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Social Science & Medicine 63 (2006) 1550–1560
www.elsevier.com/locate/socscimed
Rethinking the biological clock: Eleventh-hour moms, miracle
moms and meanings of age-related infertility
Carrie Friese
�
, Gay Becker, Robert D. Nachtigall
Department of Social & Behavioral Sciences, UC San Francisco,
Box 0612, 3333 California Street, Suite 455, San Francisco, CA
94118, USA
Available online 19 May 2006
Abstract
Over the past generation, aging and female reproduction have
been lodged within the gendered and gendering debates

regarding women’s involvement in the workforce and
demographic shifts toward delayed parenting that culminate in
discourses on the ‘‘biological clock’’. Technological solutions
to the biological clock, specifically in vitro fertilization, have
led to clinical attempts to assess ‘‘ovarian reserve’’, or
qualitative and quantitative changes in the ovary that correlate
with
aging and with successful infertility treatment. Rupturing the
longstanding historical connections between menstruation
and female reproductive capacity by specifically focusing on
the aging of a woman’s eggs, the clinical designation of
‘‘diminished ovarian reserve’’ has come to imply that a woman
has ‘‘old eggs’’. This is associated in practitioners’ and
patients’ minds with the eclipse of a woman’s reproductive
potential and with hidden harbingers of menopause.
In an ethnographic interview study of 79 couples in the US who
conceived after using donor oocytes, we found that
women voiced two different narratives that described their
experience and attitudes when confronted with an apparent age-
related decline in their fertility. The ‘‘eleventh-hour mom’’
narrative was voiced by women who initially tried to become
pregnant with their own eggs and turned to donated oocytes as a
second-choice option, whereas the ‘‘miracle mom’’
narrative was expressed by women who were generally older,
some of whom had entered infertility treatment hoping to

conceive with their own eggs, but some who knew from the
outset that it was not going to be possible. Through their
narratives women not only embodied and made meaningful
‘‘diminished ovarian reserve’’ in varying ways that connect
with cultural, social, structural/organizational, symbolic and
physical aspects of aging, they reproduced the socio-
biological project of the biological clock, but rooted this social
project in the metaphor of ‘‘old eggs’’ rather than
menopause.
r 2006 Elsevier Ltd. All rights reserved.
Keywords: Infertility; Age; Donor egg; Biological clock; US
Introduction
A wealth of social science literature focusing on
unwanted childlessness and advanced reproductive
e front matter r 2006 Elsevier Ltd. All rights reserved
cscimed.2006.03.034
ing author. Tel.: +1 415 643 4558.
esses: [email protected] (C. Friese),
sf.edu (G. Becker), [email protected]
ll).
technologies (ART) has emerged over the past 20
years that addresses a wide range of topics. These
include the experience of infertility and its treatment
(Becker, 1997, 2000; Greil, 1991; Inhorn, 1994;

Sandelowski, 1993; Thompson, 2005), its pervasive
and problematic nature globally (Inhorn, 1994,
2003; Inhorn & Van Balen, 2003; Kahn, 2000),
the complexities ART poses for understandings
of kinship (Edwards, Franklin, Hirsch, Price, &
.
www.elsevier.com/locate/socscimed
dx.doi.org/10.1016/j.socscimed.2006.03.034
mailto:[email protected]
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1560 1551
Strathern, 1993; Franklin, 1997; Franklin & Ra-
gone, 1998; Strathern, 1992), and the dilemmas
arising out of third-party parenting (Becker, Butler,
& Nachtigall, 2005; Nachtigall, Becker, Quiroga, &
Tschann, 1998; Nachtigall, Tschann, Quiroga,
Pitcher, & Becker, 1997; Ragone, 1994; Whiteford,
1989). Yet despite the considerable attention given
to these and other ‘‘reproductive disruptions’’ (Van
Balen & Inhorn, 2003), limited work has addressed
the experience of ‘‘older women’’ who conceive with
ART using donor eggs (Becker, 1997, 2000;
Thompson, 2005).
For a generation, aging and female reproduction
have been lodged within the gendered and gendering
debates regarding women’s involvement in the
workforce and demographic shifts toward delayed
parenting which culminate in discourses on the

‘‘biological clock.’’ The biological clock is a hetero-
geneous concept that carries a range of connota-
tions, emerging in the 1970s to capture the
interconnections and fissures between social and
physiological domains regarding women’s bodies
and reproduction. Central to the biological clock
discourse is the notion that the public domain,
organized around paid labor, interferes and com-
petes with a woman’s fertile years. By the early
1980s, the biological clock came to be stereotypi-
cally identified with a cohort of largely Caucasian,
educated, upper-middle class, baby-boom women
(McKaughan, 1987). Access to medical technologies
and techniques, specifically effective birth control
and safe and legal abortions, allowed large numbers
of women to voluntarily postpone childbearing.
Subsequently, women who chose to have children in
their mid-to-late 30s triggered a much-publicized
‘‘infertility epidemic’’ (Aral & Cates, 1983), char-
acterized as women anxiously pursing pregnancy
before it was ‘‘too late’’ (McKaughan, 1987). Marsh
and Ronner (1996, pp. 245–246) observe that the
extent of this infertility epidemic is contested
because precise historical infertility statistics are
difficult to obtain. Nonetheless, there is a predomi-
nant belief that infertility is a greater problem now
than previously. Some women began to see the
biological clock as a kind of deadline as they made
decisions about childbearing, a notion through
which women have been implicitly blamed for their
infertility.
The question underlying the notion of a biologi-
cal clock has been: ‘‘How late can a woman wait to
have children?’’ Menstruation and reproduction
have long been interconnected both physiologically

