'But, my goodness, do they regret having an abortion, especially when they find out later they can't have children. Sometimes it is the most heartbreaking of consultations when in the process of 15 or 20 minutes you can change the way people see the whole picture of their lives.'
Professor Ledger is especially well placed to understand many of the contradictions in modern women's lives because he is one of those rare doctors who specialise in IVF and abortions. Thus, he is in a unique position to understand why there are record levels of abortion in Britain, combined with unprecedented demand for IVF.
He says: 'More and more women are delaying motherhood, but few realise that from the age of 35 egg quality declines quite rapidly. In women over 40 undergoing IVF a live birth happens less than 10 per cent of the time — the remainder either fail to conceive or miscarry — at 42 it's down to less than 5 per cent and at 45 it's less than one per cent.'
That's the nub of a very modern crisis. With the advent of equal opportunities and sexual equality, women — educated for a competitive job market — are increasingly reluctant to sacrifice their hard-won careers, freedom and financial independence for marriage and babies in their 20s.
Statistics
Latest statistics show the highest proportion of Britain's 185,000 abortions last year fell in the 20-30 age group. The average age of all mothers giving birth is now 31 — the highest ever — while the number of women waiting until their 40s to have a baby has gone up 7 per cent in one year and doubled in a decade — to more than 22,000 a year.
There is a certain irony to Professor Ledger's life's work, which could be regarded as a microcosm of this much broader social problem. Each year 1,800 women come to see him at his nonprofit-making clinic — owned and run by Sheffield Teaching Hospital University Trust — in the hope that he can give them a baby.
Some leave eternally grateful for their 'miracle' child, but others cannot be helped. The average age of patients is 34, but increasingly he is seeing women in their late 30s and early 40s, for whom their age is the only reason for infertility.
He rarely sees women in their early 20s, unless they are seeking an abortion. For like almost every obstetrics and gynaecology department in Britain, the hospital where Professor Ledger works sees women at opposite ends of the spectrum — those desperate for a baby and those equally desperate not to be pregnant.
'Personally, I have long accepted the slightly odd nature of what I do. I have worked out a solution which is right for me but might not be for everybody,' says Professor Ledger.
'There are around 185,000 abortions a year in Britain. That is a high level which is a great, great pity, and it shows that we are failing young people on contraception. I'm sure every one of those people is a tragedy writ large. I think these women carry a very huge burden.
'The present situation is the least worst scenario, for it is not the way of a civilised society to make women have babies when they don't want them or don't have the means to bring them up. It is a very courageous thing to have a child on your own and I just can't find myself too critical of women who opt for a termination.
'Of course, the ideal situation is that people receive better access to contraception advice so that they don't get pregnant when they don't want to be.
'But to have an early termination as a day case when you are just a few weeks pregnant, and then go on to have children later, is, in my opinion, an acceptable option.
'From my experience, these women agonise over their decision. It is not a "lifestyle" choice, it is a life-changing one. It's not a case of shrugging their shoulders and thinking: "I'll get rid of it and go to the pub later."
I have seen women whose boyfriends have left them, who are at college and have yet to finish their studies, women who can't afford to bring up a child, women who were taking the Pill but didn't realise that being sick reduced its effectiveness.
'These are women who want children, but not now because they believe the welfare of that child will be compromised. They do think very hard and there is a great sadness. The decision will affect every year they spend on this planet and most do not move on easily.'
Last week, Health Secretary Patricia Hewitt turned down calls from Roman Catholics for the 24-week upper limit on abortions to be lowered, saying that the Government remained neutral on the subject and saw no need to change the law.
While Professor Ledger regards such debate as healthy in a democracy, he believes that most doctors working in this field think the current system works well and that David Steel, who introduced the 1967 Abortion Act, 'pretty much got it right'.
'I remember as a trainee at the Royal Infirmary in Edinburgh being very intrigued by a lovely suite of offices on the top floor overlooking the city,' he says.
'One nurse told me: "Oh yes, that's where all the septic abortions used to go." This whole row of rooms was where the young girls went to die after having back-street abortions. This happened in these nurses' working lifetimes, and if we restricted abortion, these women would return to the backstreets and come back with vile septic infections.
'I don't think myself or many of my colleagues in obstetrics and gynaecology would want to see the law changed. It would be such a retrograde step to see women having to try to find their own solutions again. Nevertheless, it is a very powerful, emotional moment in any woman's life and they go back over it when things later go wrong.'
Indeed, a recent study by researchers at the University of Oslo found that while miscarriage causes the most mental distress in the six months after the loss of a baby, the negative effects of abortion last much longer.
After five years, less than three per cent of women who had miscarried were still suffering distress, while the corresponding figure for women who had undergone an abortion was 20 per cent.
So why are record numbers of women in their 20s — an age when they are biologically and emotionally best suited to having children — undergoing abortions? And why are increasing numbers of women leaving motherhood so late that many will never conceive?
As well as being a moral issue, it is increasingly an economic one.
It is now estimated that one in five women will never give birth, and if current social trends continue, that figure is set to rise.
Already there are fears of a population and pensions crisis, with the Institute for Public Policy Research warning that delayed motherhood is resulting in the loss of 92,000 babies every year — children vital for Britain's future economy.
Fertility penalty
The reason for this, according to the Institute, is the 'fertility penalty'.
