What if nobody 'leaves it too late'?

Calling time on stupid fertility headlines

Photo by Saad Chaudhry on Unsplash

I was 29 when I started trying for a baby. My husband was 31. It has taken us the nine years that have elapsed since then to have one child. Behind these simple numbers, a significant and complex proportion of our lives has been given over to the project of conceiving, pregnancy, recovering from miscarriages – physically, psychically – and, eventually, raising a baby.   

Of all the many misogynistic ideas I have undoubtedly internalised, the idea that I (we) left it ‘too late’ is not one of them.

When I say ‘left it too late’ I mean this in the way that this phrase is wielded in the media. I had not passed some arbitrary birthday that would make me a gestational geriatric. Nor had I waited until I’d acquired a corner office and a designer handbag before trying to get pregnant. I’d even married the man I fell in love with at 20. What a good little girl!

Because here’s the thing: I don’t believe anyone leaves it too late. More than that, I’m not sure it’s even possible to ‘leave it too late’.

What if nobody leaves it too late? What if anybody who tries to have a child does so at the earliest possible, feasible opportunity?

There’s just as much evidence to support this, as there is for the other interpretation. Nonetheless, ‘leaving it too late’ is what women were accused of doing, by British newspapers last week.

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Many media reports of some new data from the Human Fertilisation & Embryology Authority (the HFEA, the UK’s regulator for fertility care and research) came with all the usual latent sexism – it was only women, not men, who were leaving it too late, for example.

The line from the HFEA’s Fertility Trends 2022 report that seemed to inspire all the ‘leaving it too late’ headlines was that the average age for women undergoing IVF for the first time is now 35.1. (Though no where in the report did the HFEA say that this was evidence of women ‘leaving it too late’. We’ll come back to this.)

When I say don’t believe it’s possible to leave it too late, I’m not denying the biology. Fertility might not ‘fall off a cliff’ after 35, but the risk of miscarriage does rise slowly but steadily with age – and IVF is less likely to end with a baby, the closer you are to 40 and beyond.

What I mean is that ‘leaving it too late’ is the kind of slippery linguistic construction that has us believing in things that aren’t true: that things are a way that, actually, they aren’t.

‘Leaving it too late’ is not so much a myth, as a hallucinatory idea – the human-brain OG of facts that are dreamed up by AI, thanks to misinterpretation and bias.

We’re so used to hearing ‘leaving it too late’ as a phrase, we rarely step back to consider the ways it creates a false reality. First: ‘leave’ suggests moving away from, rather than towards – as if ‘having a family’ is a destination many of us arrive at, only to turn away, thinking: ‘OK then, maybe I’ll come back in bit’.  

Yet, once someone decides they want a child, they generally do everything they can to move in the direction of that happening: getting their ducks in a row, meeting someone, creating a home, a family, building some semblance of financial and emotional security…

Then there’s the ‘too late’ part – as if a baby is a mathematical certainty if you manage to meet the deadline. Get one now, but only while stocks last.

Yet, take it from someone who knows, a baby is never guaranteed, however good the numbers might look on paper.

My point is, whether at 28 or 38, someone can only ‘leave it too late’ if there was an earlier, viable moment in time when they could reasonably have had a baby.

Dan and I, who both entered the workforce just after the 2008 recession, decided we were ready to try for a baby when – wait for it – we were finally living in the same house, in the same city. We lived apart for years after graduating, because we couldn’t find another way of making our careers work. So many people our age and younger will have their own version of this: the partner, but not the job. The house, but not the partner. The job, the partner, but not the house….

Yet, when front pages blare on about a generation of women leaving it too late, they seem to assume that the problem is simply that we don’t know – or don’t care.

For my generation downwards, I find this hard to believe. We’ve all been raised in the shadow of the composite career-woman with her ticking biological clock, a spectre first conjured by a Washington Post article in 1978.  

We had 32-year-old Bridget Jones (book and film) being told she ‘can’t put it off for ever you know, tick, tock, tick, tock!’. And Sex And The City’s Charlotte – not barren, just ‘reproductively challenged’ – tearfully slamming down a box of Tampax on the table at brunch, declaring that: ‘A woman of 35 has only a 30 per cent chance of conceiving. The numbers go down from there.’

There’s research that confounds the twin cultural delusions of ‘leaving it too late’ and the biologically oblivious career woman.