and socio-culturally. The cessation of menses has
been understood to mark the end of female
reproductive capability, thereby separating women’s
lives into the discrete time frames of menstruating/
reproductive and menopausal/non-reproductive
years (Formanek, 1990; Utian, 1990). Yet as
increasing numbers of women in their late 30s and
early 40s attempted to conceive, it became increas-
ingly clear to medical infertility specialists that the
later a woman waited to embark on a first
pregnancy, the greater the chance that age-related
factors would diminish her ability to become
pregnant at all, even following the introduction
and proliferation of ART (Edwards et al., 1984).
This impression has been confirmed by two large
data sets, one a widely publicized report from
France in the early 1980s (Schwartz & Mayaux,
1982), and more recently a report based on US data
that indicated that the chances of a live birth after a
cycle of in vitro fertilization (IVF) treatment fall
from 1 in 3 for women under age 35, to 1 in 10 for
women over 40, to less than 1 in 20 for women over
42 (Centers for Disease Control and Prevention,
2004). This led to the widespread conclusion among
infertility specialists that there is an age (arguably
older than 43–44) that precludes the likelihood of
pregnancy resulting from infertility treatment using
a woman’s own gametes.
New reproductive technologies have long been
associated with the concept of medicalization, the
process by which human experiences are redefined
as medical problems (Zola, 1972). This medicaliza-
tion process may be initiated either from within
biomedicine or by members of the public who seek
legitimacy for a social condition (McLean, 1990)

and is epitomized by the growth of medical
treatment for infertility, a condition formerly
viewed as a social problem but now perceived as a
medical condition (Becker & Nachtigall, 1992).
Moreover, consumers may, and often do, embrace
medicalization (Becker, 2000; Becker & Nachtigall,
1992). Clarke and her colleagues have reframed this
concept as ‘‘biomedicalization,’’ to encompass its
interactive process which engages all the elements of
technology development and use, including the roles
of biomedicine and consumers (Clarke, Shim,
Mamo, Fosket, & Fishman, 2003).
Technological solutions to the biological clock,
specifically the use of IVF and its related technol-
ogies that employ donor oocytes (eggs) to achieve a
pregnancy, have increasingly been at the forefront
of medical treatment. Here we see the complexity of
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the process of biomedicalization at work. Thomp-
son (2005, pp. 90–91) notes that initially a woman’s
age was not particularly seen as ‘‘biological’’ despite
its correlation with a rapid decline in fertility.
However, the growing public and legislative de-
mand for clinic accountability with respect to IVF
pregnancy rates led infertility specialists to search
for criteria that could more accurately predict the
likelihood of success of particular ART procedures.
Those qualitative and quantitative changes in the
ovary that correlate with the probability of a
woman becoming pregnant if she undergoes IVF

using her own oocytes were referred to as ‘‘ovarian
reserve’’ (Scott & Hofmann, 1995). The concept of
ovarian reserve is significant because it ruptures the
longstanding historical connections between men-
struation and female reproductive capacity by
specifically focusing on the aging of a woman’s
eggs. Furthermore, the traditional clinical emphasis
on menstrual regularity and ovulatory function as
characteristics of continued fertility has given way
to an assessment driven by the consideration of a
woman’s suitability as a candidate for advanced
reproductive technologies.
It should be noted that although over 13 different
procedures have been described for evaluating a
woman’s ovarian reserve, the criteria for normal
ovarian function is not precise, there is no universal
agreement among clinicians about what it might be,
and only women embarking on IVF procedures are
actually tested for it (Bukulmez & Arici, 2004).
Despite these uncertainties, Thompson (2005) notes
that the clinical designation of ‘‘diminished ovarian
reserve’’ has come to imply that a woman has ‘‘old
eggs’’ and is associated in practitioners’ and
patients’ minds with the eclipse of a woman’s
reproductive potential and with hidden harbingers
of menopause. She found that many women
experienced these evaluations as an additional insult
to their already compromised gender identity and
linked the denial of access to treatment using their
own (as opposed to donor) eggs to an assault on
their biological age.
The medical implications of being identified as
having ‘‘diminished ovarian reserve’’ are profound:
a woman’s treatment options are reduced to

