In most areas of medicine, we have been able to close or narrow the gender gap. We recognize that women are at risk for different health concerns than men and that even the same diseases may affect women at different times than men. For example, heart disease presents both with different symptoms and at different ages in women than in men. Women also develop different cancers and therefore have different risk factors than men. We therefore study and target preventative measures and therapies to best benefit the population in question.
One area where we have not been as successful is what I call the "Fertility Gender Gap." This gap is real and it still exists. It is a fact that women are endowed with a finite number of eggs in their ovaries during fetal life (6-7 milllion at 20 weeks gestation) and that this number decreases even before puberty (300,000 - 400,000). Further, egg number and egg quality decrease precipitously after ages 35, 37 and 40. For this reason, more women suffer from infertility and miscarriage after these ages. At age 30, the monthly conception rate is about 15-20 per cent for women who have just started trying to conceive. But by age 35 and 40 these numbers drop to 15 per cent and six per cent per month respectively. Miscarriage rates also increase from approximately 10 per cent at age 30 to almost 40 per cent at age 40. Why is this?
As women age, so do our eggs. From an evolutionary perspective, this makes sense. We have to carry the pregnancy and presumably should be healthy enough to do so. Therefore, nature has built our biological clock into our eggs rather than the uterus. Mother Nature did not know that we would maintain our health and live much longer lives nor did she know that we would devise methods through science and technology to achieve pregnancy in vitro through non-natural means.
Older eggs do not function as well and therefore result in higher number of abnormal or nonviable pregnancies. While the numbers of abnormal pregnancies are higher as we get older, Mother Nature will take care of most pregnancies that are abnormal through miscarriages. Some of these pregnancies continue, nevertheless, sometimes creating difficult decisions.
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Men, on the other hand, make new sperm every 60-70 days for the duration of their life, provided they are not exposed to toxins such as chemotherapy, injury or have genetic diseases that reduce or prevent sperm production. For women, our eggs are our age, but no matter a man's age his sperm is two months old. Hence the fertility gender gap. Men also suffer from infertility. In fact, 40 per cent of infertility is due to male factor but the reasons are different
The fertility gender gap is also influenced by the fact that more women and couples are starting their families later in life. These decisions are not always by choice. It takes longer to complete an education, establish a career, and also to find a partner. Most women who present to our offices for egg freezing do so after age 35 for the latter reason.
The "fertility gender gap affects more aspects of our lives than fertility:
1. It affects our ability to find a partner: As we age, our ability to have biologic or genetic children decrease, unless we have frozen our eggs or embryos (fertilized eggs with partner/ donor sperm) at a younger age. This is not the case for men. Therefore, there also grows a "gap" in the available pool of similarly aged men for women. Or at least a perceived gap by men who want to procreate naturally. It becomes harder for women to find a partner but not so for men.
Reproductive freedom and equality is necessary for women to enjoy equality both at home and at work.
2. It may affect our professional choices: No doubt, professional women are faced with choices that professional men are not due to the fertility gender gap. Since the time of suffrage, women have fought for the right to vote, to work, to have equal pay and promotion. We often receive conflicting advice.
Some recommend we focus on independence and career first and family later but then we are criticized when we are ready to start a family and the process is difficult. Others suggest to focus on family first but then we are criticized if / when we find ourselves left alone to support the family due to loss of a spouse ( through death or divorce) and have limited means or skills to do so. Some choose to try to " have it all" and balance both but struggle on both sides and when removed from the work force for a period of time suffer the consequences of delayed career advancement.
Reproductive freedom and equality is necessary for women to enjoy equality both at home and at work. Earlier days saw attempts at equality focussed around the prevention of child-bearing. Contraception was legalized in the mid 1960's and abortion was decriminalized in the early 1970s. These are important milestones in reproductive health. However, not until advancements in assisted reproductive technologies made egg freezing a viable option have we truly been able to attempt to plan both career and family.
To be clear, egg freezing has come a long way but it is not a guarantee. It is best done under age 35 but most women present after age 35. Infertility is a "functional" diagnoses which means that until someone tries to conceive, they do not know if they will have difficulty. If one's numbers (egg count, antimullerian hormone, etc.) are poor but she conceives, she does not have infertility. Conversely, if the numbers are good but one does not conceive, she has infertility. We do not recommend that women " freeze their eggs and forget about them" but that as soon as they are ready, whatever ready means for them, they try. The longer we wait, the fewer options we have if the frozen eggs do not work.
I believe that women deserve to understand their reproductive options and that these days education about egg freezing is as important as education about contraception when it comes to family planning. It should always be a woman's choice whether or not to proceed but the education should be part of the well woman exam.
As Canadian Infertility Awareness week (CIAW 2017) just recently took place May 7-13, the theme this year was " Start the Conversation" which is a great beginning. Let's take it one step further and " change the conversation." Let's take the word infertility out of our vocabulary and replace it with the word fertility. Egg freezing is one tool to help achieve this and to close the fertility gender gap.
For more information about egg freezing please see our blog "egg freezing deserves serious consideration" in the HuffPost Canada October 14, 2014 or visit our website: genesis-fertility.com
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