I know, you might be more familiar with age, biology, irregular periods, or male factors (aka “sperm abnormalities”) as the root causes of infertility. While that’s what the numbers tell us, what I firmly believe is missing from the conversation is how often people don’t have the information they need, when they need it, to be able to make informed decisions regarding reproductive health.
We live in an age where we have vast amounts of information at our fingertips about almost everything. In a heartbeat, we can check the weather on the other side of the globe, the nutritional value of everything we eat, and the cost of renting a one-bedroom apartment in any city. But when it comes to reproductive health, there’s a big dropoff in knowledge, and the information that is available isn’t always helpful or even scientifically based. Why is this?
Fertility research has a long way to go, and I’m sure most fertility doctors would agree with me when I say I wish there were more advancements in reproductive technology and science. Still, there’s a lot we can solve simply by making sure people truly understand how and why certain factors influence their fertility in the first place. When there’s a lack of education around these factors, their impact is compounded.
So, let’s set the fertility record straight, shall we?
There isn’t a strong enough understanding of age and fertility
Infertility impacts approximately 1 in 6 couples in the US, with female age cited as a primary reason. However, the education and awareness surrounding the age-related decline in fecundity (meaning, our ability to get pregnant each month) is severely lacking.
I can’t count the number of times that women in their 40s have come into my practice and been shocked to learn about their declining fertility, despite their very healthy and successful lives. It’s heartbreaking — for these women, certainly — but often also for fertility doctors as the messengers.
Frequent exercise, a healthy diet, and not smoking are all important, but unfortunately, they cannot reverse the decline in fertility that all women experience with age. Unfortunately, the ways our society conflates wellness with clinical health obscures the importance of age’s impact on our fertility. Our biology and personal wellness can be on totally different pages.
Women are born with a finite number of eggs at birth, approximately 1-2 million, and our ovarian reserve continues to decline over time, both in terms of egg quantity and egg quality. These changes typically happen in our mid 30s and accelerate after 40, if not earlier. This is not to say a person over 40 can’t become pregnant, but it may be more difficult and the risk of miscarriage certainly does increase: 35-year-olds have a 25% risk of miscarrying if pregnant while 40-year-olds have up to a 50% risk of miscarrying.
Speaking of pregnancies over age 40…
But wait, there are so many magazine covers showing celebrities having children over 40. “So if they can do it, why can’t I?” is a question I’m asked a lot, and it’s a fair one. While some celebrities and cultural figures have chosen to be open about their struggles with infertility or miscarriage, not everyone does. And that is okay, it is everyone’s personal decision. Public figures may choose to share certain parts of their lives with us, but that does not mean they aren’t entitled to their reproductive privacy, just like we are.
What some of those magazine articles may not discuss is how those celebrities had their children. They may have conceived spontaneously. They may have frozen eggs or embryos years ago, or they may have undergone fertility treatment for years without anyone knowing. While it is fantastic when public figures choose to share their fertility or miscarriage journey with us, they are not required to and they certainly don’t always do so.
There are too many myths and assumptions surrounding race and fertility
Anyone can be impacted by infertility — regardless of age, sex, race, religion, and sexuality. Yet, there’s a harmful myth that’s been perpetuated for decades that Black people are hyper-fertile. The reality is that, according to the National Institutes of Health, Black women may experience infertility at twice the rate of white women. But Black women are approximately 50% less likely to seek out fertility care.
This lack of awareness might also stem from the stigmatization surrounding open discussions about infertility, especially among Black communities. One study noted that over 90% of the Black female respondents with infertility felt some form of isolation regarding their diagnosis.
When Michelle Obama openly talked about her struggle with infertility, she shined a light on the topic for the Black community, and continued the conversation regarding race and infertility. But ultimately, it’s up to the medical system — not women who identify as BIPOC — to address this and drive a more culturally competent industry that serves all people.
The COVID-19 pandemic has compounded misinformation
A lack of available information often leads to misinformation. And through social media, misinformation has a tendency to travel like wildfire.
The impact of the COVID vaccine on fertility is a prime example. For the three approved COVID vaccines, pregnant women were not initially included in the COVID vaccine trials — not because the vaccine makers thought there would be harm to pregnant women, but rather because it’s standard practice to not include pregnant women. (Luckily, this is being rectified as vaccine makers are now conducting trials with pregnant participants).
Unfortunately, misinformation rapidly spread regarding a false link between the vaccine and fertility. New research from Modern Fertility and Zola shows that 27% wouldn’t get the vaccine while pregnant. We had (and have) no data to suggest that the COVID vaccine reduces fertility or increases the risk of miscarriages. The data we do have: pregnant people who are infected with COVID-19 have a higher risk of more severe infection, needing to be hospitalized, and being admitted to the ICU or receiving mechanical intubation — but not fertility outcomes.
Overall, misinformation and stigma thrive in areas where there’s a lack of widely accessible, clinical information. Fertility is prime for this. My goal, as a Reproductive Endocrinologist and medical advisor for Modern Fertility, is to continue to bridge the gap of reproductive knowledge that so many people face. Only with better, more open information can we begin to prevent the many emotional and stressful issues inherent to fertility.