Guest Host: Katherine Lanpher

A technician opens a vessel containing women's frozen egg cells on April 6, 2011 in Amsterdam.

A technician opens a vessel containing women's frozen egg cells on April 6, 2011 in Amsterdam.

The age of first time mothers in the U.S. is on the rise. Women are tying the knot later and more than ever are not marrying at all. Enter egg freezing: it’s a technology that was once used mainly for cancer patients but in 2012 the American Society for Reproductive Medicine lifted the “experimental” label and the number of women choosing to freeze their eggs as a way to preserve their fertility has since taken off. Even companies like Facebook and Apple are getting on board, offering it as an employee benefit. Guest host Katherine Lanpher and her guests discuss the growing popularity of egg freezing and what it means for motherhood, marriage and women’s careers.

Guests

  • Dr. Eric Widra Medical director, Shady Grove Fertility; former chair of the Society for Assisted Reproductive Technology (SART) Practice committee.
  • Rachel Lehmann-Haupt Author, "In Her Own Sweet Time: Egg Freezing and the New Frontiers of Family"
  • Brigid Schulte Director of the Better Life Lab program and The Good Life Initiative at New America; author, "Overwhelmed: Work, Love and Play When No One Has the Time"

Transcript

  • 11:06:54

    MS. KATHERINE LANPHERThanks for joining us. I'm Katherine Lanpher sitting in for Diane Rehm. In 2014, Facebook and Apple both announced they would offer a unique employee benefit for women, egg freezing. For some, the news was welcome. Major companies helping female employees pay for an expensive procedure that may help them both advance their careers and have a family. For others, it was the wrong solution.

  • 11:07:22

    MS. KATHERINE LANPHERJoining me to discuss the growing popularity of egg freezing and some of the questions that it raises, I'm joined in studio by Dr. Eric Widra of Shady Grove Fertility, Brigid Schulte of New America and joining us from KQED in San Francisco, Rachel Lehmann-Haupt, author of "In Her Own Sweet Time: Egg Freezing and the New Frontiers of Family." Of course, you are guest as well and you can join us in time at 1-800-433-8850, drshow@wamu.O-R-G, if you want to send us an email.

  • 11:08:01

    MS. KATHERINE LANPHERAnd you can also join us on Facebook or Twitter. Rachel, I'd like to start with you. Egg freezing has been called the birth control pill for this generation of women in their 30s and 40s. How fair a characterization is that?

  • 11:08:16

    MS. RACHEL LEHMANN-HAUPTI think it's absolutely fair. I wish is was in a pill -- I wish it was a pill, though. It's a little bit more complicated than that pill. You know, when the pill was first introduced in the 1960s, it gave women the reproductive freedom to turn off their fertility, you know. It was a tool that helped us invest in our educations, our careers and embrace our power, not just to create children, but to engage in life and build and create things for the world.

  • 11:08:47

    MS. RACHEL LEHMANN-HAUPTNow, we're in a situation in which we are putting our economic power ahead of our procreative power and because of that, we're getting married later, we're having children later and now we have this new technology, egg freezing ,which allows us to turn on our fertility when we need to, except for the fact that you have to go through a bit of a complicated medical process in order to do that.

  • 11:09:11

    LANPHERI was just going to say there's a danger that we're going to make it sound too easy, turn the tap on, turn the tap off.

  • 11:09:18

    LEHMANN-HAUPTYeah, no. Egg freezing is definitely not a pill.

  • 11:09:22

    LANPHERSo Rachel, you've written about your own journey. When and why did you start thinking about freezing your eggs?

  • 11:09:30

    LEHMANN-HAUPTWell, you know, when I was in my early 30s, I was not married, like so many people are not, so many women and men are not today. I mean, you know, there's this book now going around talking about this new era of independence for single women and I was one of those women. And I was wondering, you know, when am I going to have time to fit children into this. I'm traveling, I'm dating, you know.

  • 11:09:54

    LEHMANN-HAUPTAnd then, everybody started talking about baby panic and the fact that, you know, your fertility starts to decline around the age of 35 and I was coming up on 35 still single and, you know, not even close to thinking about having my first child. And somebody, a friend of mine, said, you know, hey, I heard there's this new technology where, you know, women can now freeze their eggs. It actually wasn't so new.

  • 11:10:14

    LEHMANN-HAUPTIt was invented in the 1980s. But, you know, it was becoming more and more available through fertility clinics. And, you know, I researched it. I went -- I flew to Italy to meet with the inventers of egg freezing at the University of Bologna and I started thinking, well, this is, you know, a viable -- becoming much more of a viable technology. It was still considered experimental by the American Society For Reproductive Medicine at that time.

  • 11:10:42

    LEHMANN-HAUPTSo I chose not to do it. But then, you know, I was around 37 and I was involved in a relationship that was not -- turned out not to be Mr. Right. In fact, it turned out to be Mr. Wrong and, you know, when we broke up, I was happy because I didn't want to marry Mr. Wrong, but I was also heartbroken by the fact that I wasn't going to have a baby any time soon.

