One of the big unknowns of combining work and family is the timing of having children. My podcast co-host Sarah and I get a lot of questions from listeners about when is the optimal time to have children if you’re trying to build a big career.
Of course, that assumes you’ll be able to have children exactly when you want, which is never guaranteed. So we were excited to welcome Dr. Ellen Goldstein to the podcast today to talk about this topic.
Goldstein is a fertility specialist practicing in Los Angeles. She became an OB/GYN when she realized, in medical school, that she absolutely loved the field. She elected to go into reproductive endocrinology because she felt like she had a special ability to connect with couples facing infertility (often a high stress time). She notes that there were lifestyle factors too. Though OB/GYN has become better on that front as people move to a group practice model, fertility medicine tends to have more regular hours, which is nice as she raises her 2-year-old with her husband (who works at a pharmaceutical start-up) and her parents, who live down the hall (!)
A few highlights from the interview:
Infertility is common. Goldstein talks about how baby-making plays out in the real world. For 100 <age 35 couples who start trying, about 25 will conceive right away (first month). About a quarter of those remaining will hit the next month. Then things start to decline: 20 percent, 15 percent, 10 percent. By the end of the year, the odds are pretty low for any of the remaining couples. There are always miracles. But if you haven’t conceived naturally in a year, the odds of it happening aren’t high. So if you would like to have a baby, it’s time to get medical help.
“I wouldn’t really worry about the years between 27 and 35.” While infertility is common, and age is a common factor, if you look at the above numbers, you’ll see that the vast majority of people who’d like to have a baby in their early/mid 30s will be able to do so. There is a lot of angst caused by literature showing that fertility declines after age 27 or so. But Goldstein noted that the decline is fairly gradual through one’s early 30s. If you are aiming to have 1-2 children (not, say, 4), then you’ll probably be fine starting around your early 30s.
(Please ignore my comment about if you find Mr. “or Mrs.” Right early, about when you should start trying. I’m always trying to use inclusive language, but LGBT family building is its own separate issue with some different factors than what heterosexual couples face. I wasn’t trying to be flippant about it!)
Anyway, Goldstein discusses how fertility treatments have changed over the years. Fertility specialists have made advances in IVF in particular. Many clinics now screen embryos for viability, and wait for the patient to have a normal cycle before implanting. This massively increases the odds of success from a single embryo, which means clinics no longer need to implant 2+ embryos. Carrying multiples creates medical risks for mom and babies.
She talked about how IVF treatments can fit into a busy schedule, and recommended finding a clinic that can see you early in the morning for most appointments, so you don’t even need to deal with missing work much of the time. (If you travel a lot for work, though, you’ll need to stay local for a while to account for these frequent appointments.)
However, there are always some unknowns. Egg retrieval requires taking the day off work, and you can never 100% know when your eggs will be ready. You could aim for the window to happen on a weekend, and then block Monday in your schedule, and most likely you will hit within that 3-day time frame.
Goldstein also briefly talked about egg freezing. It’s an interesting technology that may become more common in the future. One issue is that one’s eggs are in peak condition in one’s 20s, which is not a time most women are particularly concerned about freezing eggs, since you assume you’ll still find a partner and have babies the traditional way. By the time many women do think about this, in their late 30s, retrieving usable eggs becomes much harder. From a statistical perspective — meaning you sense you’ll need the frozen eggs, but they’re still high-quality — early 30s is probably the time to do this.
Anyway, interesting stuff! There was a little bit of endocrinologist talk (Sarah is a pediatric endo) but everything was in pretty plain language. In the rest of the episode, we talk about audio books (do we have fans here?) and powering through the work day when you are sleep deprived. And Apple Music. Please give it a listen! And if you enjoy Best of Both Worlds, will you please tell a friend about it? Word of mouth is still the best way to grow an audience. We appreciate the support!
10 thoughts on “Podcast: Interview with fertility specialist Ellen Goldstein”
Excited to listen to this one. I and an adult endocrinologist AND I know Ellen from Medical School!
@Gillian – small world! Hope you enjoy it.
This was such an interesting episode! Infertility isn’t a struggle I’ve had, but I have a number of friends who have experience with it and your interview gave me some new insights.
On the subject of audiobooks, I have noticed that classics read by celebrities can be a nice gateway, too. Sissy Spacek’s narration of To Kill a Mockingbird is beautiful, and Jeremy Irons’ narration of Lolita is riveting.
@Robin – yes, anyone with a really *good* voice can be great to listen to. There are certain voice artists who wind up doing a lot of audio books precisely because people really really want to listen to them for 20 hours straight.
I definitely recommend Trevor Noah’s Born a Crime. It’s narrated by him so it’s obviously performed very well, but he also covers a lot of serious territory because it’s about his childhood in apartheid South Africa.
Really interesting episode!
As for audiobooks: YES, they are the savior of the busy working mom! I listen to audiobooks while commuting, during those inefficient travel moments (walking down the airport corridors), and while running errands. So far this year: 20 books, 8124 pages, 195 hours (244 hours of audiolistened to at 1.25x speed).
Do audiobooks count toward pre-order stats?
I like audio books but they’re definitely something I do while doing something else (driving, jogging) so it needs to be something I can jump in and out of easily. I agree wholeheartedly with the suggestion to ease in with celebrity memoirs… I randomly picked up Martin Short’s autobiography at the library (Not something I’d have picked up to read) and I laughed, cried, and was sorry when it ended. I tried listening to Arianna Huffington’s book on sleep and I just had to quit after a couple of chapters (something about the mix of her accent and the research heaviness of it made it hard to stay interested when I was listening in 15-20 minute bites in the car), but I’ll likely pick up a copy to read at some point.
I enjoyed the fertility discussion, it was something I was lucky not to struggle with but it’s important for women (and men) to have the information.
This was a really interesting episode! I appreciated the comment about being careful in your conversations, as more people are experiencing infertility than we imagine.
Regarding audiobooks, for those of us still trying to figure out if it’s our thing, many public libraries have agreements with Hoopla Digital (hoopladigital.com) where you can access many audiobooks for free – even some new releases.
I loved listening as I experienced infertility for four years before having my twins after our second IVF with ICSI.
I found it interesting that she said not to worry between the ages of 27 and 35 as my entire infertility support group (25 ladies over 2 years) were all in that age range, with the average age being around 31-32. And we’d all been trying for a good while before starting to go the clinic route.
Would she say these factors differ by country? We’re all South African. Granted, Johannesburg is a very fast-paced, stressful city but if we were all the 1 in 8, it seems odd to me.
@Marcia- I don’t think she was saying that people ages 27-35 don’t experience infertility. They can and do. I believe her point was that the vast majority of women who try to have a baby in those ages will successfully do so. However if you have been trying for a year and haven’t gotten pregnant, it’s unlikely you will, so time to seek medical help.