conception using the ‘‘donated’’ eggs of another,
usually much younger, woman. At the same time,
women in their mid- to late 40s and older—an age
traditionally thought of as being menopausal and
thereby nonreproductive—are told that not only is
pregnancy using a donor egg possible, but that their
chances of pregnancy are equal to those of women
10–20 years their junior. In this article we examine
how women who used a donor egg to conceive their
child(ren) ascribed meaning to their own aging as
they confronted infertility. As the idea of having
‘‘old eggs’’ took root, women incorporated their
thoughts and feelings about cultural categories such
as gender, aging, and the biological clock in
reconstituting their sense of self after infertility.
Methods
Respondents were recruited through 12 IVF
centers and one sperm bank in four counties in a
West Coast state of the USA to participate in a
study addressing the disclosure decision, i.e., how
parents of children conceived with donor gametes
decided whether or not to tell their children of the
true genetic origins. Practitioners sent letters to
couples who had conceived using donor gametes
alerting their former patients to the study, and those
interested sent a postcard to the investigators stating
their willingness to consider participation in the
study. The criteria for entry into the study were the
presence of one or more living children who had
been conceived with the use of a gamete donor,
heterosexual, and in a marital relationship at the
time of the child’s conception. Data collection is
complete.

In most cases initial couple interviews were
followed by solo interviews with each partner
approximately 3 months later. The purpose of
doing both types of interviews was to collect data
on how couples jointly perceived the process as well
as to allow individuals to discuss differences or
conflicts without their partner present. Occasionally
solo interviews preceded couple interviews. If one
but not both members of a couple agreed to be
interviewed, those respondents were also inter-
viewed. One- to two-hour long interviews were
semi-structured with many open-ended questions
that focused on how the couple decided on whether
or not to tell the child about the use of a donor.
Related topics included philosophy of family, family
relationships, feelings about having used a donor,
and approaches taken to telling children and others.
Questions about age were not on the interview
schedule but age inevitably arose in the course of
many couples’ discussions about their experiences
with infertility, parenthood, and disclosure. This
was particularly true among couples who used
donor egg to conceive their child(ren). Although
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interviewers did not probe about age systematically,
interviewers did pursue questions about age when
participants raised related concerns. Interviews were
tape-recorded and transcribed verbatim.
Data were divided by whether the child(ren) were
conceived by using donor eggs or donor sperm. A

specific procedure was followed to further develop
the data analysis: core categories that repeatedly
reappeared in the data were identified and com-
pared with other emergent categories, a process that
emerges out of ongoing reading and analysis of
transcripts by the entire team. Out of these
preliminary core categories generated from mean-
ings in the data, an in-depth process of code
development was followed. Codes are highly dis-
crete categories. Each code is a very specific topic
that appears in the data. Sections of interview text
are analyzed using all codes so that the multiple
meanings of a portion of text can be considered.
Successive phases of trial coding were conducted
until pairs of coders reached a level of agreement of
95 percent or more. The entire data set was then
coded using QSR Nud*ist, a data-sorting software
program, resulting in over 100 discrete codes, of
which age [of parent] was one. The definition of the
‘‘age’’ code was broadly construed: ‘‘discussion of
age of wife and/or husband, as factor in decisions,
attitudes.’’ This article is based on an analysis of this
code, which was cross-checked by reading tran-
scripts from which excerpts had been identified to
ascertain that excerpts were not misinterpreted by
being read out of context. This approach enabled us
to scrutinize all the data on age at the same time
rather than focusing only on certain cases, as well as
to analyze the data within their broader context.
Women discussed age far more often than did men,
and this article addresses women’s narratives only.
This allowed for an assessment of how age figured
into women’s narratives about infertility and
parenting as well as how cultural discourses on
age informed their experiences. The excerpts in the
findings section were taken from this code print-out.

Findings
Findings are based on interviews with 79 couples
who used a donor egg to conceive at least one living
child. This is a sub-set of a larger sample of 148
heterosexual couples who used a donor gamete to
conceive at least one living child. The average age of
women at the time of the first interview was 45.8
(range 35–59) with 89% of the women being aged 39
or older at the time of the first interview. The
average age of men was 47.5 (range 32–64). The
average age of women at birth of first donor egg
child was 42.2 (range 32–54) and the average age of
men at birth of first donor child was 44.1 (range
30–62). The average age of the first child conceived
through donor egg was 3.5. Of the 79 couples, 29
couples (37%) had more than one child conceived
by donor eggs. Thirty-three couples (42%) had one
or more child(ren) conceived without using donor
eggs. Average annual household income for this
sub-sample was $185,069.
We found that an important juncture in many
women’s narration of their infertility experience
involved their recollection of being shown graphs or
tables that illustrated sharply declining rates of
conception after age 38. Although these tables were
usually representations of data derived from women
attempting pregnancy by using IVF, for many
women, they were interpreted as graphic illustra-
tions of the consequences of having ‘‘old eggs.’’
Furthermore, we found that when confronted with
the apparent age-related decline in their fertility,
women in our study voiced two different narratives
that described their experience and attitudes. The

