New Zealand Herald

April 22, 2002

The fertility con: It's too late, baby

New Zealand Herald

Cherie Blair, top QC and wife of the British PM Tony Blair had her baby Leo after the age of 40. Picture / Reuters

22.04.2002 - For years, women have been told they can have it all: career, happiness and, later, children. But a new book holds that, for most, this simply isn't true. MAUREEN FREELY reports.

For years we have heard about the joys of late motherhood. We have pored over the statistics, counting the reasons more and more of us are opting for it.

We have complained about residual prejudices, seeking to replace them with positive images. Hence the focus on Cherie Booth, Madonna and all those other Very Important Women who have healthy babies after 40.

Then there are those believe-it-or-not press releases from the world of reproductive medicine. Each week there is a breakthrough that will, we are told, bring joy to a new class of infertile couples.

Doctors have worked miracles with women approaching retirement age - and with men whose sperm counts are in the single digits. And did I not read the other day about research that could allow same-sex couples to produce their own offspring?

With press like that, it is easy to see why a healthy, upwardly mobile woman might think it is fine to put off motherhood until she is emotionally ready, established in her career, settled in a stable relationship and coasting into her mid-30s.

Of course, there is always a chance she may run into problems. But if she cannot produce a child naturally, there is always IVF or Gift (Gamete Intra-fallopian Transfer) or any number of exciting new acronyms to make her dream come true.

So what is the problem?

The problem is that this game plan ignores the biological and medical facts. That women have been conned.

Or so Sylvia Ann Hewlett argues in her controversial book Creating a New Life: Professional Women and the Quest for Children, which is causing a panic in the United States, where it featured as the Time magazine cover story last week.

The book's focus is the Woman Who Seems to Have It All, the high corporate achiever. When Hewlett first set out to interview them, her aim was to celebrate the achievements of the first generation of women to make it to the top.

It was only when she met them that she began to notice how many were childless. Her first attempts to dig deeper were repulsed, but because Hewlett was quick to tell them about her own problems (twins stillborn at six months, possibly because of her long work hours, many years of treatment before giving birth to her third child at 51), they opened up and confessed that they never intended to "end up like this".

Most had tried hard to have families. Some failed because they never met the right man, others met him too late. Many had been through long, humiliating treatments and still ended up childless.

The refrain for almost all was: why did no one warn me? How is it that an educated woman like me did not know the facts about fertility?

It is a difficult question to answer, because the facts are hardly secrets. Talk to any doctor, consult any support group or medical website and you will quickly find that fecundity declines after the age of 27 - first slowly, then more rapidly after 35, and very sharply between 40 and 42.

Success rates for IVF and other forms of assisted conception follow a similar curve.

So why is this news, even to the best and brightest? Hewlett, who has a Harvard degree in economics and is a fixture in the think-tank world, traces the problem back to the women's liberation movement of the early 70s.

As it embraced what she calls a "male model" of single-minded career focus, it ignored the needs and interests of women who also wanted families. Thanks to equal-rights policies, women in the workplace can depend on laws that give them parity with men - but only if they also live like men.

This has proved difficult, the pool of men wishing to be house-husbands being too small to meet the demand. That, she thinks, is why many high-flying women end up single and childless.

In a survey of 1168 "high-achieving women", Hewlett found that 42 per cent were childless at 40. For women whose annual earnings exceeded $260,000, the figure rose to 49 per cent. Her findings matched US national statistics - childlessness for women between 40 and 44 runs at 20 per cent, double the figure 10 years ago.

In Britain, the prediction is that one in every five women will never have children. A decade ago that figure was one in 10.

It is important to remember that many women are childless because they actually do not want children. Hewlett makes it clear that her book is not about them, but about the ones whose childlessness comes from what one called a "creeping non-choice".

Many found it distressing to discuss the topic at all. They chose to speak because they worried that women of the next generation were in danger of finding themselves in the same plight.

Long-hours work culture is more entrenched than ever. In most companies, the penalties for slowing down for children remain high.

High-flying men still prefer to marry younger, more nurturing women who are not their intellectual equals. And too many women everywhere believe assisted reproductive therapy means they can put off motherhood until their 40s.

But such therapy has little to offer most 40-plus mothers who run into fertility problems. We hear about the miracles - we do not hear about the majority who fail.

One in every six couples has some sort of fertility problem. Many are able to overcome them - if they allow the process enough time. In a world where couples made informed choices, women would start trying for families in their very late 20s.

