It’s Menopause – Not Infertility

Jennifer Lahl

Too many women know the heartbreak of infertility.  Too many women don’t know that their infertility relates to menopause, not disease.

Last week was National Infertility Awareness Week.  From the organization’s website:

National Infertility Awareness Week (NIAW) is a movement that began in 1989.  The goal of NIAW is to raise awareness about the disease of infertility and encourage the public to understand their reproductive health.  RESOLVE: The National Infertility Association founded this movement and continues to work with the professional family building community, corporate partners and the media to:

  1. Ensure that people trying to conceive know the guidelines for seeing a specialist when they are trying to conceive.

  2. Enhance public understanding that infertility is a disease that needs and deserves attention.

  3. Educate legislators about the disease of infertility and how it impacts people in their state.

In 2010 National Infertility Awareness Week became a federally recognized health observance by the Department of Health and Human Services.

While I am quite sympathetic to diseases which cause infertility, and the need for proper medical intervention to attempt to cure or treat the underlying cause of the infertility, in reality, many consumers of reproductive services have no disease whatsoever.

Take for example, a same-sex couple who uses these technologies to have a baby.  No disease.  No infertility.  Or consider the “single-mother-by-choice”.  No disease.  No infertility.

Or what about the growing number of women who have just waited too long to have their children?  These women are certainly not infertile; they are in (or entering) the period of menopause.  Menopause is a natural and normal event which occurs in a woman’s life, it is not a disease which needs to be treated. The biological clock is real and as women, we must re-educate ourselves to this fact and educate our daughters to this fact.  While women are living longer and healthier lives, this has no bearing on our fertility.  Women still experience a dramatic decline of their fertility in their early 30s.  If we want to have children, we need to have them when we are young.  We risk closing the door on natural childbirth if we postpone pregnancy.

The Mayo Clinic  reported that a woman’s fertility peaks between age 20 and age 24. The fertility rate remains relatively constant (at about 15–20% below maximum) through age 35. From 40 to 45, though, the decrease is a dramatic 50–95%. This translates as follows: a healthy 30-year-old woman has about a 20% chance per month to get pregnant. By age 40, however, her chance is only about 5% per month.

The following graph comes from the Centers for Disease Control and Prevention (CDC) – the only government body which gathers data (incomplete in my assessment) on the use of assisted reproductive technologies in the United States.    

Note the dramatic “percentage” rise in the use of “donor” eggs as maternal “age” increases.  The use of eggs from another woman reflects the simple biological reality that, as an older woman’s fertility declines, she must turn to younger women to provide her eggs in order to conceive, bear and birth a baby.

The older birth mother is, in fact, having the younger woman’s baby – and exposing the younger woman to the detrimental health and fertility risks associated with egg harvesting procedures.


But conception is only part of an older woman’s challenge to bearing children as her fertility wanes.  Advanced maternal age also heightens the risk of “fetal loss” – meaning the older mother’s age alone increases the likelihood that she simply cannot carry a baby to term.  One important study noted this stark conclusion:

There is an increasing risk of fetal loss with increasing maternal age in women aged more than 30 years. Fetal loss is high in women in their late 30s or older, irrespective of reproductive history.  This should be taken into consideration in pregnancy planning and counseling.


I do understand and acknowledge the heartbreak when that strong desire of women have to bear children is frustrated by age and declining fertility.  But I do think National Infertility Awareness Week should focus its resources on the diseases which affect our fertility and develop a model that recognizes biological realties and practical things we can do to promote fertility.

In my next post, I will share some steps and precautions you can take in practice to safeguard and protect the gift of female fertility.


8 thoughts on “It’s Menopause – Not Infertility

  1. I tweeted this to my Japanese followers and many people agreed with your opinion; It’s not infertility but menopause. Recently Japanese ex-minister of Consumer Affairs Agency gave birth to a baby boy using Mexican young woman’s egg in her age 50. She bought 32 eggs from the Mexican and implanted some of fertilized eggs into her womb. She was hospitalized for long time during her delivery and finally lost her womb after it, moreover, the new born baby boy suffers from serious congenital disorder and had 9 times operation since his birth even he is still 1 year old. His condition is still serious and seems not to have any anticipation to be healthy in his life. All of these mishaps were caused by the obsession; being infertile after getting older is not natural but a disease. I think your opinion should be much prevailed to avoid having another similar case.

