Science Vs - Fertility Cliff: Is It Real?

Episode Date: April 25, 2019

We’re often told to have kids quickly, before our biological clock strikes and we fall off the fertility cliff. This week we find out if that’s true for women or men. And if the cliff is real, can you do anything about it, like freezing your eggs? Plus, the sperm-aggedon! We speak to epidemiologist Prof. Lauren Wise, reproductive endocrinologist Dr. Mary Sabatini, and andrologist Prof. Allan Pacey. UPDATE 7/10/19: A previous version of this episode incorrectly identified the nationality of a character in Indiana Jones. The episode has been updated accordingly. Check out the full transcript here: http://bit.ly/35DfLE8 Selected references:  Lauren’s two studies looking at the fertility cliff. Click here if you want to be in one of her studies!  Two studies looking at success rates of freezing eggs at different ages Review of the effect of paternal aging on the health of the offspringThe 2017 meta-analysis which shows the drop in sperm counts in several parts of the world Credits:  This episode was produced by Meryl Horn, with help from Wendy Zukerman, as well as Rose Rimler and Michelle Dang. Our senior producer is Kaitlyn Sawrey. We’re edited by Blythe Terrell. Fact checking by Diane Kelley. Editing help from Caitlin Kenney. Mix and sound design by Peter Leonard. Music by Peter Leonard, Emma Munger and Bobby Lord. Recording assistance from Mary Dooe and Andy Short. A huge thanks to all the scientists we got in touch with for this episode, including Dr. Richard Lea, Dr. Hagai Levine, Professor Jens Peter Ellekilde Bond, and others. And special thanks to everyone at Gimlet who listened to the episode, the Zukerman family, and Joseph Lavelle Wilson. And a huge thanks to Christopher Suter. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus from Gimlet. This is the show that picks facts against fertilisation. On today's show, the fertility cliff. Whether you want a kid right now or you're thinking, maybe someday, you might have wondered, is it a problem if you wait too long? Like, how much harder does it really get to make a baby if you leave it until you're a little bit older?

And this worry is especially personal for one of our producers on Science Versus, Meryl Horne, and her husband Chris. They're in their mid-30s and they've been busy focusing on their careers, but recently they decided to start trying to have kids. I talked to them about it at their Brooklyn apartment. Hey. Hello. How are you? Once their dog Penny settled down, we got to chatting about Meryl and Chris's origin story. Turns out they first met on a dating site about five years ago, and Chris was immediately taken. Yeah, I had actually just seen her profile

and I thought she looked amazing. And, you know, she had this like nice black and white picture of her playing her guitar. I was like, oh, she seems great. And then a couple of days later, she messaged me. One message led to another and the two started dating. And the topic of kids popped up quite early on. I mentioned it super casually and it was like the third date or something. And then I felt really awkward about it. Do you remember that? I sort of remember that we had like an awkwardly early kids conversation. What did I say? It was like was like oh when we have kids something

something something you went for the when we have kids i think i did i don't know why i would have said that that early i'm so embarrassed for you and but i meant it like the royal we somehow like in my head it wasn't't going to be about us. It was just in general. And then Chris just made a joke of it and was like, oh, honey, what will we call them? And so that diffused the tension. Dropping the kid bomb on the third date didn't throw Chris off, though.

He always knew he wanted kids someday. And so after dating for a few years, Meryl and Chris got married and they started trying to have a baby pretty much straight away. And Meryl figured this is going to be easy. At that time, I was like, we could get pregnant immediately. And that felt super scary. And I was already kind of worried about what it would mean for my career because I was switching jobs, I was switching careers

and was like applying for Science Versus, actually. Science Versus, that's us. So, yeah, we ended up hiring Meryl. Months went by, and she still wasn't pregnant. At first, this was actually a bit of a relief. After all, she'd just started this new job with us. But then, at one point, Meryl was like, wait a sec, do we have a problem?