An educated woman who has her first baby at 24 will miss out on up to £564,000 in earnings over her lifetime, compared with losing £165,000 if she delays motherhood by just four more years. Those losses must then be set against the £50,000 cost of bringing up a baby.
Most recent statistics reveal that abortions rose 2.1 per cent in one year to 185,400 in 2004, and that it was in the 20-24 age group that the rate was highest — 31.9 per 1,000 women. Meanwhile, the birth rate for women in their 20s has dropped by 25 per cent, with the majority of women now waiting until their 30s.
Professor Ledger says: 'I don't think there are any two women who have a termination for exactly the same reasons. Certainly some of the reasons might be similar, for those women who delay having a child for so long — they can't afford it or they haven't yet met the right partner.
'Many people have the image of the slightly dilettante career woman who decides one day she wants a baby before it's too late, but in fact it's the ordinary folk who are deferring. They look at the cost of rearing a baby and they wait and wait until they have the house and then the car . . . the way we all do. There's always a million reasons to wait another year.
'I would encourage all couples to take one evening to sit down with their favourite drink and have a serious discussion about what they want from their lives and whether they want to wake up one day at 40 to realise they have left it too late to have a baby.
'Many young women these days regard having a baby as a huge financial burden in an already financially overburdened world. They are carrying massive debt and both partners have to work just to pay the mortgage. They regard children as the factor that will break the bank.
'One in three couples in their 20s will conceive within a month of trying and after a year, 95 per cent will have a pregnancy, but few women realise that fertility drops dramatically after the age of 35.
'I have had patients who are doctors themselves but who don't know how poor chances of getting pregnant are after the age of 40.
Recently I had one patient whose mother had gone through an early menopause at 34 and her auntie at 33. And she couldn't work out why her periods had stopped before she'd got round to having children. I have had women in their 50s, angry that they can't have IVF because they didn't realise you have to ovulate to have babies and they don't have any eggs.
'One woman said, when I told her she could not be treated: "You are discriminating against me because of my age." I replied: "It is not me, it is biology that is discriminating against you."
'People have unrealistically high expectations of IVF and think they can simply get a donor egg, but that is not easy in this country.
'People read magazines featuring older celebrities having babies — women who've almost certainly used donor eggs but won't admit it — and they come in with these clippings thinking it's going to be easy. If only we had more celebrities prepared to admit they spent £30,000 on IVF and still don't have a baby.
'In this day and age I think women should start thinking of starting a family at 30, which is old enough for them to have enjoyed some career and financial success, but not too old to conceive.'
As Professor Ledger's clinic is non-profit making, it charges just £2,500 for each IVF cycle. But the cost at some private clinics can be three times as much — which is why he believes that fertility treatment should be made freely available for all.
At a fertility conference in Prague last week, he argued that an investment by the government of £50million to £80million would prove 'cost-effective' by increasing the population by 10,000 within two to three years. However, he concedes that the best scenario would always be to encourage women to conceive naturally younger.
Josephine Quintavalle, founder of CORE (Comment on Reproductive Ethics), believes such arguments reveal how skewed our attitude to reproduction has become.
'Professor Ledger calculates that an average person contributes more than £160,000 to the economy over their lifetime, more than recouping the £12,931 cost spent on IVF,' she says.
Highest abortion rate
Well, if you take those statistics, it doesn't take a genius to work out that the 185,000 foetuses which are aborted each year would — if they'd been born — contribute almost £30 billion to the economy, so perhaps the investment would be better placed elsewhere,' she adds.
'We have to ask ourselves why Britain has the highest abortion rate in Europe and has now even overtaken America per 1,000 population. These are all countries where there is abortion on demand, and yet fewer women there take that option.
'What we need to look at is the lack of support for young women who find themselves pregnant.
'If you have a patriarchal society where women have to behave like men to get up the career ladder, then women will not have children. And they will want them even less if they know they will have to leave them in day care centres and hardly ever see them.'
Leading academic and labour market expert Professor Alison Wolf, of King's College, London, believes that only a radical shift in government policies — making it more financially attractive for young career women to have babies — will avert a population crisis.
'If the current trend continues, we are going to end up with a very high proportion of today's most educated women failing to reproduce and that is going to have a very profound effect on society, for it is parents far more than schools that educate our children.
'Quite simply, more women would have children and stay at home with them if it was affordable. Children are seen as a net burden, so if people are having fewer children then we have to make it more financially attractive.
'Women give up so much when they have babies — their careers and their future earnings,' says Professor Wolf, who believes Britain should look at offering cash bonuses and tax breaks to women for having children.
'The time of reckoning will come when there are not enough educated workers and there are a large number of elderly people with no family to look after them. It will probably have to get to crisis point before anyone does anything about it.
'I think young people view their options very rationally. It's not a question of their making wrong choices, they are making sensible ones in the circumstances. So if as a society we are worried about the consequences, then we have to change the options instead of preaching at women.'
It's a point Josephine Quintavalle agrees with — that in this country there must be a paradigm shift in thinking about women and careers if we are to avert a crisis.
'If you have a society where there are record levels of abortion among women who are most fertile, and unprecedented demand for IVF from women who have delayed motherhood for economic or lifestyle reasons, you have to think that something isn't working.'
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