Career or the egg? Is it time to put pregnancy first?


Whether to have a child before becoming an attending physician is a personal choice, but as a fertility specialist, I’m concerned that many people — including physicians — overestimate the effectiveness of today’s fertility treatments.

In the U.S., the average age at which women have their first child went from 21.4 years in 1970 to 26.6 in 2016. Experts attribute that in part to more people seeking advanced education and taking longer to establish themselves financially, and that includes a lot of medical students. By putting off childbearing during the rigors of medical school and residency, many couples who want to start families are faced with fertility issues.

For women aged 38-40, using their own same-age-egg, IVF, which is currently considered the best method of assisting fertility, results in approximately a 40% chance of delivering a baby, according to the Society for Assisted Reproductive Technology. The success rate drops to approximately 23% after 41.

I encourage women and men to determine their family planning goals in their early 30s. As an osteopathic OB/GYN who faced my own fertility challenges, I can tell you it’s worth shifting if having a family is a priority.

My story

It wasn’t until I was in my infertility rotation in residency that I realized how steep the drop-off in egg health is for women. My original plan was to finish residency, finish fellowship, start practice, and maybe 1-2 years into my practice consider having children. During my infertility rotation in residency, though, I was seeing women my age and younger struggling with fertility issues. My husband and I decided to change our plans and began trying to conceive.

After ten months of no success, we sought help. I conceived my first child at age 30 with the assistance of fertility medications, ultrasound monitoring, and the expertise of the fertility specialists who were training me.  Shortly after my daughter’s first birthday, I conceived my second child with the help of medical interventions. Juggling two babies with starting a medical practice was challenging, but I would never advise against it.

A woman’s timeline

While there’s some debate as to exactly when fertility declines, most clinics will not accept egg donors older than 31, and data shows a significant reduction after 35, which accelerates dramatically at 37. In my opinion, any woman who plans to wait to have children until after 35 should consult a fertility specialist and consider freezing her eggs.

There are a number of signs that you may face fertility challenges.  The risk of infertility is significantly higher if you have a history of prior ovarian surgery, chemotherapy, radiation therapy, endometriosis, smoking, pelvic infection, or a family history of early menopause. Do you experience heavy or irregular periods? That can also be an indicator.

It’s important to note that chemotherapy and radiation therapy will also impact male fertility. We’ve also seen a sharp, unexplained drop in sperm counts in industrialized nations. The research is inconclusive but many people believe environmental factors are the main culprit. Even if there’s no history, I encourage men to purchase a semen analysis test at the local drug store to get a better understanding of sperm health.

Why prioritizing children may make sense

I’ve had a number of patients express regret that they didn’t freeze eggs or sperm earlier — or pursue pregnancy at an earlier age. While we have many tools to help an individual or couple conceive and carry, little can be done once eggs have reached a certain age. A woman can have a child well into her 40s but in most cases, the egg was frozen years before or is from a younger donor.

Fertility treatments require an enormous amount of time and energy — emotional, mental, and physical. Most people will start with timed medication, followed by a series of IUIs (intrauterine inseminations) and then IVF if needed. It can take six months or more until a patient starts IVF, and many people require multiple cycles, sometimes with breaks in between. For many, the process will take years.

The treatments are challenging and time-consuming. IVF will require multiple visits per week to the clinic as well as ongoing medication. If a frozen embryo is used, a woman will typically have 9-12 weeks of daily shots of progesterone to support growth. And it’s expensive. On average, an IVF cycle will cost over $10,000. Depending on what insurance covers and how effective the fertility treatments are, the process can cost up to $70,000.

The lifestyle changes during treatment can be significant. Women will most often experience weight gain due to the hormones and the limits on exercise. Many, unfairly so, will suffer from feelings of inadequacy and shame — even PTSD in the worst cases.

Infertility treatments are a difficult road, and worth it for those who have no other options. As a fertility specialist and an osteopathic physician, I preach prevention to anyone willing to listen. Whether you begin your family sooner than intended or make arrangements to give your future self the best chances of conceiving, start planning for your future today.

Ellen Wood is an obstetrics-gynecology physician and reproductive endocrinology and infertility specialist. She is a member of the American Society for Reproductive Medicine and a distinguished fellow in the American College of Osteopathic Obstetricians and Gynecologists.

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