It took a while for it to really sink in. Oh, but now it's been a long time. And I think we might be one of those couples that's infertile. Like it made me feel kind of like I was defective or something. After about a year, Meryl and Chris went to the doctor and have started to get checked out. So far, there's nothing obviously wrong with either of them. So why aren't they getting pregnant yet? Well, one thing that crossed Meryl's mind at this point

was this idea of the fertility cliff, that once women hit their 30s, it gets really hard to have a baby. Could this be what's going on for Meryl and Chris? She's 34. I was a little confused about it, actually, because I think I just had it in my consciousness somewhere that, like, biological clock is ticking. But then I had also heard that, like, oh, no, like, you don't actually need to worry about that. That's just this kind of old sexist idea that, like, women have to be worried about having kids when really you can relax. Yeah that's what I had heard as well. Also my mom had me when she was 40 so that's I

guess was on my mind too that like maybe it'll be fine for me. Even gynecologists can't seem to agree about when a woman's fertility starts to drop. Surveys of gyne's find that a few say it happens in your 20s, while some go for the 30s and even 40s. And then, of course, there's the other half of this equation. The dude. Maybe the problem is with Chris. He's 36. Could that be the issue here?

We keep hearing stories of older men having kids. Like, according to the gossip mags, guys like Steve Martin and Jeff Goldblum had babies well into their 60s. I guess life found a way for them. But what about the average Joe or Chris? We wondered, can men really have babies forever? Today, we are going to get to the bottom of the following questions. One, is the fertility cliff real for women? And if it is, is there anything you can do about it? And two, what about men?

Is it harder for them to make babies as they get older? When it comes to fertility, there's lots of, oh honey, what will we call them? But then, there's lots of, oh honey, what will we call them? But then there's science. And by the way, some of what we'll be looking at in today's episode focuses on cis straight couples, but a lot of the research is relevant if you're in the LGBT community as well. Science versus the fertility cliff is coming up right after the break. Bumble knows it's hard to start conversations.

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Who are the people creating this technology and what do they think? I'm Rana El-Khelyoubi, an AI scientist, entrepreneur, investor, and're looking at the fertility cliff. More and more people in the US are waiting until their 30s to have kids. We want our careers in order, good partner in check, and literally a decade of partying before we have to deal with babies crying and crapping all day. But by waiting, are we actually jeopardising our shot at having a biological kid? Let's start with the potential issues of waiting for people with ovaries. The idea that women in their 30s struggle to get pregnant has actually been in the scientific literature for decades and was being taught in universities as scientific fact, which is where Lauren Wise first remembers seeing

it. There was a cliff happening at around age 30. 30. And was it pretty cliffy? It was pretty cliffy. It was like a straight line from, you know, age 18 to 30, and then this amazing drop. It almost looks like a ski hill type drop. But yeah, it looked like a pretty big cliff. Oh man, I could just imagine you guys learning about that in school. I mean, it's making my heart drop to my stomach. Yes. Lauren is now a professor of epidemiology at Boston University.

And she told us that a few years ago, one academic started questioning the science behind the fertility cliff. The criticism that was raised was that this cliff, the idea of the cliff is based on really poor data. It turned out that some of the first studies describing the fertility cliff were using data from the 1600s, while other studies were finding the cliff after looking at Amish couples who had pumped out a bunch of kiddos when they were younger,

and the researchers were now tracking to see if they had less bubs in their 30s. But for decades, what was missing in the research were modern couples like Meryl and Chris, who had never tried to have a baby until they were older. And so for the women who want to know, can I wait until I'm in my 30s? There were no data. No data? No data. Wow.

These criticisms of the fertility cliff started to get a lot of media attention. And in the last few years, we've seen more and more think pieces coming out, saying that this whole cliff thing is bunk. You know, if you don't have fertility problems already, you can have a baby later than you think. Age doesn't really affect fertility that much until you're in your 40s. 40.

So what is going on? Is the fertility cliff real or not? Luckily, Lauren and her team have dug into this. They recruited around 3,000 couples who were trying to get pregnant and tracked them to see who was the most likely to have a bun in the oven after a year. So what did she find? You still see evidence of a rapid decline in the chances of pregnancy after around age 33. So the cliff was still right? The cliff was still there. Was it as cliffy?

