It's time to blow these biological myths out of the water.
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 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 hear that a celebrity is having twins at age 52 and they don't think about the possibility that she's used donor eggs," says Friendman. "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."
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."
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."
Conceptions And Misconceptions
Since the first "test tube” baby, Louise Brown, was born in 1978, doctors have brought more than one million IVF (in vitro fertilization) babies into the world.
The next frontier is egg cryopreservation (freezing a woman's eggs and then thawing, fertilizing, and implanting them years later), which has been successful in about 75 cases worldwide, though the rate is still one percent per egg, at best.
Researchers also have been removing ovarian tissue, freezing it, and then transplanting it back into the body. Doctors in Belgium froze the ovarian tissue of a cancer patient seven years ago, before she underwent chemotherapy. Last September, she had the first baby ever born from an egg produced by re-implanted ovarian tissue.
Life expectancies are increasing. The window for motherhood is too. As the next generation of women head out to buy their first business suits, they may be able to stop off at the egg bank, make a deposit, and buy themselves more time —a decade or two—before shopping for maternity wear.
Your best plan is to get informed about your fertility—don't assume that if the stork won’t bring you a baby, your doctor can.
1. "Fertility starts to decline in a woman's late 30s and most women can have children naturally in their 40s."
Reality: Fertility begins to decline gradually in a woman’s late 20s and goes into a free-fall around age 40. By age 42, a woman has less than a ten percent chance of getting pregnant without donor eggs, and many fertility clinics discourage women over 43 from attempting to get pregnant with their own eggs.
When the American Fertility Association surveyed more than 12,000 women in 2001, many incorrectly assumed that the waning of female fertility begins in the late 30s. They were way off.
"A woman's fecundability—her chance of becoming pregnant in a single month—falls from at least 20 percent in her 20s, to between 10 and 15 percent in her mid-30s, to 10 percent at best at age 40, to a mere 2 or 3 percent by age 45," estimates Dr. Copperman.
With an average age of 38, many of the patients at his practice "are going to have egg-quality issues," he says, which lead not only to problems getting pregnant, but also to increased miscarriage rates and potential genetic abnormalities. Dr. Copperman advises that any woman over 35 should go in for an evaluation "sooner rather than later. Certainly after six months of timed trying, it’s time to investigate."
2. "The best way to conceive is not to have sex for a week and then give it one good shot when the woman's temperature goes up."
Reality: Having sex early and often—about every other day from about four days before a woman thinks she's going to ovulate until a day or so after—makes conception most likely.
If you wait for a week, Dr. Copperman explains, "First of all, you're going to have a whole bunch of old sperm there, rather than fresh sperm if the man had ejaculated a day or two before. Secondly, part of the time, you're going to miss ovulation. Ideally, you really want the sperm there before the egg is released."
Sperm can survive for several days, while the egg loses viability quite rapidly, some estimate within 24 hours.
While day 14 is the standard, the time of ovulation varies from woman to woman and sometimes from cycle to cycle. Charting temperature, noting cervical mucus changes, or using ovulation-predictor kits will help a woman become more familiar with her cycle and determine the best time to conceive.
3. "Just relax and you'll get pregnant."
Reality: There is no convincing scientific evidence to show that stress leads to infertility. This suggestion can be hurtful, as it implies that the woman’s actions or frame of mind are causing her infertility—that it's her fault.
"There really is no difference in fertility if the woman is extremely anxious, if she's a trader on the stock exchange, or if she's meditating in Tibet," says Dr. Copperman. There is the same chance of an egg and sperm getting together, the same chance of a pregnancy ensuing, the same chance of a miscarriage.
4. "Birth-control pills decrease fertility."
Reality: Birth-control pills have not been shown to decrease fertility.
Actually, the pill can help protect fertility and may reduce the risk of ovarian cancer by up to 40 percent. Pill users may experience a decrease in the likelihood of endometriosis and tubal diseases, as well as the alleviation of some symptoms of polycystic ovarian syndrome—all of which can lead to infertility.