  • 11:11:04

    LEHMANN-HAUPTAnd it was at that point that I went and I, you know, talked to a doctor, an endocrinologist in New York and she said, well, you know, we're getting pretty good numbers, statistics with our egg freezing patients at this point. I think, you know, five year ago, I would've told you probably not to do it yet. It was still too experimental. But now, you know, I think that, you know, you'd have good shot of a baby if you froze your eggs.

  • 11:11:30

    LEHMANN-HAUPTSo I decided to, you know, go through the process. I didn't have insurance covering it like so many women at companies like Facebook, Apple and Google have now and other companies and the Pentagon, but I did, luckily, have a little bit of inheritance that I could use to freeze my eggs and that's what I ultimately chose to do.

  • 11:11:51

    LANPHERI want to turn now to Dr. Widra, who I should also mention is the former chair of the Society For Assisted Reproductive Technology Practice Committee. Rachel mentioned when egg quality sort of hits a wall, and I think for many women, it's sort of -- we'd hear it described as very starkly. You know, 35, you're done. Could you talk for just a minute about what we actually know and what it means for women?

  • 11:12:20

    DR. ERIC WIDRASure. That's true. I often use the analogy with my patients that nobody ever falls off a fertility cliff at a certain age. All women have a gradual decline in their fertility, but the real problem for us is that we don't have a fertility test. We can't tell whether a woman is fertile or not. What we can tell a woman is what her egg supply or what we call ovarian reserve looks like.

  • 11:12:41

    DR. ERIC WIDRAAnd that's a surrogate marker for fertility, but it's...

  • 11:12:44

    LANPHERDid you say the ovarian reserve?

  • 11:12:45

    WIDRAYes.

  • 11:12:46

    LANPHERSounds like a really good federal bank, but okay, go ahead.

  • 11:12:49

    WIDRAIf only. So that's kind of a surrogate marker for someone's fertility, but it really just tells us how many eggs a woman has left. And there are women in their late 30s who have very good egg supply and probably are going to do well if and when they want to get pregnant and there are some women, very young, who fall at the other end of that spectrum. So no, there's not bright line cutoff or no cliff to fall off, but it is a gradual decline.

  • 11:13:15

    LANPHERYou, I believe, were involved when the experimental label was taken off. Explain what you saw.

  • 11:13:24

    WIDRAIt was a very -- one of my more interesting professional experiences to be on that committee. There was enormous pressure from both the physician and the patient community to remove the experimental label because, you know, we think this is a great option for women to have. But really, the data that are available talking about the success rates associated with egg freezing and the outcomes from the children born are pretty small, pretty small sets of data.

  • 11:13:51

    WIDRAAnd it took a while for us to feel comfortable that the right studies had been done to say, yeah, we feel like this is a acceptable technology to offer in the right hands.

  • 11:14:01

    LANPHERBrigid Schulte, who I might mention is the author of "Overwhelmed: Work, Love and Play When No One Has The Time," this conversation that we're having about egg freezing really cuts to the heart of a much bigger conversation. I really don't want to say the phrase "having it all," but there, I just did it, didn't I?

  • 11:14:23

    MS. BRIGID SCHULTEWell, you know, the thing about egg freezing, it does raise some very important larger questions and on the one hand, this is exciting technology and just like the other guests are talking about, it offers women and men more choices. You know, egg freezing is something that started and it certainly, at Facebook, Sheryl Sandberg has said, it started when a young employee had cancer and was going to have treatment and came to her and said, if I don't freeze my eggs, then I will never be able to have children.

  • 11:14:51

    MS. BRIGID SCHULTEAnd they said, wow, we should really do this and as long as we're going to do it for people who have cancer, we should do it for everybody. You know, for the military, they are beginning -- the Pentagon just announced a pilot program to offer both egg freezing and sperm banking. You know, I think what people don't realize -- and a colleague of mine at New America, Jane Carr, is going to be writing about this, you know, we think of traumatic brain injury.

  • 11:15:15

    MS. BRIGID SCHULTEThat's one of the main injuries that's returning have. But the number two injury that we don’t really talk about is traumatic genital injury. And so sperm banking for returning vets is a huge issue. So these are really important and exciting technologies to talk about. But I guess, where I think that we also need to be looking is asking that bigger question of why. Why are women delaying marriage? Why are women and man delaying marriage?

  • 11:15:41

    MS. BRIGID SCHULTEWhy are women and men delaying child birth? And a lot of that goes into the very structures, our polices, the structure of our workplaces, which are still very much set in the 1950s, which are still very much oriented around a breadwinner/homemaker kind of model that really nobody, very few people live that way anymore. And so some of the reason for the delay and some of the reason, then, perhaps for this technology, I guess we need to be asking those bigger questions.

  • 11:16:10

    MS. BRIGID SCHULTEIs this really the only answer we have for people? And I would argue, yes, offer them this technological solution, but also look at these bigger questions and ask what else needs to change.

