AMANDA ANDERSON, THIRTY-EIGHT, IS DREADING HER BIRTHDAY. As it approaches, she sizes up her life—what she has, and what she hopes to have. She has: a master’s in cell biology from Yale, a dozen publications, a devoted beagle, dear friends, and a career. She hopes to have: a husband and children.
Amanda always basked in her successes, and trusted that the rest would come in due time. Like many of her peers, she focused her time and energy on developing a career, and postponed the building of a family. In her early thirties she had a serious boyfriend, a fine man, who wanted to marry her. Amanda wasn’t ready, so they broke up. Only her mother challenged the wisdom of that decision. Later, while celebrating the acceptance of her thesis, friends had joked that Mrs. Anderson would’ve preferred attending her daughter’s bridal or baby shower. They enjoyed a good laugh.
Now it’s not so funny. Amanda is in my office because as her birthday approaches, she is moody, irritable, and distracted. She is bored with her research and disenchanted with university life. Amanda shares with me a new yearning, so profound it surprises her: to feel a new life inside her, to give birth. My patient reports with astonishment that for the first time, she envies friends—even strangers at the market!—who are pregnant. She cries every day.
Amanda labored long and hard through school and she’ll get her Ph.D. nearly a decade after graduating from college. There were setbacks due to changes in her thesis, and conflict with advisers. There were also the years out of school spent working in Europe and Africa. Grad school has been endless, but finally her thesis is nearly finished, and she’s had offers from several universities for tenure-track positions. But all that’s not enough for Amanda now, and she has begun to wonder…maybe Mom was right all this time, that a woman’s deepest fulfillment is in motherhood. Maybe Mom was right to bug her about marriage and the passing of time. These and other troubling thoughts distract my patient from her teaching and research, they intrude while she is watching a movie or walking the dog, and they keep her up at night. She is rethinking and doubting decisions made years ago about careers and boyfriends. Most of the time, she feels certain she’ll be able to have a baby, because she’s in excellent health, doesn’t smoke, and she’s not “that old.” Still, Amanda reports that last night she had moments of panic: Could it be too late?
Amanda has reason to worry. Even if she soon falls in love and marries (she has ruled out the single-mother option), her chances of conceiving each month have decreased by 75 percent, compared to when she was thirty. 1 Of course, it could still happen, if she’s lucky. But if she does conceive, the possibility of miscarriage has tripled, the rate of stillbirth has doubled, and the risk of genetic abnormality is six times as great. 2 Her pregnancy is more likely to be complicated by high blood pressure or diabetes, and her baby is more likely to be premature or low birth weight, conditions associated with neurological impairment as well as sudden infant death.
If Amanda cannot conceive naturally, and she and her husband want a biological child, her gynecologist will advise them to pursue assisted reproductive technology (ART). They will likely experience their first visit as difficult and stressful. 3 The couple will be examined and asked for details about their intimate life, with one another, and with others they may not care to recall. Following a series of tests, the analysis of semen and cervical mucus, and sometimes surgery, the cause of their infertility may or may not be found. Initial treatment is with fertility drugs, followed by in vitro fertilization (IVF). If Amanda is like many of the three million women who go through this process, she will face an awful ordeal.
How do women describe how they feel being unable to conceive, taking fertility drugs, or going through in vitro fertilization? What are the chances of success for Amanda, if she starts treatment at, say, age forty? And how much will it cost?
The answers are: angry, sad, helpless, guilty, bitter, resentful, and humiliated, “a state of desperation like nothing else,”4 “an emotional roller-coaster,” “PMS times a thousand,” “the worst experience of my life”; 3 to 5 percent; and at least $20,000.
With women delaying childbearing as never before, the offices of fertility doctors are filled with fortysomething patients desperate for a baby. “Most of the women who come in here are healthy,” said the director of the largest fertility clinic in San Francisco. “They’re here because they’re forty.”5 Amanda has a good chance of joining their ranks. Let’s take a look at what may be ahead of her.
