My first memory of sex education is one I’ve fought for years to forget. It involved a certain noisy metal TV cart and a black-and-white clinical childbirth video — on VHS, of course. While that memory is nearly 30 years old I vividly recall the overarching message: You definitely don’t want to do this.
Throughout junior high and high school, sex ed focused on the male and female anatomy. While birth control was covered, abstinence was enforced over and over again as the only way to avoid pregnancy or an STD, but isn’t there more to the story?
"The messaging that pregnancy occurs quickly leads many women to spend much of their 20s and later actively preventing what seems like an inevitability without proper precautions,” said. Dr. Carly Snyder, a reproductive and perinatal psychiatrist. It seems logical then that once a woman wants to get pregnant, it should happen easily — but, unfortunately, that isn’t always the case.
There is a wide-ranging list of reasons why it might be difficult for a woman to get pregnant, from issues with ovulation and egg maturity, structural complications with the uterus, autoimmune disorders and so much more. For men, while age is less of a factor, abnormal sperm production or function, genetic defects, certain genetic diseases and structural blockages are just some of the issues that can impact fertility as well.
So how do you get pregnant?
Like many women looking to get pregnant, I assumed removing birth control would have the opposite effect — and fast. So imagine how blindsided I felt, when shortly after getting married at 36, I wasn’t pregnant after the first month ... or the second or the third or the fourth.
Here I was, panicked throughout my entire life up to that point at the thought of becoming pregnant accidentally and now, nothing. “What’s going on,” I thought. “I’m so healthy, how is this even possible?” So after more than a year of trying and two miscarriages later, my husband and I turned to IVF to conceive.
I vaguely remember a conversation with my OB-GYN in my early 30s. “So when should I start thinking about having children,” I asked. “Oh, you’re 32, maybe when you were 26,” she replied with a smirk. I laughed at her joke and shelved it. My maternal grandmother bore 15 children. "I’ll be fine," I thought. Indeed this was my first, albeit subtle, warning into my inevitable infertility story. So why did I feel as if I was hit by a ton of bricks when it wasn't happening easily?
“Women of all ages, regardless of their education status, lack a fundamental understanding of women’s reproductive health and, in particular, fertility and ovarian reserve,” said Dr. Fahimeh Sasan, founding OB-GYN of Kindbody clinic. We seemingly spend our entire lives trying not to get pregnant, so when the time comes that we are ready to conceive, women have no idea where to begin.
Who owns this conversation?
If not teachers or parents, who should we turn to about learning fertility fundamentals at an earlier age? Is there an oversight or glitch in the health care system or is there a stigma that a doctor broaching the subject implicates a societal push for marriage and bearing children?
“Our current health care system does a huge disservice to women by making them think that an annual well-woman exam or a Pap smear means their fertility is good,” Sasan explained.
Dr. Amy Cirbus, director of clinical content at Talkspace, meets well-educated, professional women who sit in her office in their late 30s and early 40s and are astonished to hear that they cannot conceive naturally or that they have diminished fertility or ovarian reserve. “Their responses are typically ‘I never thought this would be me,’ or ‘I go to the OB-GYN every year, why didn’t anyone warn me about this?’” she said.
There seems to be no forward-thinking clinical system in place, like preventative mammograms and colonoscopies, which are timely and widely practiced. Why can’t women in their 20s and 30s opt in to ovarian reserve testing at the time of their gynecological visit? Why shouldn’t men have the option to also get a baseline on their sperm count? How can you make specific, intelligent decisions about something you've been left in the dark about? It’s as simple a fallacy as you don’t know what you don’t know.
As men and women delay childbearing because of school, career or waiting for the right partner to come along, it can be a tough pill to swallow once you’ve lined up your life to hear the vision you once had of a bustling home with several children just can’t be.
“The slope of this decline becomes shaper in the mid-30s for women and, although fertility treatments can be helpful, they are not a guarantee,” said Dr. Karen Patrusky, a board-certified obstetrician and gynecologist. “The physiologic changes of pregnancy are demanding on a woman’s body and thus risks of pregnancy complications, such as hypertensive disorders and gestational diabetes, can further complicate pregnancy in older women.”
Still, despite spiraling queries on Google, there’s very often an element of personal denial.
What I wished I learned sooner...
Sure, we were taught how not to get pregnant, but the pitch that pregnancy is always scary and painful was one that took many years of patient undoing. I was well into my 30s and absolutely terrified of the idea of childbirth, and now, having gone through it with twins, I realize it’s a small and beautiful blip in the entire experience.
The fear of pregnancy scares many young girls into abstinence, and the lingering emotions behind the message results in a lot of misunderstanding about how to get pregnant when you want to. The same fertility mindset you had at 16 doesn’t always align with what’s going on biologically at 36.
I wish I had learned about the fragility of fertility in school. I truly never knew it would be difficult to get pregnant, and the many biological and psychological factors that are at play to carry a healthy pregnancy to term.
The decisions and life choices that weigh most on me personally are ones where there was an opportunity to be one step ahead of the game, but are now impossible to recover. I now urge friends who are planning a family to request specific labs and ultrasounds to get a baseline on their fertility. Some of our parts age faster than others, and our bodies don’t always comply with our timeline. Sadly, technology can’t always come to the rescue.
The upside? This conversation is progressing. “Children in the 21st century are far smarter and have access to significantly more information than previous generations,” Sasan acknowledged. That said, I’m confident that we can begin approaching fertility in a more open manner that can empower future generations with insight (and without fear tactics) no matter where their family planning take them.