Nairi Strauch

Health complications may be life threatening. They may require our complete and undivided attention. Others, though not imminently harmful or life-threatening, can still profoundly change the course of life. Infertility affects 1.5 million women between the ages of 15 and 44 nationwide; another 11% of women experience impaired fecundity during these fertile years.[i] Yet in the modern era, women can consider alternatives to natural conception, including adoption, or at an earlier stage of development, Assisted Reproductive Technology (ART). A Stanford University course on embryonic development and a visit to the Stanford ART clinic highlighted that young women entering the world of careers and potential motherhood fundamentally lack essential information regarding such technologies that address infertility.

The personal significance of childbearing varies significantly between women. Furthermore, the age at which women begin to consider childbirth is far from uniform. The mean age of childbearing has increased over time in the United States to an average of 25 years[ii], but menarche (the beginning of menses) begins around age 13. Young women have the right to understand their own fertility and future choices.

Impaired fecundity results from ovulation stage disorders, such as polycystic ovary syndrome (PCOS), abnormal FSH, LH, or progesterone levels, premature ovarian failures, cervical narrowing, uterine complications, and tubal blockage or damage.  A low egg supply could also be the result of eating disorders, severe stress, or abnormal menstrual cycles.[iii] However, another major risk factor for infertility is age. Each woman has an ovarian reserve, a current finite supply of eggs, which decreases as she ages. Infertility rates in America increase from 1 in 10 married women between 15-29 (without children) to 1 in 4 for those between 35-44.[iv]

“A lot of women now are going to be delaying childbearing, either because they aren’t with a partner yet or they aren’t at a place in their life where they feel that they can have kids,” said Dr. Valerie Baker of Stanford’s Reproductive Endocrinology and Infertility Clinic (REI).

“So something that may have not been as much of a problem in the previous generation is now a much larger problem” Baker added.

Infertility centers, like Stanford, offer several options for women experiencing infertility. In vitro fertilization (IVF) is a lab procedure in which motile sperm fertilize retrieved eggs in a controlled environment. Preimplantation genetic diagnosis (PGD) may be performed prior to implantation to test is a test for harmful genetic conditions. Additionally, an oocycte can be retrieved from a third-party donor to be developed in the recipient. Another technique called cryopreservation involves the quick freezing of eggs or embryos for future use.[v] Though these numerous options give women freedom to control their own fertility, they bring up further moral dilemmas.

Do women want to know about their ovarian reserve? If it is found to be lower than average, will they consider ART procedures such as freezing eggs? Brindha Bavan, a second-year medical student and former Stanford undergraduate, surveyed female university students’ attitudes toward screening technologies for ovarian reserve as an honors project. Bavan asked whether women pursuing undergraduate or graduate studies wanted to learn more about their ovarian reserves and what decisions they would make if they hypothetically had low numbers of eggs. Options that Bavan included in her study were: settling down earlier (with a partner), having children earlier, freezing eggs, freezing embryos, using egg donation, adopting, stopping work and education, postponing work and education, or no action on work or education. Out of 328 women attending Stanford University, UC Berkeley, Santa Clara University, and UC Davis in 2010, 79% of these women said they would take advantage of developing medical technologies to assess the status of their ovarian reserve. Of this 79% of women, 43% wished to screen “right now” and this number increased as the options offered screening in 5 years or 10 years.[vi] In addition, “most people felt that instead of stopping their career or stopping their academic pursuits, they would rather access assisted reproductive technologies to help them,” said Bavan. “That was a really cool finding–that they weren’t willing to put personal pursuits on hold, but they thought that technology was catching up to the pace of life that they were looking for.”

It is notable that at the time Bavan conducted this study, egg cryopreservation was considered experimental. “There has been a status change, which may change people’s attitudes…Now, [freezing eggs] is mainstream,” said Dr. Barry Behr, Director of Stanford IVF/ART laboratory. “It’s normal.”

In a small discussion I conducted with Stanford undergraduate women, individuals seemed to have mixed preferences regarding future choices. One anonymous junior stated: “I’m the type of person who would probably never get the test (of ovarian reserve) in the first place because I’m more into making it work or taking the steps I need as it happens rather than preemptively knowing my status.”

Another sophomore explained: “ As of right now at 19, I wouldn’t get checked but perhaps if I was in my late twenties and I was deciding whether or not to take a promotion, I might consider checking my eggs and if they were low, then I might consider starting a family earlier or freezing eggs.”

The idea of a “biological clock” can be foreboding, especially for women who put their education and career first. However, new technologies offer women the option of assessing their fertility, as well as a number of alternate means of conceiving a child. With new advances in technology, women have gained more freedom in relation to fertility and career goals. “Sometimes you make decisions to make balance things out. If you’re confident, you can figure out a way to make it all work and not compromise the things that are most important to you,” said Dr. Baker.

 

Dr. Barry Behr is Director of the In Vitro Fertilization/Assisted Reproductive Technology Laboratory and Co-Director of the REI-IVF program at Stanford University. He is also Director of the Renew Biobank Institute for Stem Cell Biology and Regenerative Medicine. Dr. Behr received his Masters and PhD in reproductive physiology from the University of Nevada-Reno.

Dr. Valerie Baker is the Medical Director of the Stanford Fertility and Reproductive Medicine In Vitro Fertilization Program. She studied medicine at Harvard University and completed her residency in obstetrics and gynecology and her fellowship in reproductive endocrinology and infertility at the University of California in San Francisco.