Clomid is the most popular fertility drug. It stimulates the ovaries, and encourages multiple eggs to mature. The time of ovulation is controlled and the chance of pregnancy maximized. Clomid commonly causes ovarian cysts, pelvic pain, hot flashes, nausea, breast tenderness, depression, and mood swings. 6 “Mood swings may be surprising and severe,” warns the American Society of Reproductive Medicine’s guide for patients. 7 There is an increased incidence of miscarriage and multiple births, and some studies show an increased risk of ovarian and breast cancer. 8 Clomid costs about $3,000 for one month’s treatment, and most couples use it for four to six months. Amanda has a 5 to 10 percent chance per month of getting pregnant this way.
If Amanda needs IVF, she’d again take fertility drugs, and eggs would be removed surgically. They would be fertilized in the lab with her husband’s sperm, and then transferred directly to her uterus. Each IVF attempt costs $15,000.
The emotional costs are high too. Women treated for infertility suffer from anxiety and depression as severely as do patients with cancer or cardiac disease. 9 After a failed IVF attempt, fears and anxiety intensify, memory and concentration worsen, and self-esteem falls. Patients perceive their infertility as a traumatic life event. 10 One forty-four-year-old woman whose only pregnancy ended in miscarriage a year earlier, and since then had spent thousands on hormones, said, “If you ever told me I’d be having this kind of difficulty, I would have laughed in your face. I exercise, I eat well, I keep better work hours, but I’m really not in control of what’s happening with my little eggs. It’s devastating. It’s a terrible sense of failure.”11
Of course, when treatment ends in success, parents will say it was all worth it. But success is rare. At age thirty-nine the chance of a live birth after an IVF attempt is 8 percent. By age forty-four, it falls to 3 percent. 12 This is why Dr. Zev Rosenwaks, medical director of infertility services at a major Manhattan medical center, warns, “If you are over forty, ART is unlikely to solve your infertility problem.”13
If Amanda and her husband are willing to use a younger woman’s egg, it will increase significantly the odds of having a baby. They may find this unacceptable however, because the child will have no genetic relationship with Amanda. This procedure costs $15,000 to $20,000.
That’s the story. But educated as she is, Amanda is unlikely to be familiar with the risks of a first pregnancy in her forties, the ordeal of infertility, and the disappointing rate of success of ART. She may have some vague understanding that it is more difficult to get pregnant, that it doesn’t happen as quickly. But she probably overestimates her chances of conceiving naturally and delivering a normal child at term, without complications or intervention. 14
Many women share her misconceptions. A 2001 survey showed 89 percent of young, high-achieving women believed they would be able to get pregnant into their forties. 15 Another found that women have an excellent understanding of birth control, but they “overestimate the age at which fertility declines.”16 The former director of RESOLVE, a support network for couples coping with infertility, reports: “I can’t tell you how many people we’ve had on our help line, crying and saying they had no idea how much fertility drops as you age.”17
But how would they know? The media is constantly providing them with stories of babies born to older women, even grandmothers. For example, a woman like Amanda might take comfort in the recent headlines about a sixty-seven-year-old Romanian woman giving birth. Of course, she’d never wait that long, and yes, there are some ethical issues to consider, but the point she’d take from the news is that reproductive technology has given women control over their biology, and that at thirty-nine, she can safely wait to have children.
Should Amanda be reassured by the story of Adriana Iliescu, the oldest woman ever known to have given birth, 18 and by the well-publicized motherhood of celebrities like model Cheryl Tiegs (a mother at fifty-two), the late Pulitzer Prize–winning playwright Wendy Wasserstein (forty-eight), and actress Jane Seymour (forty-four)? The experts say no. They call the media coverage of these miracle births “the perpetuation of a dangerous myth.” For example, Dr. Rosenwaks wrote in a New York Times editorial,
The nonstop media parade of midlife women producing offspring is stunning…. These stories are about the fortunate ones: they beat the odds…. As an infertility specialist, I often see women…who have been lulled into a mistaken belief that there is a medical technology that will allow women to have their genetic children whenever they choose…. In our eagerness to outwit time, the media have made a bestseller out of the freshly minted fiction of “rewinding the biological clock.”
