"I'm numb. I can't believe this is happening to me," a 38-year-old patient said to me last week when, after two rounds of IVF, the three eggs we managed to retrieve failed to fertilise.
Nina and her husband James* had been together for two years and married five months before their first visit with me, referred by her GP who found that Nina's egg reserves were vanishingly low.
Nina didn't start out in life planning to be a bride in her late 30s, and she assumed when she was younger that by the time she was 38 her family would be complete. But, as John Lennon once said, "life is what happens while you are busy making other plans."
Nina and James are not unusual. In fact, their story is ever-increasingly common.
Australian families are now getting started later and staying smaller. In 1963 and over the ensuing three decades, women most commonly gave birth to their first child in their early 20s.
By 2007, the tide turned. Women were just as likely to have their first child in their early 30s as their early 20s, and the proportion of new mothers in their late 30s increased dramatically from 2 percent in 1980 to 12 percent in 2007.
Over the past 30 years, the fertility rate of women aged 40-44 has tripled.
Women's fertility declines rapidly with age, and by the early 40s that slope is a cliff. A recent Australian study found that the majority of men and women surveyed underestimated the age when female fertility starts to drop by 10 years. Only one in four correctly identified that female fertility starts to decline before age 35.
Australia's fertility rate has been below replacement level since 1976. This is a problem in just about all OECD countries, with only New Zealand, Iceland and Israel reproducing above replacement level.
The single child family is now the fastest growing family demographic in Australia. And an increasing number of women remain childless, more often through circumstance rather than choice. As early as 1999, the Australian Bureau of Statistics estimated that 28 percent of women who were then in their reproductive years would never have children.
The ABS also predicted in 2010 that, in 2031, the proportion of couples without children (43 percent) will overtake the proportion of those with children (38 percent).
Myriad reasons for this decline have been proposed: the introduction of the Pill in 1961; the Women's Liberation movement of the 1970's; the increase in the proportion of women in higher education (women now make up 57 percent of university students) and the direct correlation between educational attainment and family size; later marriage and a higher divorce rate give couples fewer years in which to have children.
Perhaps we can also attribute some of the blame to sky rocketing house prices, with children staying at home longer and, when they do leave home, the need for two incomes to pay the mortgage.
Some social commentators posit that the rise of women in education and professions has left men uncertain in their roles, leading to an "extended adolescence" and a shortage of available men.
Despite their professional advances, research shows that women still bear a heavier burden of responsibility at home and find it harder to balance work and family.
Even among Harvard Business School graduates, there is a mismatch in expectation and reality when it comes to family life.
Men expect that their careers will take precedence over their spouse's. Women expect that the load will be shared equally.
Millennial men have more egalitarian attitudes than their fathers did but they find the lack of flexibility at work, with outdated norms, makes a shared load at home impossible. In one ongoing study of men the US, before children only 35 percent thought that men should be the breadwinners and women the caregivers. After children, 53 percent of men though that men and women should take on traditional roles.
The answers to Australia's fertility crisis lie beyond paid maternity leave and affordable childcare, though doubtless these would help.
We need a wholesale revolution in the workplace and societal attitudes, with public policies that enable and encourage men to be more active participants at home and support women to remain professionally engaged.
Changes like this happen slowly, but now that Millennials comprise the largest generation in the workforce and rise to become the decision makers and thought leaders, perhaps there will be fewer couples like Nina and James in the future.
I hope I'm not retired by then.
*Names have been changed for privacy.
This blog first appeared in August 2015.
For more information about Dr Devora Lieberman visit her website: www.drdevora.com.au