Also, recent studies suggest that in the couple of months right after a woman stops taking the pill she may experience a boost in her fertility; i.e., this is a good time to try. However, the pill does not enable a woman to stockpile eggs for future use.
5. "Condom use doesn't relate to fertility."
Reality: The use of condoms decreases the risk of contracting sexually transmitted diseases, so condoms do protect fertility. Fifteen million new cases of STDs are diagnosed each year in the U.S. Many more STDs—which often show no symptoms—go undiagnosed and untreated, making it even more likely they will lead to fertility problems.
Women have it worse than men: STDs are transmitted more easily to women and they cause more damage to the female's delicate reproductive system. In women, STDs can cause pelvic inflammatory disease (PID—a common cause of infertility) and tubal disease (which is implicated in about 20 percent of infertility cases), scarring ducts and tissues and increasing the risk of ectopic pregnancies and miscarriages.
6. "A big, strong guy is usually more fertile."
Reality: Physical size and strength do not correlate to sperm count.
A "male factor" is involved in as many as 50 percent of infertility cases—odds which justify the brief embarrassment of producing the sperm sample. (Fertility clinics have private rooms with pornographic media for this purpose, and many clinics allow patients to tote a sperm sample from home as long as it can be brought in promptly.)
The process is certainly more pleasant than much of the prodding and pricking female patients must tolerate. "I think every couple having trouble conceiving should undergo a semen analysis, certainly prior to performing any invasive procedures on the wife," says Dr. Copperman.
7. "I'm generally healthy, so I'm sure I'm fertile."
Reality: General health does not correlate strongly to fertility, but a healthy lifestyle is important. Women who smoke throw off their estrogen levels, risk tubal pregnancy, and increase the chance of miscarriage, low birth weight, and birth defects.
Male smokers significantly lower their sperm counts and increase the percentage of abnormally shaped sperm. Moderate alcohol consumption—a glass of wine with dinner—probably won't diminish fertility, but much more than that may cause menstrual disorders and abnormal sperm production.
Doctors also warn against excessive caffeine consumption while trying to conceive. Stick to one or two caffeine drinks a day.
"Just say no" to any recreational drugs, as even limited use can affect male sexual function and disrupt ovulation. Being overweight or underweight—20 percent off your ideal weight in either direction—may hinder fertility in women.
Moderate exercise is good, but women should avoid exercising to the point where their cycles are disrupted.
8. "I'll get pregnant a month or two after I start trying."
Reality: The average couple of 30-year-olds takes six months to conceive naturally. "People think as soon as they try they"re going to get pregnant," says Dr. Friedman. "They hear about all their friends who got pregnant in one month, but the couple who've been trying for a year or more probably isn't announcing that."
About 75 percent of women will get pregnant within six months. Around 15 percent may pass the 12-month mark, which is when a couple is considered "infertile." Before starting to try, a woman should see an ob-gyn for a check-up and make sure that all of her immunizations are up to date.
9. "I've had a baby already, so I won't have a problem having more."
Reality: Secondary infertility—having difficulty conceiving after having conceived in the past—is almost as common as primary infertility.
Dr. Copperman explains that the causes of secondary infertility are the same problems many couples experience the first time around: "It could be egg quality, tubal disease, uterine problems, or even a newly acquired male factor. So even if a couple has gotten pregnant in the past, if they're having difficulty it's important to go through the basics—check the eggs, sperm, fallopian tubes, and uterus—because we often find that things change over time."
10. "Infertility is uncommon."
Reality: Infertility affects about ten percent of Americans of child-bearing age.
Pamela Madsen, the executive director of the American Fertility Association, aims to educate the general public, employers, and legislators, but it's an uphill battle, she says: "On a recent trip to Washington, [I was] meeting with a top Republican aide about federal legislation for infertility. This aide turned to me and said, 'Infertility? Doesn't that only happen to anorexics?'"
Part of the problem is that those coping with infertility feel alone and ashamed, and they may share their difficulties only with their very closest friends and family—if they share them with anyone. Infertility should not carry a stigma, and the more informed people are (thanks to brave souls like Madsen, who are willing to speak out about their own struggles to have children), the less isolated and helpless infertility sufferers will feel.