a contraceptive method, the Guttmacher Institute reports.
And of women in that age range, the abortion rate in 2017 was
13.5 abortions per thousand—the country’s lowest rate ever.
Cristina is a take-no-prisoners kind of person who proclaims
herself “childless by choice.” Even when she was married to a
man she deeply loved, and he wanted a child, she stayed true
to herself (at the price of the marriage). She aligns with the
growing wave of women who, for a variety of reasons, are vol-
untarily child free—a decision as valid as the opposite choice.
Then there are the postponers, those who want to wait to
bear children after a career or for other reasons. My advice
to them: Look at what the current generation of older, pro-
fessional women has gone through. Women who wait too
long have a much harder time getting pregnant (and it gets
very expensive—the average cost of a single IVF treatment is
around $12,000). Even with my medical training, I looked at the
age-at-conception statistics and somehow thought they didn’t
apply to me. Certainly I’d be like the people in the media, or the
television characters I write for, who get pregnant at the drop
of a hat no matter their age. Guess what? Wrong!
Here’s the truth: A woman’s best reproductive years are
in her 20s. Fertility gradually declines in the 30s, as both the
quality and quantity of her eggs decrease. Each month that
she tries to get pregnant, a healthy, fertile 30-year-old woman
has a 20 percent chance of doing so. By age 40, a woman’s
chance is less than 5 percent a cycle.
This is why I’m a strong advocate of fertility preservation^7
via egg or embryo freezing,^ to avoid “panic parenting” moves
such as entering into unwise relationships just to have a child.
Izzie, a surgical resident struggling to beat stage 4 melanoma,
has her eggs removed to preserve future fertility if she sur-
vives her treatments. Others use the technology in less dire
circumstances. Yes, egg and embryo freezing are expensive
processes, and not a guarantee, but they do offer a choice.
Think of them as investments in your future life!
For those who have the desire and have timed everything
right, there’s the joy of pregnancy and birth. But even these
happy times can be scary. Karen is a quirky woman married
to the love of her life, a paramedic who rushes to her bedside
when she is in labor. He gets there in time to witness the birth
of their baby girl, and it’s a happy day for all until Karen starts
feeling some pain that doesn’t seem right. She begins bleeding
profusely so is taken to the operating room, where doctors per-
form a hysterectomy. After the operation, she suffers multiple-
organ failure and has a cardiac arrest from which she does not
recover. Karen dies of pre-eclampsia, a high blood pressure
disorder that can be treated if caught soon enough.
Maternal mortality statistics track what fraction of deaths
of women ages 15 to 49 are maternity related. From 2000 to
2017, maternal mortality decreased significantly in the world
overall—but increased in the United States. Many elements
contribute to such increases; among them are obesity, chronic
conditions, socioeconomic factors, access to care, and having
- TECHNOLOGY
‘Fem tech’ tools and
childbearing choices
For women struggling with
infertility or maternity issues,
a fledgling “femtech” indus-
try is developing new devices
and services. Computer apps
and wearable monitors track
a woman’s fertile periods—
or, once she’s pregnant, her
unborn baby’s development.
A cloud-based company
offers all-in-one clinical and
financial plans for patients
having IVF or egg freezing.
Increasingly, would-be
parents get embryos or gam-
etes tested for chromosomal
abnormalities before decid-
ing whether to use them.
In a U.K. study reported last
year in Human Reproduc-
tion, about a third of patients
who chose to test expressed
some regret that they’d done
so—especially if abnormali-
ties were revealed, but even
if they weren’t. As a result,
study authors suggested that
“additional counselling and
support” be offered in con-
cert with testing. —PE
WOMEN’S HEALTH 83