  • 11:16:20

    LANPHERI want to remind everyone that they can join this conversation. It is 1-800-433-8850. It is drshow@wamu.O-R-G. You can also join us on Facebook or Twitter. We're talking to Brigid Schulte, who you just heard, director of the Better Life Lab program and The Good Life Initiative at New America, the author of "Overwhelmed: Work, Love and Play When No One Has The Time." Also, here in the studio, Dr. Eric Widra, medical directory -- excuse me, medical director at Shady Grove Fertility, the former chair of the Society For Assisted Reproductive Technology Practice Committee.

  • 11:17:01

    LANPHERAnd we're talking to Rachel Lehmann-Haupt, author of "In Her Own Sweet Time: Egg Freezing And The New Frontiers Of Family." I'm Katherine Lanpher and you are listening to "The Diane Rehm Show." We are hoping, hoping, hoping that you will join us at 1-800-433-8550. We know this is an important topic. We'll be back.

  • 11:20:01

    LANPHERI'm Katherine Lanpher, sitting in for Diane Rehm, and we are continuing our conversation about egg freezing, relatively a new procedure for women to preserve the fertility. But what does it mean for our society at large? We're talking to Rachel Lehmann-Haupt, and author of "In Her Own Sweet Time: Egg Freezing and the New Frontiers of Family," also Dr. Eric Widra here in the studio, medical director at Shady Grove Fertility, and Brigid Schulte, who is the author of "Overwhelmed: Work, Love and Play When No One Has the Time." Rachel is joining us from KQED in San Francisco.

  • 11:20:36

    LANPHERAnd Rachel, I'd like to return to you. Just before we took our break, we were talking about the larger implications of this question of egg freezing in that is this really the solution. You know, what is the opposite take on egg freezing in terms of the way society should change?

  • 11:20:57

    LEHMANN-HAUPTYeah, it's a good question. Well, you know, I always say that there should -- you know, if there's a technology solution, there's also always a human solution. And I think what's very interesting about egg freezing is that the majority of the companies that are starting to cover it on their insurance plans, like Facebook and Google, are also some of the most progressive companies in terms of family leave and in-house daycare at the companies.

  • 11:21:30

    LEHMANN-HAUPTAnd so yes, I definitely -- you know, I think that, you know, women -- fertility is definitely an issue among women. I mean, I think the CDC has reported last year or this year that one in eight couples are now having trouble getting pregnant or sustaining a pregnancy. And, you know, a lot of that has to do with -- I mean, that's a whole conversation, but a lot of that has to do with having children later.

  • 11:21:57

    LEHMANN-HAUPTSo definitely I think that there needs to be better social structures in place in terms of, you know, supporting the family work-life balance. You know, the first is work leave. I mean, I believe that -- you know, Netflix announced this year that they are going to be offering one year parental for both men and women leave. And many other companies are following suit in that, and I think that helps. And also, you know, giving working mothers, especially in the first three months, I would also for the first three years since those years are so important for children, you know the flexibility to be mothers in the way that they need to.

  • 11:22:37

    LEHMANN-HAUPTBut, you know, the other thing that I want to say is that egg freezing is -- can be very good because there is an advantage to having a child older, and that is that you are more economically stable, you are more emotionally stable, and, you know, obviously Mother Nature doesn't always agree with that position that you're in when you're older, and, you know, you have trouble getting pregnant.

  • 11:23:12

    LEHMANN-HAUPTBut having a baby in your late 30s or early 40s, a lot of women say it's wonderful. And, you know, I was thinking about this yesterday when I was reading David Brooks' column in the New York Times about the midlife surge, that it's no longer about a midlife crisis that, you know, people are starting to do new things with their lives, you know, when they turn 40 or in their mid-40s. And I think that also includes becoming parents for the first time.

  • 11:23:38

    LEHMANN-HAUPTNow men have been -- can do that and have been doing that, but the idea that women can do that with advanced reproductive technology and, you know, the idea that we are living longer, I think that there -- that's, you know, potentially a very good choice if you're not ready to have children when you're young, or you want to, you know, invest more years in your career, or you haven't found the right person yet, or you just want to travel the world.

  • 11:24:05

    LANPHERDr. Widra, I wanted to turn to you for a moment. This whole question of whether egg freezing is the wrong answer to a societal problem, I realize I don't want to talk you out of your profession here, but I'm curious from your viewpoint what you think.

  • 11:24:22

    WIDRASomething that Rachel said struck me, and that is that this is a technological solution to a bigger problem. And like all technologies that get introduced into our culture, there's waves of acceptance. And I do think that this is still in the kind of early adopter phase. There is not a lot of data about what egg freezing means over the long term. There have been relatively few children born from this technology. And I think as the technology matures, we're going to start to feel differently, maybe better, maybe worse, about what it means in terms of the choices that women are making and what it means from a cultural, societal standpoint.

  • 11:24:58

    WIDRAYou know, having a cell phone used to a sign of wealth and uniqueness. And now, you know, half my patients have two of them. You know, it's -- the way technology gets ingrained in our culture is a process, and this is I think a very exciting technology, but it's far from perfect.

  • 11:25:18

    LANPHERBrigid, I want to talk to you for a minute about the cost of egg freezing. It's not cheap.