I would say it was as cliffy as what the previous data showed, but at a slightly later age. Back in school, Lauren had seen that women's fertility starts dropping at 30, while her new research found that the cliff really started at around 33. And that actually matched what she personally had gone through. So it wasn't surprising to me because I was living that experience. I mean, I had trouble trying to conceive my first born child at age 32. So I was feeling that age was already catching up to me and that maybe it was having an impact on my own fertility. Meanwhile, another study came out showing the same thing.

The fertility cliff is real, and it starts at around 33. So for Meryl, who's 34, how dire is this? Like, once you hit your mid-30s, do you just fall off the edge of the cliff like that chick reaching for the cup of Christ in Indiana Jones? Well, not exactly. It just gets harder, on average, for women to get pregnant. For example, let's take a group of women

trying to have a baby in their mid-30s, say they're 34 to 36. How many get knocked up after a year? Over a 12-month period, it's about 75%. 75%? It's not too bad. It's not. It's not terrible. So within a year, three out of four women in their mid-30s will be pregnant. The problem is that after your mid-30s, with each passing year,

your chances of getting pregnant get lower and lower, so that when you're 40, around half of women will get pregnant after a year. So that's where some of the confusion about whether the cliff exists might be coming from. It's not like no women get pregnant after their mid-30s, but on average, it does get harder. So rather than a cliff, it really is more like a fertility ski slope. Meryl, our producer who's struggling with this right now, was here all through this conversation with Lauren, and knowing about the ski slope kind of changed how she felt about her own situation.

If it could just be sort of normal aging, it kind of makes me feel like a little bit better on the one hand, that like, oh, it's nothing, you know, it's not that I'm defective. This is just part of the natural process. But then it's hard to know how worried I should be. It's hard to tell. I mean, I think, you know, it's a normal process, and it makes sense that women in their 30s are going to start having problems conceiving. And so, yes, I can see

how that's somewhat reassuring. I know it's hard to hear when you're in the middle of it, but I wish you the best of luck. So now that we know this fertility ski slope exists, we wanted to know what's causing it. Like, what is going on in our bodies to make it so much harder to get a kick in the caboodle? To find out, we spoke to a bona fide expert. So my name's Mary Sabatini. I'm a reproductive endocrinologist and infertility specialist, and I work at the Massachusetts General Hospital. Mary told us that there's this idea out there that women have a harder time getting preggers in their 30s

because they start to run out of eggs. But she says that's actually not what's going on. So this is one of my, I think, the biggest misconception that's out there. It is true that women are born with lots of eggs, millions, and the number goes down and down. But by the time you're in your 30s, you still have around 50,000. And you know what they say, you only need one egg to make a small omelette.

OK, so there's a test that tells you whether your egg supply is running low. It looks at your so-called ovarian reserve. But a recent study found that this actually doesn't do a good job of predicting who will get pregnant naturally. So there are great studies out there that show that there are people with great ovarian reserve who can't get pregnant, and there are people out there with terrible ovarian reserve who get pregnant easily.

So it doesn't look like the number of eggs is the problem here. So Meryl wanted to know, if that's not the problem, what is? So what's going on? What's happening? Why are my eggs less likely to end up turning into a baby? So it's the quality of the egg that changes. Yeah, the eggs themselves are getting worse over time.

It's much like buying eggs and putting in your refrigerator. You can't just leave them there forever. And the best evidence that we have that ageing eggs are the problem here is because of research done on people who have had IVF. This is a process where you take a sperm and an egg and combine it in a petri dish and then pop the embryo into a uterus. Now, through the magic of science and capitalism, you can now do this with all kinds of combinations. So you can mix and match using a donor sperm or donor egg or donor uterus, like

with a surrogate. And because of this, scientists have now figured out a lot of what really matters for baby making. One of the things that IVF taught us is that the age of the uterus is irrelevant. That is, if you use a younger woman's egg in combo with an older uterus, it still has a high chance of eventually working. So we really know, so it's the eggs, they're the ones that are getting older in this process? Unfortunately, yes. And, you know, I think that's what's so hard about reproduction in women in today's world is that it really is about time. And what's happening in that time is that it gets trickier for your eggs to do this critical thing. So to make a baby, your egg has to chuck out some of its DNA

so that it can make room for the DNA in the sperm. And that process can go wrong, especially as we get older. So you start to see more mistakes in the DNA. And those can lead to issues like miscarriages, Down syndrome and other genetic conditions. OK, so if you're on the edge of the fertility ski slope and you're not ready to have kids, this can sound pretty scary. Is there anything we can do about it?