first narrative was that of ‘‘eleventh-hour moms,’’
women who initially tried to become pregnant with
treatment that utilized their own eggs but were
unsuccessful and turned to donated oocytes as a
second-choice option. Here, the socio-biological
project of the biological clock was reproduced, but
now rooted in the metaphor of ‘‘old eggs’’ rather
than menopause. The second narrative was ex-
pressed by women who were generally older, some
of whom had entered infertility treatment hoping to
conceive with their own eggs, but some who knew
from the outset that it was not going to be possible.
These ‘‘miracle moms’’ rejoiced that their bodies
had the ability to become pregnant even into the
perimenopause and after, an age they previously
thought of as ‘‘non-reproductive.’’ Across these
differing experiences, women connected the notion
of ‘‘old eggs’’ with discourses on gender and the
cultural, social, structural/organizational, symbolic
and physical aspects of aging.
Eleventh-hour moms
Women who voiced the ‘‘eleventh-hour mom’’
narrative expressed the view that their ‘‘old eggs’’
had, in effect, condensed and shortened their years
of potential fertility, making them ‘‘too old’’ to
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conceive a child earlier than they had supposed.
Women often believed that they were still fertile if
they were menstruating regularly and assumed they

could in turn get pregnant up until they were
approximately 45 years old. One woman, age 40 at
her child’s birth, stated, ‘‘I honest to God thought if
I was still cycling, life was good.’’ For many, it came
as a surprise when they realized that these assump-
tions could be wrong. For example, one woman, 44
at the birth of her child, gave this description of her
initial meeting with a reproductive endocrinologist:
I ended up at what now is the [infertility clinic].
Total novice. I purely was thinking that I needed
a better kind of thing [treatment]. And that was a
rude awakening because I started to see some real
statistics on what my chances were.y It never
occurred to me that age could be an issue because
I was still in my thirties. After all, wasn’t that still
young? Maybe, but not reproductively it wasn’t.
The treatment trajectory that women experienced
was shaped by where they saw themselves in the
graphic displays of rapidly declining conception.
For example, one woman, 40 at the birth of her
child, stated: ‘‘ythen we went to the [infertility]
clinic. We had to go through their lecture, which
talked about old age and the gray—we were in the
gray area. We weren’t in the black yet.’’ Women
who saw themselves as being in the gray area often
described a treatment trajectory wherein they first
used in vitro fertilization in the hopes that they
would be able to become pregnant using their own
ova and turned to donor egg only after failures,
believing that their eggs were too old. Here, the use
of donor egg was often configured as a second-
choice option that must be rapidly pursued because
of having lost time and having reached the end of
fertility.

For many women, learning of age-related inferti-
lity was the first time they were being categorized as
old, which led some to the self-perception that they
were themselves both aged and unhealthy. One
woman, 39 at the birth of her child, stated in an
interview: ‘‘I felt that my infertility—it felt like I was
unhealthy, to me. That’s how it felt. And that I was
older, and I was trying to get pregnant. So I felt old,
a little bit.’’ Martin (1987) has shown how the
themes of decline and decay work to negatively
evaluate menopause. Here, old eggs are similarly
construed, which shapes this woman’s self-percep-
tion. At times, this made women feel self-conscious
about their pursuit of pregnancy, which is viewed
culturally as a symbol of youth. Another woman, 42
at her child’s birth, stated: ‘‘It’s hard when you’re
thinking about having a child—that whole sense is
one of youthfulness. The person is youthful and
useful if they can bear children. And if you can’t,
then you’re old.’’
Lost time and medical care
Women described a condensation, shortening, or
curtailment of their reproductive years that was
experienced not only as premature aging but as
having lost time or being in a state where precious
time was constantly slipping away. For some, lost
time also implied waste: in time, opportunity, or
eggs. Through the notion of waste, one woman
blamed herself for her infertility:
I walked around with all these little, bubbling
eggs inside me, and I didn’t give it a thought. I
didn’t show appreciation. I didn’t give thanks for

it. I didn’t think it was something valuable. I just
pissed on it, you know. And now, that I want it,
it’s gone (43 at birth of child).
Another expression of lost time was the notion
that time had sped up after women were told they
had old eggs. The notion that women’s ova age in a
manner that lowers the chances of pregnancy
despite continuing normal menstruation collapses
women’s number of fertile years. In turn, time
condensation propels a greater sense of urgency in
getting pregnant quickly. Procedures like in vitro
fertilization require much preparatory time and, for
women given an age prognosis, are likely to fail.
One woman, who was 37 at the time of her first
birth, stated: ‘‘By the standard of IVF stuff, every
month is a lot for someone trying to get pregnant
that way—every week really, especially after forty.
You have to be thrown into the fire.’’
Some women blamed their obstetrician/gynecol-
ogist for this lost time and were upset that they did
not have proper information to make their repro-
ductive decisions. They were resentful of the medical
community for not providing them with informa-
tion about the ways in which aging eggs have
consequences for female infertility. Some women
noted that they would have done things differently
if they had been provided with this information. For
example, one woman recounted how she was given
an 8-month supply of clomiphene from her obste-
trician/gynecologist to assist her in getting pregnant
at the age of 42 after having tried with her husband