  • 11:25:21

    SCHULTENo, it's very expensive, you know, which is why there's been...

  • 11:25:25

    LANPHERWhat is the range?

  • 11:25:27

    SCHULTEWell, from what I understand, from what I've read, you know, the retrieval itself is, what, something like $10,000 to $15,000. Oh, it's lower?

  • 11:25:35

    LANPHERDr. Widra is going thumbs-down.

  • 11:25:38

    WIDRAThere's wide geographic variation on what it costs from center to center and from location to location. Ten to 15 thousand is very much on the high side. I'm not saying it's inexpensive, it is. I think a more reasonable estimate would be somewhere between $6,000 and $10,000 for a complete treatment cycle, and some programs do other -- innovative financial things to make it more accessible. But that's not to say it isn't expensive. It is quite expensive.

  • 11:26:04

    LANPHERAnd then there's the storage costs on top of that, right?

  • 11:26:06

    WIDRAThose are, I think -- most people would consider relatively modest, in the order of hundreds of dollars a year, not thousands.

  • 11:26:11

    LANPHERI'd like to go to one of our callers here, and that would be Karen calling from Herndon, Virginia. Hi Karen.

  • 11:26:22

    KARENHi there, thank you so much for taking my call. My husband and I had children a little bit later, and we had two healthy children from in vitro fertilization. So this is something that we've, you know, often talked about is, you know, when -- when is the right time for us to stop considering having children. And what I wanted to ask all of you is do we see -- is there a concern for the health of the children, now that we have all this support in the workplace, which is wonderful, to allow women to have families a little bit later, is there a concern there for the health of those children as we move towards having children later in life as a society?

  • 11:27:07

    KARENAnd then the second part of my question is, who and when do we maybe draw that line, so to speak, of when does it become dangerous. And when do we say, you know, it's not healthy to be having children maybe in your 40s or 50s, or is that a call that we make at all? I mean, I'd just love to get your thoughts.

  • 11:27:27

    LANPHERI'm going to turn to Rachel first. I can see her nodding her head over there in KQED, on our monitor.

  • 11:27:35

    LEHMANN-HAUPTWell, I know that the Pacific Reproductive Center here in San Francisco has a cut-off age of 55 for in vitro fertilization. And in my mind, you know, I'm now -- I'm now 46, and you'll hear a little bit more about what happened to me in terms of whether I used my frozen eggs, but I ended up having a baby at 41. Now that felt like a really good age to have a baby. I, you know, a lot of people say, oh, were you tired, and I don't know if I was tired. Yes, I was tired, but, you know, maybe I would've been less tired when I was 31, but I definitely know I was more emotionally prepared at 41.

  • 11:28:20

    LEHMANN-HAUPTNow if you ask me, I'm now, you know, 46, and I have a three-and-a-half-year-old, and if you ask me if I wanted to have another baby, then I would sort of start saying, well, you know, I don't know. I'm starting to feel more middle-aged. And so the idea of having a baby at 55 sounds a little bit outside the box.

  • 11:28:48

    LANPHEROkay, thank you. Brigid Schulte, if only people could've seen your facial expressions as Rachel was talking.

  • 11:28:54

    LEHMANN-HAUPTOh, well, no, actually, as the caller -- I think that what I wanted to respond to was the idea that the workplace is supportive or is more supportive now of caregiving and families. And I want to really make the point that when we talk about having families and caregiving, we really need to not just talk about women, but we need to talk about men, as well. You know, particularly in the millennial generation, there are surveys that show there's really a sea change in terms of what men expect and want in their lives in terms of caregiving and being part of raising a family.

  • 11:29:27

    LEHMANN-HAUPTBut I just think it's very important to talk about -- when we talk about the companies that are offering insurance coverage for egg freezing, we are talking about a very small, very elite minority of companies. We are not talking about, you know, the vast swaths of companies out there. When we talk about companies offering paid leave and family supportive structures and flexible work, we are also talking about a very small portion of our economy.

  • 11:29:56

    LEHMANN-HAUPTRight now only 13 percent of the civilian workforce has any access to paid family leave at all. I think that's really important point to make. We are -- when we were talking about egg freezing, we are talking about a very narrow portion of the population. When we are talking supportive workplaces, there's lot of research that shows women have been graduating in greater numbers from college, from getting master's degrees, from Ph.D.s for decades than men, and they are still stuck in the lower and mid-ranks of our workforces.

  • 11:30:30

    LEHMANN-HAUPTThere is the wage penalty, we call it the motherhood -- you know, you hit the maternal wall. There's sort of this unexplained wage gap. Fathers tend to get a fatherhood bonus because we tend to think, again, these old kind of 1950s structures that when a guy becomes a father, he's going to be a better provider and more of a breadwinner, and if a woman becomes a mother, well then she's going to be less committed to the workplace.

  • 11:30:54

    LEHMANN-HAUPTThere was a recent Harvard study that found, you know, that's what we all believe, that women are less committed to the workplace once they become mothers. So there's still an awful lot of unconscious, as well as conscious, bias out there, and there are really not that many family supports and certainly no governmental supports, other than the Unpaid Family Medical Leave Act.

