Once upon a time, a woman's ovaries were her own private affair. Aspiring mothers struggling with fertility issues whispered to their doctors about their travails, took drugs to stimulate their follicles and crossed their fingers. Today, aging eggs and donor sperm are the topic of open conversation on blogs, on Oprah and in movies like "Baby Mama" (storyline: a 37-year-old businesswoman hires a surrogate after being told her chance of getting pregnant is just about nil). Even politicians are in the fertility limelight. Sarah Palin's baby, Trig, was born when she was 44. And the newly appointed New York senator, Kirsten Gillibrand, cast a vote in Congress the day before giving birth to son Henry at age 41 last May.
And yet, despite the outing of the female reproductive system, many young women still don't fully understand the facts about age as a risk factor for infertility. Their Ob-Gyns don't always tell them. And 40-plus Hollywood mothers (some of whom are presumably using donor eggs to get pregnant) and cases like Palin and Gillibrand reassure them. So this week, the American Fertility Association (AFA) is launching "Manicures & Martinis" at the Dashing Diva Nail Salon in Manhattan, the first in a series of one-hour conversationsabout reproductive health. The event, targeted at women in their 20s and 30s who want to have children someday but aren't ready now, features a leading fertility expert, who'll talk about the reality of the biological clock and other risk factors for infertility. Yes, there'll be martinis—an offering criticized by some health advocates as irresponsible—but there will also be an organic alcohol-free "fertilitini."
Corey Whelan, AFA's director of development, says this is the kind of program she wishes existed when she was trying to get pregnant in her 20s and 30s while suffering from polycystic ovary syndrome. "I wanted to create a program that was soft, that was light and that was non-threatening," says Whelan, now 53 and the mother of 13-year-old twins conceived through in-vitro fertilization (IVF). The goal is to inform women so they can explore their options at an earlier age, she says, and the message is "one of hope, not one of doom and gloom."
To get the word out, AFA is joining the world of social marketing, advertising the event on Web sites like Facebook.com and Meetup.com. Whelan's hope is that women who attend will spread the word to their friends in person and electronically—a girlfriend-to-girlfriend experience, as opposed to some dreaded medical information session that few young women would be inclined to sign up for. "We would not be able to bring this particular demographic into a lecture hall or symposium," she says. "They wouldn't be interested and it wouldn't work."
But will women show up? AFA's Manhattan event is fully booked, with 25 women signed up and more than 30 on a waiting list. The confirmed participants are all single and between the ages of 21 and 34. One woman registered her daughter, her niece and her daughter's best friend, says Whelan, who plans to offer similar events in other venues (cheese shops, billiard halls) across the country in 2009.
Talking to women about age and motherhood is always controversial. No matter how public the topic of reproduction has become, an individual woman's fertility and the choices she makes about when and how to have children remain highly personal. While many women and health-care providers believe that informing women about age as a risk factor is empowering, others say that harping on the topic smacks of paternalism and is unfair to women who are still in search of a partner. It is a challenging line to walk, says Dr. Michael Soules, who spearheaded a public-awareness campaign about age and other infertility risk factors for the American Society for Reproductive Medicine in 2001. Doctors don't want to encourage pregnancy before women are ready, nor do they want to make them feel guilty about putting career first. "We never want to induce people to panic," says Soules, managing partner at Seattle Reproductive Medicine, a private fertility clinic.
Fertility can vary dramatically among women. One 35-year-old woman might have a better "ovarian reserve" than another and get pregnant naturally with no problem. Population studies show, however, that on the whole, fertility does begin to decline when women reach their late 20s, and then drops off significantly by the late 30s. Eleven percent of childless married women between the ages of 15 and 29 are infertile, compared to 27 percent of women between 40 and 44, according to the CDC's National Survey of Family Growth. And while reproductive technology has helped hundreds of thousands of women become mothers, it is not magic. In a study of 6,000 women undergoing IVF, published in the New England Journal of Medicine this month, researchers found the treatment to be very successful overall. But the data showed a clear shift in efficacy as women aged. Over the course of six IVF cycles, 86 percent of women under the age of 35 ended up with a baby, compared to 42 percent of women over 40. "We can't take an infertile patient at 43 and give her the fertility of a 33-year-old," says Dr. Beth Malizia, the study's lead author. "We can't reverse the biological clock."
That's the message the AFA hopes to get out. Though women have become more educated about age and fertility, says Dr. Jamie Grifo, who will lead this week's salon event, "I still think there's a way to go." The goal of the program, says Grifo, program director at the New York University Fertility Center, is "not to be paternalistic or dictatorial, it's to be educational so people make decisions consciously rather than unconsciously." Grifo says young women may assume they'll be mothers one day, but often they haven't thought much about how to get there. "It's so easy to deny and not think about these things and then show up in my office at 44 and say, 'I've tried for two months, what's wrong?'" The focus isn't age alone. Grifo plans to talk about the negative effects of STDs, smoking and substance abuse. And he'll discuss the reality of egg freezing as an option for delaying motherhood, too. The procedure, which can cost $10,000 or more, is offered by some fertility clinics; more than 700 babies have been born worldwide from frozen eggs, says Grifo. But the treatment is still considered experimental by the ASRM.
Infertility awareness campaigns can backfire, and not all women are keen on the AFA's event. Lena Aburdene, 28, says "Manicures & Martinis" makes it look like doctors are "on a misson" to get women to have children. She wants to have at least three someday, but she won't make any decisions based on the shelf life of her eggs. "My first priority is to be financially secure and be with the right person before I have any kids," she says. Loretta Goodridge, 27, an MBA grad, says nobody—not her doctor, not the AFA—needs to remind her about her fertility or put pressure on her to have kids. Goodridge says 40 is too old to start having children; she hopes to have hers in her 30s. When women want information, she says, they should talk to their own physician.
Like other informational events, the AFA's program isn't purely altruistic. It was launched with $25,000 from drug maker Schering-Plough, which makes the fertility drug Follistim. Other sponsors include a New York-based pharmacy that provides fertility prescriptions and several fertility clinics. Doctors who lead the discussions are asked to make a donation to the AFA, and gift bags that will be given to attendees will contain handouts from the sponsors as well as educational information. Whelan is matter-of-fact about the AFA's need for financial support for their infertility prevention program, which is free to the women who attend. But, she insists, "We're trying to decrease the patient population, not increase it." When one potential speaker asked for a promise that his participation would get him patients, Whelan balked. "'I'm not willing to do that,'" she says she told him. "'My job is not to get you patients, my job is to educate women.'" It'll be up to the women to decide whether she's succeeded or not.
With Dina Fine Maron