We can’t and we haven’t.19
Dr. Rosenwaks was not alone in his effort to warn women. The largest professional organization of infertility doctors, the American Society of Reproductive Medicine (ASRM), sponsored a campaign in 2001 called Protect Your Fertility. Their ads highlighted the four major causes of infertility: advancing age, sexually transmitted diseases, smoking, and unhealthy weight. Like the media campaigns we’ve all seen discouraging cigarettes and drug use, the ads were placed on buses and in malls and theaters. But unlike the antitobacco and antidrug campaigns, the infertility ads were considered controversial and provocative. The ASRM drew the ire of the National Organization for Women (NOW), who argued that they sent a negative message to women who might want to delay or skip childbearing. 20 Mall and theater managers refused to make space available. The campaign died.
Thanks in part to these organizations, the message did not reach women like Amanda. A spokesman for ASRM pointed out the irony: “Our doctors were getting sick of hearing patients say, ‘No one told me,’ so we tried to educate women. Then we were accused by women’s organizations of fear-mongering.”21
One item Amanda probably did see is the publicity given a new company, Extend Fertility, and the service they provide—egg freezing. It would have been hard for her to miss the exposure. It was featured on NBC News (“Beating the Biological Clock”), Good Morning America, Fox News (“Egg Freezing May Offer Fertility Freedom”), 60 Minutes, and CBS Marketwatch. There were articles in the New York Times, the Washington Post, U.S. News and World Report (“The Biological Clock on Ice”), Nature (“Age Is No Barrier”), Newsweek, Forbes, Cosmopolitan, and Elle (“Want to Hit the Snooze Button on your Biological Clock?”). 22
Egg freezing has been available since 1994 to women facing sterility due to chemotherapy. When Christy Jones, a thirty-four-year-old Harvard MBA, heard about it, she apparently saw dollar signs. Jones opened Extend Fertility, the first commercial facility to provide egg cryopreservation, in 2004. The business seeks to attract women like Amanda, who hope to outwit their biology.
One of the facility’s press releases reads: “The days of the biological clock are over. In the past, women were bound by the limitations of time when it came to their reproductive choices. Women who wanted to get pregnant later in life were faced with egg quality issues. Now they have the option of extending their fertility by preserving their eggs at a time when they are much healthier. It’s quite remarkable.”23 More recently they’ve moderated their claims, promising women “the opportunity to effectively slow down their biological clocks.”24
But fertility specialists say the technology is not ready for marketing, that the company promotes unrealistic expectations, and that there is “a very high risk of exploitation of this patient population that is looking for hope…. Extend Fertility’s Web site offers hope where many fertility experts would argue there is very little.” The site claims success rates of 35 percent, called “unbelievable” by a world expert. The actual rate for successful birth using frozen eggs is closer to 2.5 percent. 25 Nonetheless, Extend Fertility is up and running in Los Angeles, New York, Boston, and Austin, Texas, ready to collect $10,000 for their services—financing is available—and another $400 a year for egg storage. And their Web site continues—evidently without any objections from NOW—to invite Amanda to “put her biological clock on ice.”26
Maybe we shouldn’t be surprised when NBC, CBS, and Cosmopolitan—or a CEO building her business—is less than responsible. They are permitted their agendas. So whose job is it, aside from Mrs. Anderson’s, to remind Amanda of the possible consequences of waiting too long?
Well, to begin, how about the campus resources Amanda’s been visiting for years for help in sorting out and planning her life? For instance, campus counseling and career centers state that their mission is to promote normal emotional development. Is parenthood an important part of adult development?
Erik Erikson thought so. This giant in the field of human development was the first to suggest that maturation is a lifelong process, from cradle to grave. Not only in childhood are there stages, each with certain tasks to be negotiated and mastered: to walk and talk, to be toilet-trained, and to make friends. Erikson’s widely accepted theory holds that development continues into young and middle adulthood, and beyond. As in the growth of infants and toddlers, in adult development there is a built-in, biological thrust—a maturational push—to master the challenge at hand, and move on to the next. With each success, there is a change in the sense of self, there is growth and fulfillment.
