Monday, June 3, 2013

Family planning at the cusp of a career (Part II): Get busy fertilizing or get busy freezing?

In my last post, I discussed an all-too-familiar concern of many young professional women (and a recent campaign bringing it to the fore): the competing desire to have a successful career and the ever-increasing risk of age-related infertility. The problem, of course, is that many young, professional women “spend [their] prime baby-making years in the trenches” and put children on hold until later in life. The average age for entering medical school students at UC Davis, for example, is 25, making the average age at graduation roughly 29. The next three to five years are spent in grueling residency programs, resulting in new doctors finally beginning their careers between the ages of 32 and 34. By then, even the healthiest young female doctor’s fertility has already started its rapid, irreversible decline, while the young woman has barely had time to establish herself in her profession.

The response to this dilemma from some, including the aforementioned campaign, is to pressure women to conceive earlier lest the prospective mother “fritter away” her twenties. (N.b., Of course, I can only speak accurately for myself here, but I would imagine many women would not characterize the time they spent in graduate school or the professional trenches -- working toward their goals and overcoming ubiquitous male preference -- as time “frittered” away.). Other women, though, are turning to technology to give them ultimate control over family planning. How? By flash-freezing their healthy eggs and storing them for future use.

The flash-freezing process is fairly simple and can be completed over the course of a few months: the woman takes hormones throughout her menstrual cycle and is monitored for a period of time by physicians until her eggs are ready to harvest. At that time, they are removed trans-vaginally, frozen, and preserved until the woman is ready to have them fertilized. Cost estimates for the procedure range from roughly $2,200 to $18,000, and the technique has dramatically increased in popularity since last fall, when the American Society for Reproductive Medicine lifted its “experimental” label on the practice. Since then, a number of women, including Yale professor Marcia Inhorn, have published books and op-eds imploring their younger counterparts to take advantage of the technology while their ova are still healthy and, as a result, take greater control over their careers.

But the procedure, unsurprisingly, is not without risk and certainly gives rise to other ethical concerns. First, the technology is so young that there has been very little research done as to its long-term success. Indeed, as author Miriam Zoll recently wrote, “The only thing we really know about [the procedure] is that an estimated 1000 babies have been born to women younger than thirty years of age who were facing life-threatening illnesses. . . . We don’t know if these live births were the result of 3,000 or 10,000 trials. We have no information about how many miscarriages or stillbirths may have ensued, and we have no idea how flash freezing might affect offspring’s health later in life.” Further, as Professor Inhorn has acknowledged, as a result of the availability of the procedure, “employers may come to expect women to postpone childbearing through egg freezing” and “[w]omen may be pushed into a burdensome and costly medical procedure that cannot provide guaranteed future fertility outcomes.”

The counter to the latter concerns, I think, is that similar arguments could be made against various forms of contraceptives, but since their introduction in the early twentieth century, the feminist response has been predominantly positive; indeed, the increased ability to plan one’s family has largely been credited as one of the primary reasons women have gradually moved out of the domestic sphere and into the marketplace. Might this same technology effect a similar result? That is, now that young women have entered the professional workforce, perhaps allowing them to postpone childbirth into their forties -- when they are still able to carry children and presumably are in better positions, professionally -- will increase the number of women who make it to the “top” of corporations and law firms around the country. Now that we have our foot in the door, perhaps this technology is the ticket -- at least for some women -- to finally climb the corporate ladder on their own terms and at their own pace.

Saturday, June 1, 2013

Family planning at the cusp of a career (Part I): Beating the clock

Practically every time I see my family, I’m asked for an update as to when my husband and I are going to have children, and it bothers me. It really, really bothers me. But my problem isn’t that they are holding me to some traditional, domestic female standard or that they want me to duck out of the workforce for a few years -- they aren’t, and they don’t. They ask because in the past, they’ve heard me talk about how much I want children, and they ask because they know that being a mother is what I want to do. In fact, my problem is not with them or their question at all. My problem lies with the ominous internal reminder that inevitably follows: you’re not having kids anytime soon -- not with those student loans, not with that new job, and certainly not with those lofty career goals. And so another family conversation ends abruptly with my dismissive, standby response: “We’ll get to it eventually.”

Lately, though, I have been unable to escape the message that “eventually” is not soon enough. Granted, I’m still young -- not yet 30 -- but pregnancy (much less childrearing) still hasn’t found a place in my five-year-plan. And that, according to a number of women, is simply alarming. In fact, “Get Britain Fertile” a new ad campaign in the UK, where the average age at first pregnancy is 30, is determined to remind young women like myself that “careers and finances [may] seem important, but you only have a small fertility window.” (Gee, thanks a lot, GBF.) One of the faces of the campaign, 46-year-old, successful British TV personality Kate Garraway, specifically wants to caution women that they should “start thinking about their fertility at a younger age than [her] generation did” and to “get prepared and make informed choices early so there is no chance of sleepwalking into infertility” later on. Ms. Garraway had her two children at 38 and 42 and deeply regrets that today, her “fertility door is slamming shut.

In theory, the campaign is innocent enough -- Ms. Garraway and her co-ambassador, Zita West, seem genuinely concerned about educating young women as to the effects of age on fertility. Yet, it is worth noting, I think, that the effort is sponsored by First Response pregnancy tests, and the name itself -- “Get Britain Fertile” seems to be more of a push for pregnancy than a call for increased fertility awareness. Further, the information the ambassadors have distributed thus far is not exactly being presented in a strictly-PSA format. Indeed, the photo slapped across British newspapers to promote the nascent campaign was the photo below: one of Ms. Garraway dressed as what some critics are calling a “cartoonishly ancient-looking pregnant woman.”
Get Britain Fertile, rather than simply educating, latches on to a fear already present in every young professional woman who wants to have children and rattles that fear into a panic with a message worthy of a Jack LaLanne infomercial: Act now! The miracle of creating human life can be yours -- but only for a limited time! You’ll look like this old woman before you know it… Conceive today and receive a FREE First Response EPT.

Whether the message is fear-mongering or not, though, it still fails to address the campaign’s ultimate underlying problem: how to embrace motherhood at a young age (which they certainly seem to be advocating) while still keeping a professional career on track. Tellingly, Ms. Garraway herself has had a busy fifteen years in the entertainment industry, but when asked about the double-standard her campaign seems to reinforce on young women seeking successful careers, she simply offered the following moderately coherent but impossibly nonresponsive answer:
“[W]e applaud young career women in their twenties and then before you know it you find yourself as I did at a friend’s wedding and being quizzed by everyone about why you haven’t got round to reproducing yet. If we listened to society we would be in a total spin. I am hoping this campaign will help everyone who is interested to get the information and facts they need to equip themselves to make their own life choices.” 
I, too, hope that anyone seeking to make family planning decisions is adequately informed of their options. But I also hope that British women are strong enough to recognize that three-kids-by-thirty is not the only path, nor is it necessarily ideal.

As for me, the marketers at Get Britain Fertile, which is scheduled to officially launch this week, can turn their attention elsewhere. Their message has been received, I consider myself warned: the clock, as I’ve known since childhood, ticks on, and one day it will stop. And notwithstanding the modern, vibrant conversations about leaning in, making it work, and having -- or rather, not having -- it all, I am still ultimately left with the unsatisfying conclusion that if I want to be a mother, the question is not whether to sacrifice my career, but when.