Do women deserve to be infertile?

I went to dinner with a group of friends a while back—some I knew well and some only in passing. I intentionally sat next to a woman I didn’t know so we could get to know each other better. We chit chatted the usual getting to know you talk and got around to what each of us did. When I told her that I headed up a nonprofit that provided education for infertility and adoption, her interest picked up because both her sister and cousin had struggled with being unable to easily get pregnant.

As often happens with any discussion of infertility (with me at least) the topic turned to the finances. (My poor family and friends suffer through my personal mission of educating the world about what I perceive as the unfair financial burden of infertility.) I mentioned that insurance seldom covers fertility treatment.

She responded: “Well, to be honest, I’m not sure insurance should cover infertility. After all, it’s a lifestyle choice that these women made.” She hastened to add, probably when seeing my jaw hit the floor, that she wasn’t trying to be uncaring, and that she really felt for her sister and cousin. Her perception of infertility, which is shared by far too many, is that infertility is the logical consequence of being the stereotypical over-35 career woman who married late. Not wanting to get into a drawn out discussion of the causes of infertility, both medical and social, I simply shared that infertility could affect women at any age, and then moved the discussion to our mutual love of arugula. Her words stayed with me, however, long after that evening.

Is It All About Age?

This woman is neither ignorant nor callous, but she is misinformed, at least partly. As with any persistent myth, there is an element of truth. Age is by far the #1 risk factor for infertility. Some of us who rail against the financial injustice of infertility often try to down play this fact, but it remains the unfortunate truth. But it is only part of the truth.

Infertility can affect women and men of any age. There are many causes of infertility in women in the 20s and early 30s, including premature ovarian failure (also known as early menopause, primary ovarian insufficiency, POF, premature ovarian aging, premature ovarian syndrome, premature ovarian insufficiency) and male factor infertility. Among 30 year old women trying to get pregnant, 75 percent will conceive within a year. (That number falls to 66 percent at age 35, and 44 percent at age 40.) That means that 25% of 30 year olds who are trying to conceive will struggle with infertility. That’s a lot of relatively young women who will have this disease.

Sure, if they had started trying in their early 20s, they probably would have conceived more easily, but most of us would assume we’ll be in the 75%. Each of us walks in grace, and neither deserve our luck to be in the majority, not our bad luck when we draw the short straw.

Infertility is So Darn Unfair

I think the reason my new friend’s comment stuck with me so long, is the inherent unfairness of it all. Even for those women who are infertile because they waited, it seems so unfair to “blame” them for the choices that they made when in many ways these decisions were abetted by our society.

It’s true that our fertility peaks at age 22, but how many of us in our culture are ready to parent at that age? In the past, most 22 year old women were married and their husbands had a job that paid enough to support the family. In the past, few women had career options that required education and long years of paying your dues in the form of long hours in order to work up the ladder. That is not, however, the world of today or the near past.

Today’s infertiles who waited until after age 35 to have a child came of age in a world of burgeoning career options for women and an expectation that we would grab for the ring. The average age of first marriage crept up to the mid 20s, and the divorce rate skyrocketed, accompanied by later second marriages and the desire to have a child with this new husband. There was precious little talk 10 years ago about the risk of waiting to have a child.

Reproduction Issues for the Millennials is More Complicated

While I think we are making great strides in educating today’s 20 somethings about the risk of waiting too long to have children, their options are even more complicated–lousy job opportunities, expectation of graduate school, college debt (student loan debts have surpassed the $1 trillion mark, with 68% of 2016 graduates with an average of $30,000+ in loans), extended adolescence and young adulthood (for better or worse), and an even greater delay in marriage (the average age at first marriage for men is 28.7 and for women is 26.5).

And this doesn’t address the quandary faced by single women who dream of becoming a mom when they are in a stable committed relationship preferably with at least some version of their Prince Charming. What should they do if they are 32 and haven’t found him yet?

While I think egg freezing offers hope, it comes at a steep cost both financially (approximately $7,500 to $10,000) and medically (weeks of injecting ovulatory stimulation medications and minor surgery for egg retrieval), and no guarantees of success. In an ideal world I’d like to see professions acknowledge that young woman and men need to be able to have both a career and a family. I’d love to see more options for parental leave and high quality convenient day care. In the meantime, I’ll continue to preach to the younger set that fertility doesn’t last forever, but I won’t blame those who thought it did.

Image credit: HighwaysagencyAlexSeattle Municipal Archives