Admittedly, I have a deep bias because of what I do for a living…if you have a hammer everything appears as a nail. But the problem is real. Often times, issues such as this are portrayed as black and white in the public eye. But we live in the real world, a Technicolor one, where the shades of gray that determine our ability to predict the future, are difficult at best. Determining the precise, or even approximate time, when a woman will lose her ability to have children that are genetically her own, is fraught with uncertainty. The tests used to predict “ovarian reserve” are quite poor at identifying which woman will be able to conceive a child and which one by our modern technologies in assisted reproductive medicine, no matter how advanced they may be.
In the end, decisions can only be made after as much information as possible is obtained. Then each person must perform their own risk- benefit analysis. What is the risk of action? What is the risk of inaction? What is the benefit of action? What is the benefit of inaction? To a certain extent, the field of reproductive medicine is fortunate in that many of our treatment options do not carry a large physical risk. The cost is high, but in the world of medicine today, not exorbitant. The psychological burden is significant because of the work involved, the private nature of the issue, and the importance of the issue at stake.
As a guideline, the older a woman is and the longer she has been trying to conceive without success, the more important it becomes that she seeks help in gathering information so that she can make an informed rational decision about what is best for her. [Successful conception means having a full – term, healthy child as miscarriages are often the first signs of a reduced ovarian reserve.]
Our data and experience over the past years has finally resulted in a continuing campaign to educate women as to their limited reproductive years, offering them proactive options including egg freezing, embryo banking and other alternatives that may offer them a greater window of time. This single study that seeks to invalidate this information is irresponsible. As much as we would like the situation to be different and the reproductive cycle as infinite, the truth is that in the area of human reproduction, time is not our side.
Those of us who practice reproductive medicine will continue to try to find ways to help women who may have delayed childbearing too long, and/or for no fault of their own. But for now, our primary weapon is providing accurate information to our patients so that they can decide when it is appropriate for them to act.