Well, one idea that's been getting a lot of attention recently is that to stop the biological clock, women should be freezing their eggs. This has been in the news a bit with some tech companies like Google now covering the cost of this for their employees. And lots of fertility start-ups are popping up offering to put your eggs on ice. Freezing your eggs is such an empowering choice because you're taking control of your life.

We truly can have it all. Egg freezing is becoming more and more popular. But when we asked Mary about it, she talked a little less about empowerment and a little more about the unpleasant realities of egg freezing. She ran us through the steps. It takes about two weeks from start to finish of taking daily injections, light anesthesia, transvaginal ultrasound. There's a needle that pokes directly through the vaginal wall into the ovary and suction is used to extract those eggs.

And sometimes you'll need to go through this process more than once because you won't get enough eggs in one round. On top of all that, it's really expensive. If your insurance doesn't cover it, it can cost tens of thousands of dollars. So, egg freezing. It's a hell of a process. But after all that, does it actually work? I asked Mary if this can really keep your eggs young and fresh. I mean, is that a way to increase their shelf life? Ten years ago, I probably would have said no, but I think the technologies for freezing eggs have become so good that I do think it's a viable opportunity for women. We're in the early days of

this egg freezing frontier, but a couple of studies have estimated that a woman in her mid-30s who does all this has about a 70% chance of eventually walking away with a baby. So it's not bad. The thing is, though, if you wait too long before you freeze your eggs, that success rate drops pretty quickly. Conclusion. Women do have a fertility cliff. Well, it's more like a fertility ski slope.

And it's because their eggs age over time and the DNA can get messed up. If you can afford it, it's not a bad idea to think about freezing your eggs. Although it is kind of an ordeal. And by the way, one thing that Merrill had heard a lot about is that if you really want to boost your fertility, it's best to cut out all alcohol and caffeine from your life. But we looked into this and there is no need to go cold turkey. Studies have found that you can swig one glass of booze and up to four cups of coffee a day and it won't affect your fertility. So it's not all bad news. Okay, that's the story with eggs. After the break, sperm.

There's been fears in the news recently that we're in the midst of a sperm-pocalypse, with sperm counts plummeting across the United States. Is this true? And we go back to our couple to find out, are Chris's swimmers OK? Low motility, I don't know what you do about that. Motivational talks. Yeah.

Come on! Get it together, boys. That know what you do about that. Motivational talks. Yeah. Come on. Get it together, boys. That's coming up after the break. Welcome back. We just learned that for women, the fertility cliff is pretty much real. At around the mid-30s, it starts getting harder and harder for a woman to get pregnant. Now we're talking about the other side of this,

people with testicles. Because even though the focus of getting knocked up has historically been on the women, when you look at everyone, regardless of age, for half of all infertile couples, it's the men who have the problem. And funnily enough, early on, our producer Meryl Horne and her husband actually had the same idea about who was the source of their troubles. And this is going to sound mean, but I always just kind of felt like my body is good because

I've been able to track my ovulation and it looks so good. Yeah, I think part of me just assumes it's Chris. No, I mean, I think I've generally assumed that if something was wrong with one of us, it was probably me. Really? Yeah. Chris went to the doctor for some initial testing and they didn't find any obvious problems with his plumbing.

Yeah, the testicles look good. So that brought us to a broader question. Could Chris have just fallen off his own fertility cliff? I mean, do men have one? For this, we had to talk to Alan Pacey. He's a professor of andrology at the University of Sheffield, and he's been studying all kinds of sperm for decades. So my PhD was on a little worm

that lived in the sand. So like the sperm of a sperm really? The sperm of a worm and it was really stressful but interesting. So this is a worm that only breeds once a year okay and not And not only that, all of the males ejaculate in the same half hour. Oh my gosh. It seems to be synchronised with the moon or the tides or something. After a surprisingly long chat about worm sperm, we got onto the topic of the male fertility cliff. And Alan told us that a lot of people have this assumption that men can just go on

having babies until they're decrepit. And you get that impression from rock stars, Mick Jagger, people like Charlie Chaplin, who was 72 when he had his 11th child to his fourth wife. Right. But are these men anomalies? For the average guy out there, do they have to worry about a fertility cliff? I wouldn't say that men, older men face a reproductive cliff edge. They kind of have a, like a rolling slope. Things happen slowly. So if you compared it to, um, like the female fertility cliff, is it as scary? No, I don't think it is. Um, I don't think it't think it's as steep in a man as it is in a woman.

