For Caroline Gallup it all started too late. She met her husband-to-be at 32 and by the time they bought a flat together four years later her chance of conceiving naturally was already biologically in freefall.
It took another two years for the couple to discover they were both infertile. When she embarked on IVF, Caroline was 39 and too old to have it paid for by the NHS. Despite pouring in thousands of pounds and making every effort she could, early rounds of treatment failed.
It was only when she turned 41 – when her chances of a successful round of IVF had fallen to between 2% and 5%, the money was running out, she was emotionally damaged, physically ill and her relationship with her partner Bruce severely strained – that Caroline decided it was time to stop.
On Friday, as she sat down to a gin and tonic in her London home and celebrated her 46th birthday with her husband, she knew – as she had known every day for the past four years – that she would never become a mother. "It was like a bereavement, a kick in the stomach. You imagine what that child is going to look like and to let go of that is a very painful process," she said. "It ruins lives."
Cases like Caroline's are becoming more and more frequent and have led medical experts, economists and campaigners to warn that the trend for women to put off having children may have gone too far. Britain, they say, needs a "fertility wake-up-call".
With the average age at which married women have a first child constantly rising and now above 30, academics are asking: "When will it stop?" They want couples to realise that despite decades of cultural evolution, women's biological clocks have not changed; that IVF is not always the miracle cure and its chances of success decline rapidly with age and that celebrities who give birth in their late 40s are almost always using donor eggs whether they admit it or not.
As a result, some are calling for a major educational campaign through schools, college and universities to highlight the realities. Dr Mark Hamilton, a consultant obstetrician and gynaecologist and former chair of the British Fertility Society, argued that pupils should be taught about their biological clocks alongside lessons about safe sex.
"There is patchy understanding about fertility among the general public, even among those who are well-read and highly educated," said Hamilton, who argued that far too many people believed fertility treatments were more successful than they actually were.
"Sexual health messages at the moment focus entirely on avoidance of sex but this should be coupled with promotion of awareness and other factors linked to fertility potential. Schools should be teaching these lessons along with their other sexual health education. It should be taught at university and colleges. It should be talked about in magazines, published in Department of Health leaflets and publicised in the media. It should be at the heart of a culture that prides itself on responsible sexual health messages."
Susan Seenan of Infertility UK agreed that the only emphasis for younger women was currently on contraception. "We spend our twenties trying not to get pregnant and our thirties trying very hard to get pregnant," she said. If women choose to put off having a family it should be with a full understanding of the risks, she added.
Others suggested a wake-up call for every couple in the country. Professor Bill Ledger, a member of the HFEA based at Sheffield university, said that 30-year-old women who do not have children but want them should have a "fertility MOT". That would involve discussing their medical history with a doctor to fully assess any risks and undergoing a blood test to measure ovarian reserves. If necessary that could then lead to an ultrasound for a more thorough examintaion. Ledger admitted it was not something that the NHS was likely to fund and said the cost of the initial test was around £100.
Critics warned the move could be dangerous, with those shown to have a strong reserve then tempted to defer parenthood even further. But Ledger said the process would make couples "wake up and smell the coffee" and could save money on IVF if they used the information to start trying for a family earlier than planned. He also called on the government to use policies to encourage couples to consider conceiving in their 20s instead of 30s. Britain, he argued, could be "kinder" to young mothers by emulating policies in other countries across Europe and the world.
In France mothers with three children can take a year off work and receive a monthly pay-cheque of £710 from the government. Families are also given access to low-cost preschool, subsidised at-home care, cut-price travel and holiday vouchers.
In Sweden both parents are offered 18 months government-paid leave while Australia plans to introduce a paid national parental leave scheme that would see parents receiving £6,000 over 18 weeks.
"There are a number of reasons that women put off having children," said Ledger. "If it is because they make the choice to live life to the full as a single person, to travel the world and enjoy themselves, then that is fine. But if the reason is that they are worried about stepping out of their career, because they fear losing their job or being demoted, then perhaps society could be kinder to young mothers with children. There could be stronger laws to protect people, more paternity leave, support for employers."