According to Erikson, the tasks of young adulthood are intimacy, work, and generativity, the latter defined as “establishing and guiding the next generation.” For most people, that means parenthood. 27
Current studies confirm the importance of generativity. A Harvard researcher, who directed the longest prospective study of physical and mental health in the world, considers taking care of the next generation “a key to successful aging.”28 Another eminent authority in the field of child and adult psychiatry explains that responsible parenthood “propels development”29 and leads to ongoing fulfillment on many levels—by the creation of a new person to love, by the opportunity to redefine one’s relationship with parents and to appreciate and give back to them, by the maturation that is stimulated as relationships with children shift over time, and by turning to children and grandchildren in old age for solace, continuity, and hope.
Amanda wants these things. Her yearning for a child comes in part from the drive, the maturational pull, to take on a task central to this time in her life. It’s hard-wired.
To avoid scenarios such as Amanda’s, therefore, it seems logical for campus counselors to explore with a woman, in particular a woman nearing graduation, her thoughts and feelings about parenthood. This can be compared to the therapist bringing up issues of sexual identity, or autonomy from parents, with a client, and is consistent with the widely accepted view that counseling needs to recognize the “whole person.”30 If a woman indicates that motherhood is a goal, the therapist is in a position to educate her and to explain the risk of putting off childbearing indefinitely. Therapists, vocational counselors, career counselors—all these professionals have the opportunity to remind a young woman to give marriage and pregnancy some priority as she plans her career.
Sounds logical, right? Wrong. The psychologists writing in the American Psychological Association’s guide Career Counseling of College Students have a different perspective. 31 In a chapter on counseling women, the authors focus on discrimination and “sociocultural indoctrination.” For example, they cite problems of occupational and gender-role stereotypes, gender bias in education, the failure to encourage women to pursue careers, pay inequities, work-place harassment, the glass ceiling, and other “external barriers” as “pervasive and largely intractable.”32
Career counselors, they write, are in an excellent position to intervene in issues relating to career and family. How? They can “highlight patterns of gender socialization that create imbalances in heterosexual two-job families.”33 They can offer workshops for the campus community that showcase working couples who successfully manage home and family. The authors suggest that gay and lesbian couples be included, as their perspectives “include highly creative, non-gender-stereotypic solutions to problems in managing the work-home interface.” The only reference to children in this chapter, devoted specifically to guidance of women, is to say that their care can be a barrier to career success.
The authors urge counselors to “empower women to challenge patriarchal structures.” They explain that “all professional activities are political acts,”34 and argue that counselors who do not advocate for social change are implicitly maintaining an oppressive status quo, because their work does not attempt to challenge a society built on unequal access to power and privilege. 35
Huh? Did I miss something? While it’s true that there are still some instances of harassment or discrimination, for each patient with that complaint, I have fifty like Amanda: she’s got the education/degree/career thing down, it’s this love/marriage/family thing that she can’t get right. The issues of on-site day care or managing home and family are problems she can only dream of having.
How about the student health center? Amanda drops by there a few times a year. Like most students, she buys the university-sponsored insurance plan every semester, and therefore the wellness center provides her medical care. Health-conscious and responsible, she comes in for treatment of minor ailments and for her annual women’s health check. Since Amanda’s arrival on campus at age thirty-two, she has dutifully appeared six times for this appointment. What happens at an annual woman’s health check at the campus health center?
The visit begins with Amanda filling out a computerized questionnaire. Why are you here? Are you having any symptoms? Have you noticed a discharge, unusual odor, fever, irregular bleeding, or pain during intercourse? Are there any aspects of your sexual lifestyle which might have a bearing on your care? A new partner? A change in your sexual orientation? What type of contraception do you use? Have you had unprotected sex since your last menstrual period? Who do you have sex with—men, women, or both? Number of male lifetime partners? Number of female lifetime partners?
Amanda can then take a seat in the waiting room. On the counter is a cute basket shaped like a rabbit, filled with free condoms. She can pick up one of the health center’s pamphlets: What Every Woman Should Know about HIV/ AIDS, Acquaintance and Date Rape, Contraception: Choosing a Method, Safer Sex, Woman to Woman: Three Steps to Health for Lesbian, Bisexual, or Any Women Who Have Sex with Women.
