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Health

Why Ob-Gyns May Be the Worst People to Talk to About Fertility

New research shows women may want to start thinking about their fertility by age 32. But between IVF, egg freezing and embryo freezing, it’s increasingly hard for ob-gyns to advise their patients.

This week the American College of Obstetricians and Gynecologists released an opinion saying that women's ability to have babies decreases gradually but significantly beginning around age 32 and then goes down more rapidly after age 37. The younger estimate may come as a shock to women who have long been conditioned that 35 is the “I’ve got to deal with this!” age and that 40 is the cut-off for either freezing your eggs or giving your on-the-fence man an ultimatum.

However, the information is intended to help ob-gyns educate their patients about their baby-making deadlines. Because doctors see a wide spectrum of patients—from the 30-year-old who’s having trouble ovulating to the 42-year-old who got pregnant the first time she tracked her cycle by peeing on test strips from Duane Reade—it makes sense for them to stay on message that it’s never too early to be thinking about when you want to get pregnant. Case in point: The statement was released at the same time as a report stating that IVF births are at an all-time high—61,740 babies in 2012, which is up more than 2,000 infants from the year before, according to the Society for Assisted Reproductive Technology. The numbers reflect a welcome trend of doctors directing women who are having trouble conceiving into treatment earlier, rather than advising them to try naturally for “a few more months.” But the rise is also due to more women needing a little IVF help because they’re waiting longer than ever to have babies.

So it’s good news that doctors are being encouraged to have that uncomfortable fertility chat with patients and ask “So do you plan on having children in the future?” at annual exams. I wrote an op-ed in The New York Times more than a year ago urging ob-gyns to educate women about the option of egg freezing, in case their patients planned to take the slow road to motherhood. I still cringe when I meet older women who forlornly tell me, “I wish I would have known about egg freezing when I still had the chance. I wish my ob-gyn had told me.” The push couldn’t come at a better time, either. In a study of women who froze their eggs between 2005 and 2011 at New York University Langone Medical Center, only one quarter had learned about the fertility preservation technique from their ob-gyns. But what’s even more shocking: Of the three-fourths of women who felt they knew the facts of fertility in general, only 30 percent learned about them from an ob-gyn.

Yet ob-gyns are put in a tough position. Even though they’re talking about science, they’re still humans with their own emotions and viewpoints. It would be helpful if every patient responded to “So do you plan on having children in the future?” with a definitive “Yes, I do next year. Can you tell me which supplements to take to improve my fertility?” But the question is often met with long sighs and TMI about bad boyfriends and breakups. What would you have done if you had to chat with my freaked-out friend who throughout her thirties asked her ob-gyn “You’ll tell me when I need to worry, right?” The poor doctor chose to console my friend, rather than add to her anxiety with one more reminder that her eggs were getting older and older.

Then there’s the question of which options to suggest to single women who are bumping up against the deadline, but aren’t yet ready to become moms. You can get pregnant now with donor sperm or later by freezing embryos made with donor sperm. Or if you still want time to find the guy and worry he won’t be game for using embryos made from an anonymous man’s swimmers, then egg freezing is the best option. It’s not a perfect solution: At $7,000 to $12,000 a cycle, it’s expensive, and it’s not guaranteed to work.

The problem is that even though egg freezing is no longer considered experimental, many doctors are really uncomfortable recommending it. The fear is that women would wait too long to try to thaw those eggs and waste their remaining fertility in the meantime. It’s not exactly a rewarding part of the job to run into your childless patient at Pinkberry and wonder whether you contributed to her life choices. Ob-gyns probably don’t care about whether you and your boyfriend are currently on a break or whether you’re thinking about trying a new online dating site because they guys on Match have been lame lately. No, their job is to look out for your reproductive health, and if having a baby on your own right now is going to give you the best chance of bringing home a healthy baby, many doctors are going to tell you that. You can figure out your romantic life later.

But whether your doctor is the comforting type or the kind to scare the bejeezus out of every 32-year-old, it’s important to remember he or she is but one source of information. Their conversations should (hopefully) educate women about all the possible roads to take if they end up on the other side of 40 and can’t have a biological baby. In addition to adoption, another possibility is frozen donor eggs, which are becoming cheaper, more accessible, and have a more than 50 percent success rate. You can also now grow a couple’s leftover IVF embryos in your own body.

When it comes to baby-making, women have plenty of options.

Sarah Elizabeth Richards is the author of Motherhood, Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It  
  

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