Society has a unique way of influencing how people act, react and feel — sometimes harshly and unfairly altering decisions made. The stigma surrounding infertility and/or not having a child has fallen into that undeserved abyss.
As stereotypical as it sounds, some people will go to great lengths to have a baby. Unfortunately — and seemingly exacerbated where a traditional male-female relationship is lacking — the stigma associated with not having a child has wrongly dissuaded some people from seeking fertility options, such as undergoing treatment solo and/or pursuing fertility preservation options like oocyte (or egg) freezing.
While infertility affects one in five male-female couples and up to a third of women age 35 and older, the number of people who contemplate fertility-enhancing treatment yet fail to pursue it is unknown. Not moving forward may be due in part to shame, specifically shame associated with deviating from expected parenthood norms. Associated humiliation and a sense of personal failure can be overwhelming for both a man and a woman. Empowering individuals that it’s OK to be a parent, even when the rest of life hasn’t followed the “expected” path, can be helpful. Positive reinforcement encourages people to educate themselves, and potentially, to take advantage of family-planning options previously unfamiliar to them or seemingly out of reach. It also provides a greater sense of control.
In 2019, people are faced with more choices than ever as it relates to partnership and/or parenthood. Knowledge about available fertility treatment options in varying situations can be helpful. Importantly, erasing any stigma associated with infertility or the lack of achieving family by a pre-conceived “right” age or in the “right” situation is necessary to permit both men and women to feel comfortable with choices and to take charge of their fertility.
While men are relatively fertile beginning at puberty and extending until death, a female’s reproductive prime is between the ages of 16 and 28. Despite this, the mean age of first birth for US women is age 26 — in other words, at the end of prime. Why has this delay occurred?
In today’s fast-paced world where 30 is the new 20 and 40 the new 30, men and women are highly focused on education and careers, making it easy for them to surpass their “golden” parenthood years. This is in the background of being openly encouraged not to have children at a young age, but rather to abstain from sexual activity and/or to use birth control at young fertile ages for the past 50 years.
Societal norms for both men and women now seem to favor postponing childbirth past a woman’s reproductive prime so as to afford pursuit of a job or a degree. If a woman becomes say, a lawyer or a doctor, she will certainly have surpassed her reproductive prime when it comes time to focus on having a family.
Tracing back through history, the advent of oral contraceptive pills (aka: the Pill) in 1960 was the single greatest ignitor for this societal shift in reproduction. Some say the Pill represents the biggest sociologic experiment of modern day. While initially approved in the US for married women only, 1972 legislative action expanded usage to include all female citizens – married or not. Today, oral contraceptive pills are frequently taken every month for decades as a means to alleviate worries associated with becoming pregnant when not ready. The trend toward extended usage has secondarily postponed having a baby until much later in life.
Birth control thus, seamlessly became a societal norm, allowing women to forget about having children right through reproductive prime presenting challenges for women past the age of 35. We know egg age is central to success in achieving pregnancy. Waiting to have children translates to trying to create pregnancy with older eggs having less potential for a healthy live birth.
Thankfully, the internet has led to widespread dispersion of information and helped to educate people about the risks associated when delaying childbearing. It has also provided availability of an untold number of supportive female voices on the topic, the sum total of which has made fertility delay a mainstream conversation that has helped to remove any associated stigma.
There’s a common misnomer that there are too many people living in the USA and in other industrialized nations around the world.
While there is truth to that, the current societal shift away from reproduction has led to birth rates in industrialized nations now being the lowest they’ve been since the Great Depression. This has become an issue in countries like Japan and Italy, where there aren’t enough people to carry on traditions.
It is important for humans as a species to continue to reproduce, for many reasons. Aside from continuing the human race, reproduction is critical to evolving as people. Families promote happiness and satisfaction, financial security and a sense of belonging. People need people.
Women seeking fertility treatment and fertility counseling often arrive at their consultation feeling anxious and even upset. These feelings stem from stigma associated with failure to follow traditional relationship norms or, in the case of prior failed pregnancy attempts, feeling less-than at the onset of the appointment.
No matter what the issue, my message to the patient is clear — you are not alone. I tell them there are many people walking beside them in the quest for a child. In fact, more than a quarter of the patients I treat have a similar story.
This is often a welcome relief. Typically, in the course of an hour consultation, patients go from feeling anxious to comfortable, and leave the appointment armed with information, ready to move forward and take positive action toward future family if that is right for them.
Egg freezing first came on the reproductive scene about 15 years ago as a viable option to delay parenthood, offering women a potentially viable autologous means to postpone having a child until they are ready.
Egg freezing allows appropriately aged (late 20s to early 40s) women to proactively take control of their reproductive situation and confidently plan for the future. Notably, if a medical condition warrants fertility preservation, even teens are appropriate candidates. Fertility preservation treatments have vastly improved over the past decade — meaning, it’s no longer a pipe dream to freeze eggs and have a child later, as long as one is not too old at the time of freezing. The age of the egg is the No. 1 determinant to successful pregnancy. It’s important to appreciate though, that even when a woman freezes eggs at a relatively young age, egg freezing is not a guarantee for future parenthood.
As a process, an egg-freezing cycle is completed in about two to three weeks. The person takes fertility drugs that have the ability to cause multiple eggs within the ovaries to mature simultaneously rather than the single egg that is naturally programmed to release. Once sufficient stimulation of the eggs has occurred, the eggs are harvested from the ovaries using a needle during a quick and relatively simple procedure. After being removed from the woman’s body, the eggs are carefully frozen and placed in little vials and then stored in liquid nitrogen. There is no shelf life for frozen human eggs; they can be stored for decades without damage.
At this point, I have frozen eggs for more than a thousand women. To date, the longest freezing duration that resulted in a successful life birth from thawed eggs under my care is 10 years. I suspect, though, the storage duration could be indefinite.
Thankfully, egg freezing is now a mainstream option for women wishing to extend options for future parenthood.
At present, egg freezing is often not covered by one’s insurance plan, although New York State recently passed legislation that will mandate insurance coverage for cancer patients in need of fertility preservation. That new law is set to take effect January 1, 2020.
Given the current milieu of worldwide childbearing delay in industrialized nations, isn’t it time we consider extending fertility preservation to all women in our country?
Nicole Noyes, MD, is Northwell Health’s system chief for reproductive endocrinology and infertility. She has treated more than 30,000 infertility patients over the past three decades. She joined Northwell this year after cofounding the NYU Langone Fertility Center.