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to become pregnant for over 1 year. After 2 months
of taking medication without getting pregnant, she
requested a more comprehensive fertility plan and
was sent to an infertility clinic. In her first meeting
with the reproductive endocrinologist she was told
that, due to her age, the only option available for
her in achieving pregnancy would be donor egg. She
stated: ‘‘So when I was 40 I should have been at the
fertility clinic, not 42. And so I feel like I lost those
two years and I had a lot of resentment [at being in]
that position.’’ Another woman went to see her
obstetrician/gynecologist at the age of 38 to find out
if she needed to make pregnancy an immediate
priority or if she had some time to wait. Her
physician said she would be fine unless she waited
until she was 44. Because she was in the midst of a
number of stressful life events, she decided to wait.
When she reached the age of 43 and started trying to
conceive, she learned her eggs were no longer viable.
Educating others about age-related infertility
Many women were upset that they did not have
adequate information in making their reproductive
decisions, and some became vocal advocates en-
gaged in educating women about the implications of
age and fertility. This was particularly evident
among women who gave birth between the ages of
39 and 43, but also among women who delivered
before age 39. These women advocated that other
women, given the knowledge that they had lacked,
have children earlier, were it possible to do so. They
believed this would be preferable compared to

undergoing the emotional and physical stress
associated with invasive infertility treatments. One
woman, 35 at the birth of her child, stated:
I tell people, ‘don’t wait too long.’ I wouldn’t
wish this on anybody.y I don’t love my
daughter any less, and I’m not angry that I had
to go through this, but I would never wish this on
anybody else. I would not want somebody to
have to go through this way of conceiving
children. But it doesn’t mean that, in the end, it
didn’t turn out okay for me.
Furthermore, some women were concerned that
younger women would interpret their successful
pregnancies at an older age as a signal that it is
possible to get pregnant later in life:
I think they’re creating false hopes for women
over forty when other women over forty hear
that these women have had children and they
ask, ‘How did you have them?’, and they say,
‘We tried hard and we finally got our child.’
They’re creating false hopes.y I’m sad that this
myth is prolonged, that you can do everything in
life and still have a child at age forty. They’re
probably going to more extreme measures but
they’re not telling people (44 at birth of child).
Another respondent, 43 at the birth of her child,
noted how easy it would be for her to perpetuate the
notion that woman are fertile until they reach
menopause, but her sense of social responsibility in
educating other women took precedence:
My desire to make this rightyis to put my ego to

the side, versus get all the accolades of ‘She’s so
beautiful, she’s got your eyes and your hair’ y I
would rather have them know the real story and
have them say ‘Oh my gosh, you’re kidding,’ and
then take that information and again be more
beneficial. Versus going, ‘I ran into a 44-year-old
woman and she has a baby. Oh, don’t worry. It’s
no problem.’
Many women, however, also believed that tech-
nological solutions should be available to women
and some argued for more and better technologies
that could serve as ‘‘back-up plans’’ or ‘‘insurance
policies’’ for women who did not have control over
the contexts that shaped their reproductive prac-
tices. Women defended themselves against those
who would blame them for their status as infertile
by pointing out that the social practice of delayed
parenting is often not a choice and gave reasons for
the reproductive decisions they made, including
their formerly single status, financial insecurity, or
meeting their husband later in life. For these
women, delayed parenting was a fact of life and
technological solutions were the only means avail-
able for contending with their situation. Some
women argued for even greater technological
intervention in reproduction.
Miracle moms
A second cluster of attitudes and experiences held
by women regarding their use of donor eggs reflects
a narrative that we call ‘‘miracle moms.’’ A typical
example of a ‘‘miracle mom’’ can be seen in one
woman’s description of her pregnancy as ‘‘at the
edge of miracles’’ and her description of her son as

‘‘definitely a miracle child.’’ Although miracle
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moms were generally less prevalent than eleventh-
hour moms, through this narrative women de-
scribed a novel conceptualization of the relationship
between infertility, age, and donor egg that may
provide insights into changing notions about the
body. Miracle moms asserted that there was not just
one biological clock, but rather many clocks that
differentially shaped the possibilities of the body.
Although women who gave birth at age 45 or later
often espoused this view, it was sometimes voiced by
women who gave birth between 38 and 44, as well.
Whereas eleventh-hour moms discussed the ways
in which new medical concepts about age prema-
turely curtail the body’s potentiality, miracle moms
expressed relief and surprise in learning all the
reproductive functions that women’s bodies are still
capable of when a younger egg is used to conceive.
One woman, age 50 at the birth of her child, stated:
‘‘yI’m still breastfeeding. I didn’t know you could
do that after menopause. They [clinical staff] were
very supportive. [They joked] ‘Of course your
nipples are sore. They’ve been there for fifty years.’’’
In contrast to the rueful old eggs dialogue voiced by
eleventh-hour moms, miracle moms expressed relief
in the realization that the use of a donor egg
obviates some of the concerns about maternal age,
infertility, and infant health. For example, one
woman, 41 at the birth of her child, stated: ‘‘I was

