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More Doctors Talking About Age, Fertility With Female Patients


While it used to be that women often got married and had children young, in recent years, increasing numbers of women have been pushing motherhood back. In fact, a Pew Research Center study shows that between 1990 and 2008, the number of births to women 35 and older increased from 368,000 to 603,000. Forty percent of all babies born in the U.S. in 2010 were born to women 30-plus, and 15 percent were born to women 35 and older.

With more women choosing to wait comes an increasing feeling of obligation among doctors to talk to their patients about their fertility and age, according to a piece published in the Wall Street Journal. While they may be hard topics to broach, when it comes to fertility, age is more than just a number.

"I hear many people say 40 is the new 30. But not reproductively, it's not the new 30," Cynthia Austin, medical director of in vitro fertilization at the Cleveland Clinic told the Wall Street Journal. "Our ovaries are aging at the same rate they did 50 years ago."

Shari Brasner, an ob-gyn in Manhattan, agrees.

"This is something I talk to my patients about all the time, even the ones in their 30s," she says. "I've had 48-year-old women come to me and say that they'd like to start thinking about a family, and I have to tell them: Fertility has nothing to do with the way you look or feel. It's all about ovarian aging and reserves, and no matter how well you take care of yourself, there's not really a correlation."

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A similar piece published in the New York Times in 2011 explored what doctors call a "widening disconnect" between what women see in the mirror and what they experience when they try to get pregnant, with a growing number of women thinking that because they're in good health physically, they'll have no problems getting pregnant as they get older. Dr. Brasner attributes this partly to Hollywood and the media's focus on celebrities having babies in their 40s and older.

"It drives me crazy because these stories of celebrities having babies almost never gives you the full story," she told SHAPE. "There's almost never any discussion of the techniques or technologies that are often used—donor eggs, surrogates, IVF—which a lot of women don't have access to."

Patients focus on the things they can control, like diet and exercise, Alan Copperman, M.D., director of the division of reproductive endocrinology and infertility at Mount Sinai in New York says, because it's harder to focus on the things you can't control, like the number of eggs you're born with.

There's also almost never any discussion about the risks of having babies at an advanced age, Dr. Brasner says. While many healthy women get pregnant at 35 and have healthy babies, women who get pregnant after 40 are at a higher risk of having a miscarriage, heart complications, gestational diabetes, and placental problems, as well as fetal birth defects.

There's a danger in being overly reassuring, Dr. Copperman says. "I don't think we should be telling 35-year-olds, 'Don't worry, you'll be able to get pregnant forever.'"

However, this is a subject that has to be approached with great sensitivity, he says.  "A good way to start might be to say, 'You might be at risk for certain issues. What steps can we take to make sure we optimize your fertility?'"

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The decision to have a child is a personal one, and one that everyone seems to have an opinion on. In an era where women are being told to "lean in" at the same time that they're hearing they "can't have it all," while also being reminded not to let your 20s go by without anything to show for them, it's a wonder people are getting pregnant at all, but if pregnancy is something you want, it's important to understand all your options.

This is a conversation that should be happening with every doctor and patient, Dr. Copperman says. "It doesn't matter if you're single or married or have a partner. If you're single, maybe you can consider freezing your eggs; if you have a partner, you could talk about freezing embryos. It's a conversation that should happen between every ob-gyn and patient, and I'm afraid it's not."


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