To Those Who wait

Mark Oshinskie
December 21, 2014
Reproduced with Permission

It saddens me to know couples in their late thirties trying unsuccessfully to conceive. The idea that a woman can easily conceive at any age under 40 -- and perhaps beyond that -- has taken broad, but mistaken, hold. The American College of Obstetrics and Gynecology recently published a meta-analysis concluding that women's fertility begins to drop significantly at 32 and drops rapidly at 37. This study reaffirms a similar 2008 statement by the American Society for Reproductive Medicine. The broad postponement of parenthood rests on a series of dubious notions.

Initially, the belief that one has at least until one is 40 to conceive probably gained currency because 40 is a round number. It provides a defined, large amount of prospective liberty to sample the companion field, develop one's career, travel and pursue other personal interests. But the body is calibrated to nature, not round numbers or the fulfillment of bucket lists. Americans manage conception as they do money or weight: they focus on the present and leave little margin for the future.

Americans have internalized the notion that, despite many millennia of human history, biology has suddenly changed and that they are aging better than their parents; fifty is the new forty, etc. Our parents smoked more, ate worse, exercised and dyed their hair less, dressed funnier and listened to schmaltzier music through their thirties than do their modern counterparts. But looking slightly younger, having Jay-Z on your I-Pod or running 5Ks does not enhance reproductive function.

Further, Americans are exceptionalists; we think rules about risk and failure that apply to others don't apply to us. Our books and movies foster the belief that the individual controls his/her own destiny, and that the force of will can surmount any challenge. Those familiar with the biological clock think that they will have exceptional reproductive longevity. Or the exception becomes the rule: some think that because their 41 year old neighbor -- who had her first child years before - is pregnant, a first time pregnancy is virtually guaranteed at 38.

Our culture has also mistakenly concluded that it is never too late to try anything. From the 80 year old skydiver on down, the "Man Bites Dog" media casts suspicion on age-based limits. Mothers or grandmothers who hint at a fertility end date are dismissed as archaic and insensitive. But science bears out their concerns. If a food additive had a fraction of the effect on fertility as age does, every form of protest would be marshalled against it.

Our culture also tells us we can all have it all. While many are clearly struggling to break into the job market- and something needs to be done about this -- even many with jobs postpone childbearing in order to accumulate wealth, ostensibly so their kids can live better. But doing so projects parental material desires onto kids, who are as happy playing with a kitchen pan as with a store bought toy and care little about the kind of dwelling they inhabit. It may be that we can have it all, just not all at one time. It may even be that we can't have it all.

Most fundamentally, the willingness to postpone conception until one's late thirties arises from the oft-promoted, but mistaken notion that women and men are equal. Laws and cultural messages can advance gender equality, but biology need not conform.

Though widely touted as boons to women, synthetic birth control and abortion have placed women at a reproductive disadvantage to men. As Fed Chair Janet Yellen chronicled in 1992, these technologies have given men full, consequence free (save for STIs, another leading cause of infertility) access to women's bodies. As long as women remain sexually available, men can outwait women seeking Mr. Right and cause her to accept Mr. Right Now in her late thirties. Men can wait considerably longer for Mrs. Right Now. It's not fair, but this scenario plays out frequently.

When fertility is lost to time, Americans characteristically rely on technology and public subsidies. But IVF, sperm and egg buying and surrogacy present significant, under-publicized physical, moral and social problems, including, but not limited to: complicated pregnancies, embryo surpluses, increased risk of birth defects, eugenics, exploitation of low income women as egg sellers and surrogates, and huge costs to societal medical and insurance resources.

Postponing parenthood is a high stakes risk with high social costs. Americans should carefully examine the cultural notions and technologies enabling this growing trend.