Recently a very close friend left me a lengthy voice mail after she returned from her honeymoon. In a whirlwind year she had finally met the world’s most amazing man and married him in a surprise ceremony after a storybook nine month courtship. She breathlessly recounted the events of the honeymoon and then got right down to business. “We want to have a baby,” she said. “I’m not sure if I should be worried, but we haven’t used any birth control in the past few months and so far, nothing. What do you think?” I should also mention that like me, my friend is in her mid-forties. She’s an educated, technology-savvy professional. I immediately realized that our next conversation would be a difficult one, and I also realized that I felt pretty guilty about it. How had I, who for over 10 years has been immersed in the world of third-party reproduction allowed one of my very best friends to escape her mid-thirties and into her forties without understanding the rules of diminished ovarian reserve and advanced maternal age? The answer is an uncomfortable one for me. I had assumed that she knew, just as I assumed most women my age know that a woman over 40 has a 1 in 3 chance of conceiving normally and a 35% chance of miscarriage and that these rates increase dramatically with each passing year. When I spoke with my friend later that week she said, “I feel so stupid- I figured it would just take a few injections and everything would be fine.” Heartbreaking.