Good news for reproductive endocrinologists: assisted reproductive technology (ART) is expected to become a $45 billion industry by 2025. Unsurprisingly, one major contributor is people delaying parenthood for one reason or another. According to the National Center for Health Statistics (NCHS), however, the more than 3.8 million babies born in 2017 — 60 for every 1,000 women ages 15 to 44 — is a 2 percent reduction from 2016 and a 30-year low overall. While delaying parenthood could be beneficial for the reproductive medicine landscape, it also inhibits people's ability to complete their families.
Below is an overview of today's parenthood patterns, the role of ART in this changing picture and how reproductive endocrinologists can help patients who decide to delay parenthood.
Why People Are Delaying Parenthood and Having Fewer Children
Although one might assume people are too focused on building their careers rather than having children, the reality is more complex.
A survey conducted by Morning Consult for The New York Times of women and men ages 20 to 45 found that respondents felt child care is too expensive (64 percent), are worried about the economy (49 percent), are waiting due to financial instability (43 percent), want more leisure time (42 percent), don't have enough paid family leave (39 percent), and about half a dozen other reasons not directly related to moving up the ladder at work.
Additionally, the millennial generation tends to delay marriage, driving the average age of first-time mothers to 26 — up from 21 in 1972 — and first-time fathers to 31 — up from 27. That may sound young, but the NCHS report concluded that, in 2017, birth rates decreased compared to 2016 for women ages 15 to 39 but increased for women ages 40 to 44.
How Assisted Reproductive Technology Contributes to Delaying Parenthood
Assisted reproductive technologies — ranging from egg freezing to inseminations to in vitro fertilization — moved out of the experimental phase decades ago. Women (and men) can put things on pause until they are ready to build their families.
Because of insufficient insurance coverage, however, ART remains cost-prohibitive. When the reasons for delaying parenthood are financially motivated, putting aside money for ART increases the age at which people feel comfortable affording children.
Women may freeze their eggs and couples may create embryos when they are relatively young fertility-wise, but the time when they actually attempt pregnancy may be many years down the road.
The State of Fertility and Reproductive Medicine Awareness
A Healthline survey of millennial women found that 53 percent of respondents would consider freezing their eggs. Their reasons included lacking the ability to financially support a child (42 percent), health issues (34 percent) and not having found the right partner yet (18 percent). While 70 percent of respondents said they understand the impact of age on their fertility, nearly as many were not aware that up to 50 percent of women over 35 need ART to become pregnant.
Because most millennials consult their OB/GYN (86 percent), primary care physician (76 percent) or the internet (74 percent) about their fertility, it's clear that there needs to be a coordinated effort between reproductive endocrinologists and other physicians about awareness and checkups.
After all, 58 percent of these women believe they can delay their first fertility wellness checkup to between ages 25 and 34 — but their ability to conceive might have already started to decline by then.
Family Planning for Women Delaying Parenthood
Delaying parenthood for any reason is a perfectly valid choice. The challenge becomes: How can reproductive endocrinologists best help these patients build their families once they are ready to become parents?
Again, the first step should be to educate OB/GYNs, PCPs and the general internet consumer about fertility wellness checkups and various ART approaches. The goal would be for people to understand their fertility status and options before they are ready to conceive — ideally, much sooner.
This can be accomplished through developing and distributing written, audio and video content to appeal to different learning styles. Also, reproductive endocrinologists should consider hosting in-person or online educational sessions once a month that are open to both the general public and other area physicians.
Once individuals or couples become patients, they should be encouraged to choose assisted reproductive technologies that will help them complete their families — not merely start them. This takes a different mindset from both the patient and doctor because the suggestions, protocols and timelines vary drastically when considering long-term family planning versus having a baby as soon as possible.
The bottom line: Delaying parenthood reduces the likelihood of completing one's family. However, with proper planning, it is possible. That's a message that all physicians need to drive home.
