Creating a life? Fertility and postgraduate medical education.

It seems that despite years of medical advances, the sequencing of the human genome, and an almost endless expansion of knowledge about the creation of human life, the American baby wars have started again. In the past 6 months, almost every magazine and news program has featured heartrending stories of infertility in career women and the price that a “high-powered” career represents. This veritable media frenzy over fertility and family priorities, triggered by recent academic investigation into the lives of professional women, has become almost a horror show for women involved in higher education or intense vocations. The hard data are enough to scare many women: a recent study of 1400 professional women showed that 42% of them over 40 are childless, and only 14% chose to be so. Yet it is the almost voyeuristic true-to-life stories of these childless, professional women, not just the statistics, that have many women avoiding (or voraciously reading) these stories; tearful vignettes of women who believed that conception after 40 was more easily attainable, and women whose long hours at work, incessant business travel, late-in-life marriages made maternity impossible. For all of the dubious personal commentary of these articles, they make an important point: conceiving a child after age 40 is an incredibly difficult endeavor with no guarantee of a favorable outcome. This message has been underscored recently by the Mayo Clinic. A study of fertility rates by age at the clinic showed that fertility drops more quickly than previously thought: 20% after age 30 and 95% after age 40. This, of course, is an especially important concern for the medical community and for medical meccas like Massachusetts in particular, which has the distinction of being the only state that since 1995 to consistently have more women over the age of 30 give birth than women under 30. It is a remarkable departure from the country as a whole, which has an average maternal age of 23 for first-time births. Some research points to the relatively large volume of in vitro fertilization procedures in Massachusetts as one reason why so many women in the state give birth later in life, but anecdotal evidence also suggests that higher education—as the old joke goes, the most common reason for infertility—may also be part of the reason that the average maternal age in the state is higher than the national average. The notoriously long road of medical school, residency, fellowship, and tough years of early practice means that even some of the youngest medical students, those who entered immediately after a 4-year undergraduate career, will be about 30 years old at the end of postgraduate training. And, with a nationwide average age of 26 for students entering their first year of medical school, the road to “having it all” with a balanced life of family and work seems even more difficult. This is not an entirely new problem for doctors-in-training or medical school administration; a featured report in the summer 2001 Harvard Medical Alumni Bulletin by alums Joshua Sharfstein ’96 and Yngvild Olsen ’96 discussed the problems of childbearing during residency training based on their own experiences as parents-to-be and residents.