In 2016, Danish researchers gave a cohort of (mostly female) university students a questionnaire to try to establish their knowledge about fertility. Three quarters of the female participants surveyed said that they ideally wanted their first child when they were between 25 and 29. Only 2 per cent stated that they wished to have their first child over the age of 35. Sixty per cent said they wanted to have completed their families before they were 35.

Meanwhile, a 2018 study led by Marcia Inhorn, a Yale University anthropologist, who interviewed women about the reasons they were freezing their eggs found that, contrary to the persistent stereotype, the lack of a partner, not career planning, was the reason most women gave.

Likewise, the most recent UK data suggests that the average age of single women beginning IVF treatment on their own is just over 36.

It all points to women being well aware of the constraints of biological time. We’re not leaving it too late: we’re doing everything we bloody well can.

And while we’re letting the facts get in the way of a misogynistic narrative, let’s look at the original data that prompted newspapers to trot out the ‘leaving it too late’ line.

The HFEA report simply states that the average age for women undergoing IVF for the first time is now 35.1 – the highest it’s been since 1991, when data started being recorded. But, for context, since records began, up until around 2000, the average age for starting IVF ranged between 33 and 34. And during the same period, the average age that women have their first child has also increased by more than a year – now standing at 29.2, according to the Office for National Statistics.

So, yes, the latest data suggests women are accessing fertility treatment at an older age - but this is not the same thing as more women needing fertility treatment because of their age, as those ‘women waiting too long for IVF’ headlines imply.  

In fact, so many outlets got this so wrong, that this week the HFEA released a follow-up statement condemning the way the story was handled by the Press, Julia Chain, chair of the HFEA, said:

‘We do not judge, blame or criticise those who are accessing treatment at any stage. The HFEA publishes data on fertility treatment to ensure that the public have accurate and impartial information.

‘I am therefore disappointed that some of the media coverage of our report this week used our data to “blame” women for delaying motherhood – or to mistakenly accuse the HFEA of doing so.’

What the HFEA actually pointed to for the age increase were factors such as long waiting lists for gynaecology referrals, a backlog for treatment due to Covid-19, and people delaying paying for private treatment due to rising living costs.  

And, its report seemed to say, we need to adapt accordingly to this age increase, with more timely referrals for fertility treatment – and less of a postcode lottery for funded cycles.  

Yet, there is deep cultural reluctance to engage with anything that might make it easier for women to have children later.

Did you see the story this week about a repurposed cancer drug that can slow down the ageing process in the ovaries – or so early results from a new trial suggest? If you missed it, I’m not surprised. For some reason, it didn’t get quite the same coverage as ‘women are leaving it too late’.  

Likewise, in the HFEA’s report, there was a less widely reported line that pregnancy rates from IVF had increased since 2012 – across all age groups, including for people over 40 (albeit these were still much lower than for people under 34).

So often, ageing and fertility is presented to us as a done deal: that we are and always will be powerless against the march of time. Yet this is an assumption. (And medical science has attempted far wilder, more ‘unnatural’ things than extending our reproductive lives).  

So then, here is what ‘don’t leave it too late’ really is: it’s an excuse. It’s a convenient phrase that lets people in power off the hook when it comes to thinking about how we might actually make things better. It’s a great, all-purpose get-out clause that diverts attention from the many things we don’t know about reproductive health and women’s bodies.

Unexplained fertility? Don’t leave it too late.

Miscarriage? Don’t leave it too late.

PCOS? Don’t leave it too late.

And, guess what: there’s a through-the-looking-glass phrase to ‘don’t leave it too late’, which you will perhaps only hear if you are under 35 and you lose a pregnancy or go through a round of fertility treatment that doesn’t work:

‘You’re still young’.

‘Don’t worry, you’ve still got time’.

Yet, if social trends continue the way they have been, fewer and fewer people are going to have this time – sold to us as a luxury – to keep trying; rolling the dice over and over, relying on luck and repetition alone. Without massive societal change in other areas of our lives – housing, job security – we’re going to need better medical knowledge and more precise fertility treatments.  (And, y’know, both might be nice).

If anyone has ‘left it too late’, with all that phrase’s implications of neglect and abnegation, it’s politicians (and the people who fund them) who, for decades, have pushed living standards to their brink, who’ve made precarity the norm, and who have sat by as good health became increasingly linked to how much you earn. So often, these are the same people for whom women’s bodies are perpetually an afterthought: something to be controlled and shamed, not cared for.

But – as falling birth rates around the world suggest – time’s up. Tick, tock.