As couples struggle to conceive, what does the future of childbearing hold?
American fertility rates hit an all-time low this year — the lowest they’ve been since record keeping began in 1909. The birth rate in 1957 was 123 babies per 1,000 women, but the birth rate this year is just below 60.
Researchers attribute some of this to the decline in teen pregnancies. The teen birth rate in 1991 was 61.8 per 1,000 females aged 15 to 19. That number has decreased to 24.2 as of this year, but that’s still higher than most developed nations. Canada, for instance, has a teen birth rate of 14.2.
One in six couples struggles with infertility, up from one in eight only two years ago.
But mostly this “baby bust” comes from decreased fertility among adult women, many of whom feel social and economic pressures to delay childbearing until later. Now one in six couples struggles with infertility, up from one in eight only two years ago. “I think social and economic factors make them feel like they don’t have a choice [to delay children],” said Dr. Peter Ahlering, director of the Missouri Center for Reproductive Medicine.
Dr. Ahlering said he sees numerous patients who struggle with heavy financial burdens after college and who have to get multiple jobs to make ends meet. There’s not much room for children in a strapped lifestyle.
Births to unmarried women have also continued to fall, and many men and women feel social pressure to wait for marriage to try for kids. Americans continue to get married later in life — the average age is 27 for women now and 29 for men.
The decrease in childbearing does not, however, reflect a decrease in the desire for children. More than 40 percent of American women near the end of their childbearing years report they have fewer children than their ideal number.
For better or worse, delaying childbearing for career and marriage can be compromising our fertility rates. It’s a simple biological fact that egg quantity decreases in older women, and sperm quantity can also decrease. Ninety percent of the fertility cases he addresses usually come down to diminished egg and sperm quantity, said Dr. Ahlering.
However, there has also been a recent rise in infertility among younger adult women, ages 20 and 32. Polycystic ovarian syndrome, a hormone imbalance, is the most common cause of female infertility among this age group. But nobody really knows why infertility among young adults is on the rise.
Some evidence points to environmental factors as the cause for diminished female fertility while in vitro. For example, babies exposed to pesticides, herbicides, or certain types of disinfectants could have diminished fertility later in life. Hormone disruptors, such as bisphenol A (or BPA), are prevalent throughout our plastic products and can contribute to endometriosis or other fertility disorders. These chemicals permeate everyday products, from makeup to detergents. Some research has even linked the presence of these chemicals in plastics to the dip in testosterone levels among American men.
However, it’s extremely difficult to craft a study of in vitro infants and their exposure to pesticides; a study like that would have to span 30 years or more.
Dr. Ahlering conducted a small study among his patients and found that close to 15 percent of women younger than 32 had diminished egg reserves. The diagnostic process for infertility is simple: a quick ultrasound and a blood test.
“That just blew me away,” he told LifeZette, and added that a diagnosis like this “could absolutely radically change your life.” Women who had counted on having children later would need to make decisions about freezing their eggs now or giving up on biological children altogether.
Ninety percent of fertility cases usually come down to diminished egg and sperm quantity.
Depending on how greatly their reserves had diminished, extracting eggs can cost about $6,000 or $7,000. And insurance almost never covers those expenses. Thereafter, it costs about $500 a year to maintain the eggs.
Expensive in vitro fertilization procedures now account for close to two percent of all births. Alissa Voss, a 30-year-old production editor in Houston, Texas, went into early labor just yesterday, but it took her years to get there. Voss and her husband, James, conceived on their own at first, but it was an ectopic pregnancy and she miscarried. After that, she developed some complications that doctors said would make it 10 times harder to conceive. She also struggled with a lack of progesterone, which made it impossible for her fertilized eggs to attach to the uterine wall before her body rejected them
Voss felt some amount of loneliness in her struggle, especially since so many friends were getting pregnant. “Every week someone would announce that they were pregnant,” she told LifeZette. “I was feeling a little bitter.”
When she and her husband moved to Houston, they found a doctor who knew about an IVF study. He suggested they might qualify. At the time, Voss was freelancing and her husband was busy with student teaching — there was no money to spare for an expensive IVF procedure. Turns out they had just the right mixture of fertility problems to qualify for the study comparing two different drugs, Menopur and Gonal F. So they got one round of IVF for free. Voss will likely deliver their first son this week. “I can’t wait to meet him,” she said.
Not all IVF couples are so lucky. Reproductive history, maternal age, cause for infertility, and lifestyle all play into whether the fertilized egg will take. Even then, pregnancy doesn’t always result in a live birth.
Dr. Ahlering said that women and men can forestall some fertility problems later in life by taking measures to freeze their eggs or sperm early and by getting screened. “Egg freezing and ovarian reserve or fertility screening are solutions to this problem that medicine has to offer,” he said. “We can’t change society and economics, but we can help address the problem that I think is a major issue.”