relieved to think that it was not going to be my
advanced, old eggs that weren’t doing me much
good right now and how much were we going to try
to manipulate these things to try to produce a
child.y It really was such a relief.’’
The extension of fertility
Rather than the eleventh-hour mom view of
fertility being curtailed by age, miracle moms view
fertility as being extended. Many of the women in
our study were concerned about the potential health
risks to both the woman and the fetus due to their
age. They reported learning that age limits a
woman’s ability to conceive and older eggs increase
the risks to the fetus. However, they also learned
that age does not limit a woman’s ability to sustain
a healthy pregnancy. One woman recounted:
We were trying to find out from somebody who
was an Ob/Gyn [obstetrician/gynecologist] what
issues might come up for an older mother.
Basically medical [issues], but anything that they
wanted to tell us, because there’s just not that
much research out there. And his advice was that
there is really no difference. The uterus is still
capable of bearing a child to term, even though
you’re past menopause (54 at birth of child).
Whereas many eleventh-hour moms extrapolated
the old eggs diagnosis to define themselves and their
bodies in a holistic manner, miracle moms viewed
eggs as one exchangeable part of the body that does
not define one’s total self. This represents a more
plastic view of the body, wherein exchanging one
bodily part can make the whole body operate anew,

creating new kinds of possibilities in pursuing social
identities across the life course.
In contrast to the eleventh-hour mom perspective
of ‘‘lost time,’’ a prominent theme within the
miracle mom narrative was the notion that donor
eggs allow one to turn back time. Many women
discussed their ability to avert the risks associated
with older pregnancy by using ‘‘young eggs’’ and
making their pregnancy into one that was ‘‘like that
of a younger woman.’’ One woman, 44 at the birth
of her child, stated: ‘‘Once I was pregnant with her
[donor’s] eggs, it’s like you’re a 24-year-old. I didn’t
have to worry about amniocentesis. I didn’t have to
worry about the risk of miscarriage of 43-year-old
eggs. It’s very interesting. There’s a certain relief
that comes with having young eggs.y It’s like the
fountain of youth.’’
The donor solution
Miracle moms often gave birth at or after the age
of 45 and thereby experienced a different clinical
trajectory when compared to eleventh-hour moms.
Miracle moms were often told right from the start
that pregnancy with their own eggs, even using IVF,
would be essentially impossible. Women felt that
this clinical decision was legitimately supported by
the statistical evidence that women have extremely
low rates of conception with their own eggs after the
age of 43, high rates of miscarriage, and high rates
of disability. Some women also entered the inferti-
lity clinic when they were menopausal or post-
menopausal and thereby ‘‘knew’’ that they could
not become pregnant.

As a result, women who gave birth at age 44 or
older were presented with fewer options as they
pursued pregnancy compared to younger women.
Many women noted that their age barred them from
adoptive services, which meant that donor egg was
the only route through which they could raise a
ARTICLE IN PRESS
1560 1557
child. Whereas donor egg was frequently viewed as
a fall-back option by eleventh-hour moms, donor
egg was the only option for miracle moms. One
woman stated: ‘‘I didn’t have a problem [with
infertility]. I mean, I never had issues with infertility
because I wasn’t ever trying to have a baby. When I
finally decided to have a baby, I was 48. And we just
went right to IVF. I was told that I couldn’t try
‘cause after 44, they won’t let you—they won’t even
attempt to have a woman use her own eggs. So we
went right to the donor solution.’’
Despite being informed that there were no known
physiological reasons for why a woman who is
perimenopausal, menopausal or post-menopausal
could not sustain a pregnancy using a donor egg,
many miracle moms nonetheless experienced some
type of stigmatization as a result of this reproduc-
tive decision. Some couples were excluded from
treatment altogether on the basis of age. Others
experienced age-related negative reactions from
physicians and/or therapists as they sought infor-
mation before pursuing pregnancy. One woman
stated: ‘‘One of the clinics said that they used a rule

of thumb that if the combined age of the parents
was over one hundred, they wouldn’t do a donor
egg procedure. We wouldn’t be eligible, which we
found kind of ridiculous—more than ridiculous. We
found it offensive’’ (49 at birth of child). Another
woman stated:
Some medical professionals injected their perso-
nal opinions in, and would not always give us
medical understanding. Some were very careful
to just answer our questions. It didn’t feel like we
were trying to do something immoral or im-
proper. We just wanted information. We’re quite
capable of making the moral decision’’ (54 at
birth of child).
Discussion
The fact that new reproductive technologies have
made it possible to extend the child-bearing years
beyond the traditional historic biologic barrier of
the menopause has far-reaching implications for the
restructuring of the entire course of life (Becker,
2000). Women have become actively engaged in and
even proponents of the biomedicalization of in-
fertility and aging as the child-bearing stage of life
has been lengthened for an additional 20 years.
With the possibility for restructuring the life course
so dramatically, the question is raised of why
women seek out and subject themselves to such
intensive and invasive medical treatment at this time
of life. Considerable literature interrogates reasons
for the pursuit of children. Van Balen and Inhorn
(2003, pp. 8–9) summarize these as: (1) social
security desires, that children are necessary for their
later support of aging parents; (2) social power

