Baby panic: why are the risks not being told as they are?
I am a healthy 37 year old woman, in a stable relationship and only beginning to discuss starting a family with my partner, with no firm decision made either way. Should I panic at my forthcoming February birthday hastening me towards 40? Should I start to swallow folic acid with growing anxiety? Well, reading many newspapers over recent years, I should be planning my family with great haste or be deemed irresponsible, career-hungry and selfish. (Incidentally, nobody seems to have anything to say about my similar-aged, professional male partner.)
England’s Chief Medical Officer (CMO) Prof Dame Sally Davies recently spoke at a debate, offering remarks about the ‘shift to have children later’ (you can read the Guardian’s report on this, on 17/1/14, here). Women are repeatedly told that they are at a higher chance of facing these problems if they try to conceive over the age of 35 years. Any women who has ever picked up a newspaper or women’s magazine in recent years won’t fail to have noticed the often cited figure of 1 in 3 women over the age of 35 years will fail to conceive within one year. Is this true?
The research, from where this reportedly originated, is a 2004 paper published in Human Reproduction. The author, Leridon, concluded that 66% of women starting to try to conceive at age 35 years will have a conception ending in a live birth within 1 year. In other words, 1 in 3 will not have conceived. Louis Henry originally gathered the data used in that study, which was collected on the French population between 1670 and 1830, based on parish registers. So, this figure was obtained from birth records from 1700’s France. As others have noted (including David James, Clinical Co-Director of Women’s Health, in a BBC radio 4 programme), an issue with this approach is that it includes women not trying to conceive and/or not having sex. These data were also collected at a time when life expectancy was not comparable to contemporary Western societies, and had no modern antibiotics or healthcare.
The Daily Mail wrote that Prof Twenge ‘controversially claimed’ that the chances of conceiving in one’s late 30s was not that different to one’s early thirties. Prof Twenge looked to research on modern populations, which excluded those with diagnosed fertility problems (for example, endometriosis). Dunson and colleagues found 86% of women aged 27-34 years conceived within 12 months compared with 82% of women aged 35-39 years. This is not a significant difference, and it showed fewer than 1 in 5 women in their late thirties were not pregnant within one year, which is not 1 in 3. These newer data are now reported in guidance on fertility by the National Institute for Health and Care Excellence (NICE). Perhaps the Daily Mail might refer to NICE as controversial?
I resent science being misrepresented in the media, particularly over very personal issues affecting the everyday realities of ones life. Getting science reporting wrong about the Mars Rover, for example, is all kinds of annoying, frustrating and limiting to the public’s understanding of such wonderful scientific achievements. However, getting the science wrong over health-related issues can raise anxieties in people over short and longer terms. There should be an ethical duty to report accurate science, given the potential harms poor reporting can cause.
Fertility specialist, Lord Robert Winston, has spoken about the risks, but suggested they are not ‘major risks’. He also, rather importantly, points to advantages of having a baby later, including being more likely to be in an established relationship, be more secure and be healthy (given improvements in population health).
We are happy to consider evidence as part of the background of our huge decision, but we need access to accurate, non-judgmental, non-gender biased and up-to-date evidence.
To learn more, visit the NICE website for guidance on fertility.