Dr. Meg Jay on Knowing Your Fertility
Dr. Meg Jay’s 2013 TED talk
Why 30 Is Not the New 20 has been
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Q: In your book, The Defining Decade, you tell the story of Kaitlyn (name changed for privacy), age 36, who was in a serious relationship. You make the comment that "Kaitlyn didn't know the facts (about fertility)." How so?
A: Kaitlyn was relying on a reasoning error known as the availability heuristic. The availability heuristic is a mental shortcut whereby we decide how likely something is based on how easy it is to bring an example to mind. Kaitlyn was right that it is more common than it used to be for older women to have babies. She personally knew two forty-year-old women who had succeeded, and she could think of lots of famous women who had as well. But she did not know the statistics about how easy it is— and is not— to have kids as we approach our forties. Kaitlyn didn’t know the facts.
Sadly, Kaitlyn and Ben, her husband (name changed for privacy), never had a baby. Kaitlyn tried intrauterine insemination, a few rounds of IVF, and hormone treatments, but none were successful. By forty-three, clinics were no longer willing to treat her. Doctors suggested egg donation or adoption but, for the time being, Ben and Kaitlyn felt too physically and financially exhausted to go forward. After working with Kaitlyn as she scoured the Internet, first for wedding venues and then for a way to have a baby, our sessions were now about grief.
Q: The guidance you give twentysomethings is to be purposeful and think ahead about priorities. You worked with Kaitlyn on this point. What happened?
A: Kaitlyn wanted the big wedding that all her friends got to have. She wanted the dress and the pictures. She knew she wouldn't be through an engagement and a wedding for at least a couple of years and she also wanted a couple of years together without kids. Given her age of 36, I asked her to think more about this. "I still want you to make sure a child isn’t something you might want to prioritize even more.” Kaitlyn assumed she would be able to conceive like her two forty year old friends had but it didn't work out that way. Our culture has told women that the decision about whether to have a baby is something that, even at thirty-six, is not pressing.
Q: Does the Media give women false hope about pushing the boundaries for their biological clocks?
A: There was a fair amount of media buzz when Demi Moore, age forty-seven, said she wanted to have a baby with her then-husband, Ashton Kutcher, age thirty-two. In a May 2010 interview with UK Elle magazine, Ms. Moore said, “We talk about it and it’s something we would like. He’s an amazing father to my daughters already, so I have no doubt that if it’s in our future, it would be an incredible part of our journey together.”
From the article , it’s not clear whether Ms. Moore meant that the couple wanted to adopt or use an egg donor or have a baby the old-fashioned way. But the headlines flew: DEMI MOORE WANTS TO HAVE A BABY WITH ASHTON KUTCHER; DEMI MOORE AND ASHTON KUTCHER HOPE FOR A BABY; ASHTON KUTCHER TALKS BIOLOGICAL BABIES WITH DEMI MOORE. These headlines troubled me. I envisioned young women everywhere imagining that Ms. Moore was pushing the boundaries for their biological clocks just as she has for how great women can look after forty. Unfortunately, it is not that simple.
Q: Twentysomethings have the opportunity to build the lives and families they want but it takes intentionality and good information, particularly when it comes to fertility. What do twentysomethings most need to know in this area?
A: According to a National Survey of Family Growth, about half of childless couples are not childless by choice.1 They are like Kaitlyn and Ben. They are thirtysomething and fortysomething women and men who feel they did not consider the facts about fertility soon enough, like maybe when they were twentysomethings who, even if they weren’t ready to have children, could have planned work and family trajectories with different outcomes.
Fertility may seem like a women’s issue, but as more couples have their first child in their thirties and forties, timing affects everybody. It affects women and men when ovulation kits come on the honeymoon and sex becomes a calendar-driven quest for a baby. Many couples suffer through multiple rounds of fertility treatments, shrouding marriage, pregnancy, and even babyhood in anxiety and stress. Lesbian couples and single women who want biological children will likely face some “fertility” intervention, and these become trickier and costlier the later they occur. Too many men and women grieve not having all the children they want, or not being able to give their child a sibling, as they find that, because of their twentysomething choices, they have now run out of time.
Q: It seems like we learn the facts about fertility in 5th or 6th grade when we really can't even begin to absorb it. You present an extensive set of fertility facts in your book. What are the highlights?
A: Compared to their twentysomething selves, women are about half as fertile at thirty, about one-quarter as fertile at thirty-five, and about one-eighth as fertile at forty. That’s one reason why, if we look at the actual base rates for babies born in the United States in 2007,2 about one million babies were born to mothers aged twenty to twenty-four, another million were born to mothers aged twenty-five to twenty-nine, just under one million were born to mothers aged thirty to thirty-four, about half a million babies were born to mothers aged thirty-five to thirty-nine, only about 100,000 were born to mothers aged forty to forty-four, and fewer than 10,000 were born to women forty-five and over.
The average cost of a fertility intervention for a twentysomething couple is $25,000. By thirty-five, the cost is about $35,000. After age 35 , as the obstacles to pregnancy increase, so does the price tag. At forty, couples who need fertility treatments will pay an average of $100,000 for one live birth. By age forty-two, the average cost goes up to about $300,000 for a baby.
Twentysomethings deserve to be educated about fertility statistics before they themselves are the statistics. None of this means that your 20s are when you need to rush out and have a baby you're not ready for. But it does mean that your 20s are the best time to educate yourself about your body and your options. Empower yourself with information and be kind to your future self and your future family.
Reprinted with permission. Jay, Meg (2012-04-17). The Defining Decade: Why Your Twenties Matter--And How to Make the Most of Them Now (pp. 175-187). Grand Central Publishing.
1 See J. C. Abma and G. M. Martinez’s article “Childlessness Among Older Women in the United States: Trends and Profiles” in Journal of Marriage and Family 68 (2006): 1045– 1056.
2 The actual numbers are 1,082,837 babies born to mothers aged twenty to twenty-four, 1,208,405 born to mothers aged twenty-five to twenty-nine , 962,179 born to mothers aged thirty to thirty-four, 499,916 born to mothers aged thirty-five to thirty-nine, 105,071 born to mothers aged forty to forty-four, and 7,349 born to women forty-five and older. See National Vital Statistics Reports, Volume 57, Number 12, titled “Births: Preliminary Data for 2007,” available online from the CDC at http://www.cdc.gov/nchs/births.htm.