Amanda then meets with a clinician, who examines her, performs a Pap smear, and screens for chlamydia, trichomonas, or gonorrhea infection. At the end of the appointment, there is time for “basic women’s health education.”
What topics are covered? At a minimum, women’s health education is about performing monthly breast self-exams, getting regular exercise, and preventing osteoporosis. If needed, there is also discussion of contraceptives, drug or alcohol abuse, immunizations, and mental health issues like anxiety or depression. That’s it. 36
The average age of female students on campus is twenty-six. 37 Almost all plan to have children. They hear all the time about breast cancer and bone disease, the importance of exercise and a healthy diet. But from my review of campus health Web sites and pamphlets, I see no evidence that anyone is teaching these young women about the best time to have a family.
Not a surprise. The American College Health Association doesn’t have it on their radar. A search of nearly all their journal archives turned up one 1983 article, “Fertility Awareness.” Written by a nurse at the Berkeley Student Health Service, Fertility Awareness was a program on that campus instructing coeds how to examine their own mucus and cervix at various points in their cycle, in order to use “natural family planning.”38
Yes, campus health centers make sure that Amanda has expertise at preventing pregnancy, but neglect to remind her of the biological limitations on childbearing. With this approach, they are following in the footsteps of many organizations claiming to advocate for women and their health.
“A powerful network of educated women” is how the American Association of University Women describes itself, and “reproductive rights” is one of the issues for which they advocate. “AAUW believes that individuals should be given complete and accurate information about their reproductive health and family planning options,…only with reliable and complete information about their reproductive health can people make informed and appropriate decisions.”39 But a look at their list of position papers suggests that this group believes that the only challenges facing educated women is lack of access to sex education, birth control, and abortion. Here’s their list of position papers:
Is the AAUW unaware that the waiting rooms of infertility centers are crowded with professional women who bought the myth that they could wait, postpone, and wait some more until they decided it was the right time, only to end up with no choice at all about their reproduction? Should they not support educational campaigns like that of the ASRM, and have a position statement denouncing businesses targeting vulnerable women, urging them to invest in a controversial procedure? Why does only the distress of women with unwanted pregnancies reach the AAUW, and not the anguish of those mourning the pregnancies they will never have?
Like AAUW, Planned Parenthood’s mission is to provide “accurate and complete information to make childbearing decisions,” and to preserve “reproductive freedom—the fundamental right of every individual to decide freely and responsibly when and whether to have a child.” Planned Parenthood advertises in campus newspapers, and is almost always found as a link on the Web sites of college health centers. What exactly would Amanda have learned from this organization if she had turned to them as a teen or young adult, and how would they have helped preserve her reproductive freedom?
Planned Parenthood describes three goals in their educational curriculum, which is designed to begin in pre-school. Their program seeks to: increase understanding of sexuality as a normal, healthy, lifelong aspect of human development; enhance awareness that there are differences in sexual expression and that sexuality is a personal matter; help individuals understand their sexuality, communicate their sexual feelings and decisions to others, and accept responsibility for their sexual decisions. 40
In Planned Parenthood’s Young Woman’s Guide to Sexuality, Amanda would learn that “we are all sexual,” and that “sexual expression is one of our basic human needs, like water, food and shelter.” She’d read about sexual attraction, enjoying her body, and sexual relationships. She could take “The Perfect Partner Quiz”: Does your partner carry condoms and help pay for other birth control? Does your partner have an annual checkup for sexually transmitted infections? Would your partner stand by you emotionally and financially if you got pregnant?
Nothing here, though, about those facts she learned in tenth grade but hasn’t thought about since—that she was born with all the eggs she’ll ever have, and that when she turns thirty, her eggs do too. One would assume that “reproductive choice” refers not only to the choice to prevent or terminate a pregnancy, but also to the choice to conceive and give birth. After all, isn’t it parenthood that’s supposedly being planned here? But on the topic of how a young woman can preserve her fertility and maximize her chances of becoming a mother, Planned Parenthood is silent.