  • 11:31:14

    LANPHERDr. Widra, when a woman comes into your office, in her 20s or her 30s, what do you tell her?

  • 11:31:21

    WIDRAWe have a conversation about what -- how reproductive aging works, and we talk about the probabilities of pregnancy as a woman ages and why it changes. And it changes because women have fewer eggs, and those eggs change in quality as they get older. But when I tell women who are interested in egg freezing is this is an insurance policy. This is not how you're necessarily going to start your family.

  • 11:31:44

    WIDRAPlan A is, if you're heterosexual, you find the right partner, and you try to get pregnant, and if that doesn't work, you come back and see me again. And we don't necessarily use your frozen eggs at that point. This is an insurance policy that in fact most of the women who freeze their eggs won't need to use.

  • 11:31:57

    LANPHERAnd how do you know who is the right candidate?

  • 11:32:00

    WIDRAAh, if only. As I mentioned before, we only have really surrogate markers for who's a good candidate to freeze their eggs, and that's a measurement that involves ultrasound and blood testing of what we call egg supply. How many eggs would they likely give us in a single treatment cycle? And like most insurance, the less you need it, the cheaper it is. So someone who has really good egg supply is going to have a very easy time freezing a bunch of eggs, but statistically she's a bit less likely to need them in the future, whereas someone who has very poor egg supply, even at a young age, may need to go through a lot of treatments to build up a reserve of eggs in our bank, as opposed to her own, that may not be as successful later.

  • 11:32:39

    LANPHERI'm Katherine Lanpher. You're listening to the Diane Rehm Show. And if you're listening, we'd like to have you join this conversation. It's 1-800-433-8850. 1-800-433-8850. You can also email us at drshow@wamu.org. Or join us on Facebook or Twitter. Rachel, I do want to turn back to you. You said that we could find out what happened to your frozen eggs. So we know you have a boy. What happened?

  • 11:33:15

    LEHMANN-HAUPTWell, I -- first of all, I just want to commend Brigid for acknowledging that the companies that are covering egg freezing and the women who are doing it and the companies that are offering paid family leave are definitely a minority now, and it is a very privileged set, and, you know, I think -- I commend them for being leaders in this, but I do agree that there needs to be more government support, and more companies need to follow this lead by offering this toolbox of choices to families.

  • 11:33:47

    LEHMANN-HAUPTUltimately, I, after I froze my eggs, I decided at the age of 41 to start trying to get pregnant on my own, with a sperm donor. I was still single, and I decided that having a child, a biological child, was more important to me than having a relationship. I felt like I had the rest of my life to find love but not the rest of my life to have a biological child. So I did not go to a fertility center. I merely worked with a midwife, who came over to my house, and I got pregnant that way, and I never even touched my frozen eggs.

  • 11:34:29

    LEHMANN-HAUPTI was very lucky in that I got pregnant through in-uterine insemination naturally, or, you know, relatively naturally for artificial insemination, and I got pregnant and had my son as a single mom by choice. And I think that, you know, I love the fact that I had my eggs as an insurance policy, you know, and many people ask me if I'm ever going to use them now to have a second child. And the jury is out on that. But I like having the insurance policy, and I also think just when I did freeze my eggs, there -- having that really turned what was really a very profound baby panic into peace for me.

  • 11:35:14

    LEHMANN-HAUPTAnd I think that there was something about feeling more peaceful and not being so worried about getting pregnant or, you know, trying to have it all that allowed me to be more relaxed and get pregnant. And I do, you know, know -- I mean, a lot of people get upset when they say women, oh, you'll get pregnant if you just relax, but there is truth that, you know, if you are in good physical health and, you know, in a good state of mind that pregnancy does come easier for women.

  • 11:35:51

    LEHMANN-HAUPTSo I think that having the insurance -- the insurance policy really did help.

  • 11:35:56

    LANPHERCan you describe baby panic in a few short lines?

  • 11:36:00

    LEHMANN-HAUPTI think baby panic is the fear that, you know, you are not in the right place in your life, and, you know, whether you don't have a relationship, or whether your career is so overwhelming to you that you think how are you going to fit children in, and you are, you know, up against -- up against this wall of your biological clock. Now we know -- I like the fact that it is not a cliff that falls off. It is a very variable thing, fertility. You know, some women, you know, do have trouble getting pregnant around, you know, 37, but some people, women are very fertile into their 40s.

  • 11:36:39

    LEHMANN-HAUPTAnd in fact, you know, there was a story in The Atlantic last year that the data that most fertility doctors use is actually based on, like, 18th-century French birth records. So...

  • 11:36:53

    LANPHERWell, isn't that a comfort?

  • 11:36:56

    LEHMANN-HAUPTSo the fact is that, you know, the data that is used that tell women that their fertility is declining is -- has not been updated very recently.

  • 11:37:07

    LANPHERAll right.

  • 11:37:09

    LEHMANN-HAUPTAnd so there -- so therefore, I mean, that's -- that's enough to cause baby panic. I think, you know...

