Just the facts, ma'am: coming clean about fertility☆

There goes another one. Another gloriously airbrushed, prodigiously pregnant famous personage, apparently the very embodiment of fecundity.

Maybe she is. Maybe she's not. No one but she and her obstetrician/gynecologist, and if needed, a tight circle of specialists, will know. We lay people are meant to assume that regardless of her age or her history of eating disorders, substance abuse, body sculpting surgeries, or whatever, she can pull fertility out of a hat and, presto, make a baby.

Okay, perhaps we've become a bit more sophisticated and cynical than that. Over the last 2 years there has been a crush of articles, TV shows, and books debunking the commonly held conviction that women control their reproductive destiny; that the biggest problem is preventing conception, not achieving it.

Despite the infotainment onslaught and solid education campaigns by the American Society of Reproductive Medicine and the American Infertility Association (AIA), we've only managed to dent the public consciousness. When I say we've become a bit more sophisticated, I do mean just a bit. An AIA survey of more than 12,000 women yielded a grim picture of the state of our knowledge. Only one respondent answered all 15 questions about the reproductive life cycle and basic fertility correctly. A whopping 88% overestimated the age at which infertility begins to diminish by 5 to 10 years. Most respondents conflated good general health with good reproductive health.

And that brings us to you, the OB-GYNs. You are on the front-line of information delivery. For decades, the uniquely private and intimate practice has made sure women that women know their contraceptive options, what to avoid, what would be most efficacious given their lifestyles and health histories. Our survey revealed that an overwhelming proportion of respondents understood very well the benefits, drawbacks, and risks of most pregnancy prevention methods. Doctors shouldn't flinch when it comes to asking important, if uncomfortable, questions about sexual conduct because of the health of the patient is paramount. Patients expect nothing lessFig. 1.

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Fig 1.

What women now need is that same level of open discourse about fertility, its preservation and its natural, inevitable decline. Fertility is as much a matter of well-being as a Pap test or breast exam. We depend on our OB-GYNs to make it clear that while technology can make biological progeny a reality for many who grapple with infertility, it's not the all-purpose fix we've come to believe. OB-GYNs should ask their patients about their one-day hopes and plans for parenthood, because there's much women can do to safeguard fertility. And yes, that includes talking about age.

I know how dicey and, possibly, politically incorrect a proposition this may seem. We've all heard the howls of outrage: Women will feel repressed by the facts of life beyond the “where do babies come from” material. Knowledge about the inverse relationship between age and fecundity will be so scary that otherwise intelligent women will grab the first man off the street and bamboozle him into a frenzy of marriage and procreation before it's too late. What are we trying to do? Strip women of 30 years of gender equality gains? Toss liberated womanhood back into the 1950s?

We don't need to be protected from reality. We need candor. None of us should be blindsided by infertility if we don't have to be.

Not to throw terms around, but the words “condescending” and “paternalistic” do spring to mind. Information is power and we are the rightful owners. All of us need to grasp the reality, not some media-generated fantasy, of how our bodies work. (When was the last time you read about a 40-something celebrity mom confessing that she did it with someone else's eggs?) Information is the only way we can make clear-headed choices.

As the director of a national infertile patient advocacy organization, I've heard hundreds upon hundreds of despairing women fume that they didn't know their fertility peaked years before they tried making babies. Maybe, they say, they would have started families earlier in their marriages.

“How come no one told me?” is a refrain we shouldn't hear ever again.

There's no better opportunity to discuss this and everything else related to reproductive health than when patients who trust you come for a visit. Sure, it's easier to talk about weight and diet with someone who is trying to get pregnant. But what about having a chat about the impact of healthy eating, caffeine, smoking, alcohol, and even over-exercising before a patient actually begins, or even contemplates, family-building? Preserving fertility may not seem critical to the 22-year-old just out of college and fixated on a career. But having insights into how her body functions may empower her to make sounder lifestyle judgments.

We all accept that life is uncertain. Anyone who has made it past dreamy-eyed adolescence should accept that having it all may not be in the cards. We adults know there is no prescription for love or a soulmate. We also know that we do exert some influence over what happens to our bodies, that we can help keep our reproductive selves in good form for as long as we can.

We don't need to be protected from reality. We need candor. None of us should be blindsided by infertility if we don't have to be. We need our OB-GYNs to give it to us straight. Gently, but straight. Believe me, we'd be eternally grateful.