Biological clocks ticking

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Pasquale Patrizio, professor of obstetrics and gynecology and director of the Yale Fertility Clinic, was a co-author of a paper published March 5 on the journal Fertility and Sterility’s website that discusses the misconceptions women hold about the health and fertility consequences of delaying motherhood. The article is based on the increasing number of women over the age of 43 who come to the Yale Fertility Clinic uninformed about the limits of assisted reproductive technologies (ART), such as in vitro fertilization. The News spoke with him about his observations and his proposals for addressing women’s overly-optimistic misconceptions.

Q What led you to study women’s understanding of the consequences faced in delaying motherhood?

A There are more and more women coming to fertility clinics across the nation. I have seen a profound and alarming misconception about fertility in women coming to our practice. [Women] in their late 30s and early 40s sound very surprised when they learn about their poor prognosis for pregnancy. They say ‘I wish I knew this would be a problem. Nobody told me.’ The great majority of women believe that ART can overcome their aging related decrease in eggs.

Q What is the source of this misconception?

A Over the past three to four years, we have noticed an increased number of women coming to clinics who are extremely unprepared with the information that their biological clock is ticking fast. They are under the wrong impression and think ‘maybe if I go to an IVF (in vitro fertilization) clinic, they can fix me.’ We cannot unwind the clock. This misconception is only compounded by the media. The women see celebrities having babies without problems in their late 40s. Celebrities do have pregnancies in their late 40s, but they are not always using their own eggs. That is not reported in the media. All of this creates an alarming misconception.

Q Why are more women turning to in vitro fertilization clinics and assisted reproductive technologies?

A There are many factors. One is that more and more women are pursuing education and career goals so they are postponing fertility until they reach the goals they set forth. A second is the discomfort with the notion of becoming parents before they have reached the right point in their lives. It is important to them to reach financial security and stability in their relationship.

Q What are the health concerns associated with delaying pregnancy?

A This is definitely an important parameter that has to be an object of information presented to women. If you are under 35, the chance that you can have a baby is about 50 percent. If you are 42, the chance is about 9 percent but if you are 45 the chance is about 1 percent. Not only is it more difficult to get pregnant, but the risk of having a miscarriage is over three times higher if you are over the age of 42 than when you are under 35. There are also problems with the pregnancy itself. When a woman gets pregnant after the age of 40, the risk of having a child with chromosomal abnormalities increases. By being pregnant over 42, you are going to increase the risk for gestational diabetes, have a higher risk for cesarean section, and you may have babies who are smaller for their gestational age.

Q How do you propose addressing the misconceptions surrounding delayed motherhood?

A First, I am hoping that this [study] can open the discussion of fertility between patients and OBGYNs and family practitioners. When they do their annual check-up on women, they should also bring up the issue that reproduction is tightly linked to age. The second route I want to use is social media to remind women about the links between reproductive age and the risks of pregnancy. I also want to add to this information the options women have. Today we have a fantastic opportunity to help by offering egg freezing. If you are 30 and are not ready to have a baby, you can use the technique of egg freezing. Then when you are 40 or 42, you can use the eggs that were frozen and the rate of fertility is the same as at your peak fertility age. [Egg freezing] allows women to have their own biological baby.

Q Is the delayed motherhood trend unique to America?

A No. My colleges in Canada have noticed the same thing. I have also heard from colleagues in Italy and Israel who have seen similar trends. In Israel, they view age-related infertility as a medical problem and the fertility treatments are all paid for [by the public health system].

Q Would you advocate for something similar to the Israeli system in the United States?

A Yes. What is important is to realize that it is not only the health professionals that get involved, it is the responsibility of the society at large. In the United States, there is still a stigma if you are a woman pursuing your dreams. People question why she is not having a baby. We need to abolish this stigma. There is plenty of opportunity now to decide when you want to have a baby. Women are not being told or properly informed about these options. Let’s give these women the chance to be mothers later on by treating age related fertility as a medical condition. We should make sure that social services are available for providing these options to women. We should simplify the process and make it less expensive.