Words || Eleanor Taylor
What is common knowledge about fertility now?
If you have a uterus, you’ve probably heard of the fertility cliff. Maybe it went by another name, or perhaps it was never named, but we hear the facts behind it echoed repeatedly. From the moment we hit adulthood, through to our late thirties, women are constantly bombarded with pressure and messaging about motherhood. We all know about the biological clock and have had it ticking since our first periods. Women over the age of thirty-five are geriatric pregnancies, and once you hit forty, it’s game over. The idea of the fertility cliff is that after you hit thirty-five, your fertility rapidly drops off and the window to have children shrinks with it. Not only does it become difficult to get pregnant, but the chance of having chromosomally abnormal children is sky-high. Not only is this the common knowledge we have now, but it’s the approach that is still often pushed by doctors as well as our friends and families. While all these people undoubtedly mean well, the lack of transparency about where fertility data comes from means we should not accept it uncritically.
Where did we get this data?
Where do we get statistics like “one in three women over the age of thirty-five will not get pregnant within a year of trying?” It would be perfectly reasonable to assume these facts, as widespread and accepted as they are, originate from well-researched peer-reviewed studies and reflect the health outcomes of modern women. The mainstream perspective of the fertility cliff has surprising origins: Church birth records from an eighteenth century French village. Researchers put together birth data from a French town and saw notable declines in childbirth after a woman reached her forties. Because it was the seventeen hundreds, and healthcare was of a lower standard, women often tried to avoid having children after forty; it was risky enough when they were younger. Because of the immense changes in healthcare and a reduction in maternal mortality rates since this data was recorded, we should not view these statistics as applicable to us now.
*Oprah voice* “So what is the truth?”
The idea that thirty-five explicitly is “the cliff” stems from old medical guidelines on when invasive medical testing for chromosomal abnormalities was least risky for pregnant people. Doctors recommend women under thirty-five get ultrasounds and blood tests as their children are at a lower risk. The recommended practices for women over thirty-five include amniocentesis and are far more invasive and carry an increased minor risk of causing miscarriages. Thirty-five was chosen as the cut off for this testing because that was when the risk of miscarriage equalled the risk of having a child with chromosomal abnormalities such as down-syndrome. This rule relied on the assumption that women would view miscarriages and chromosomal abnormalities as equal risks; this is obviously an insane assumption to make and rooted in deeply complex ideas. These outdated guidelines were updated in 2006 to reflect a modern understanding of fertility, but the impact of these ideas have shaped how our society views women and motherhood. A paper by David Dunson published in 2004 found that 82% of women aged between 35 and 39 fell pregnant within a year of trying. This paper is widely regarded as one of the best articles on the topic. From up to date evidence (ya’ know the stuff that isn’t 300 years old) it is clear that fertility declines as women age but this occurs far more gradually than women have believed. Fertility remains high in the mid-thirties, and while it declines during the late thirties, fertility is still relatively high. There is a notable increase in the risk of chromosomal abnormalities for women over thirty-seven, but even this is often overstated, remaining at under 4% of births. Ultimately women’s fertility changes depending on the woman involved. Some women will continue to have children with no problem once they turn forty, other women will need IVF treatments in their thirties. Data showing fertility cliffs is based on averages, and this means that some people fall on different sides of the spectrum. Every person has a different body, and this means we all have different health outcomes including when it comes to fertility.
Appealing to women’s deepest insecurities
As with any expectation, the pressure to have children intensifies when there’s a time limit attached. By perpetuating the idea that not only will all women have children, but they need to have them by thirty-five, we have created a culture where not being able to have children is often a woman’s most profound insecurity. We have created a culture where some women will have children before they feel prepared because they believe that their time is running out. To take advantage of female health concerns to make a profit is cruel and disingenuous.
The Australian fertility industry is worth over five hundred million dollars per year and its major players are Monash IVF, Genea and Virtus Health. Monash IVF claim women over thirty have a 20% chance of pregnancy, while women over forty have a 5% chance, Genea and Virtus health both push similar narratives. SBS reached out to these companies, asking them where they sourced these facts from, and none of them were able to give them studies which would prove what they were stating. In fact, Genea provided a study from the 1950s they claimed supported them, but those findings were inconsistent with what Genea had presented. In fact, not only is this particular study outdated, but it represents a small group of two hundred women from an obscure religious community who don’t believe in contraception. This lack of transparency should concern us all. If the fertility cliff was as harsh and real as we have been led to believe, then we would expect copious amounts of research to support it. There is nothing wrong with IVF or seeking medical assistance to become pregnant, and for many people, these are necessary processes. However, people should only consent to these treatments when they are fully informed about their fertility.