  • 11:37:13

    LANPHERAll right. Thank you very much, Rachel. We're going to return to this conversation and to your calls. I'm Katherine Lanpher, sitting in for "The Diane Rehm Show."

  • 11:40:01

    LANPHERWelcome back. I'm Katherine Lanpher sitting in for Diane Rehm. We are continuing our conversation on the technique of egg freezing, what it means for society, what it means for women with motherhood and career both in sight. If you'd like to join us, it's 1-800-433-8850, drshow@wamu.org. Of course you can also find us on Twitter.

  • 11:40:26

    LANPHERDr. Eric Widra is one of our guests. And you had a response to Rachel Lehmann-Haupt, who was -- who's speaking to us from KQED in San Francisco.

  • 11:40:36

    WIDRAWell, I think much of what Rachel said was very resonate for me, with the exception of the commentary about normative data on expectation of pregnancy and birth. Those data are actually updated very frequently by the U.S. Census Bureau, the Centers for Disease Control and lots of non-governmental organizations. So we're not building airplanes based on the Wright brothers' model.

  • 11:40:55

    LANPHERWell, and for those just tuning in, Rachel had referenced some research that had showed that the data that people were using is based on -- Rachel, 18th century French women?

  • 11:41:10

    LEHMANN-HAUPTYeah, it was an article that a psychologist named Jean Twang wrote in "The Atlantic Monthly." I think it was last year. And yes.

  • 11:41:18

    WIDRAWell, I think here in Washington, the Census Bureau would disagree that our birth data are based on that. But what Rachel did say that was very resonate for me was a really beautiful articulation of exactly what we see every day in our offices, women coming in saying -- they're not saying I want to climb my corporate ladder, I want to do this.

  • 11:41:36

    WIDRAThey're saying, well, I haven't found the right life situation to have kids. And I'm really worried about what that means for my future. And many of these women, when they finish their treatment, call or come in and just say I wanted to say thanks because I feel better. I don't know that this is gonna work, but I feel like I've done what I need to do to give me options for the future.

  • 11:41:54

    LANPHERWe're gonna take a call. Hallie is calling from Severna Park, Md. And she's a genetic counseling student. Hallie?

  • 11:42:02

    HALLIE…for the introduction. My question, I think, is mostly for Dr. Widra. I wanted to know if there was any correlation. So we learn about advanced maternal age, which is -- starts at 35. And it's kind of this slope upwards with an incidence of chromosomal abnormalities, like trisomy 18 or Down syndrome. And so, like you said, there's no cliff, but I wanted to know if you could speak to seeing women coming in for the perceived fear of those, I guess, as the eggs get older with the maternal age.

  • 11:42:33

    WIDRAThanks for that question. It's a really important one that we do deal with every day. Yes. As women age their eggs become less genetically stable. And so there's a much higher risk as a woman gets older, especially into the early and mid-40s of having a chromosomally unbalanced pregnancy. The good news is is that most of those pregnancies either don't get started at all or end in an early miscarriage.

  • 11:42:55

    WIDRAI know that sounds strange to say that's good news, but compared to having to face a decision of terminating a pregnancy or bringing a child with severe abnormalities into the world, it is probably better. When we counsel patients about how many eggs they should freeze we talk about that. We say, okay, if you have 20 eggs at a particular age, some of them will be normal, some of them will be abnormal. What's our long-term goal here and how do we come up with a strategy based on relatively limited data about how many eggs to freeze and what your expectations should be if you need them.

  • 11:43:25

    LANPHERI'm gonna go to another caller. We have Joe joining us from Tulsa, Okla. Joe, welcome to "The Diane Rehm Show." Hi.

  • 11:43:33

    JOEYeah, hi. Thank you. Well, I just wanted to mention briefly on the topic of a supportive work environment. You know, I'm an owner of a small business. We employ about 19 or 20 people. And it's one thing from, you know, Netflix and large corporations that are cash rich, you know, to provide great rich benefits, like a year of family leave and that sort of thing.

  • 11:43:59

    JOEBut the vast majority of jobs are provided by small business owners like myself, who are simply happy to make payroll and eke out a profit. So the likelihood of us being able to add a benefit so rich is not likely. And it's not because we don't care or want to support that sort of thing, it's just an economic reality.

  • 11:44:20

    LANPHEROkay. Joe, Brigid Schulte is here from the Good Life Initiative at New America and she has a response.

  • 11:44:27

    SCHULTEYeah. No, what Joe's saying is absolutely right. That you have a lot of small business owners in particular, many of them, they're like family-oriented kind of atmospheres. They will come up with ad hoc policies. They'll try to make it work. You know, that's -- these are environments where people really know each other and really want to support each other. But financially it is very, very difficult.

  • 11:44:50

    SCHULTEAnd that's why you've got these efforts in -- right now they're in the states, right now California, New Jersey and Rhode Island. They have the only statewide paid family leave programs just for this very reason. Because there are the big employers who can afford these kinds of -- or should be able to afford these kinds of employee benefits. You know, the United States is the only advanced economy that does not have a national paid family leave scheme.