Yeah, so there's not a cliff per se. It's more like a fertility grassy knoll. Several studies suggest that as a guy gets older, it takes more time to get a woman pregnant. But when it comes to exactly how much more time, well, the studies are all over the map. It's also not clear when men start rolling down their fertility grassy knoll, but Alan puts it at roughly around 40. And why is that? So men by the age of 40, have been making sperm for, gosh, 25 years or more.

The engine is getting a little bit tired at that point. That tired engine starts to affect sperm and it means that men don't make as many good swimmers as they used to. So what does this mean for Meryl and Chris? Chris is 36. Has he been affected by his fertility grassy knoll? Alan told us about this home test that you could do. Sitting on my kitchen table at home

is a device that you can clip to an iPhone and a little chamber where you can put a drop of your sperm. And it will use the iPhone to make the measurement for you. It sounds super dinky, but it's actually FDA approved to basically tell you if your swimmers can swim. I think that's fantastic. So Meryl and Chris decided, why not give it a go themselves? All right, should we get this thing started?

Yep. Turn your phone into a sperm testing device. All right. To start, Chris mixes some of his semen with a special little powder that turns the semen pink. But it can be a little tricky to use. Oh, I think you put the wrong end in the bottle. Did I?

Yeah. See, I tried to ask you. I needed a scientist. I thought that was really helpful. You just put the wrong end of their pipette into the bottle. So I'm going to have the sperm juice on my hand. They put the sperm juice onto a plastic slide, which slots into a device so that your camera then acts like a tiny microscope. And, like, what else can you put in this thing?

And just, like... Oh, we should go to the park later and collect, like, pond water and then look at a little pair of mesium. Yeah. What a nerd. No wonder we hired Meryl. The results pop up telling you how many swimmers you've got and whether it's low or normal.

And while this whole thing started out a little jokey, it started to hit home that this could actually explain why Meryl and Chris were having trouble. And they both got a little anxious. Like, I just got like a flutter in my chest. Yeah, I hope it's good. We'll see.

One minute and five seconds. Whoa, it's so precise. One minute and five seconds. High range. High range of normal. High range of normal. I passed. Wow. My boys can swim.

Later, they got this checked by a real doctor too, and those results matched up with this dinky DIY kit. Yeah, so are you happy now? I mean, I guess. I don't know. Then why aren't we pregnant? So Chris's sperm doesn't seem to be the reason that Meryl isn't pregnant. And at 36, Chris probably isn't rolling down his fertility grassy knoll.

But zooming out here, the research is showing that it's not just about whether your boys can swim. There's another concern. As men get older, you start to see an uptick in certain medical conditions in their kids. Here's Alan. You see more disorders like achondroplasia, which is when someone has short stature.

You see mutations related to autism. So the risks are actually quite small, but they're statistically significant. So, for example, one big study found that if a chap is in his 30s, the risk that his child will have autism is 1.2%. That risk goes up to about 1.4% if he's in his 40s. And it just keeps creeping up. And to understand why we think older dads are more likely to have kids with

various conditions, we have to tell you about your granddad's jizz. Kinda. Okay, here we go. So testicles. They pump out fresh sperm throughout a man's life. And that means even 90-year-olds are making new sperm every day. And by now, their gear is getting a little clumsy and it starts making mistakes. Genetic mistakes. So many different genetic errors would be evident in the sperm of a 40-year-old in comparison to a 20, 25-year-old. Scientists have actually mapped the genome of different aged fathers and their kids,

and they could see that as men got older, their children had more genetic mutations. Alan has an analogy for what seems to be going on here. He's like, think of the sperm-making machinery as a kind of mould, like a waffle iron. Year after year, you use that same waffle iron to make sperm. And over time, it might get a little damaged. But if somebody scratches the inside of the mould... In this case, is that the testicles?

