The number of births is the United States is its lowest level in 30 years. The National Center for Health Statistics reports that US fertility rate fell in every reproductive age group, except in women age 40-44. This reflects a new generation of women who are delaying marriage, pursuing more education and climbing the corporate later.
In just one generation we moved from childbearing in our 20s to having the kids in our late 30s or even early 40s. And this change has resulted in more women having difficulty building their ideal families. Did you know that by 40, more than 50% of women have difficulty conceiving? It’s just one more thing in the long list of gender inequities, that men make new sperm every day, but women are born with all of their eggs. By 35, half a woman’s eggs are abnormal and by 40 it approaches 80%. This means if a woman is waiting until her late 30s, each egg is less likely to cause a pregnancy-- increasing the time to pregnancy and the risk of miscarriage.
What this also means is that women are trying for baby number one at a time where it is already more difficult to achieve pregnancy. It is at this juncture that I ask my patients to consider their family building goal. It is not un-common for this goal to be “we want two, maybe three kids someday, but we are just focusing on this first one.” I would be doing my patients a disservice if we didn’t discuss options at this point for not only fertility treatment for their immediate goal of pregnancy but also fertility preservation, for the children they hope to have in the future. Very few patients are focused on their overall family building goal, most of us are of course focused on “how will I get pregnant with number one, ASAP?!!”
With the wide spread use of fast freezing method called vitrification and pre-implantation genetic testing of embryos for aneuploidy (PGT-A) making IVF success rates better than ever before, we are moving to a different era of family planning. While family planning has traditionally referred to birth control methods and access to abortion, the definition of family planning by the US Health Department is “the educational, comprehensive medical or social activities which enable individuals to determine freely the number and spacing of their children and to select the means by which this may be achieved.” Just like a woman can proactively prevent pregnancy, she can also freeze her eggs or embryos. We spend a lifetime learning and planning for our financial future, it is time to do the same for your fertility future.
Being a fertility patient when you are ready to have a baby is very traumatic. I see every day how frustrated women feel after spending a lifetime preventing pregnancy, only to find out that it can be harder to achieve pregnancy than they ever imagined. Realize if you are already having difficulty conceiving, or if you are planning to wait until mid to late 30s, achieving pregnancy doesn’t get easier with age. This changes the conversation from fertility treatment to include fertility preservation and increases the time to pregnancy as patients do more IVF to save healthy (chromosomally normal) embryos for future children. No one thinks achieving pregnancy will be difficult for them, but looking young and being healthy doesn’t equal good fertility. Know the statistics, consider your family building goals and learn about your options.
What can you do to get ahead of your fertility:
1. Ask your doctor for fertility testing at your yearly well woman visit. This is an AMH level and can be followed over time as a little window into your fertility. It doesn’t tell you if it will be hard to achieve pregnancy but it does tell you if you have eggs left. Every woman is different, and you don’t want to find out when it is too late that you are out of eggs.
2. Take care of your health: Minimize alcohol and eliminate marijuana, minimize reproductive toxins in your life, and protect yourself from sexually transmitted infections that can cause infertility.
3. Talk to a fertility specialist, and learn about your options. Consider if preserving your fertility with egg freezing or embryo freezing is right for you.
What can you do when you are in the middle of fertility treatment:
1. Know your fertility. Understand how age and your ovarian reserve effect your chances of conceiving now versus when you will be ready for a second or a third child.
2. Define your over-all family building goal. Allow yourself to Dream Big. Be honest with yourself, is your goal just one baby or have you convinced yourself that it is too overwhelming to think past the idea of more than one pregnancy?
3. Make a Plan. Talk to your fertility specialist and make a treatment plan that is right for you to meet your family building goal. This could involve saving eggs or embryos for future pregnancy attempts.
4. Don’t compare: Every patient is different, and no plan is the same, and that is okay. Everyone’s resources: physical, emotional, financial are limited in different ways. Allow yourself to feel confident in yourself, your doctor and your plan for your future family.