Whether to have a child during one’s medical training is a personal choice, but fertility specialist Ellen Wood, DO, is concerned that many people—including physicians—overestimate the effectiveness of today’s fertility treatments.
In the U.S., the average age at which women have their first child went from 21.4 years in 1970 to 26.6 in 2016. Experts attribute that in part to more people seeking advanced education and taking longer to establish themselves financially, and that includes a lot of medical students. By putting off childbearing during the rigors of medical school and residency, many couples who want to start families are faced with fertility issues.
In vitro fertilization, which is currently considered the best method of assisting fertility, results in approximately a 40% chance of delivering a baby for women aged 38-40 using their own same-age egg, according to the Society for Assisted Reproductive Technology. The success rate drops to approximately 23% after 41.
Dr. Wood, a distinguished fellow in the American College of Osteopathic Obstetricians and Gynecologists (ACOOG), encourages women and men to determine their family planning goals in their early 30s. An osteopathic ob-gyn who faced fertility challenges, Dr. Wood shifted her plans to accommodate her health concerns and counsels her patients to consider the same.
The DO asked Dr. Wood questions about infertility and awareness in the U.S. Following is an edited interview.
What would you like to be better understood about fertility?
I was an ob-gyn and it wasn’t until I was in my infertility rotation in residency that I realized how steep the drop-off in egg health is for women. There’s some debate as to exactly when fertility declines, but most clinics will not accept egg donors older than 31, and data shows a significant reduction after 35, which accelerates dramatically at 37. In my opinion, any woman who plans to wait to have children after 35 should consult a fertility specialist and consider freezing her eggs.
Your infertility rotation changed your life. What happened?
My original plan was to finish residency, finish fellowship, start practice and maybe 1-2 years into my practice consider having children. During my infertility rotation in residency, though, I was seeing women my age and younger struggling with fertility issues. My husband and I then decided to change our plans and began trying to conceive.
After 10 months of no success, we sought help. I conceived my first child at age 30 with the assistance of fertility medications, ultrasound monitoring and the expertise of the fertility specialists who were training me. Then, shortly after my daughter’s first birthday, I conceived my second child after seeking help quicker the second time around. Juggling two babies with starting a medical practice was challenging, but I would never advise against it.
Are there warning signs that might indicate a woman or man will experience fertility challenges?
For women, there are a number of signs. If you have a history of prior ovarian surgery, chemotherapy, radiation therapy, endometriosis, smoking, pelvic infection, or a family history of early menopause, the infertility risk is significantly higher. Do you suffer from heavy or irregular periods? That can also be an indicator.
Chemotherapy and radiation therapy will also impact male fertility. Additionally, we’ve seen a sharp, unexplained drop in sperm counts in industrialized nations. The research is inconclusive but many people believe environmental factors are the main culprit. Even if there’s no history, I encourage men to purchase a semen analysis test at the local drug store to provide a better understanding of sperm health.
Many couples are pursuing careers and a financially secure home into their 30s, which delays pregnancy. What is your recommendation to find a balance?
I’ve had a number of patients express regret that they didn’t freeze eggs or sperm earlier—or pursue pregnancy at an earlier age. While we have many tools to help an individual or couple conceive and carry, little can be done once eggs have reached a certain age. A woman can have a child well into her 40s but in most cases, the egg was frozen earlier or it is from a younger donor.
What is poorly understood about fertility treatment?
It’s an enormous amount of time and energy—emotional, mental and physical. Most people will start with timed medication, followed by a series of IUIs (intrauterine inseminations) and then IVF if needed. It can take six or more months before a patient starts IVF, and many people require multiple cycles, sometimes with breaks in between. For many, the process will take years.
The treatments are challenging and time-consuming. IVF will require multiple visits per week to the clinic as well as ongoing medication. If a frozen embryo is used, a woman will typically have 9-12 weeks of daily shots of progesterone to support growth. And it’s expensive. On average, an IVF cycle will cost over $10,000. Depending on what insurance covers and how effective the fertility treatments are, the process can cost up to $70,000.
What kind of impact does this have on the patient?
During treatment, lifestyle changes are significant. Women will most often experience weight gain due to the hormones and the limits on exercise. Many, unfairly so, will suffer from feelings of inadequacy and shame—even PTSD in the worst cases. It’s a difficult road but typically worth it.
We’ve discussed egg quality as being a major factor. Is the woman typically the cause of infertility?
It’s actually a fairly even breakout: about 33% male, 33% female, and 33% combined. In the past, it was more often associated with the female but that has changed in recent years, and I’m especially concerned about how sperm counts are continuing to fall.
Should men freeze?
Typically no, because age does not have as much of an impact on men. But I would encourage men to be proactive about testing their sperm health. It’s simple and inexpensive and can prevent a great deal of stress. I would also encourage anyone, male or female, to consider early testing if you’re concerned about your fertility health.