New York magazine cover described it, and a blitz of media debate (Time, Newsweek, The Oprah Winfrey Show, 60 Minutes) over the right timetable for childbearing.
Proponents of raising awareness encourage ob-gyns to bring up the subject of fertility with women before their window of opportunity slides shut. While some doctors won't "invade their patients' privacy" on this issue, offering advice only if asked, others, like Manhattan ob-gyn Dr. Lynn Friedman, do open the discussion, because of trends she sees in her practice. At least half of Friedman's over-40 patients wishing to conceive end up seeing a fertility specialist, and she has found that those over 42 are usually not successful using their own eggs—a reality that catches many off guard.
"They'll point out the one person they know who is in her forties and pregnant, and they'll hang their hats on that one person," says Friedman. "They'll hear that a celebrity is having twins at age 52 and they don't think about the possibility that she's used donor eggs. Of course women have a right to their privacy, and generally they won't publicize it if they use donor eggs, but it ends up being misleading to other women. I had a 45-year-old come in saying she wanted to try to get pregnant and when I explained to her that she should see a fertility specialist and look into donor eggs because she had a very small chance of getting pregnant, she was livid. She got up and stormed out. She did end up needing donor eggs. I don't know if she was successful or not."