Yeah, that's what I mean. Then forevermore, the thing you're making will be defective. It's that defective sperm making machinery that passes little genetic mistakes onto kids. Now, a lot of the time, it's not a big deal, but it does up the chances of kids having some genetic conditions. Conclusion. Men's fertility does go down a little as they age, but it is not like a cliff. It's more like a gentle slope. But our final question is this.

Could there be another threat lurking around the corner for male fertility? Because some studies are reporting that men's sperm counts have been dropping dramatically and that we could be heading into a fertility crisis soon. A health alert tonight regarding sperm counts. A new study just out showing they're plummeting. So sperm count in men declined by 50 to 60 percent.

If this continues, we're doomed. These scary reports are based on real science. A big review came out a couple of years ago which seemed to show that since the 1970s, sperm counts in North America, Europe, Australia and New Zealand had dropped, on average, by more than 50%. And while we're not at the point where it's affecting fertility now, some are saying that if things keep going the same way, this will cause a massive fertility crisis in just a few decades.

Now, currently, it's not clear what might be causing this sperm-pocalypse, but one clue is that the drop didn't seem to be happening everywhere. This study didn't find it in South America, Africa or Asia, which is making some think that it's something about our Western lives that's killing the sperm. Here's Alan. People always gravitate to kind of Western habits, be it pesticides, be it processed food or what have you, but really we don't know. But before we prepare ourselves to live in a handmaid's tale, Alan says that there is actually a huge debate going on amongst sperm

counting boffins as to whether this spermageddon is happening at all. And a big reason for this is because of the difficulties of counting sperm. While you can roughly tell if you've got enough swimmers on an iPhone, like what Meryl and Chris did, you need to be a lot more precise to do these kinds of studies, which is tough because sperm are tiny and they wiggle and jiggle inside a sticky, gooey liquid. Alan explained it like this. Semen is a viscous substance. Even picking it up in a defined way, I want to measure 100 microliters of semen and I want to see how many sperm is in that. You can't even pick it up in a good way because it's really viscous.

It's like the cheese on the top of a pizza. It will keep on going. Thanks for that image, by the way. Wonderful. So when you're trying to count sperm, that's just one potential source of error. There are so many tricky things with counting sperm and such a lack of consistency from lab to lab, country to country. In fact, the World Health Organization publishes a guide to examining human semen and the latest edition was 271 pages long. So for now, Alan and others that we spoke to say this really could be a huge counting error. I'm a sceptical on the fact that the sperm counts are declining on the basis of the data that I've seen.

So when will we know if sperm counts really are dropping? Well, one answer to that is if they are dropping, we might know when we finally get infertility and men don't have any sperm left, but that's probably too late. Alan is kind of joking here, but also kind of not. Because if it is true and sperm counts do keep dropping to the point where they actually start affecting fertility, this really could open up a whole can of sperms for humanity, particularly if you couple this with the fact that lots of people are having babies later and later. Is this age at which

couples are wanting to have their children going to carry on increasing? And if it does, the two together are a perfect storm. Conclusion. There is some scary research suggesting that sperm counts are dropping. But scientists are still fighting over this, so it doesn't look like it's time to panic yet. Just try to enjoy your next slice of cheesy pizza. So, when it comes to the fertility cliff, does it stack up? One. Is the fertility cliff real for women? Yes.

Kind of. It's more like a ski slope. So while many women will get pregnant later in life, on average, fertility does start to drop off in their mid-30s. And from there, it just keeps falling. The reason this happens is that our eggs start to get older, which can mess up their DNA, and that can cause genetic conditions in the bub. Two, what about men?

Are their swimmers healthy forever? No. While men don't have a fertility cliff, they do have to worry about genetic mutations in their sperm, which can increase their baby's risk of getting some medical conditions. So what does this mean for Meryl and Chris? Well, Meryl's only 34. She's on the fertility slope, but she's not skiing down a black diamond run just yet.