  • 11:45:17

    SCHULTEIt's us and Papua New Guinea. So there is a lot of good evidence about other countries have been able to do this to support their families. You know, the cost of entry into creating a family in the United States is very, very high. We do not make it easy for people to start families. We do not make it easy for people to make these decisions, which is one of the reasons why people end up delaying.

  • 11:45:43

    SCHULTEYou know, marriage is also changing. That's absolutely another factor. We, you know, we're waiting for sort of love matches. There's great data that shows that marriage itself is changing. But at the other hand, you know, we are not, we are not making it easy for people to make the choices to start families. And that is one of the reasons why these more -- the state solutions, there are other, you know, New York, is looking at theirs. Washington, D.C., right now is considering passing a paid-leave program.

  • 11:46:13

    SCHULTEThere are bills pending in Congress, but unfortunately, you know, nothing seems to moving in Washington these days at the federal level. But the very point that he makes, that it's very difficult economically for smaller businesses, really makes the point that it's time to talk about how can we do this in a way that works for everybody.

  • 11:46:32

    LANPHERRachel, I want to go back to you in San Francisco. And that is, if you could talk for a moment about how egg freezing and other techniques and possibilities -- how is it changing the way that we look at family and define family?

  • 11:46:51

    LEHMANN-HAUPTIt's changing a lot. I mean, I want to pick up something that Brigid said about marriage. You know, a recent Pew Center poll said that 44 percent of millennials and 43 percent of gen Xers think that marriage is becoming obsolete. That's a sign that we're not only getting married later, but we are not getting married anymore. I mean, at the same time the people that do choose to get married, the divorce rate is dropping, which is a good thing.

  • 11:47:21

    LEHMANN-HAUPTBut, you know, I think the shape of family is changing. I mean, I mentioned before that I ended up having -- putting the cart before the horse and having a child as a single mom by choice because I was, like Brigid said, waiting for a love relationship. I didn't want to just marry somebody for economic reasons because I can take care of myself economically. So I think it is right to wait for love. And then, you know, there are less chances of getting divorced.

  • 11:47:51

    LEHMANN-HAUPTSo but the -- but it is -- the country, it needs to react. And companies and people need to react to the fact that family is changing, the shape of family is changing. I know that single moms by choice or what I've called D-I-Y moms, do-it-yourself moms, are a very, very small minority of women. But we are a growing minority.

  • 11:48:14

    LEHMANN-HAUPTAnd in fact, Claire Cain Miller wrote about us in the New York Times. And she said that, you know, in many cases we're having babies outside of marriage by choice with more resources in education than the typical single mom. You know, we're still minority. But if this trend continues, single motherhood become -- could become less of a sign of family instability. It could be -- increasingly become one of the ways people are choosing to form families in an era where both marriage and divorce are declining.

  • 11:48:42

    LANPHERBrigid, you had a response.

  • 11:48:44

    SCHULTERight. I think that what Rachel's saying is absolutely true. We've got all sorts of demographic shifts in, you know, in terms of how we're forming families. You know, when we talk about the family, we're really not talking about any one thing anymore. It's become very diverse. And you do want -- you want to be able to honor those choices that people make and are able to make. At the same time, I think it's really important when we think about marriage to really look at the statistics.

  • 11:49:08

    SCHULTEWhat you're seeing, you're seeing kind of a real class division there. That people with education and with resources, they are the ones that are tending to -- they may be marrying later, but they do tend to marry. And they do have more stable economic foundation, if you will. And we do have quite a number of, you know, single mothers who are still living very much in poverty situations.

  • 11:49:35

    LANPHERI want to go ahead and take a call here from Raymond, who is calling us from Greenbelt, Md. Raymond?

  • 11:49:43

    RAYMONDYes. Well, I wanted to say that egg freezing is another technology among many. And they're all really tangentially related, like embryo freezing, sperm freezing and selling, where one could imagine that egg freezing would also enter into the selling market. Surrogacy, abortion, contraception, in vitro…

  • 11:50:17

    LANPHERRaymond, I need you to scoot to your point, okay?

  • 11:50:20

    RAYMONDWell, I'm gonna scoot to it, but I want to ask aren't all these a tendency to make having babies a commodity?

  • 11:50:34

    LANPHEROkay. That's Raymond. Dr. Widra, I'm looking at you first.

  • 11:50:37

    WIDRAThanks. We hear this all the time. Sperm donation has been around for a generation, in terms of helping couples, in fact, originally and now single women conceive. Donation solves a unbelievably difficult problem for many, many couples and is widely considered in the mainstream. And there's a great deal of ethical opinion that suggests that both of technologies are reasonable.

  • 11:51:02

    WIDRAEmbryo donation allows couples who have created embryos through in vitro fertilization to help other couples build a family without commodifying it. So that fear is always there with any new technology, especially around medicine or reproduction. But I think if you really look at the data, that hasn't happened.

  • 11:51:20

    LANPHERBrigid Schulte?

