Beating the biological clock

SO THERE YOU are on the No. 10 bus, going cheerfully about your business, when suddenly your eye catches on a disturbing image: It's a baby bottle shaped like an hourglass with the sand running out. The message: "Advancing Age Decreases Your Ability to Have Children." Thud—there it is: your biological clock, not just ticking, but running out of time.

Anxious? The American Society for Reproductive Medicine (ASRM) wants you to be. They're the group of doctors and fertility specialists behind the $62,000 national ad campaign, which will soon be expanded from buses in three cities (New York, suburban Chicago, and Seattle) to doctors' offices and college campuses nationwide.

The ASRM just got through a nasty bout of controversy over the first phase of the campaign, which was featured in a Newsweek cover story on infertility and on national television. University of Washington reproductive endocrinology department director and former ASRM president Michael Soules says the group is trying to teach women a painful truth: Contrary to what many women want to believe, time is running out. "Our sense [at the ASRM] is that most women are aware of their biological clock, but they can't read it very well," Soules says. "When you talk to educated women about it, they say, 'I know my fertility will drop when I get older,' but when you ask when that is, they don't have a clue."

Doctors generally agree that a woman's fertility begins to drop at around 30 and banks substantially after 35, when egg reserves start drying up and the eggs that do remain are of poorer genetic quality. But women's advocacy groups such as the National Women's Health Network (NWHN), which works to give women reliable health information, say the ASRM campaign pushes women—and their doctors—to be too anxious, too soon. Amy Allina, policy director for the Washington, D.C.-based NWHN, says the group does believe "it's very important for women to get reliable information about the factors that affect fertility, like smoking and sexually transmitted diseases," two less-controversial focuses of the ASRM campaign. "What women don't need [are] alarmist ads designed to make them feel anxious about their ability to have children."

While the ASRM campaign focuses almost exclusively on female infertility and images—like the baby bottle—strongly associated with women, the truth is that infertility affects men and women with almost equal frequency. Age, according to Soules, is a major factor in just 10 to 20 percent of all cases of infertility—so why, women may well wonder, all the hue and cry over "informing" women that their biological clocks are tick-tick-ticking?

Sean Tipton, public affairs administrator for the ASRM, says he's more perplexed by why some women feel threatened by the ads in the first place. After all, "Did everyone get onto the Cancer Society for telling people to get out of the sun?" But telling women they need to give birth by the time they're 30 does raise alarms, Tipton acknowledges. "A lot of physicians say they're afraid to have these kinds of conversations with women in their 20s and 30s," he says. "They're afraid the women are going to say, 'You just want me barefoot and pregnant.'"

That's only part of the problem, Allina says. Another troubling feature of the campaign is that it makes infertility seem like a preventable problem, when often that isn't the case. In 30 to 40 percent of infertility cases, the cause is unclear.

And in most cases, women have complex reasons for deciding to "delay" starting a family. "Women are not postponing childbearing because they think age doesn't have an impact; they're doing it because they are not at a point in their lives where they're ready to have children," Allina says. She cites professional interests, a lack of a suitable partner, or educational commitments as some of the reasons women decide to wait.

James Kustin, an infertility specialist in Seattle, says most of the 35- to 45-year-old women who come into his office seeking help conceiving were aware that their decision to delay childbearing had an impact on their fertility. "They're pretty well-educated and seem to understand the risk they're taking," Kustin says. "Life's changed now—people pursue careers, they delay getting married, and delay starting families. Life has evolved, and people have evolved with it."

AS THE ASRM expands its campaign onto a college campus near you, advocates worry that an already troubling campaign will become downright condescending. If working women were offended that a group of (mostly male) doctors were telling them their biological clock was ticking down at 30, imagine the response of a 19-year-old college student heading to the campus health center for a routine Pap exam. The ASRM's Tipton says the group has women's best interests in mind. "You need to explain it to women when they're young," he says. "If they're 30, it's already too late."

Another question that remains unsettled: Is there an infertility "epidemic" in the U.S., as Soules has publicly suggested? Or is this, as Allina alludes, a manufactured crisis, created by a group of doctors who "depend on women's willingness to spend a lot of money on fertility treatments"? The U.S. Census Bureau reveals that the number of childless women between ages 40 and 44 increased to 19 percent in 2000, from just 10 percent in 1980. That could be the result of infertility, which ultimately affects about 10 percent of couples. On the other hand, first births to women in their 30s and 40s have quadrupled since the 1970s, as women have postponed having children and new fertility treatments, such as in vitro fertilization and microsurgery, have made it possible for women to bear healthy babies in their late 30s and beyond. Ultimately, Allina says, there's only so much a person can know about their ability to have children at any age. "No one is going to be able to tell you, 'This is the age by which you will not be able to have children," Allina says. "There will always be a certain amount of information that is unknowable."

ebarnett@seattleweekly.com