When Does Your Fertility Decline? Uh… Sooner Than You Think?
So there was an announcement made last week by the American College of Obstetricians and Gynecologists (you know, that ACOG acronym after your doctor’s name) saying that fertility now starts declining at 32 and picks up speed like a rolling snowball at 37. So that old 35 advance maternal age line is now more like a hotel swimming pool that has a nice shallow end, then a little dip, and then a big drop off so people can dive head-first without breaking their necks. Except it’s the opposite. It’s more like, dive in when the water is shallow because… well… this analogy isn’t working.
The point is, they just took 3 years from your midlife plan.
Except, of course, they didn’t. This fact has always been there whether we want to recognize it or not. And a decline is just that, a decline. If you were going to be infertile at 27, you haven’t suddenly gained years of fertility, and if you were going to be fertile at 40, then you get to keep going with the babymaking. And a decline is a nice way of saying, “maybe or maybe not.” It’s sort of the equivalent of the word “nice.” What does nice mean? Well, you can make it means sort of anything you want. You know it’s not bad. But it certainly doesn’t sound effusively good. It’s just sort of there. And that’s what this fact is too. It’s just sort of there, something you’ve known your whole life: if you want kids, don’t wait.
The Daily Beast has an interesting article on how OB/GYNs walk a fine line in passing along this statistic to their patients. It’s not difficult for a general practitioner to let their patient know how that case of sugary soda they’re drinking daily may kill them. It doesn’t present a conflict when an eye doctor tells their patient about advances in laser surgery or a dentist broaches the topic of teeth whitening; especially when there is no pressure in the offer and it’s being held out as a possibility. I don’t even think it’s a problem if an OB/GYN brings up the idea of egg freezing despite its success rates, the difficulty of IVF, and the cost (emotional and financial). I look at it as education; placing the ball in the patient’s court.
But what about counseling a person to build their family before they’ve started to build their family?
Encouraging a person to take on responsibilities they may not be prepared to take? To raise another human being? To telling them that if they wait it may be too late, but perhaps in turn pushing them before they’re really ready due to a fear of the unknown (which may or may not affect them)? That’s really tricky. This advice doesn’t just affect the patient; it affects an unborn human being who may then be born into a situation where the parents are ill-prepared.
And what sort of judgment call do the doctors make? Do they tell it to all women, regardless? Tell it only to women above a certain age (and then, what age)? Tell it to only married women? Only those they think would make a great parent, or do they tell even the ones who are barely holding their own lives together? And how do they decide that when all they really know about you is whether or not you shave your legs for the appointment or how your cervix looks?
But if it’s not the OB/GYNs job to counsel on family building, whose job is it? And if no one is passing along the information, how do we expect women to know it?
It feels like in an effort not to offend or cajole, to not place women in an uncomfortable position socially or over-assume their intentions, everyone is dropping the ball on having this conversation, and in turn, there are plenty of women who feel blindsided when they discover that fertility declines; maybe even sooner than they thought and therefore didn’t know there was a problem they should address in a timely manner when they do start family building.
Do you think OB/GYNs should discuss family building with all women who walk into their office and if so, should it be every appointment, after a certain age, in various situations?