And Chris's swimmers, as best we can tell, they look good. So that shouldn't really explain what's going on. With that out of the way, they figured, well, let's keep trying to have a baby. Maybe it'll happen. On a recent evening in their Brooklyn apartment, Meryl took another pregnancy test. Yeah, it feels like maybe it'll actually be positive this time because now we know there's nothing wrong with us so there's no reason it shouldn't be positive right

alright do you want to look at it yeah alright we're gonna go look at the test. So, Chris has his phone out and is, I guess, recording a video. Why are you recording this video? I don't know, just in case.

No, but it's gonna be sad when we turn it over and it's negative. We don't have to do anything with the video. No, it's okay. Let's just do it. It's only one line, which means it's negative. It's just one pink line. Well, I'm kind of sad. I don't know.. I don't know. I just don't know what else I could be doing.

It's not your fault. So it's your fault. It's nobody's fault. Like it just hasn't happened yet. Yeah. It's not all happy endings. It might be a happy ending. It's just an unhappy middle.

Yeah. Right now, we don't know why Meryl and Chris are having trouble making a baby, and whether this would have been easier for them if they'd started trying years ago. And that's the thing about stats like the fertility ski slope. You can't

know ahead of time whether this is actually going to be a problem for you. And while that may be scary and anxiety provoking, Meryl and Chris actually feel better about this all now that they're armed with a ton of facts. They decided to start treatment next month and they're feeling pretty good about it. That's science versus the fertility cliff. Hi Meryl. Hi Wendy. So how many citations in this week's episode? I have found, along with the rest of our team, 121 citations for this script.

121 citations. And where can people go if they want to see them all in all their glory? You can find them in our show notes or our website. And if you want to look at the fertility cliff in all its non-glory. You mean the fertility ski slope. The fertility ski slope. You can find that on our Instagram, which is science underscore VS. Oh, and by the way, if you liked this week's episode, Gimlet has just released a new show, a brand new show that you should check out. It's hosted by reproductive psychiatrist Alexandra Sachs, and each episode is kind of like therapy for women struggling with all kinds of issues. It's actually really good. I've already listened to the first two episodes and I'm addicted. Oh, wow. It's called Motherhood Sessions. We're going to play a little bit of it for you here. In this episode, Alexandra talks to a woman called Tony, who is facing the fertility ski slope

as a single woman. Here it is. If there's one thing you could get help with today from me, what would that be? I think I have always wanted to be a mother. If you asked me what I wanted to be when I grew up as a child, it was not a ballerina or a teacher. It was a mother. I thought that was like the ultimate job. But what if that doesn't come to fruition? What if what doesn't come to fruition? If me becoming a mother does not come to fruition, like, how do I process that and how will I feel okay about it? And I'm at the point where, like, for many years it was just like, I don't care about a plan.

Like, things will happen when they happen how they happen. I think, unfortunately, that biological limitation is what kind of creates this whole kind of uncertainty. Yeah. is what kind of creates this whole kind of uncertainty. I have many friends who are in the same situation where I'm like, this is the year where I kind of have to figure it out. Like, if that person does not materialize, I have to prioritize a child over my soulmate. Because I literally have my entire life to find my soulmate and I do not have my entire life to birth children.

That's Motherhood Sessions. Find it on Spotify or wherever you listen to podcasts. We're taking a week to work on more stories, but then we'll be back with the placebo effect. Does your mind have the power to heal you? This episode was produced by Meryl Horne, with help from me, Wendy Zuckerman, as well as Rose Rimler and Michelle Dang.

Our senior producer is Caitlin Sorey. We're edited by Blythe Terrell, fact-checking by Diane Kelly. Editing help from Caitlin Kenney. Mix and sound design by Peter Leonard. Music by Peter Leonard, Emma Munger and Bobby Lord. Recording assistants from Mary Dowie and Andy Short. A huge thanks to all of the scientists that we got in touch with for this episode,

including Dr Richard Lee, Dr Haggai Levine, Professor Jens-Peter Elikilder-Bond and others. And a special thanks to everyone at Gimlet who listened to this episode, as well as the Zuckerman family and Joseph Lavelle-Wilson. And finally, a huge thanks to Chris Suter. We couldn't have done this without you. I'm Wendy Zuckerman. Back to you next time.