But critics warn against over-simplifying the issue. The reasons women and men are increasingly pushing back parenthood are extremely complex and tough to crack, they say. Last month a report from the women's rights organisation the Fawcett Society illustrated just how dramatic the impact of having a child was on a woman's career. The report, entitled 'Not Having It All: How motherhood reduces women's pay and employment prospects', found that just over half of mothers with children under five were in paid work compared to nine out of 10 fathers. Women in relationships who did not have dependent children earned 9% less than men, the study found. But for those with two children the pay gap rose to 21.6%.
The recession, meanwhile, had made pregnant women feel even more vulnerable with increasing numbers seeking help because they felt they had been discriminated against. Meanwhile, an article in The Observer's business section this week shows a sharp increase in the number of employers using the downturn as an excuse to shed female workers who are pregnant or have small children.
Mary Macleod, chief executive of the Family and Parenting Insitute, said society had changed dramatically in the past couple of decades and that people in their twenties often did not feel ready for a family. "The way we live now – it is almost impossible to have even modest pleasures such as holidays and a house on one income," she said. "And there is an issue about when men are willing to commit. Young people are much more dependent than they used to be – a quarter of men aged 18 to 30 and 18% of women live at home. Establishing themselves financially is a much bigger struggle and often they aren't in stable relationships."
"Being young" in 2009, added Macleod, often meant living life in a way that didn't fit with having a child. But others pointed out that whatever the cultural or social arguments for delaying parenthood, the biological ones remained stark. However uncomfortable the subject, they said it needed to be discussed.
Dr Ros Altmann, a former investment banker and Downing street adviser who now works as an economist, said failure to act could be a demographic disaster. "The support ratio of younger people to older people is top heavy and getting more so," said Altmann. "We have more people in their 60s, 70s, 80s and 90s and not enough young people. One option is to keep older workers in the workforce longer, but it would also be beneficial to help women understand the risk of waiting." She argued that what was needed was a shift in society so that women who were in a position to have children felt able to step out of their careers in their 20s. "If you start work at 18 and drop out at 30 then you have only had 12 years. You could argue if you have your kids in your 20s, then start in your 30s you have decades uninterrupted to build your career." Altmann said that such a shift would require "far-sighted employers", training and education. "The general trend to say it is safe to wait is dangerous to women themselves and to the economy," added Altmann, who returned to consultancy work after having three children. "The idea for me would be for women to think differently. Firstly to recognise the risks of waiting and secondly to recognise the potential of coming back to the labour force and having a clear run. It would save money on IVF and a lot of heartache from thinking those who thought they could wait but then realised their bodies would not allow them that luxury." It was fine for couples to wait as long as it was not based on the "naive idea" that having a child in your 30s was the same as in your 20s, she said.
Carey Oppenheim, co-director of the Institute for Public Policy Research, agreed that more education was needed to encourage people to think about parenthood earlier. But she did not believe that the government could use policies to trigger such a change.
"It is quite difficult to think about incentives for younger women to have children," said Oppenheim. "I think because people are making those choices for a wide range of reasons – some because of work and getting settled into a job, some because they see the life-span increasing and everyone is living longer, some are waiting for the right relationship, some for cultural reasons. I think that actually what we should be doing is improving the work-life balance, paternity and maternity leave, access to flexible working and be much more ambitious about that – but it has to be available to men and women at any age." One idea would be to turn around flexible working so it was the employer's responsibility to offer it rather than the employee's right to ask.
But myths about fertility needed to be broken, she added. "There was certainly a view among my generation that you could wait for ever and it would all be okay – maybe it was almost a kind of arrogance that comes with science being able to solve everything – but actually there are difficult choices to be made."
Ledger said the reason he was pushing couples to make those difficult decisions was because of what he saw day in, day out in his clinics. It was common for patients to break down – often in tears – as they were told that their dream of becoming a parent was in tatters, he said. Educating people about the age factor could ease that pain for at least some.
