Does the biological clock still matter? The Egg Whisperer weighs in
The 1970s were a decade of game-changing reproductive freedom. And pushback. And patronizing paternalism. Women who had kids were blamed for overpopulating the planet and those who didn’t were blamed for wasting their fertility. For women who struggled with having a baby and a career, that was their own damn fault — they’d been warned.
From its inception, the analogy of a biological clock was used to scare, guilt, and tell women: It’s all on you and all your fault. The term was coined in a 1978 Washington Post editorial written by Richard Cohen titled, “The Clock is Ticking for the Career Woman.” Despite claiming that women won their fight for equality (really?), Cohen declared, “This is where liberation ends.” There was no explanation on the biology. And zero discussion on why motherhood was harder than it needed to be.
Fifty years later, it feels like the ’70s are on permanent rerun. Roe’s been reversed. Stepford wives are now “trad” ones. A new generation of girls are being inflicted with anxiety-provoking sexist standards. And women are often still playing a game of fertility musical chairs, trickily timing childbearing around work demands, and never-enough finances, all while under the threat of an unforgiving ovarian ticking clock.
But there’s no debating — reproductive technologies have advanced. In 1978, the very first “test tube baby” was born via IVF. Today, more than 2% of babies born in the U.S. are IVF-conceived. Egg freezing is opening up new options. So, does the biological clock still matter?
To give you the latest on today’s changing reproductive landscape, we talked to Dr. Aimee Eyvazzadeh, a.k.a. the Egg Whisperer — a highly sought-after fertility doctor practicing in the San Francisco Bay area. Eyvazzadeh is internationally known as a visionary reproductive endocrinologist, dedicated fertility advocate, and caring obstetrician and gynecologist.
De-mystifying the ticking biological clock
Most people know menopause marks the end of fertility. The chance of getting pregnant at age 50 is essentially zero, says Dr. Aimee. But she notes that fertility starts declining years before the final menstrual period.
Age 37 is often referred to as a “fertility cliff” because it’s when the rate of fertility decline typically starts accelerating. However,Dr. Aimee points out that an individual’s timeline can vary based on other factors than age, including environmental and genetic factors.
In the end, the only fertility window that really matters is your own. While there is no “cure” for age-related fertility decline, checking in on it early is best if you want to become pregnant. Dr. Aimee recommends an occasional fertility “check in,” beginning at age 20 or 21. This early discussion allows women to be proactive and informed.
For example, she notes that birth control pills can be used to prevent progression and growth of endometriosis, a common cause of infertility. In addition, if your ovaries are aging faster than expected, that could be caught earlier, and at a time when you have more options.
If possible, Dr. Aimee recommends finding out the reproductive history of your biological mother — and she encourages you to share your own history with your daughter.
Better IVF outcomes for fertility treatments
Patients today are coming in with the most realistic IVF expectations, says Dr. Aimee, which she attributes to the trend for openly sharing IVF journeys. She says today’s 39-year old comes in saying, “My friend did six IVF cycles…I don’t expect this to be easy,”
Still, today’s IVF odds are better for women over 39 than ever before, says Dr. Aimee. Improved outcomes are due to a number of techniques that she’s been on the forefront of using. Examples include human growth hormone, ovarian rejuvenation, and ovarian PRP (platelet rich plasma) procedures.
Today’s IVF odds are better for women over 39 than ever before, says Dr. Aimee. Improved outcomes are due to a number of techniques that she’s been on the forefront of using. Examples include human growth hormone, ovarian rejuvenation, and ovarian PRP (platelet rich plasma) procedures.
In recent years, IVF insurance coverage is becoming more common as well as more inclusive for singles and same-sex couples. Still, IVF is expensive and out of reach for many, especially lower-income families and those without private health insurance.
Egg retrieval: Freeze and forget (for now)
Since 2012, egg freezing has surged 400%. While having eggs on ice doesn’t guarantee a future baby, this gives you the potential to extend fertility by boosting your future IVF odds when your existing egg supply has dwindled.
Most women can wait until they’re 32, says Dr. Aimee. But she notes that even age 30 might be too late for some women. “If I were to save everyone from the heartache and pain from infertility, I’d say [to freeze by] 23 to 25,” she adds. Another benefit of freezing at a younger age is getting more viable eggs and needing fewer freezing sessions.
To complicate this, elective egg freezing isn’t typically covered by insurance so most people pay out of pocket. The procedure itself is costly and then there’s the storage and future IVF costs to account for.
Dr. Aimee is also seeing moms who experienced infertility themselves encouraging — and even paying for — their adult daughters’ egg freezing. They don’t want them to feel the pain of infertility, she explains.
