Following my call last week to Nicky Morgan for fertility education to be introduced as part of the school curriculum for both genders, I have been disturbed by the number of educated and influential figures making public statements that female fertility does not decline with age. This standpoint is seriously misleading, and one which could potentially result in women in making choices that lead to a lifetime of regret. This misinformation demonstrates the need for effective fertility education, so that we can shift the paradigm from treatment to prevention.
Some have challenged the scientific basis of female fertility decline and supported their assertion with an article by Jean Twenge in the July/August 2013 Issue of The Atlantic lay magazine, which claims that age does not affect a woman's fertility. Worryingly, the article bases this belief on the critical misreading of two papers published by scientific journals, which clearly state facts to the contrary.
In the first paper quoted, by Dunson and colleagues, 782 couples up to the age of 40 years-old were recruited from 7 European centres. Conducted over a long period of time, the study demonstrated significant reductions in a woman's fertility as she aged. For example the number of women failing to conceive in one year was 8% in the 19-26 year group, but 18% in the 35 to 40 year group. In the second paper, by Rothman and colleagues, 2,820 women without an explicit infertility issue were studied. The study showed that a couple's fertility (fecundability) peaks at around 30 years, and at age 40 declines by approximately half - with most but not all of the entire decline attributable to the female partner.
Both these papers are complex academic studies and deserve more than this brief summary, but crucially they confirm the well-known decline in female fertility over the age of 35.
The fall in female fertility in accordance with age must be recognised as a proven fact - as all biological evidence points in this direction. The fall in egg number and quality has been documented by histological examination, ultrasound follicle counting, and the measurement of hormones such as AMH, as well as epidemiological studies such as the ones quoted by Twenge. They all tell the same story: that there is a steep fall in egg reserve from 35 years onwards. Of course in some women this fall in egg reserve will be less steep than others, which is why we hear anecdotal stories of successful pregnancies from women in their mid-40's. However if a woman wants to delay childbearing then she should take the sensible step of checking her egg reserve, through an ultrasound scan and blood test, so that she knows how much she has left in her ovaries. There are other medical and life style factors affecting one's fertility, which could be addressed through early education or treatment for both women and men.
This leads me to surmise that some opinion leaders who champion female rights may end up obscuring biological reality. Women's reproductive systems are different from those of men, and we must face up to this. Even Lord Winston has surprisingly followed this up yesterday with the statement: "Women are leaving childbirth till later and I think it is really good thing. I am very unhappy about doctors pontificating about when the right time is to have a child." I am not prescriptive about the age at which people should have a child, my aim has always been to facilitate the choices of both women and men through education.
Indeed, it is my experience with patients every day that has led me to fight for this campaign; meeting women and men who just wish they had been given information earlier in their lives so that they could have acted to prevent or minimise infertility. As medical professionals, I believe it is our duty to educate and prevent illness, to give people the ability to live in control of their health. We have an opportunity to empower our young people, let's not miss this opportunity.