  2. This article misses the main point regarding the growing social phenomenon of later motherhood. The author talks about “women who have just waited too long to have their children” as if this decision is purely an individual one, as if these women are being egocentric and have not planned ahead. However, when discussing this topic we must remain aware of the strong social forces at play. For many young women, becoming a mother at the age of 20-24, “a woman’s fertility peaks”, is impossible. They experience strong social pressures and are living in a reality that does not support such a choice. Without paid maternity leave or subsidized childcare, how is a 24 year old supposed to manage motherhood, her education and establishing her career to ensure future financial stability for the her family?

    The social message is that to be a responsible mother, a women should first be established. Many young women feel immense social pressure to pursue their education and career before becoming mothers. In these circumstances, the reality of older moms cannot – and should not – be explained solely in individualistic terms. It is shaped by social factors.

    The discussion of older motherhood in the terms of this article is unfair and misleading. One should not address this issue without addressing its social dimensions and without arguing for social policies that promote women’s liberty to choose when to become mothers.

    As a young medical student recently wrote about the way others discuss her “reproductive future” with her: “instead of voicing support for social policies like paid maternity leave or subsidized child care, the comments seem to place the onus of the problem on me as an individual. In this formulation, I’ll come up short as a physician and as a mother, and that problem will be entirely mine to bear, as if my future employer and society at large – not to mention these hypothetical children’s other parent! – won’t also play a role.” (see: )

    • Dear Vardit,

      I am in agreement with the social realities and the need to change this dimension in society. I think it will make a good topic for a future blog piece on this site! We need social policies which support younger motherhood/fatherhood and changes in employment policies which to date, put women in the position of having to choose or lose. I often remind women, when I speak on university campuses that we live longer, but our fertile years remain the same. I went back to graduate school quite late in life. Perhaps a paradigm shift is needed to also encourage returning studies and those enter professional careers in their 40s like I did.

  3. The notion that women are self-absorbed in their careers and therefore “wait too long” is an accepted stereotype and one very damaging to both young and midlife women in industrialized nations. It suggests that “women who wait” are selfish and don’t consider the future of their potential children.
    The reality is that women today find themselves in the unreasonable position of being in a pressure cooker where they are expected to educate themselves, become financially viable and have children all at the right time. Another emerging phenomenon is an attitude amongst some modern men that suggests a greater reluctance to commit. I suggest that the demographic of single mothers via sperm donor, over 40, will continue to grow., an advocacy website for the support and education of women on the journey of later motherhood, has recently launched a short film and a series of expert interviews in the area of bioethics, obstetrics, reproductive endocrinology, women’s studies, child psychology and psychotherapy to begin to open an important dialogue on age-related infertility–where the biological cause has become the real byproduct of an existing, and growing, cultural/social phenomenon. We’ve been fortunate to have Vardit Ravitsky, a renowned Bioethicist, on our expert panel.
    Jennifer, I invite you to visit the site and hear what the experts have to say. I would also very much welcome an open dialogue with you to explore areas of mutual support and understanding. There are many causes of infertility and to assume that women wait out of ignorance of selfishness would be a disservice to all women, especially the next generation maturing behind us. Would you be interested in connecting?

  4. Dear Angel,

    I would very much be interested in connecting! Thanks for contacting me and commenting here. I am not sure how my pointing out the biological realities of maternal age and how that negatively impacts fertility should suggest women are self-absorbed or selfish. My goal is to better inform younger women on their reproductive health.

  5. Please let me know the best way to reach you–perhaps an email address? You can reach me at angel at flowerpowermom dot com.
    Look forward to connecting!
    All the best,

  6. Jennifer,
    The social implications of this truth are enormous and heartbreaking. Thanks for all your work on behalf women