  • 11:51:20

    SCHULTEYou know, there are, you know, I think, you know, Dr. Widra is saying, there are these kinds of fears, particularly when you're talking about creating a human, you know. That people tend to get freaked out by that. And that, you know, certainly there are markets. You know, right now with egg freezing, there is a market. There are, you know, there's marketing and there are egg parties that people get sort of invited to. They're sort of Groupon style kind of coupons that you can take advantage of.

  • 11:51:53

    SCHULTEYou know, but that said, I do think that this is where medical ethics, bio-ethics, having, you know, a really strong sense of, you know, conversation and what's right about it, I think this is -- having that layer of bio-ethics is very, very important in these decisions.

  • 11:52:10

    LANPHERI'm Katherine Lanpher and you're listening to "The Diane Rehm Show." And we're continuing our conversation. If you want to join us, 1-800-433-8850 and drshow@wamu.org. And of course you can also find us on Twitter. Speaking of which, we have an email here -- excuse me, not Twitter, email from Lauren. "I have seen some recent research that suggests that paternal age is also important for having a physically and mentally healthy child.

  • 11:52:41

    LANPHER"As much as millennial women are getting married later and not finding Mr. Right, men are doing the same. Is there talk in the fertility industry on encouraging men to freeze their sperm at a young age?" Dr. Widra, I believe that would be you.

  • 11:52:56

    WIDRAThank you. It's a great question. And there has certainly been a great deal written about the effects of the father's age on reproductive outcomes. When you really look at the data closely, the links there are very weak. There probably is a small increase in the risk of miscarriage as fathers age. There may be a small increase in the risk of autism Asperger spectrum disorders and possibly other psychiatric disorders.

  • 11:53:21

    WIDRABut we don't see those effects until men are actually pretty old for being new dads, 55, 60 and above. But we do certainly have that conversation with men. And as the science improves and we understand better what those real effects are I think the caller makes a great point. Maybe freezing your sperm when you're younger will help you have a healthier family as well.

  • 11:53:44

    LANPHEROkay. We're going to go to Laura, who's calling us from Greenville, N.C. Laura, welcome to "The Diane Rehm Show."

  • 11:53:50

    LAURAThank you very much. I wanted to add a comment to the commentator that talked about the fact that she was questioned having a child now that she's 46, etcetera. And I would say to all women who would possibly consider, you know, and IVF or going to a fertility center at an advanced age to consider these things. I had a child at the age of 53. It's my one and only.

  • 11:54:18

    LAURAAnd actually I was married for 28 years when we had this child. We had thought that we weren't gonna have children and then later on I decided, no, I wanted a child. So the social setting that the person is in, the family setting that the person is in, that the woman is in is very important. I -- my parents, my mother was deceased. I had really no family support. I was involved with elder care with my father.

  • 11:54:45

    LAURAAlso, it kind of puts you off generationally with your other women friends, you know. Most of the women, you know, are much younger, who have children. I am thrilled that I had my son, even at the age 53. But I would tell women to be, you know, to look at their setting, be proactive before undergoing IVF. You know, be proactive, be realistic. And I think my saving grace is that physically I was in very, very good shape before I had my child.

  • 11:55:17

    LANPHERThank you for sharing your experience, Laura. Rachel Lehmann-Haupt, I could see you shaking your head on our monitor where you are in San Francisco.

  • 11:55:28

    LEHMANN-HAUPTWell, I want to congratulate that caller. That's amazing. And she's brave and thoughtful, clearly, about her choice. And I agree that it's a really important choice. But it also made me think about this whole area of reproductive choice or reproductive technology is bringing up a lot of ethical questions. I actually write about it. I have launched a newsletter called "The Art and Science of Family," that you can find on my website, InHerOwnSweetTime.com.

  • 11:55:55

    LEHMANN-HAUPTAnd, but, you know, one of the things also that's very important to look at is the social setting. And, you know, everybody -- I want to point people to a really important academic book that came out last year from a psychology professor at Cambridge University. Her name's Susan Golombok. It's called "Modern Families." And she looks at the new family forms. She looks at the children created via donor eggs from gay marriage.

  • 11:56:21

    LEHMANN-HAUPTShe looks at the children, you know, of single moms by choice, the very, very small minority of single dads by choice who have babies via surrogates and egg donors, and lesbian couples that have children, as well as children born from IVF. And this, you know, the majority of her 25 years of research, which culminates in this book, shows that these -- in the name of the movie, the kids are all right.

  • 11:56:50

    LANPHEROkay. Rachel, we're gonna have to culminate the show right here right now. But thank you for that recommendation and thank you for your time. That's Rachel Lehmann-Haupt, author of "In Her Own Sweet Time: Egg Freezing and the New Frontiers of Family." We also heard from Brigid Schulte, the director of the Better Life Lab program and the Good Life Initiative at New America. And we were joined by Dr. Eric Widra, medical director at Shady Grove Fertility. I want to thank you all. And thank all of you for your calls and emails.

  • 11:57:20

    WIDRAThank you, Katherine.

  • 11:57:23

    LANPHERThis is Katherine Lanpher and I'm filling in for Diane Rehm.

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