Protect Your Fertility Or Protect Their Careers:
The American Society for Reproductive Medicine's 'biological clock' ad campaign
The American Society for Reproductive Medicine is launching a controversial ad campaign reminding women of their "biological clock". While ASRM claims its motives are altruistic and scientifically based, the factual support is lacking. ASRM is the professional society that represents the Infertility Industry. Is this campaign is a thinly veiled attempt to blame the questionable past practices of the industry (which triggered a landslide of litigation and regulation) on Boomer women's "biological clock"? Does it also seek to prematurely heighten age-related fertility concerns of Gen Xers in order to fill the empty exam rooms being vacated by the Super-sized generation that preceded them? Will it exacerbate the current problem of unwanted pregnancy over forty, as a by-product?
ASRM's ads state that "women in their twenties and early thirties are most likely to conceive." While literally true, it is much like the statement "women in their early and mid-twenties are most likely to receive college degrees". It simply describes what the average U.S. woman does and is not the implied commentary of the ability to do it at a particular age. The statement "advancing age decreases your ability to have children" is also literally true. The two statements are juxtaposed and combined with the image of the hourglass filled with a baby bottle. (1)
While U.S. medical authorities put a woman's childbearing years up to age 44 and international experts go up to age 49 (2). The ASRM ads insinuate the cut-off is more like 33.
THE MEDICAL LITERATURE ON WOMEN'S AGE AND FECUNDITY (CHILDBEARING ABILITY)
The reality is that the medical literature has never thoroughly examined female age alone and ability to conceive and deliver.
Women's tendency to forego partnership in later years, to have voluntarily completed childbearing, or to have infertility due to uterine scarring from many past pregnancies obscure the conclusions of population studies.
ASRM ignores the differences in socio-economic status of the average pregnant 20-something vs. 40-somethings in the U.S. and its distortion of medical statistics. Those who wait are more affluent. Thus, the impact of better access to medical care with increased detection and reporting of problems taint many of the difference in percentages. This includes rates of infertility itself. The younger cohort's rate is artificially low due to a) those who have fertility problems but are not yet aware as they haven't tried to be pregnant yet and b) those who are aware but don't get counted as they don't have the financial resources to present for themselves to the medical community. The higher fertility treatment failure rates in older women are marred by the Industry's past tendency to take a higher percentage of poor prognosis (not related to age) patients in the senior age group because of their ability to pay. A number of lawsuits against clinics by patients claiming to have been deceived have been filed. (3)
The false perception of problems in fertility is higher among the more educated and older cohort themselves. They know more about the conception and their cycle. But, they tend to overestimate the control that knowledge gives them and are alarmed when they are not pregnant within a month. They do not know that home ovulation prediction methods have not been shown to speed up the process. Intercourse at the right time is only one factor in a chain of events that must occur and it is not easy to predict. In the best of circumstances a pregnancy will takes several months of very frequent intercourse week in and week out. (4).
Women's tendency to partner with men their age and older is the biggest factor clouding the picture. Many American doctors have only recently acknowledged male age related decline. Like the ASRM ads, they still minimize its importance. Almost comically, some American doctors cite men's decreasing frequency of sexual intercourse as they age as explanation as to why older men father fewer children, as if this is a conscious behavioral choice. It is men's increasing time between erections that goes with age that is the biological phenomenon that leads to less intercourse and is at the heart of men's age-related fertility decline. Contrary to what many educated and intelligent people think, trying to time intercourse to "the right days" of the woman's cycle as quick ticket to parenthood works better in theory than in practice. Chances drop off dramatically if intercourse (and the required erection) does not occur at least once every other day for several months at a time (4) something older men have a bit of trouble with. Is it a coincidence that women over 40's unintended pregnancy rates surpassed teens the year after Viagra came out?
International health experts have a greater recognition of these methodological problems and confounds in the medical literature. They acknowledge the social and behavioral factors that often prevent women from realizing all their biological reproductive potential and monitor women's reproductive years for a full 5 years longer than the U.S. (2)
THE IMPACT OF THE BABY BOOM ON THE FERTILITY INDUSTRY
The Baby Boom's impact on the American Infertility industry may explain the discrepancy between the US and international interpretations of the data. Like many non-medical industries, when the peak of the Boom reached the age of its typical customer, the industry swelled. But, so did this industry's problems. As investment dollars flowed in, clinics sprang up and so did the pressure to compete for "market share". Infertility is not widely covered by health insurance. Procedures were performed on the more affluent, older couples based on their ability to pay rather than their potential for success. Lawsuits against infertility clinics have been common in recent years as the consequences of these strategies came to light. (3). Regulation of the Infertility Industry also resulted.
In addition, the Boom has now largely passed through leaving excess capacity in the infertility clinics. Based on demographics alone, the number of prospective infertility patients will decline from 6.1 million to to 4.7 million. (5) Will the Gen-Xers raised in the age of AIDS with condoms have even less tubal damage related problems? Will this generation have less infertility producing gynecological problems due to its awareness and improvements in their treatment? This could mean even more empty chairs in the waiting rooms of the Fertility Clinics in the US. Bankruptcies in Infertility Clinic chains are already commonplace. (2)
Like older Boomers, younger patients can and have been targets of unnecessary fertility treatments. But, unlike their older counterparts, they tend to be treated before it is clear there is a confirmed, serious fertility problem. They haven't yet taken the time to discover if they have more minor issues that can be overcome simply with increased time. If run through unnecessary fertility treatments, many will have the children, just as they would have had without treatment. The desired outcome, regardless of its true cause, reduces the threat of a lawsuit for unnecessary treatment to the clinics. The trends of the last decade towards insurance coverage of fertility treatments, affluence at a younger age, a shrinking number of women of childbearing age, coupled with the inherent "success rate" of treating questionable infertility complaints are converging. They make Gen X women the perfect new target market of the Infertility Industry. Are fertility doctors trying to replace Boomers who had no real hope with Xers who have no real need?
ASRM releases generic denials of financial motives in its campaign without ever addressing these specific issues.
So what should the medical profession really tell women about having children based on facts?
-We don't know exactly how much a women's age per se is the cause of the decrease in the percentage of women who give birth. Other coinciding factors seem to play a major role.
-If you are over 40 and don't want to be pregnant you need to use birth control.
-In some cases, a young woman who waits will improve her chances of having a biological child. An infertility problem she has that is untreatable today may not be in 10 years.
-If you want to be pregnant, you need to have sex! Have intercourse at least once every other day for at least 4-6 months. Women who have a younger man for a partner are more likelihood to actually do this and therefore become pregnant. A fertility monitor won't overcome the need to do this.
(3) see Karlin vs. IVF America at http://www.courts.state.ny.us/tandv/art9-95.html and Center for Human Reproduction/Gyncor bankruptcy for examples)