Infertility--a Non-Issue
NBC recently ran an interesting television special called “The Baby Business.” The program began on a troubling note. Infertility, NBC said, was becoming a major national problem. Correspondent Maria Shriver asked: “Is this surge in infertility the yuppie disease of the ‘80s: the curse of the career woman?”
Despite the fact that it is a real problem of intense concern to many, despite the fact that NBC left a different impression, the real answer--although complicated and qualified--is probably no .
Most scientists and researchers believe that there has been a moderate increase in infertility. But recent medical advances cancel out much of, or more than, the reported increase.
The reasons and arithmetic: The older a woman gets, the less likely she is to be fertile. Data from the National Center for Health Statistics show that only 2% of couples trying to have children are infertile in their teens, 10% in their 20s, rising to 14% between ages 30 and 34. The big jump occurs at about age 35: The rate for couples aged 35 to 39 is 25%, and rises to 27% at ages 40 to 44. (This includes couples wanting a first child and those seeking more than one child.)
Recently people have been marrying later and are likely to try to start having a family later in life. In this sense there is not much infertility as such, but only an increase in older women trying to get pregnant at an age when it is harder to do so.
Another factor: Young people are likely to have more sex partners before marriage than in earlier times. This increases the risk of sexually transmitted diseases, which can be a cause of infertility. Still, the vast majority of women have not contracted any such disease, a large majority of women who have had such diseases remain fertile, and a little more than half those who have developed problems can still get pregnant, typically by in vitro fertilization.
So: Sadly related to age and disease, there has indeed been some increase in infertility. How much is debatable. It is hard to measure, and harder to judge; refined statistics don’t exist. One set of NCHS data show that 2.3% of all couples were childless and infertile in 1965, and 5.8% in 1982. Most of the rise occurred before 1976.
That can be seen as an increase of 150%. But the increase is from a small base. Such numbers, while representing real human tragedy, do not seem to most experts to be of a magnitude to bolster the idea of a Yuppie Curse. Moreover, infertility for couples seeking more than one child is believed to have gone down.
In any event there is countervailing activity. From a different perspective, Dr. William Andrews of Norfolk, Va., a past president of the American Fertility Society, makes this overall estimate: Of 100 couples, about 80% can get pregnant within a year, 10% can get pregnant by trying for another year, and the remaining 10% have a fertility problem. Of those, about half can be treated successfully in an uncomplicated way. The remaining half need more sophisticated treatment, and, of these, about half will be able to conceive and half won’t.
This means that 97.5% of all couples who are willing to do everything possible can conceive. There has been a medical breakthrough in fertility enhancement. Andrews estimates that 20 years ago only about 50% of the problem cases could be helped. Now it is 75%. Ten years from now it may be 85%. (And progress could be quicker and greater if the National Institutes of Health rescinded the fool-hardy policy of not funding any in vitro research.)
Andrews believes that, on balance, fertility enhancement has been greater than the rise in infertility.
This means that, while it may be more difficult for some, women today who want to get pregnant have a somewhat better chance of success than did women in their mothers’ generation.