Another organization reaching out to women like Amanda is the National Women’s Health Network (NWHN). They declare themselves to be “a voice for women, a network for change.” Their Young Women’s Health Packet, 154 pages, is designed for girls ten to college age. In the Reproductive Health section, Amanda would find the usual instruction on STD identification and prevention, and get tips on broaching delicate subjects with a new partner, like sharing sexual histories and getting tested. She’d learn how using a condom can be fun. There’s a first-person account here about having an abortion, and a list of states requiring parental consent to get one. And there are seven pages on the topic of masturbation.
From her appointments at the campus health, counseling, or career centers to the educational campaigns of AAUW, Planned Parenthood, and NWHN, it does not appear that preserving Amanda’s fertility has much priority. In fact, it would appear to be a nonissue.
Of course, it’s vital to provide Amanda with options for preventing pregnancy. But it is just as vital—especially given a mission of assuring “the right to reproductive freedom”—to offer her wisdom and clarity about when is the easiest and healthiest time to conceive.
In fact, there is such an obsession with preventing pregnancy, and with avoiding the bacteria and viruses that accompany promiscuity, there is such an inundation of information41 about condoms, hormonal contraception, emergency contraception, abortion, the diaphragm, IUDs, HIV, HPV, Pap tests, chlamydia, gonorrhea, and warts, that a biological truth—one that Amanda sorely needed to hear—has been lost: pregnancy won’t necessarily happen when she decides she’s ready. There’s a window of opportunity, then the window closes.
And with this lapse by the providers of “women’s healthcare” begin many tales of heartache and despair.
Of course, some will argue it’s too sensitive, it’s too loaded an issue, patients will get upset. Ask a single woman who is carefully planning her career if she wants to have a family? Remind her the clock is ticking? No way! But we ask our patients difficult questions all the time. From bowel movements to suicide to genital warts—isn’t that our job? We also feel obligated to warn patients about the consequences of their lifestyles, whether it be the dangers of cigarettes or junk food. When painful probing now may prevent worse suffering later, patients deal with it. A mammogram isn’t fun, and a colonoscopy’s no picnic, but we wouldn’t dream of denying a patient these tests.
It’s an apt comparison—infertility, miscarriages, and childlessness can be as awful as a lump in your breast.
Listen, if you’re able, to excerpts from the story of one forty-five-year-old who survived three miscarriages:
I’ve wanted to be a mom all my life…I lean over and smile at infants in baby carriages and marvel at the sensations in my body. It’s as though my flesh yearns to hold and hug a small body…. So I was deeply shocked by the idea I might be infertile. How could this be happening to me?…After four months on Clomid I got pregnant. We were ecstatic for eleven all-too-short weeks. Then I miscarried…. I will never forget the agony of seeing our partially formed baby outlined on the screen—stiff, still, and lifeless. That first loss was hard, very hard.
A few months later we tried again. This time I did Clomid and something called HSG—a procedure that involves shooting stuff into your fallopian tubes to make sure that they are super clear. And sure enough I got pregnant. This time I miscarried in week thirteen…. This second loss was even harder…. We were beginning to believe we would have this baby. We had even picked out some names.
After the second miscarriage we got deadly serious. We took out a second mortgage on our house and signed up for IVF. Twelve months and three cycles later I got pregnant again, only to miscarry in week five…. I told myself that this loss wasn’t as bad as the others because it was so early. Whether or not this was true, I knew I needed to build some kind of wall between me and my colossal, cumulative grief.
Those IVF cycles were completely debilitating—and I’m not just talking about the money. For months we were whiplashed by a treatment regime that jerked us from hope to despair. The drugs and the procedures created huge stresses in my marriage and even undermined the way I felt about my body. I began to resent my sexual organs. I mean, if these parts and these functions turn out to be completely useless, how can I do anything but resent my big breasts and bloody periods. They are merely burdensome.”42
I found this and other gut-wrenching interviews in the book Creating a Life: Professional Women and the Quest for Children. The author, Sylvia Ann Hewlett, set out to write about the lives of highly educated, high-earning women as they turned fifty. She intended to focus on the strategies they used to break through the glass ceiling. After meeting with ten women who were prominent in a diverse set of fields, she confronted a remarkable fact: none of them had children. And when she went back and explored further, she learned that they all regretted their childlessness. It had not been a choice for any of them.
