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Today, there are about 8 million people, about 1/8 couples, suffering from infertility.  According to a survey commissioned by RESOLVE (www.resolve.org), three out of four men and three out of four women overestimate by five years the rapid decline in a woman's fecundity [the ability to conceive].  According to the National Center for Health Statistics (NCHS), at early 20's there is about 2% female infertility, by late 20's, 16% (1/6 – the same odds as playing Russian Roulette), 25% at mid-30's, 60% at 40, and unlikely to conceive after 43.  www.aperfectmatch.com advertises for egg donors in Ivy League student newspapers offering $20,000 from donors under age 29.  The American Society for Reproductive Medicine (ASRM) has a poster which states, "...a woman is most likely to conceive in her 20's to early 30's."

http://www.resolve.org/site/PageServer?pagename=fmed_mcpr20051027

TIMING OF DECLINE: ...Only 26 percent of women and 29 percent of men knew that figure is generally believed to be at age 35. With prime childbearing occurring up through the age of 32 for females, it was troubling that the majority of men and women thought that a woman's fertility first begins to seriously decline after 40 years of age.

This misinformation is probably largely because people see celebrities having children in their 40's not realizing that they are frequently using eggs from a donor no older than 30 and because of an overreliance of on the promise of Assisted Reproductive Technology (ART).

Until they plan on having a child, many women see internists or family practitioners who they themselves are not aware of the age of rapid decline of a woman's fecundity (they themselves present to reproductive endocrinologists).  Thus, these internists and family practitioners are writing birth control prescriptions without being able to counsel patients about the relative risks of delaying pregnancy since they themselves do not know the correct information.  Meanwhile, many female Obstetricians have their children in their 20's while working their residencies with the understanding of their residency programs because they themselves do know the risks of delaying childbirth.

ATIME.org, an Orthodox Jewish fertility treatment lay group that serves mostly the "Yeshivish" and "Chasidic" populations who tend to marry when the wife is in her late teens or early 20's claims to have 4,000 members with branches in New York, Dr. Sherman Silber, a fertility specialist, www.infertile.com who invented the reverse vasectomy and reverse tubal ligation operations and is a co-inventor of the ICSI procedure to inject a single sperm in the egg during IVF, recommends that women "manage their biological clock" by getting an antral follicle count trans-vaginal ultrasound by an OB/GYN when she is 25 if she expects to delay childbirth beyond 30. I also have an extensive referral network and I now of some others.  Because they are worried about libel lawsuits, ASRM and lay fertility organizations such as RESOLVE, TheAFA, and ATIME, will not recommend one practitioner over another but especially in older women there is a great deal of difference.

Another important education issue is that patients do not see reproductive endocrinologists in a timely enough fashion.  The standard of care is after one year of unprotected intercourse for a woman under 35 otherwise six months.

There are a number of options that men and women can be made aware of to accommodate child rearing with a busy career.  For instance if a couple marries young but wish to delay child rearing they may elect to freeze embryos.  Reliable egg freezing technologies are now becoming available within the last two years and as this technology gains acceptance this may be an option for some.  Others may elect to do ovarian tissue freezing.  Both of the later techniques are in use for women undergoing cancer treatments where they will experience ovarian failure.  Sperm or progenitor sperm from the testes can be used for azoospermatic men.

From the book, The Baby Business by Debora L. Spar of Harvard Business School:

http://www.amazon.com/gp/product/1591396204/sr=8-1/qid=1142968630/ref=pd_bbs_1/104-7181790-1626323?%5Fencoding=UTF8  

Failure to Produce: The Causes and Conditions of Infertility (Pages 15-16)

For women who suffer from age-related infertility, the emotional toll appears to be particularly high.  These are women, after all, who could have had babies if they had started earlier, women who may have put off childbearing to pursue a career or other personal goals. Acknowledging infertility in these cases is especially tough.  As Diane Aronson, a former executive director at RESOLVE, a U.S. national infertility association, recounts, "I can't tell you how many people we've had on our help line crying, saying they had no idea how much fertility drops as you age." ⁴²

Regardless of the cause, however, and regardless of age, infertility wreaks inestimable havoc on those who suffer from it. Although it does not have physical effects in the manner of, say, cancer or tuberculosis, and although childlessness is not itself life threatening, it tends to produce an emotional reaction akin to major illness. In studies conducted at Boston's Beth Israel Deaconess Medical Center, for example, Dr. Alice Domar, an expert on the connection between women's physical and psychological health, has shown that infertile women register abnormally high levels of depression, similar to those induced by cancer, HIV, and heart disease.43 One infertility sufferer recounts, "When you take away being able to have a child biologically, it is like having to face death—almost like having half of you die . . . because having kids is the main way that people deal with the fact that they are mortal." ⁴⁴ Other women (and men) express similar sentiments—of worthlessness, despair, lack of hope or desire.

