Friedman broaches the subject with married and single patients alike. "When a woman reaches her mid- to late thirties, I bring up fertility issues with her and let her know about the possibility of freezing embryos if she isn't quite ready, or using donor sperm to be a single parent," she says.
Of course, every movement has its backlash. Groups such as the National Organization for Women fear that fertility—awareness advocates are pressuring women into having babies before they are ready. Dr. Alan Copperman, director of the Division of Reproductive Endocrinology at the Mount Sinai Medical Center of New York and part of the top-notch team at Reproductive Medicine Associates, summarizes the debate: "It's become an issue as to how much we should educate the public versus alarm the public as to the decline in female fertility. Apparently some of the women’s groups feel that educating young women in secondary school health education that their fertility may be falling off in their thirties may dissuade them from pursuing a career, because they are being told there's a choice they can make: Be a mom, or be a business success. Other groups are suggesting that it is our responsibility, if not obligation, as health-care providers, to educate and say that there really is a decline in fertility. It doesn't mean that a 35- or 40-year-old can't get pregnant; it does mean they should be informed up front what their options are going to be and what the potential ramifications of their decisions will be."
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The bottom line? Dr. Margaret Garrisi, medical director of assisted reproduction at St. Barnabas Medical Center's esteemed Institute for Reproductive Medicine and Science, encourages people to be proactive: "Come up with a plan for having children, just as you would plan for your education or your career."
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Step one, for most people, is finding a like-minded mate. Psychologist Susan Heitler, Ph. D., author of The Power of Two, advises couples to discuss kids early on in their relationship. "If your visions are significantly different, move on," she says.