There is a secret out there, a painful, well-kept secret: At mid-life, between one third and one half of all high-achieving women in America do not have children…. The vast majority of these women did not choose to be childless. Looking back to their early twenties, when they graduated college, only 14 percent said they definitely had not wanted children.
I had assumed that if these accomplished, powerful women were childless, surely they had chosen to be. I was absolutely prepared to understand that the exhilaration and challenge of a megawatt career made it easy to decide not to be a mother. Nothing could be further from the truth. When I talked to these women about children, their sense of loss was palpable. I could see it in their faces, hear it in their voices, and sense it in their words.43
As a result of her unexpected finding, Hewlett decided to write instead about the struggle for children among successful career women. The interviews, grouped into chapters with titles like “Baby Hunger” and “The Sobering Facts,” are a painful read. For example, there’s this from the late Wendy Wasserstein:
For me, the reproductive thing has been huge…I have just spent seven years trying to have a child on my own…. By this point I’ve gone through so many procedures—and been injected with so many drugs—I can’t even keep track of them all. What did I get out of all this? All I’ve proved is that I can’t get pregnant, that I’m not really a girl…. I’m no longer sure that this new technology is remotely empowering. You take a woman of my generation, someone who is seriously accomplished, but is in her forties and hasn’t had a child. This new technology becomes a way of telling her that whatever she accomplished, it isn’t enough. And then when she fails to get pregnant—and most of us do fail—it erases her sense of professional competence and erases her confidence as a woman. I know these procedures left me feeling more depressed than at any other time in my life.”*44
In addition, Hewlett writes, many of the high-achieving women who have children have fewer than they want, because they started too late. In her study, a majority of women with one child had wanted at least one more. “For many,” she writes, “this is a source of deep regret.” Let’s listen to Sonia:
There are three of us who meet at a nearby health club Saturday mornings. Three women, each with one precious child. The pretense is exercise but we really meet to grieve. We sit in the juice bar and talk—and weep—and talk some more…. We share this aching loss around children we will never have. It sounds crazy, doesn’t it? How can an imagined child provoke such deep grief?…Part of it is we all have much-loved older children and know what we are missing…. If only I had realize dearlier on how fiercely I wanted that second child.45
“If only”: these words capture the essence of this book. “If only women knew the facts; if only they were not blinded by hype and misinformation; if only they understood that if they wait they’ll hit a wall.”46
Remember, these are the women who got the high SAT scores and were valedictorians. They attended Harvard and Yale. They are surgeons, academics, CEOs. They’ve made it.
I have one question: Shouldn’t our daughters be warned? For those women who include motherhood in their list of goals, shouldn’t we do everything we can to prevent them from, as one childless professional put it, “inadvertently squandering [their] fertility”? 47 Of course, doing so would acknowledge the value of parenthood, and the differences between men and women. So don’t hold your breath.
Here’s a suggestion: As part of their basic women’s health education, maybe student health centers should have, next to the condoms and date rape brochures, a few copies of Hewlett’s book. Along with teaching breast self-exam and osteoporosis prevention, explain a woman’s biology, that there is an optimal time for easy conception and birth. Tell women that just as there are advantages to delaying parenthood, so too there are risks, and suggest that they consider this information as they plan their careers.
They might also make available excerpts from a Good Morning America interview with Professor Adriana Iliescu, mentioned earlier, who had her first child at sixty-six using donor eggs. “I don’t advise anyone to do what I did,” she said. “My message is for young women to make an effort to have children in their youth. We should not count on miracles. Young women should learn from this that you can become desperate from not having a child.”48
As for Amanda, her birthday came and went, and she survived. She’s not yet counting on miracles, or desperate at not having a child. She’s grateful for her friends, her dog, and the trips abroad. A fortysomething friend just became pregnant, so that was good news. Her mom stopped bugging her. Realistic or not, she manages to stay hopeful, most of the time. No doubt the Paxil helps too. She takes care of herself, tries to be upbeat, joined an online dating service, and avoids maternity stores. For now, it’s one day at a time.