desires, that children serve as a valuable power
resource; (3) social perpetuity desires, the perceived
need to continue group structures such as lineage;
and (4) political investment, as children are used to
promote causes and engage in demographic wars.
The desires of women and men who are growing
older to parent can easily be identified as reflecting
concerns about security in old age and continuity
through the generations.
It should be noted, however, that biomedicaliza-
tion is uneven—that is, it is not a uniform process.
That many women felt their physicians, often
general obstetrician/gynecologists, had not ade-
quately informed them about the consequences of
an age-related decline in fertility raises the question
of medical ignorance, incompetence, or negligence.
These narratives highlight two phenomena: (1) the
‘‘risks’’ of age-related infertility are not adequately
assessed and appreciated by either the general
medical profession or the popular culture, and
(2) the medical evaluation of age-related fertility in
the US is almost solely the provenance of a small
number of highly specialized reproductive endocri-
nologists who provide IVF services to a relatively
small percentage of all women experiencing inferti-
lity. Furthermore, the medical evaluation of ‘‘ovar-
ian reserve’’ is an evolving clinical process that is
subject to interpretation and is rarely employed
except as a precursor to IVF treatment. Although
the concept of medicalization has traditionally been
seen as something ‘‘done to’’ patients, it must be
noted that women in both this study and in other
studies of reproductive technologies wanted more
medicalization to ameliorate the problem, not less
(Becker, 2000; Inhorn, 2003).

In our study, eleventh-hour moms discussed their
infertility trajectory as a deeply disruptive experi-
ence that inhibited their pursuit of a desired future.
On the other hand, miracle moms had given up the
expectation of motherhood, especially with their
own eggs, so they retell their stories of conception,
pregnancy and birth through a narrative structure
in which initially pessimistic expectations are
happily overturned. Both of these narrative struc-
tures make the evolving concept of age-related
ARTICLE IN PRESS
15601558
infertility meaningful in a manner that connects
with broader discourses on and around the biolo-
gical clock. Consistent with the notion of a
biological clock, eleventh-hour moms positioned
infertility in women’s behavior, specifically in the
act of delaying parenthood, but redefined and
temporally advanced the endpoint from menopause
to the late 30s, coincident with recent observations
concerning the age-related decline in the fertilization
potential of oocytes. As such, eleventh-hour moms
re-ground the biological clock discourse in a
different root metaphor, that of old eggs.
The notion of old eggs represents a fissure in both
medical and popular discourses and practices that
have been created in and through a menses/
menopause model of female reproduction. The
sense of surprise women experienced at being told
their fertility is challenged by their age and the

notion that time has been lost are based on
assumptions that follow from the menses/meno-
pause model. Eleventh-hour moms reacted to the
shifting biomedical perspective on female reproduc-
tion from a menses/menopause model to one that is
centered specifically upon the aging of ova.
By recapitulating the biological clock narrative,
eleventh-hour moms considered their reproductive
choices in a context through which they perceived
others to be blaming them for their age-related
infertility. To defend themselves against this attack
on their reproductive decision-making, women who
drew on the eleventh-hour mom narrative structure
frequently pointed to the fact that there has been
changing knowledge about female fertility that
precluded them from conducting themselves differ-
ently. In other words, women used the changing
status of expert knowledge on female reproduction
to contend that they themselves are not culpable for
their infertility. This narrative reinforces the notion
that the etiology of female infertility is embedded in
women’s behavior and can work to deem women
responsible for their status as infertile. Many
women who articulated the eleventh-hour mom
perspective engaged with the politics of blame as
they discussed aging and reproduction. While
women articulated varied responses to politicized
discourses that blame women for their infertility,
the eleventh-hour mom process is nonetheless
engaged with these discourses.
Miracle moms also configured themselves in the
context of the biological clock but in a very different
way. For miracle moms, the surprising component
of the notion of old eggs was that there is not a

single biological clock but instead a variety of
biological clocks. These women did acknowledge
that there is a physiological deadline for women to
conceive with their own eggs. However, they
contended that their eggs are just one part of the
reproductive process and that the rest of their body
is capable of sustaining a pregnancy. By dispersing
reproduction, miracle moms did not extrapolate old
eggs to mean that their bodies are past reproductive
capacity. Indeed, miracle moms rarely considered
themselves infertile per se. This fracturing of
reproduction problematizes the notion that female
fertility has a discrete end and allows miracle moms
to consider their reproductive practices outside of
the politics of blame. Whereas eleventh-hour moms
engaged in the discourses of blame in various forms,
miracle moms often bypassed this discourse com-
pletely.
Rather, miracle moms often expressed joy and
relief in the kinds of possibilities dispersing repro-
ductive functioning made possible. Clarke (1995)
has discussed how the focus in reproductive sciences
is on controlling reproductive bodies in ‘‘moder-
nity’’ and on changing reproductive bodies in
‘‘postmodernity.’’ Miracle moms could be under-
stood as women’s embodiment of postmodern
reproduction, wherein an understanding of bodies
as malleable allows for the pursuit of desired social
identities. Featherstone and Hepworth (1991) have
argued that in postmodernity the life course is de-
institutionalized and de-differentiated, resulting in a
blurring of what had previously been considered
clearly differentiated life stages. Miracle moms fit
within what Hepworth and Featherstone (1982)
have called the ‘‘new middle age,’’ the baby-boom

