Gynecologists and obstetricians argue that the majority of women who want to have children will conceive, and indeed this is true. But as David Meldrum says, "The cup they are looking at is half full, and the one we're looking at is half empty." The one-in-five rate of impaired fecundity among all childless women aged thirty-five to forty-four, and the one-in-eight rate for those aged twenty-five to thirty-four, don't strike this observer as amounting to terribly good odds. They're not cause for panic, but they are worth mulling over. John Collins, of McMaster University, says, "Clinicians should tell women, 'These are the facts, and you see how that fits in with the remainder of your life.'" He believes that his approach—to empower women with information rather than advise them to get pregnant at a certain age—comports with that of the majority of his colleagues. Jean Benward, the California social worker, says, "People's life trajectories are very complicated, and circumstances are not always within our control. Knowing the facts may not have an impact on a woman's behavior, but I think it's valuable for women to have the information so that they can make informed choices."
Of course, those who, having delayed parenthood, find themselves unable to conceive naturally can choose to enter the high-tech world of assisted reproduction. But this path is generally costly (patients must pay tens of thousands of dollars out of their own pockets, because only a few states mandate insurance coverage for infertility treatments), as well as unpleasant (women undergo painful daily injections of fertility drugs, frequent blood tests, general anesthesia, and invasive surgery). Medically mediated conception is also time-consuming and encourages a kind of obsessiveness. Some women, among them the journalist Anne Taylor Fleming, who has written a disquieting account of her own unsuccessful attempts to have a child in Motherhood Deferred, spend the better part of ten years in and out of infertility clinics. If artificial insemination and the various in vitro fertilization options fail, women who want children but don't want to adopt now face the ethical and other quandaries built into two exotic new alternatives: trying to become pregnant using another woman's egg, and enlisting a surrogate mother.
The unfortunate bottom line is that infertility specialists cannot help all couples who seek their services. Even leading clinics using the latest procedures offer no guarantees. True, a certain number of couples who don't succeed by high-tech means go on to achieve pregnancies by the old-fashioned method. But many others are left childless, in debt, and anguished over their failed dreams.
Some reproductive endocrinologists point out that when researchers learn how to freeze eggs (so far, sperm can safely be frozen and thawed, as can embryos, but eggs have proved refractory), women will be able to consign a clutch of young eggs to the cryopreservation tanks when they are twenty and reclaim them at a later date. Clever as that sounds, it seems a highly impractical solution to the problem. As already noted, egg retrieval is expensive and invasive. Without a radical restructuring of health care, few women would be able to take advantage of an option like egg cryopreservation.
Perhaps there's another way. Suppose America put its money where its mouth is on family values. Politicians endlessly invoke that shibboleth, yet the United States—notwithstanding the Family and Medical Leave Act signed with much fanfare by President Clinton in February of 1993—still offers far less social support for childbearing than do most other industrialized countries. Luxembourg, whose state-mandated maternity and parental leaves are among the least generous in the European Union, provides women with up to ten weeks of paid maternity leave and gives parents the option of unpaid absences for certain periods until their children are fifteen years old, with the guarantee of a job upon their return. Italy, whose policies are among the most generous in this regard, gives women up to five months' fully paid maternity leave, and has a proviso allowing either parent to take two or three days at a time off to care for a sick child under three years old. Paid maternity and parental leaves and safe, affordable day care, which are taken for granted by citizens of other nations, remain out of reach in the richest economy in the world.