"People grieve because they are going through a bereavement for the child they never had," said Ledger. "You see relationships ending, people taking strong antidepressants, people who spend all their money. One person told me she spent £60,000 and no baby.
"And often the person who waited until 39 to try is the successful career woman, who passed her school exams, went to university, got a good job and climbed up the career ladder and suddenly she can't have something that everyone else can."
Ledger added: "There is a lot of psychological ill health – otherwise sensible, well-balanced people who do crazy things because they can't have a baby."
One growing trend that has emerged is for men and women to spend hundreds of pounds on upmarket fertility retreats which offer yoga, acupuncture and meditation that they claim could improve egg and sperm quality – something medically-trained experts say is impossible.
Dr Gillian Lockwood, a spokeswoman for the British Fertility Society and head of clinic at Midland Fertility Services, said there was evidence that lifestyle choices such as smoking and drinking could reduce the risk of a woman damaging her eggs. "I have seen people literally waste years doing these so-called natural programmes only to discover that all along there was a medical problem which it is now far too late to treat," she said.
And it is that very issue that is driving many of the experts who have spoken today. To encourage men and women to realise that while fertility treatments are extremely advanced they are not a miracle cure. And to understand that if they want a child above a certain age their only hope may be donor eggs, or adoption – and that even this becomes more difficult with age.
For Caroline Gallup it simply wasn't something that she wanted. "The automatic assumption is that it is a baby at any cost," said Gallup who ended up deciding that for her and Bruce it was not going to be at any cost. Her body, finances and emotions were ravaged by her desperate attempts to get pregnant and in the end adoption was not something she wanted to consider.
But she is strongly of favour of educating women who are younger than her to understand how difficult it can be. "We may be evolving culturally but when it comes to fertility we are not evolving biologically," she said. "And out culture is absolutely not geared up to deal with that. We need a sea change."
The generation gap: same wishes, different expectations
Margaret Carroll, 56, brought up her son and two daughters in Stalybridge, Greater Manchester. She explains just how much has changed between her generation and the next.
"I met my husband, Steve, when I was 18. We were engaged at 21 and married at 23. We've been together ever since. We started trying for children 18 months after we got married and I lost three in succession. It was the most amazing feeling when I gave birth to Matthew at the age of 28. That was old back then – all my friends already had children by then."
Margaret left school at 16 and went straight into work. But once she became a mother, she dropped out of the workforce until her youngest, Claire, was in secondary school. That was 'the done thing' back then. Now she works in childcare and sees "babies dropped off at 7.30am and picked up at 6pm". "They probably go home, have a bath and are put to bed, which is sad," she says.
But she admits it is a different world to the one she grew up in. All three of her children went to university and both her daughters are determined to succeed in their careers before turning to family life. That is despite the fact that Sarah – now 26 – has been in a relationship with her boyfriend, Grant, for nine years and the couple live together.
"I had always set the age for having children at 30," said Sarah who works as a pharmacist.
"I knew I wanted to go to university, get a job and work for some years beforehand," she explains. Besides, at 26 she doesn't feel anywhere near ready for a child. "I don't feel I could have a child at all," says Sarah, laughing.
"I work full time, I pay the mortgage but I can just about get myself up in the morning."
And fertility is not something she and her friends ever discuss: "It never even crosses your mind. We all just assume we will have kids, and never think we won't be able to. We don't talk about the fact that you have a ticking time-bomb." At school, she says, there was some sex education but the issue of fertility was never mentioned. "For my mum's generation it wasn't an issue not to have a career – but for ours it absolutely is."
Claire, who at 23 is training to be a sports teacher, agrees: "I want to wait until I am 30 or 32. I just want to get my career sorted first. I want marriage first. A mortgage first. I want to be stable and these days that is hard."
Claire has one friend who has already had a baby "and she has found it difficult to get back into her career because she hadn't really got into it in the first place".
