Two major trends have been pervading fertility treatments over the last 20 years: the rapid aging of the fertility patient population and an almost equally rapid increase in numbers of women who seek fertility treatments as single parents. We have addressed the “graying” of fertility services on repeated occasions; here, for the first time, we address the voluntary choice of women to become single mothers.
As of 2018, U.S. statistics suggest that over 11.3 million families in the country are headed up by a single parent, 81.5% of those by a single woman. Approximately 16.4 million children under the age of 18 are currently being raised without a father. Historically, the high numbers of single (female) parent families were viewed as a part of a vicious social cycle of poverty since most single parent families were minorities and poor. Single teenage motherhood has, however, dramatically declined over the last decade and in older women one must clearly differentiate between those women who accidentally conceive and a rapidly growing number of women who pursue single motherhoodwith full purpose, often involving fertility treatments and donor semen. It is this last group, we want to address here.
Though numbers are hard to come by, Emma Johnson offered up some interesting statistics: Among babies born to millennials, 57% were born out of wedlock and 64% of millennial mothers had at least one birth while not married. Somewhat outdated numbers demonstrated between 2007 and 2012 a 48% increase in births to unmarried women at ages 35-39 and a 29% increase in women at ages 40-44 years.
Single women with professional careers are increasingly choosing to parent solo, often using fertility treatments to conceive.
Driving these developments are dramatic societal changes: Women in the work force socialize less, marry less and, as we discussed in these pages before, have a much harder time finding suitable partners. In addition, 1.2 million couples divorce every year, and traditional families with two parents in the house are now in the minority. As Emma Johnson also reported, 46% of millennials and 44% of GenX consider marriage an obsolete social construct. With women becoming economically more independent, they can afford single motherhood more easily.
We observe this or similar scenarios at CHR with increasing frequency, and not only in wealthy individuals. The creativity of arrangements that we have seen single professional women coming up with in order to facilitate their single motherhood is really remarkable at times, from banding together with other women in the same position to hire help, share housing facilities, engage family members and friends to switching into jobs that allow them more flexibility in the amount of attendance in business offices or even permit full-time work from home. With employers now being more prepared to show more flexibility, such arrangements seem to multiply rapidly. We here at CHR, therefore, are convinced that the rapidly growing trend of becoming single professional mothers will continue to expand.
If you are a single woman and are considering becoming a mom, you are probably best advised to see a fertility specialist before reaching any major decisions on your own. There is good reason for this advice because we have seen considerable harm when women started with treatments, like self-inseminations, on their own. Not only can self-inseminations be dangerous if the source of the semen is not properly vetted, but in order for inseminations to even have a chance of success, the fallopian tubes must be open and properly functional. To start insemination before tubes are verified to be open, therefore, means taking an unnecessary risk.
Since most women who decide to become single mothers are a little older, other infertility problems may also be present. It, therefore, is really worthwhile to consult with a fertility specialist, have basic diagnostic testing done and discuss with the physician what the options are to conceive.
Single women always need donor semen. Not uncommonly, they intend to use semen from a “friend.” Such a choice, however, strongly complicates and delays their pregnancy attempts because, under professional guidelines and the law, donor semen must be quarantined for at least 6 months before use. Donor semen in sperm banks has usually already been quarantined and, therefore, can be immediately used. The only exception to the 6-month rule applies if the donor and patient are sexually intimate. Since the female in such a case is naturally exposed to the donor’s semen, quarantine is not required.
Once the woman has undergone the appropriate testing, it will be abundantly clear what the options are for her to conceive. In principle two options exist: To perform intrauterine inseminations (IUIs) with donor semen or to use the donor semen in an IVF cycle. It would exceed the framework of this discussion to go into too much further detail; only so much: In order to even consider IUIs, at least one fallopian tube must be open and properly functional. If that is not the case, IVF is recommended because tubal surgery is no longer recommended as an alternative in most cases. IUIs are also not advised if women are over age 40 and/or have low functional ovarian reserve for their age (i.e., suffer from premature ovarian aging, POA).
At CHR, we are not only concerned about the physical wellbeing of our patients but also about their psychological and social welfare. In other words, we are trying to make their life better, not worse, and that requires considerations beyond just medical decision making. We, therefore, seek the advice of clinical psychologists and/or social workers in many cases.
Here is a very good, as of this moment still unresolved, example. Only less than two years ago, a CHR patient at advanced age gave birth to a beautiful daughter. Now, she wants her to have a sibling when she grows up. The woman is perfectly healthy, socially stable and economically well-off, but CHR’s physicians raised the question whether, at her age, having to care for two infants, would really “make her life better.”
We will, likely, proceed with this patient, and hope to be successful in giving her daughter a sibling to grow up with. But before we do so, we will try to make certain that adding another infant to the family will not disturb what currently appears to be a truly idyllic situation.
Even for the wealthiest professional woman it is not easy raising children without another parent in the family, but that does not mean it cannot be done successfully. Most psychologists agree that children need both parents as guides through life. But when father figures are missing, alternatives can be pursued. The young Barak Obama, who felt abandoned not only by his African father but also by his Caucasian American mother, offers in that regard an interesting example: When his white grandparents, who at the time were raising him in Hawaii, concluded he needed a black “father figure,” they brought such a figure into his life in the form of a well-known black writer, journalist an political agitator who, at least in a political sense, indeed, did become something of a father figure for him.
What represents a family has in the last few decades been radically redefined in much of the Western world. As a leading health care provider in our field, CHR not only recognizes this fact but also perceives a responsibility to adjust the center's services accordingly. This does not only mean serving the fertility needs of the LGBTQ community but also serving single woman and single men who wish to become single parents and for whom such an opportunity, indeed, would make their lives better and happier.
This is a part of the March 2019 CHR VOICE.
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
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