By Dr Devora Lieberman, Medical Director, City Fertility New South Wales clinics
When I tell people what I do for a living, one of the most common responses is something along the lines of: ‘Wow, business must be booming with women leaving it so late these days.’
Trying to start a family in a woman’s late 30’s or early 40’s is hardly a new phenomenon. In fact, 20 years ago the American Society for Reproductive Medicine ran a controversial education campaign with billboards and magazine ads like this one:
Source American Society for Reproductive Medicine
I blame over-cautious family planners, for leading people to believe that every single act of unprotected intercourse will lead to a pregnancy. In fact, human beings are ridiculously inefficient reproducers.
For women, the greatest challenge is ageing eggs that are more likely to be chromosomally abnormal. That’s why everything gets harder as we get older- getting pregnant, staying pregnant, and increased risks of conditions like Down syndrome.
Even at the age of 22, a woman’s monthly chance of conception is on the order of 25%. Monthly fertility declines slowly to age 35, when the possibility is around 15%. After 37, the slope gets very steep. By 42, half of us will not be able to conceive at all with our own eggs.
An Australian study in 2013 (K. Hammarberg et al., 2013) found that men and women underestimated, by about 10 years, the age at which male and female fertility starts to decline. Only 1 in 4 correctly identified that female fertility starts to decline before age 35, and only 1 in 3 identified that male fertility starts to decline before the age of 45. The past 50 years have seen a paradigmatic shift in the roles women play in and out of the home. Increased levels of higher education and professional workforce participation have come at the price of later childbearing and increasing rates of childlessness.
The age-related decline in fertility has been the subject of media attention in Australia for nearly two decades, yet levels of fertility awareness in the community are surprisingly low. The majority of men and women underestimate the age at which female fertility starts to decline.
Inclusion of fertility awareness education in school and in the GP’s office can contribute to better understanding of reproductive health and enable people to better plan their families from an earlier age.
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