The male biological clock?
Even though men continue making sperm throughout life, their biological clocks tick too.
Sperm from older men is more likely to have genetic changes that lower the chances of pregnancy and increase the risk of complications. According to the National Institutes of Health, a couple’s infertility is just as likely to be due to male physiology as female.
“It’s always nice to have sperm on ice,” Dr. Aimee says. And because sperm freezing is non-invasive and less expensive, she says doing it is a no-brainer. In fact, she’ll recommend her own sons do it when they’re college-aged.
In practice, when Dr. Aimee sees a couple with a late 30s male partner, she’ll recommend freezing sperm if they’d like to try for another pregnancy in a few years. “I’d rather use your 37-year-old sperm than your 40-year-old sperm,” she tells him. In addition, she stresses the need for men to pay attention to lifestyle habits (alcohol consumption, smoking, etc). while preparing for pregnancy.
“It’s always nice to have sperm on ice,” Dr. Aimee says. And because sperm freezing is non-invasive and less expensive, she says doing it is a no-brainer. In fact, she’ll recommend her own sons do it when they’re college-aged.
Modern families, modern fertility
“I’m seeing a change in society,” says Dr. Aimee. The rise of non-monogamy is creating a situation where women are having a hard time finding men who want to settle down, she explains. These men are sometimes dubbed “Peter Pans,” and this trend makes it harder for women to find suitable partners.
In Motherhood on Ice, Marcia C. Inhorn describes the majority of women who choose egg freezing as college-educated women in their 30s who want kids but can’t find a partner to conceive with. In these cases, egg freezing is a way to pause fertility while finding a partner.
The rise of non-monogamy is creating a situation where women are having a hard time finding men who want to settle down, she explains. These men are sometimes dubbed “Peter Pans,” and this trend makes it harder for women to find suitable partners.
But a growing number of women — the highest number Dr. Aimee has seen — are going straight to motherhood, skipping the exhaustive search for Mr. Right. “Women are like, ‘If the love of a man comes around, great. But I’m not gonna wait for him,’” she explains.
Dr. Aimee also points to yet another contemporary conception trend: The use of donor embryos by same-sex couples or other people who are okay with not using their own DNA.
The new world of “open donation”
When it comes to egg or sperm donation, there’s no such thing as anonymity anymore, says Dr. Aimee, noting the rise of DNA and ancestry databases.
But Dr. Aimee thinks open donation — where the donor is known to the family and vice versa — is good for several reasons. First, it removes anxiety over a future meeting and keeps the communication lines open for sharing health information. Plus, it discourages “serial donors” which can lead to large numbers of bio-sibs (i.e., half siblings from a single donor).
Post-Roe threats to fertility care
Since the overturning of Roe, many states have advanced fetal personhood laws. The American Society for Reproductive Medicine has warned that personhood laws, which grant legal personhood beginning at conception, could negatively impact (and even ban) IVF.
Dr. Aimee was asked by the PBS Newshour to comment on the IVF impact following Alabama’s court ruling that frozen embryos are people. “Embryos are precious cells,” Dr. Aimee explained, while simultaneously pointing out that an embryo is not a child — in her words, ”an embryo is a chance for a baby.” In addition to halting IVF completely (as happened for a time in Alabama), other possible implications noted by Dr. Aimee include:
- Individuals being forced to use embryos they didn’t want to use
- Not allowing embryos to be frozen for later use
- Requiring individuals to transfer all of the embryos created or limiting the number of embryos that can be created
It’s easy to see how limitations like these could decrease the chances of IVF leading to a live birth while increasing costs and emotional and physical hardship — especially for individuals without the means to afford additional cycles or travel expenses to another state.
Given the widespread support for IVF — close to 90% according to recent polls — many Republican lawmakers are scrambling to protect IVF procedures. For example, Alabama’s legislature passed a law protecting IVF providers from lawsuits. But RESOLVE (a national infertility organization) says the long-term implications for IVF in the setting embryo personhood laws still remain under threat.
Meanwhile, public support for abortion rights is at an all-time high, but popular opinion doesn’t necessarily lead to policy. Voters will face important choices in the fall: Should we be a country where your reproductive rights depend on the state in which you live? Or should reproductive rights be codified into national law?
Passing a national reproductive-rights law, like the Women’s Health Protection Act, would likely require a Democratic win of the White House and both chambers of Congress next fall — and even then there’s no guarantee.
Reproductive freedom means having choice — absolutely. But it also means having the help and support needed if you’re seeking a path to parenthood. If there’s one lesson learned from the “You’ve come a long way, baby”-‘70s, it’s that we’ve still got a long way to go — and no one can get there all alone.
