Conceptualizing the Biological Clock: How late is too late to talk about the timeline behind reproducing?

Fact: A woman’s best chance to conceive a healthy child without a birth defect is before age 35.

This biologic reality has in recent years become a visible social issue. The age of a woman’s first birth has risen dramatically in the Western world over the past decades, a phenomenon commonly attributed to contraception, college and career choice. Delaying childbearing can grant a woman time to pursue a profession or simply establish her identity. However, according to Dr. Michele Evans, the assistant medical director of Pacific Fertility Clinic-Glendale, “there is a biologic reality to our time when we can have kids.”

Dr. Evans remarked that there are great misconceptions about what assisted reproductive technologies such as in vitro fertilization (IVF) can do for people. IVF entails hormonally inducing hyper-ovulation (the ovulation of multiple eggs at one time), removing those eggs from the ovaries, and fertilizing the eggs outside of the body with sperm from either the woman’s partner or a sperm donor. The resulting embryo is then re-implanted inside the woman’s uterus. However, there comes a point when assisted reproductive technologies can no longer help women conceive biologic children. “Women come in when they are 44, 45 years old,” said Evans. “And they say okay, I’m ready, I’ve done all my stuff I want to do and I’m ready to have a baby; and they don’t realize that there is really nothing that I can do for them beyond helping them use an egg donor.” The stories portrayed in the media play a role in these misconceptions. Evans said that older women are hopeful because “they have read about these women who are 48 and having twins and 50 and having babies, and want to do the same. And what they’re not realizing is that most of those people who you hear about are either using donor eggs or they froze eggs or embryos in the past.”

“Around 35 is that age when women, if they feel like they don’t have a partner in their life but may meet someone in five years, think that it might be time to freeze their eggs,” said Dr. Pei Yun Lee, a lecturer in the department of molecular, cell and developmental biology (MCDB) at UCLA. Evans confirmed Lee’s statement, relating that in the past week she had seen three women, ages 34, 35 and 36, who were interested in freezing their eggs. Evans calls 35 a magic age: “It sounds very young, but when it comes to obstetrics, (35) is considered to be that threshold where things become more risky, pregnancy rates are decreasing and birth defects are increasing.” According to Evans, it is valuable for women to know the facts about reproduction so that they do not end up like many of her patients, who receive devastating statistics at age 44 and wish they had known their options earlier.

Assisted reproductive technologies (ART) such as IVF offer an opportunity for those seeking biologic parenthood who would otherwise have no option, said Dean Judith Daar, a professor of law at Whittier Law School and member of the American Society of Reproductive Medicine (ASRM) Ethics Committee. Yet as a solution to delaying childbearing, IVF is very problematic, said Dr. Hannah Landecker, a sociology professor at UCLA. “There’s something wrong with the problem if the solution is freezing your eggs. Or there’s something wrong with the problem if the solution is being treated for infertility,” said Landecker, who teaches a class about the politics of reproduction. “There are all kinds of ways in which people might think about (IVF) as being something women just do. But the physical and emotional toll of it is profound. So it isn’t a solution.” What then is wrong with the problem? One social criticism is that in most work trajectories it is not made possible for the age range between 20 and 40 to be a good time to have a family.

“Why is it if you want a career and you want to be successful, then you have to think about when you’re going to have children?” asked Dr. Lee. “Why is it that we cannot have a system where we are more understanding and supportive of women who choose to have a child and choose to take six month or maybe a year off and be compensated?” The issue, she said, is that people want to have children, be with their babies when they are little and return back to work. Yet Lee has witnessed many women lose their careers or suffer a significant setback after having children. She has also seen “women who are very driven, who are very focused, come back to work very quickly because that is their only option.” Lee said that social pressure and the lack of pay for maternity benefits both contribute to their rapid return to work.

The fact that women are cultured to think about professional life before family life is a modern phenomenon. Dr. Landecker emphasized the suddenness of this cultural shift. “Major social changes have affected what women choose to do in their twenties. More and more women are going to university, and what they do there is also changing,” said Landecker. “The very fact that the ratio of men to women in medical school or law school has shifted dramatically in just a few decades. You can see there’s a huge social shift in how women think of their possibilities in terms of careers. And it can happen so fast. My mom had me when she was 24; I had my first child when I was 36. And it never would have occurred to me to have children when I was 24.”

Shifting maternal age and the increasing visibility of infertility in the United States have created a thriving industry for assisted reproductive technologies. Landecker said it is important to keep in mind that many reproductive services are offered in private clinics where prices are not regulated by federal or state agencies. Treatments are expensive and for the most part not covered by insurance; these technologies are therefore limited to those who can afford them. Furthermore, the marketing arm of the industry, said Dean Judith Daar, “does play upon women’s expectations in order to garner patients. That is what some people say is very troubling; I guess you could put it in the same box as any industry that aggressively markets their product.”

Another reason to exercise caution when dealing with ART, Landecker said, it that there is very little systematic epidemiological follow-up of babies born by different techniques, cultured in different media and frozen for different lengths of time. Landecker also questioned the health outcomes of hormone injections that cause super-ovulation in women who are donating eggs or undergoing IVF. “There are a lot of questions about long-term outcomes that we just don’t know about,” she said. “I think there are all kinds of fantastic things about not having to have a conventional heterosexual union in your 20s in order to have a family. I just want to say to be really careful; don’t put your faith in either biotechnology’s success or corporate control of these agencies to feel that you know everything.”

Socially, alerting women about their ticking biological clocks may be misconstrued as an attack on their autonomy. However, biologic awareness may be beneficial to women who see children in their future. “I think it’s okay to say, ‘I’m a feminist, but I’m interested in reproduction or babies or motherhood,’” said Dr. Landecker. In order to be a feminist, she said, one does not have put everything associated with motherhood second. Perhaps a larger issue than the social association of women with motherhood is the neglect to associate men with reproduction. “Reproduction,” said Landecker, “is seen as a woman’s issue. Well, it is profoundly an issue for men as well.” Landecker listed behaviors that may affect men’s reproductive health from professional cycling to smoking. She added that there is currently great biomedical interest about the effects of advanced age of both parents, not just women: “To assume that it is all down to women to think about (reproduction) and worry about it and control it is a huge part of the problem.”