Since I started specializing in fertility, I have noticed a common belief in which women trust their fertility will stay strong until the early forties. As part of the treatment process, I discuss family planning with all reproductive aged women. There are so many misconceptions around fertility and beliefs about when to conceive, most young women (late teen age years to late twenties) don’t comprehend how this is will be a long journey for some. Too many women see other ladies in their forties pregnant and believing it occurred naturally. Women don’t realize the pregnant forty something moms have undergone multiple failed IVF cycles or used donor eggs. The secretiveness around fertility treatments and hiding the emotional obstacles allows young women to think that “I can wait because everyone gets pregnant” or IVF will work its magic later in life. The missing component for them is what they do not see – the pain, the years of trying, the cost and the disappointment. I try to educated all women who are not actively conceiving, in the hope that one woman will not experience the infertility journey. I encourage women, who have experience this journey to speak out and educate young women that IVF, acupuncture, supplements and yoga are not a romantic part of the journey. Waiting for life’s pincales may not be worth the pain a couple will experience by putting off conception until the last moment. Only by ending the silence (remember cancer used to be the taboo subject) will the next generation understand how precious conception is.
The following article documents the misconceptions women hold and the lack of knowledge around the success rates of IVF.
Women’s awareness and perceptions of delay in childbearing
Volume 90 Issue 4 Pages 1036-1042, October 2009
Abha Maheshwari and et
Demographic studies from Europe and the United States have shown that the age at first pregnancy as well as the number of pregnancies in women more than 35 years have been rising since 1980. Extensive use of contraception and the growing popularity of assisted reproductive technology (ART) have given women the impression that female fertility may be manipulated at any stage of life. Although this is true in terms of fertility control, the assumption that fertility can be resumed at a more convenient time is erroneous and can result in future subfertility. Pregnancies in older mothers are also at increased risk of low birth weight, preterm delivery, miscarriage, Down’s syndrome, and other chromosomal anomalies.
Epidemiological data have consistently shown that fertility declines as early as the middle of the third decade and female age remains the most important determinant of success in an IVF program. Although there is no strict definition of advanced reproductive age in women, subfertility becomes more pronounced after the age of 35 years. Only half of the age-related decline in fertility that occurs between 30 and 35 years and a third of that between 35 and 40 years can be overcome by IVF. With expected live birth rates of 25%–30%, in women in their 20s and 30s, IVF can be seen as an expensive and invasive treatment with a relatively low success rate. Live birth rates are even lower (10%) in women more than 40 years and treatments other than oocyte donation are unlikely to be effective in such cases.
Although postponement of childbirth is common in the postcontraception era, women may be unaware of the implications of this decision such as its potential impact on their own health, the health of any future children, and the possibility of age related subfertility. As early as 1982, it was believed that appropriate information about the consequences of delay should be provided for all women considering having children later in life. However, this is still not common practice and research exploring women’s own perceptions of their decision to postpone childbirth is limited.
The present study was designed to explore women’s awareness of issues associated with delayed childbearing, including its social and medical implications, and the limitations of available treatment.
Results
Of those women who had delayed their first pregnancy until after 35 years of age, 26/36 said that this decision was influenced by relationship issues.
The decision to delay childbearing was associated with feelings of regret in 35.5% of subfertile women and 11.5% pregnant women.
Most women (93.0%) in the subfertile group and 88.3% in the pregnant group indicated that they were aware that age could affect their chances of pregnancy; 85.1% of the subfertile women and 76.5% of the pregnant women believed that the chances of pregnancy decreased between the age of 30 and 40 years. Fewer women (53% and 45.6%, respectively) were aware that the chances of having a baby with IVF decreased between ages of 30 and 40 years. More women in the subfertility group (84.6% vs. 76.8%) believed that fertility treatment could overcome the effect of age. Approximately half of these women (52%) believed that the chances of pregnancy after IVF only declined after the age of 40 years.
A third of all women in both subfertile and pregnant groups were prepared to consider undergoing IVF even if the expected success rate was less than 10%. A similar proportion was happy to undergo self-funded IVF treatment at the same success rate. A small proportion were willing to undergo IVF even if the predicted success rate was less than 1%.
Women in both groups (subfertility and antenatal) believed that they should be provided with information about the risks and benefits of delaying childbearing (95% vs. 94.2%). The best time to provide such information was perceived to be the early 20s. School age was the second choice.
Few women had heard of any tests of ovarian reserve that might inform a decision to postpone pregnancy without risking infertility. Most of those who had, could not remember either the name or the mechanism of action of any such tests. Only 10 women were aware that these tests were designed to predict the number of eggs left in the ovaries.
Discussion
Women in the subfertile group were more likely to have tried for their first pregnancy after 30 years of age. Most of the women were aware of the complications associated with maternal age, but were overly optimistic about the ability of IVF to overcome the effect of age on fertility, especially after the age of 40 years. This may reflect the growing popularity of ART and the way in which it is portrayed by the media. It is also possible that pregnancies in older women achieved by means of donor eggs may have perhaps encouraged women to believe that female fertility can be manipulated at will.
A significantly higher proportion of women in the subfertile group believed that they had postponed pregnancy and many regretted this delay. This may reflect feelings of remorse or guilt in women who are now experiencing problems with conceiving. This has been reported in a previous study on women using donor eggs because they were too old to conceive using their own.
It has been suggested that various factors influence women’s decision about delaying motherhood. In order of importance they are professional development, financial security, and the presence of an appropriate partner.
In the past there has been a significant emphasis on avoiding teenage pregnancies and relatively little attention has been drawn to possible problems associated with postponement of childbirth. As a result there are misconceptions in the community about the effect of age on natural fecundity and the outcome of fertility treatment. Many women are currently choosing to delay motherhood in the interests of personal and professional development. Although starting a family is a personal preference, free choices cannot be made without full knowledge of their consequences. The results of this and other studies suggest that women should be provided with the appropriate information on the possible outcomes of a decision to delay motherhood.