What Women Need To Know (But Don't) About Fertility

Photographed by Tayler Smith
At her clinic in Vancouver, fertility specialist Dr. Caitlin Dunne has seen a serious spike in egg-freezing procedures — up 180% between 2017 and 2018. It’s a sign that science is putting women in the driver’s seat when it comes to their reproductive options. (Now if only social norms and stigma would take the hint.)
Infertility affects approximately 16% of Canadian women, “but it’s still something that most people don’t feel comfortable talking about,” says Dunne. To that end, she will appear on Faces of Fertility, a new podcast produced by the Canadian underwear brand Knix, which premiered Monday to coincide with Infertility Awareness Week.
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Here, Dunne weighs in on what women should know (but don’t) about their own procreation prospects, Justin Bieber’s recent pregnancy prank faux pas, and what workplaces can do to become more fertility friendly.
That 180% rise in egg-freezing statistic is pretty staggering. Does it reflect a more widespread spike in women freezing their eggs?
Definitely we have had a lot of success at our clinic, but yes, it’s part of more general uptick based on a few different factors. Egg-freezing was considered "experimental" until the American Society for Reproductive Medicine removed that label in 2013. That really opened the gate for companies like Facebook, Google, and even the American military to start offering egg-freezing as a perk. Since then, women have become a lot more aware, which is really the key goal. There has been so much forward motion in terms of the science, but fertility is still a topic that not enough people are talking about.
Hence a podcast like Faces of Fertility. What else would you like to see happen in terms of eliminating stigma?
It’s really just talking about things more openly. If you haven’t dealt with infertility, you’re probably not going to realize how difficult it can be, so it’s helping people to understand that. One of the things I hear from patients is that as soon as you’re trying to get pregnant and can’t, it feels like everyone in the world is having a baby. Or you have friend groups where one person is privately struggling with infertility and something like going to another friend’s baby shower might be incredibly difficult. It’s often an incredibly isolating experience — because no one is talking about it, you feel like nobody else is going through it.
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We are seeing progress, though. Celebrities like Chrissy Teigen, the Kardashians, and Gabrielle Union are sharing their own struggles — that’s really powerful. From a doctor’s perspective, the best thing I can do is to dispel the myths and help women to understand the facts, which can be enlightening and empowering.
Let’s start with misconceptions. What are the big ones?
One key misnomer is that women are to blame for infertility. We see it in society and also in women blaming themselves. Of course, no one is to “blame” in these scenarios, but if we’re looking at the most common cause of infertility, it’s male factors (sperm count or mobility). The second most common cause is pelvic factors, so things like endometriosis and scar tissue, which are out of a woman’s control. After that you have cycle abnormalities and then age.
I’m surprised age isn’t higher on the list.
The age factor really varies geographically and is a lot more significant in urban centres. My clinic is in Vancouver, and the average age of the women I see is just over 38.5.
Do you wish they’d come to see you a few years earlier?
I really try to avoid saying anything that’s going to make a woman feel guilty. We put so much pressure on women, over this 10- to 15-year time period, to get an education, build a career, meet the right someone, buy a house, start a family. And then, on the flip side, we’re not doing a good enough job of educating them about the realities of fertility. There was a study published recently out of the University of British Columbia where they surveyed undergrad women. The vast majority stated that having a family was important to them, but they also said they weren’t going to start thinking about doing so until their mid-30s. So there does seem to be a disconnect there, even among educated women.
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Maybe it has something to do with this whole 40 is the new 20 mentality...
I think there is this idea of, "I eat healthy and do yoga, and I don’t look 38, so my eggs must be okay." Unfortunately eggs don’t work that way.
What are the realities around age and fertility?
I tell women that your egg health (meaning the chance an egg is going to lead to a miscarriage) stays pretty steady up until 34. At 35 things start to change much more rapidly. So at 33, you might have a 15–20% chance of miscarriage, and at 40 it’s going to be 50–60%.
You wrote an op-ed in the Globe and Mail called “Want to hire more women? Make your workplace fertility friendly.” What does that look like?
A lot of progressive work places are starting to provide benefits that are designed to attract young women, but at the moment most of that is still geared towards maternity. What about the women who aren’t ready for that? Supporting fertility means financially and also any time off required. I think that helps to attract skilled women and it also sets the tone within a company that this is a female-friendly work environment.
You mentioned celebrities raising awareness around fertility. What did you make of Justin Bieber’s recently April Fools' “prank,” where he pretended his wife was pregnant? A lot of people said it was pretty insensitive.
I don’t think Justin Bieber meant any ill will, but it does bring to light how we need to be more sensitive about the way we treat and talk about infertility. I can’t think of another medical illness where you’d think it was fair game for a prank. You wouldn’t make an April Fools' joke about cancer. This is why we need to start looking at infertility as a public health issue. I think that’s the best way to encourage open conversations so that women and couples can feel confident making the decisions that work best for them.
Caitlin Dunne is a fertility specialist at the Pacific Centre for Reproductive Medicine. She is doubly certified in Obstetrics & Gynecology and in Gynecologic Reproductive Endocrinology & Infertility.
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