It can be hard for the average person to get a handle on what’s really happening with the fertility rate in the United States these days.

A report released last summer revealed that it had plummeted to an historic low, which wasn’t exactly surprising since the statistic has been trending downward for decades. Then, this month, the Centers for Disease Control and Prevention reported that while year over year births have fallen, more women are becoming mothers, and the likelihood that a woman will have kids has increased from a decade ago. Some population experts are worried we’re on a path to disaster, while others are still playing wait-and-see. In summary: It’s complicated.

One thing we know though, not only from the data but from observable culture, is that women today are having kids later than any generation before. That can be chalked up, in part, to our elevated social status. We have more choices, personal and professional, than we did even five years ago, and work culture for parents appears to be swinging in the right direction.

Longer lifespans, later marriage, medical advancement and innovations in reproductive technology (not to mention the proliferation of 40-something celebrity moms) have all contributed to making older mothers not only possible but a “new normal.”

A potential ‘crisis’

But while medical, technological, and societal advances have given women the option to hold off on starting families, some fertility experts are concerned that we’re on the cusp of an infertility epidemic — and that, without some serious course correction, it could bloom into a crisis within just a few generations.

“I am not prone to hyperbole. As a scientist, it gets trained out of you,” says Piraye Beim, whose women’s health company Celmatix has pioneered genetic testing in the reproductive arena. “But I think one of the few areas that I would use a word like ‘crisis’ is in reference to what’s going on with fertility rates, not just in the U.S. but in the world.”

What does that mean? Start with the fact that in some nations, more people are dying than being born, a shift that has the potential to wreak havoc on social systems that function on the premise of population stability. Then there are reproductive toxins — synthetic chemicals found in everything from makeup and cleansers to food and pharmaceutical products — which can cause infertility, birth defects and a host of other health issues, and which are nearly impossible to avoid in our everyday lives, and will continue to be barring some extreme change in environmental policy.

Furthermore, in the United States, government funding for women’s health research is severely limited at a time it’s sorely needed. Though the private sector has picked up some of the slack, people who tend to see infertility as an issue are often women themselves, and it’s harder for women to raise money or rise to positions of impact and thereby affect change. Tack on the increased risk factors for pregnancy at “advanced maternal age” — which, by the way, begins at 35 — as well the dearth of education about the realities of reproductive biology and you start to see what Beim is talking about.

The limits of biology

Aimee Eyvazzadeh, a board-certified OB-GYN who specializes in infertility and reproductive endocrinology, agrees. Since starting her practice in the Bay Area a decade ago, she’s been frustrated by the way that IVF and egg freezing have been misleadingly positioned as insurance for women trying to plan for their future. “I see messaging like ‘freeze your biological clock’ and ‘egg freezing is an insurance policy’,” says Eyvazzadeh.

“But when you freeze your eggs when you’re 35 years old, and give yourself a 50 percent chance to have a baby, and then you delay until you’re 43, you’re going to be pissed if you thaw those eggs and find out you need a donor.”

“That’s not insurance, it’s a chance,” she adds. “That’s biology.”

So what needs to change to help women better understand their chances — and their options? Elena Trukhacheva, the medical director at the Reproductive Medicine Institute in Chicago, is another physician who thinks we need to have conversations with women more grounded in reproductive reality.

“What I see on an everyday basis makes me feel like we should educate young women to consider having children as soon as their social situation allows,” she says. “Not at 18, not at 22, but once you’re done with your education, and you’re reasonably comfortable in your career. It’s a great idea to travel the world. But if you want them, having kids should be some kind of priority.”

“We jokingly say that there is no exercise for the ovaries,” she adds. Women are born with all the eggs they are going to use throughout their lifetime, and from a medical perspective, age absolutely matters.

“Some people say that nature gave women this lousy system. But only about 200 years ago, life expectancy for women was about 40,” says Trukhacheva. “For most women, there was no contraception or multiple degrees. Most women were getting pregnant around 16, and weren’t trying to have more babies after 30 — they were grandmothers by then. Nature didn’t plan for what would happen to us as humans.”

“Everybody starts to have changes in egg quality at some point,” she adds. But she also points out that there is a group of women who have suboptimal egg quality at a younger age than average, and they should be armed with information. “There are some specific genetic mutations we know about, and some that we don’t. “But because we have changed how we live in general, and the age at which women start having babies has changed, it has become a bigger issue.”

One way to arm women with more insight into their own reproductive health: Add seeing a fertility doctor to your regular checkup rounds, says Eyvazzadeh.

Technology isn’t keeping pace

But while access to expertise can give women more insight into what they’re potentially up against, Beim, of Celmatix, emphasizes the importance of looking at the bigger picture. She wants to see more technology aimed at mitigating the environmental factors contributing to infertility issues, as well as policies followed up by concrete action.

The answer is a grand scale commitment to women’s health, including funding for research and technological advancement — both of which are currently lacking in the United States.

“Women are counting on innovation,” she says. “What we hear from millennials is: I don’t have to change my plan and my biology. Technology will solve this for me.” But as of right now, the technology isn’t keeping pace.

Beim’s own company is a promising bright spot in the women’s health landscape: Celmatix pioneered Fertilome, a multi-gene genetic screening that can give women a picture of their reproductive health long before they’re actually trying to have kids.

The company is also encouraging women to talk more about fertility in general. Early in January, it launched wesaytheFword.com, a mission-based platform aimed at combating the stigma around talking about fertility and infertility issues. One goal is to just get women talking with the women in their families, including the ones on their father’s side, to talk about fertility history.

“A woman’s father never went into menopause but she still could have inherited menopause related genes from her father,” says Beim. But while those conversations might shed some light on potential challenges, family history also might not be the best indicator for women having kids 10 to 15 years later than the previous generation. That’s where tests like Fertilome come in.

“The new power of genetics is that it lets you look under the hood and find out if you were dealt a high-risk reproductive hand.”

It seems like a no-brainer. And yet, Beim often finds herself fielding questions about whether or not we should “worry women” about risk factors they can’t change.

“We worry women about stuff all the time. Why not we put the choice in their hands?”

The good news about where we’re at with fertility in 2018: We’re finally talking about it out in the open. Doctors like Eyvazzadeh are working to raise awareness about women’s options, both for planning their path to pregnancy and knowing the facts and infertility risks as you age. Companies like Celmatix are cracking the glass ceiling of the private sector and putting talent behind research initiatives and data-driven product development that is helping women right now and will continue to do so down the line.

And even though some feel there is good reason to hit the panic button, Trukhacheva is optimistic about the future. “I think it will be okay. As a society, we have different issues now than we once did,” she says.

“But I wouldn’t be too pessimistic,” she adds. “Even though there’s a lot of work to be done, we have amazing ways to treat women, and it’s only going to get better.”

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