It's time to redesign family planning

Strolling through Walgreens, I recently stumbled upon the “Feminine Hygiene,” Section; an aisle filled with pregnancy tests, condoms, and spermicides. I recall a time, not so long ago, when this aisle was called the “Family Planning,” section.

While this age-old term often refers to preventing pregnancy, advancements in reproductive technology, such as egg-freezing, IVF, and hormone testing are redefining what it means to build a family. Now, perhaps “family planning,” isn’t only about preventing births, but also about preparing for them.

For example, when it comes to staying healthy, research shows yearly screenings for heart disease, diabetes, and high cholesterol can keep severe illnesses at bay. But, while websites, health magazines, and television commercials advertise the importance of these tests; similar ads rarely address women's reproductive health. And even though we’re advised to have yearly gynecological check-ups, including mammograms and pap smears, we’re rarely told to monitor our fertility (unless we’re trying to conceive).

Women often come to see me for “reproductive” counseling before they’re pregnant. Many have questions about whether or not to freeze their eggs, preserving the chance to become a mother on their timeline, instead of feeling pressured by Mother Nature. Others seek support after being diagnosed with reproductive health concerns, like Polycystic Ovarian Syndrome and Endometriosis. For these young women, anxiety swirls because they often worry that these health conditions will affect their ability to begin a family.

Media Fueled Reproductive Myths

Unfortunately, advancements in reproductive technology may lead women to believe that even as their biological clocks age, science can keep them ticking. Certainly, this is what media outlets often convey by glamourizing celebrity pregnancies. But, while Janet Jackson, Mariah Carey, and Kelly Preston became mothers in mid-life, studies show fertility begins to decline after the age of 27, dropping off more significantly after a woman turns 35. However, seeing these “celebrity moms” grace the cover of US Weekly can fuel misconceptions about conception.

A recent study, published in the journal Fertility and Sterility found that popular print magazines like US Weekly, Cosmopolitan, and People frequently ran celebrity stories about fertility, motherhood, and pregnancy. The study researchers analyzed these glossies over a 4-year period and found that fertility was highlighted on 33% of magazine covers.

The majority of celebrities mentioned in the glossies were of “advanced maternal age,” meaning they were older than 35-years-of-age. According to the American College of Obstetrics and Gynecologists, after this age, it may be harder for women to conceive; and for those who do, the risk of pregnancy-related complications rises.

However, while these celebrities shared their motherhood joys, often they failed to mention their fertility struggles, illuminating how women often feel ashamed of their reproductive challenges. And according to the study researchers, this inaccurate portrayal can be misleading, causing women to believe conception is feasible when it’s not.

How Common is Infertility?

Contrary to popular belief, infertility affects 7.3 million Americans. Unfortunately, many women and men aren’t aware of their challenges until they struggle to conceive.

This is unfortunate since coping with infertility can be just as stressful as managing a chronic illness. Studies also show that this stress can increase a woman's risk of becoming anxious and depressed.The most recent data from the Center for Disease Control shows that  15% of couples begin families after the age of 35. With this knowledge, it can be beneficial to monitor one’s fertility before trying to become pregnant.

Family Building for the “Modern Family.”

Even though IVF is often paired with infertility, not all women who undergo this procedure are infertile. Over the years, families have evolved and modern families now include; single moms, same-sex parents, transgender parents, and single dads. Other prospective parents may know that they have a genetic condition and need to rely on IVF for embryo selection. More and more people are turning to science to start a family. “Family planning” may also entail mapping out when you want to have kids naturally (a window that culturally, has changed a great deal) or reserving financial resources for pregnancy or adoption, along with monitoring one’s physical health along the way.

Planning for the Future

There are a number of ways to preserve one’s fertility, as well as monitor one’s reproductive health. With advancements in reproductive medicine, women can now freeze their eggs, preserving the chance to begin a family. Other couples may do an IVF cycle, even if they’re not ready to become parents, freezing their embryos for future family building.  “It’s important for women to tend to their physical health prior to conception,” says Dr. Alan Peaceman, chief of maternal and fetal medicine at Northwestern University. Peaceman adds, “Women with underlying health conditions, like diabetes and hypertension should talk to their doctors prior to becoming pregnant.  

Integrative and holistic health care can also promote reproductive wellness. Individuals may receive acupuncture, Mayan abdominal massage, or naturopathic medicine. Holistic health professionals focus on whole person wellbeing, integrating the mind, body, and spirit.

Finally, developments in hormone testing have made it possible for women to keep a close eye on their fertility. With a simple blood draw, women can check important hormones associated with reproductive health, like FSH, AMH, and luteinizing hormone.

AMH and FSH levels can offer clues about a woman’s “ovarian reserve,” which refers to the number of eggs in your ovaries. Ovarian reserve can help us understand our reproductive timelines, menopause onset, success in egg freezing and IVF, and check for red flags.   And while most young women have plenty of eggs, red flags like premature ovarian failure can cause eggs to diminish prematurely.

With this information in mind, many women feel empowered taking charge of their health by freezing their eggs, or using hormonal testing to help them spot health concerns before they’re more problematic. This testing can initiate conversations with doctors that otherwise may not have occurred early enough. In the end, these tools are meant to empower women, giving them more knowledge to make informed family planning decisions.


Dr. Juli Fraga

Dr. Juli Fraga is a psychologist and health writer in San Francisco. As a psychologist, she specializes in women's reproductive health. You can find her on Twitter @dr_fraga.

Fertility Unfiltered