Podcast: Interview with fertility specialist Ellen Goldstein

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.

That said…

“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!