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The Abiding "Fertility Myth"

by Gina Maranto, Biopolitical Times guest contributor
November 9th, 2011

Since at least the mid-1990s, the popular press in the developed world has been spreading the word that women’s ability to get pregnant declines with age. I wrote an Atlantic Magazine cover article on the implications of delayed childbearing in 1995, and the biological facts haven’t exactly changed over the ensuing 16 years.

It’s true that IVF success rates among older women have increased due to the use of donor eggs. Too, egg freezing has become more viable due to the advent of the high-speed cooling process known as vitrification [PDF]. That technique has led to a whole mini-industry in egg banking, a.k.a. elective oocyte cryopreservation, but success rates continue to be quite low [PDF, registration required], so the procedure doesn’t significantly alter the situation despite claims to the contrary.   One recent meta-analysis suggested that those women who have opted to freeze their eggs might have done so too late to make a real difference. 

So I was surprised to discover, checking up on recent literature, that unrealistic views about women’s fertility continue to be quite common among college graduates in the West. In the last several years, studies in Sweden and Canada have shown that young people in those countries consistently overestimate women’s chances of conceiving naturally as they age, and a report this September, out of Israel, echoes their findings, and more.

  • Sweden: In a 2005 study published in Human Reproduction, Claudia Lampic, then in the Department of Public Health and Caring Sciences at Uppsala University, and three colleagues, surveyed 222 female and 179 male university students by mail.  Swedes in large numbers say they want to have children (in one major 2001 survey, 95% of those age 23-25 said they intended to do so), even as Swedish women, like those in other developed countries, have increasingly been putting off having children in order to pursue higher degrees and establish themselves in their careers.  Among Lampic’s respondents, a large proportion could identify the period of women’s highest fertility – age 20-24 – yet, at the same time, only a minority knew that women’s ability to conceive began to decline at age 30 and to fall off steeply in the late 30s; indeed, about a third of the males thought the sharp decline did not occur until after age 45. The participants “markedly overestimated” the chances of achieving a pregnancy at any age.
  • Canada: In similar work whose results were published in Fertility and Sterility in 2010, Karla Bretherick and colleagues surveyed 360 undergraduate women at the University of British Columbia in Vancouver.  They found that although most of the women “were aware that fertility declines with age, they significantly overestimated the chance of pregnancy at all ages and were not conscious of the steep rate of fertility decline” for women in their 30s. Nor were they aware that age was the primary factor in miscarriage; instead, nearly half thought that “physical and emotional stress” presented the strongest risk.
  • Israel: Most recently,  a study published in the September 9 issue of Human Reproduction revealed that college students in Israel also have overly optimistic beliefs about women’s capacity to conceive, not only naturally, but also with the aid of IVF.
Yael Hashiloni-Dolev and Amit Kaplan of The Academic College of Tel Aviv-Yaffo and Shiri Shkedi-Rafid of Kings College, London and the Hebrew University of Jerusalem, administered a questionnaire to 410 students (with a mean age of 24) attending four institutions in Israel. The sample mainly consisted of women (73.5%), most of whom were majoring in the social sciences and humanities. Of the total, 12.1% of the students were in health-related fields and 8.4% in computer studies.

As in the other studies, students consistently overestimated women’s chances of becoming pregnant at any age, even though they knew that chances diminished over time. Notably, the students thought women over age 46 had 6 times as likely a chance to become pregnant naturally than medical literature shows. In general, students pursuing health-related majors were closer to actual rates than the rest, but even they overestimated. The highest rate of error – or, put another way, the highest degree of optimism – belonged to students who said they intended to have children.

The Swedish and Canadian studies had suggested that their subjects also had faulty understandings of the degree to which IVF could help. The Israeli study sought to probe this question further, asking the participants “to estimate the likelihood of women, in various age groups, giving birth via IVF treatments,” and then comparing their answers with data drawn from several key studies of IVF success rates.

Here, the students generally did better, giving “a relatively realistic estimate of the chances of women aged 20–39 years giving birth with the aid of IVF treatment (their answers fell within the range of published medical data); however, IVF birth rates above the age of 40 years, and even more profoundly, above the age of 44 years, were significantly overestimated.” About a third of the students gave women 48-52 years old a 20% chance of having a child by IVF, and close to a fifth gave women 53-58 years old a 20% chance (when the actual chance of such women having a child using their own eggs is roughly zero).

As it happened, the researchers had asked an open-ended question regarding such “late” or “very late” pregnancies: what medical procedures were responsible for facilitating such births? “Only 11% of the students gave the correct explanation, that is, egg donation or egg freezing” – in other words, 89% did not know that aging eggs are responsible for women’s declining fertility.

What these studies suggest is that young women, especially, continue to make reproductive decisions based on what the Israeli researchers term the “fertility myth.” They have more faith in biology and technology than they should. Many of the women in the Swedish survey said they “intend to have children during age periods when women’s fecundity is markedly decreased,” which means they “may subsequently end up involuntarily childless or suffer secondary infertility. This is particularly alarming in view of the great importance these women put on parenthood,” wrote Lampic and her colleagues.

The Israeli researchers posit that the widespread misperceptions, especially about births by women in their 50s, “can be explained by technological ‘hype’ and favorable media coverage of very late pregnancies.”  While cultural attitudes differ, media attention to older mothers in the U.S. has been largely positive and, the researchers write:

Findings from a recent study looking at media treatment of the topic in Israel show that late as well as very late pregnancies are portrayed as possible, legitimate, and even advisable and preferable, as they are understood to express a constructive parenting strategy. The doctors who assist such pregnancies are looked upon favorably as sources of national pride, and women who become pregnant at older ages are often presented as mature, emotionally stable and ready for motherhood (Shalev and Lemish, 2012).

As the Israeli researchers conclude, it is important for physicians and public health workers to “counter the fertility myth, especially among young people, as it may result in reliance on costly, unpleasant techniques, with potentially disappointing outcomes.” Unfortunately, it seems that the public has, over the last several decades, bought more into the bogus narrative of the techno-fix than into the hard biological truths.

Previously on Biopolitical Times:

Gina Maranto is Co-Director of Ecosystem Science and Policy and coordinator of the Environmental Science and Policy program at the University of Miami's Leonard and Jayne Abess Center. She is the author of Quest for Perfection: The Drive to Breed Better Human Beings (1996).


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