Re: Biology vs career

Dr Verchere’s editorial [BCMJ 2014;56:314,355] addresses a critical and inadequately discussed topic. There is no doubt that a woman’s fertility declines steadily after age 30. The significant milestones are 30, 35, 37, 40, and 43. Fecundability does not take your career goals into account. The advice I give my patients, colleagues, and friends is that once you are ready to have a baby—whatever that means for an individual (relationship, finances, and perhaps career)—sooner will likely be easier and more successful than later. This is true regardless of whether women pursue an alternative strategy such as egg or embryo freezing, which has quite good success rates but is not always successful. Additionally, the risks of pregnancy increase with maternal age for both the fetus and the mother. As physicians we know this, and we counsel people about this, but in general we don’t always do our best to accommodate our colleagues and trainees in planning their families.

As an example, a few years ago while working in San Francisco I met a bright, accomplished 33-year-old medical resident who wished to freeze her eggs. I was astonished to learn that she had not yet had a serious relationship. She had spent so much of her life working that she realistically did not see how she would have the time to build a serious relationship over the next few years and then also have a family while finishing residency and pursuing a fellowship. I was impressed by her thoughtfulness and practicality. I encouraged her to try to have a family as soon as she was ready, even if she had not accomplished all her career goals, and referred her to one of the best clinics to freeze eggs, because at that time very few had documented success rates. It’s better now, but not perfect.

The bottom line, unfortunately, is that too often women find out too late about their decline in fertility. While there are always options and solutions (egg freezing, use of donated eggs, adoption), delaying child bearing is not a great option biologically. For women who feel they must delay, egg freezing is the best means we have at present to preserve their fertility—and, again, the earlier the freezing is done the better. One day we will be able to make eggs from stem cells. We are almost there with sperm.

But until then, as Dr Verchere has stated, we must try to support and show compassion to our trainees and colleagues in their quests to have families. After all, it is the only legacy any of us truly leave behind.
—Sonya Kashyap, MD
Medical Director, Genesis Fertility Centre