If, after two years, they were still getting nowhere, they could proceed with their partners to a clinic for tests. If IVF proved necessary, they could undergo the treatment while the odds were still in their favour. If they succeeded, they could try for a second child before their odds began to decline.

The way forward, says Hewlett, is for women to plan a family in the same way (and at the same time) as they plan their careers. They cannot be expected to do this alone, she says. They need a workplace that supports them.

She and her interviewees have concrete suggestions: "Time banks" allowing for paid parenting leave that could be taken at any time until a child's 18th birthday.Restructured retirement plans, to eliminate the penalty for career interruptions.Job-protected career breaks.Part-time career tracks that allow for promotion. Tax breaks for those re-entering the workforce. "Alumni status" for women who have left their careers for family reasons, to allow them to remain in the "loop".

Work-life balance research, now available in abundance but largely ignored by business, shows that well-put-together, family-friendly policies attract high-quality applicants and create staff loyalty.

It is to promote these policies that Hewlett has written her book - and has aimed it at high-achieving women. These women may not yet have the clout of their male colleagues, but they have more power than the rest of us.

She hopes that they will be sufficiently alarmed and angry to push for real change. Such changes, she says, would benefit us all.

"When a woman has a child, she is not indulging an expensive hobby, she is taking on an awesome responsibility that has serious societal significance. Having it all is good - for individual women and for the nation."

But she admits that there is an "impressive array of forces lined up against policies that support working mothers".

She mentions conservatives who want no interference in private life, and the child-free brigade, who think people with children have enough perks already.

But the biggest enemy is corporate culture. The men at the top have budged very little - partly because they do not see it as in their interests to do so, but mostly because they do not have to.

The captains of the media industries are no exception. Which brings me to the press coverage that Hewlett's book has received in the US.

Read the cuttings, and you would assume her only motive was to publicly humiliate women for trying to succeed at work. Time could not resist digs about old eggs, ticking clocks, and Women Who Are in Hysterics Because They Left It Too Late.

Pamela Madsen of the American Infertility Association grieved: "Those women who are at the top of their game could have had it all, children and career, if they wanted it. But no one told them the truth about their bodies."

How cruel. But is it true? Up to a point, yes. The database for post-40 pregnancy and birthrates is thin.

But in Britain, as in the US, the accepted medical view is that women over 40 have conception rates of about a third of the overall rate - and that most of those who succeed are 40 or 41.

In general, a woman aged 35 or younger will have a 22 to 28 per cent chance of achieving a live birth from one cycle of treatment. By 39, that drops to about 8 per cent, and by 44 it is as low as 3 per cent.

When you're doing your arithmetic, don't forget to check your bank balance. Assisted conception can be costly, and treatment, even when it works, is extremely stressful.

Hewlett's book is not the first on this subject. And in Britain the tabloid press gives us almost daily updates about the perils of postponing motherhood. So why is the message not getting through?

Because it is too negative, says Dr Cecilia Pyper, who is a GP, a researcher in the Department of Public Health at the University of Oxford, and a long-time campaigner for fertility awareness.

It fans fears and does not provide the reader with information she can work with. The problem begins, she says, with people's approach to sex education. With concerns running so high about HIV and teenage pregnancy, the emphasis is on how to block conception.

As sensible as this may be in the short term, it leads to the "false idea that fertility needs be controlled vigilantly". That is why so many women are shocked when, later in life, "they open Pandora's box to find out that nothing's there".

It might be better, she thinks, if all schoolchildren were given a more general grounding in fertility awareness.

They would then enter the adult world knowing that fertility is finite, that it is good to start thinking about children early, even if you do not act on those thoughts right away, and that there are many things they can try to enhance their odds before seeking high-tech solutions.

For example, women are far more likely to conceive if they understand when their fertile times are. A surprising number of very educated women do not. Neither are they aware of how long it takes at various ages to conceive after coming off the Pill.

"Many high-flying women aren't conceiving because they're only making time for sex twice a month," says Pyper.

And don't forget the men, she adds. Often their patchy knowledge of fertility means they are making, or obliging their partners to make, very uninformed decisions. And new research suggests men have their own biological clock that begins to fail in their 50s.

"Often, women aren't getting pregnant because their 50-something husband can't get it up," reports Pyper.

But their main problem is the tyrannical workplace. It still does not provide the structures that would make it possible for men and women to work as well as to bring up children.


©Copyright 2002, NZ Herald