On a personal level, such unsatiated demands are the stuff of tragedy. Infertility wrecks many of the marriages it affects; it drains bank accounts and often challenges the sexual identity of its victims. Yet commercially, such deep-seated demand is also undeniably attractive. In 1982, 4.5 million women in the United States reported that they suffered from infertility. This number rose to 4.9 million in 1988 and 6.2 million in 1995. ⁴⁵

The Costs of Reproductive Technology (pages 228-229)

A fourth principle to consider is cost, specifically the cost that even private transactions in the baby-making realm can impose on the rest of society. Consider, for example, the babies born to twenty-five-year-old Teresa Anderson in April 2005. Anderson was a gestational surrogate who, for $15,000, had agreed to carry a child for Enrique Moreno, a thirty-four-year-old landscaper, and his wife, Luisa Gonzalez. To increase the chance of pregnancy, doctors in this case transplanted five embryos into Anderson's womb. They all survived, and Anderson subsequently bore quintuplets for the couple.⁴⁹ When the babies arrived, news media carried the happy story, showing the smiling surrogate, the delighted couple, and the five relatively healthy babies.

These babies, however, were extraordinarily expensive: the costs of delivery almost certainly ran to more than $400,000. ⁵⁰ Gonzelez and Moreno paid to conceive these children, but the rest of us—through insurance fees, hospital costs, possibly even special education as the children mature—are paying as well. According to one recent study, the total cost of delivering a child born through IVF ranges from $69,000 to $85,000. If the child is born to an older woman, the cost rises to $151,000-$223,000. ⁵¹ The prospective parents in these cases are paying part of these costs—the IVF, the hormones, the multiple medical visits—but we are paying as well.

Meanwhile, we may also be paying the costs that accumulate as these children grow. Currently, about 35 percent of all births resulting from IVF and ICSI are multiples. ⁵² Although many of these children are perfectly fine, a significant portion of them arrive prematurely or underweight, conditions that can burden them with problems later in life. Approximately 20 percent of low-birth-weight children experience severe disabilities, for example, and 45 percent need to attend special education programs. ⁵³ If multiples thus have a higher risk of both premature births (it does), then individual choices about procreation are creating costs for society at large. In making policies about assisted reproduction, we need to consider these costs. ⁵⁴

From CBS News, August 17, 2003:

Fertility doctors like Marcelle Cedars [a co-author of the American Society for Reproductive Medicine brochures] at the University of California San Francisco, say it's astounding how few women know this: "I have doctors, I have PhDs, I have lawyers, I have very intelligent, educated women in my office every day who tell me, 'But I eat right and I exercise, and I'm healthy. How could I not be able to have a child?'"

Twenty five years ago, 35 appeared to be the biological cutoff. What happened?

"I think women have seen technology advance, so they think technology has the answer. They see in the press: 45-year-olds with twins," says Cedars. "But they assume that it is someone at 50 or 52 having a pregnancy with their own eggs, and I think that's very misleading to patients, patients who are struggling."

In fact, in most of these cases, it is almost invariably not their own eggs. Which means those children have somebody's DNA other than their mothers.

However, women have a window of fertility and Dr. Cedar says science hasn't yet changed that.

There is very little age related decline in fertility in men. This disparity is because a man produces sperm every 70 days whereas a woman's eggs are implanted when she is a fetus and women are losing 1,000 eggs per month and even the eggs they have not lost yet (that are older) are less likely to be fertile. Ultimately even a man who has no sperm output at all can get a woman pregnant through the ICSI/IVF procedure.

[Classified pages of the January 2, 2007 on-line edition of the Columbia Spectator]

Our ovum donors  [Website of "A Pefect Match" "www.aperfectmatch.com"]

"A Perfect Match has approximately 350 registered women under the age of 29 who have expressed an interest in donating their ova to infertile people."