Kristen Mancinelli, Director of Partnerships at Extend Fertility
When our content editor asked me to write a blog post about why OB/GYNs should talk to their patients about fertility, I said “Sure! I definitely have a lot to say on the subject.” But when I sat down to write, what came out was the story of a personal experience, rather than the tips I want to offer to physicians everywhere who care for women in their fertile years.
So, this post will be in two parts: first is the personal essay, a story of what motivates me to do this job, and the second will be a practical piece about why OB/GYNs can and should proactively address age-related fertility decline with their patients. Look for the second piece later this month.
A few months after I joined the staff at Extend Fertility, a close friend called from California to catch up. We hadn’t spoken in a while, and she didn’t know I’d started a new job with an egg freezing practice. We talked cheerily of life, love, and plans for the future, and then her voice turned quiet with sadness and frustration. Her life coach, of all people, had recently suggested she get some fertility testing done. You see, my friend wasn’t sure she wanted to have children with the man she was dating at the moment, but was very sure—and had known for decades—that she indeed wanted to raise a family someday, with the right guy. Her coach brought this fact to her attention, suggesting that she find out what sort of timeline she was on, biologically speaking, and whether she could do something to extend it.
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I listened as my 38-year-old friend tearfully described her information-gathering process: the web searches that turned up conflicting facts about when, and how much, a woman’s fertility declines with age; the fear mongering, seemingly meant to convince women to drop all their life’s dreams and aspirations and rush swiftly toward motherhood before time is up, and the opposite of that, the irresponsible media stories that tell women that their fertility barely declines in the decade of their 30s (untrue) and thus they needn’t worry at all. My friend was scared, confused, and increasingly angry. Why, she asked, had no gynecologist she had ever seen mentioned to her that fertility declines quite meaningfully in her 30s (and was it even her 30s)? Why did they speak to her every year about the threat of diabetes, despite her normal weight and healthy diet, and yet never mention something so important to her particular health and life goals? Why, for that matter, had none of her physicians ever even asked what her life goals were, and if they included having a family someday?
Finally, she asked me if I knew anything about this, since I work in healthcare. I was stunned. Yes, yes I knew about this. Recently, I’d come to know quite a lot about it, but I never thought to put out a public service announcement to my loved ones. This conversation was making me think I ought to. I had heard this exact story too many times from the healthcare team at the office. Time and again they encounter women who were only made aware of the option of fertility preservation in their late 30s or early 40s, after age had begun to diminish the reserve of healthy eggs in their ovaries. To be sure, those women were fortunate to find fertility preservation while they still had fertility left to preserve, and many women have successful egg freezing cycles at later ages. But younger tends to be better, on the whole, and getting information from one’s physician that the late 20s might be an optimal time to consider the option of egg freezing would certainly go a long way toward alleviating the panic some women feel about the loss of fertility as they age.
My friend went on to say that she felt very foolish for not knowing the statistics on fertility decline. She thought she ought to have known, and that her lack of awareness was her fault. “Most women know this, right?” she asked. “Maybe I just haven’t been paying attention all these years. I guess I should have done more research. But I just wish my doctor would have told me. If I had known about this when I was 30, I might have made different life choices.”
This is really the crux of the matter. After doing what research she could, my friend had gotten her AMH (a measure of ovarian reserve) test done, and it was well below average, meaning she’d have a harder time getting pregnant or producing enough eggs to freeze.
But she needn’t have ended up in that place. Almost all physicians take the Hippocratic Oath; in it, there is a line that says: “I will prevent disease whenever I can, for prevention is preferable to cure.” How does one prevent infertility as a result of age? By advising younger women that the risk of infertility climbs with age, and that they have options. They can, if they choose, arrange things to have children earlier in life. They can freeze some eggs for the option to have children later. They can talk to their mothers and grandmothers to learn at what age they experienced menopause. And they can, at a minimum, simply get a fertility assessment to know (biologically) where they stand.
And the person who should be telling them this is the person to whom they turn for guidance on their reproductive health: their gynecologist.
Kristen’s friend isn’t alone. Studies say that while 89% of women believe fertility education should be part of a regular OB/GYN visit, only 26% have actually discussed the topic with their doctor. Stay tuned for practical tips for OB/GYNs who want to prompt these conversations with their patients—or, if you’re thinking about preserving your fertility now, learn more about what you can do at your OB/GYN’s office to jumpstart the egg freezing process.