generation rejoicing in the fragmentation of social
expectations associated with aging.
This analysis has shown that two interconnected
threads in women’s lives were central to the ways in
which they made age-related infertility meaningful.
The first thread centered broadly upon the woman’s
life course and her (and her husband’s) expectations
upon entering the infertility clinic. Specifically, a
woman’s own understanding of her body as
(in)fertile in relation to age shaped her reception
of information regarding the declining quantity and
quality of eggs. How women understood their
bodies as (in)fertile connected with medico-scientific
and popular-cultural discourses and practices
around the biological clock and menopause. The
second thread occurred when women are presented
with data that demonstrated a rapid decline in the
ARTICLE IN PRESS
1560 1559
response to infertility treatment after the age of 38.
Because women between 38 and 41 are frequently
counseled to try in vitro fertilization with their own
eggs first and then, if unsuccessful, ‘‘move on’’ to
the use of donor eggs, they construed donor eggs as
a second-choice option within the context of this
clinical encounter and frequently felt propelled by a
sense of urgency to conceive before time runs out.
While loss of time is prominent in narratives about
infertility generally (Becker, 2000; Martin-Matthews
& Matthews, 2001; Sandelowski, Harris, & Hol-
ditch-Davis, 1990), by narrativizing this urgency vis-

à-vis cultural discourses on the biological clock,
some women discussed their experiences of inferti-
lity in a context through which they perceived
blame.
It appears from this research that women in the
38–41-year-old age group experienced a more
complex infertility treatment trajectory than women
42 and older. This age group commonly tried to use
in vitro fertilization with their own ova first but
when these attempts were deemed failures and
women turned to donor eggs, they felt rushed to
achieve a pregnancy. This sense of urgency, in turn,
reinforced the notion that reproductive capacity is
ending. By turning to donor eggs because they
believed they had waited too long, eleventh-hour
moms considered their reproductive decision-mak-
ing through a discourse of blame. In retrospect,
some women felt they had waited too long and cited
a variety of reasons (that were beyond their control)
that range from lack of readiness for children to
time invested in IVF with their own eggs. Dis-
appointment in shifting from the anticipation of a
biogenetic child to a child conceived with a donor
egg is undoubtedly part of the adjustment process
women in the 38–41 age group undergo.
On the other hand, women who began infertility
treatment after 42 were more often advised to use a
donor egg immediately. While severing the genetic
connection with their potential child was certainly
difficult for many women in this age group, these
women did not express the same kind of urgency as
they recounted their infertility trajectory because
using their own eggs was precluded by the policies
of medical practices. These women were apparently

able to enjoy their reproductive capacity outside the
politics of blame.
In conclusion, the extension of the child-bearing
years into later phases of the life course is a complex
process that has been growing in scale since the
introduction of donor eggs, yet the phenomenon has
been largely overlooked except by those immedi-
ately affected. Historical shifts in the twentieth
century in how women’s reproduction is viewed,
combined with the process of biomedicalization,
have led to a new era in how the life course and its
potentialities are viewed. Life stages are no longer
discrete. They have become much more fluid and
indeterminate. In the process, women who use new
reproductive technologies are forced to rethink their
gender identity in relationship to ideas about what
age means for women who reproduce later in life.
This research suggests that women’s views about
age and infertility shift rapidly during the 38–45 age
range as part of this process of reconceptualizing
age and gender identity. The narratives of these
women speak to the profound social changes that
engulf them and provide a window into a social life
transition that is occurring globally. The resulting
social changes are currently being experienced as
upheaval, but it is likely they will be seen in the
future as commonplace.
Acknowledgements
This research was supported by a grant from the
National Institutes of Health, National Institute of
Child Health and Human Development—RO1
HD39117, The Disclosure Decision After the Use
of Donor Gametes—awarded to Robert D. Nachti-

gall, Principle Investigator; Gay Becker, Co-inves-
tigator. The authors would like to express their
gratitude to all of the respondents who shared their
personal stories to contribute to this study. The
working group on the project was invaluable to
creating this paper: Anneliese Butler, Julia Duff,
Jennifer Harrington, Kirstin Mac Dougall, and
Dena Shehab. Special thanks are due to both
Jennifer Harrington and Kirstin MacDougall for
carefully reading the many iterations of this paper
as well as to the three anonymous reviewers.
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Rethinking the biological clock: Eleventh-hour moms, miracle
moms and meanings of age-related
infertilityIntroductionMethodsFindingsEleventh-hour momsLost
time and medical careEducating others about age-related
infertilityMiracle momsThe extension of fertilityThe donor
solutionDiscussionAcknowledgementsReferences

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