*2 Technically speaking, you can take your temperature vaginally, orally, or rectally to chart your BBT. The books classically say to use an oral glass mercury thermometer immediately upon waking to get the most accurate reading. Digital oral thermometers work well, too, as long as they have the appropriate accuracy and precision.
*3 If you’re trying to get pregnant, the more often you have sex during this window, the better. Especially one or two days before you ovulate, because the egg starts to deteriorate quickly after it’s released from the ovary. Think of it like a sperm cell waiting in the wings, ready to greet the egg cell as soon as she emerges.
*4 They’re most effective when multiple FAMs are used together. Using FAMs perfectly correctly and consistently throughout the menstrual cycle, though, can be difficult to do. With typical use—using FAMs the way the average person does, which is sometimes incorrectly or inconsistently—pregnancy rates increase.
*5 I use Clue Plus, the paid version of Clue’s app, which gives access to many features and modes. As of this writing, it costs $10 per month or $40 per year; the price varies depending on the user’s region.
*6 These apps can also be quite useful for alerting the user to trouble with their cycle. Clue has a whole section, for example, for when one has recurring cramps and what that might represent. Or whether it’s normal to have a nine- or eleven-day period (which, again, helps close the information gap from our childhood).
*7 For women who are trying to conceive, fertility tracker apps can be a helpful tool, particularly when using the app to transition from preventing pregnancy. Also neat: Several fertility-tracking apps have a feature that lets users share their ovulation info and cycle monitoring with a partner or a friend.
*8 Explicitly asking users if they want to share their anonymized information is, obviously, the best practice here; Clue, for example, invites users to opt-in to doing so and “be part of closing the diagnosis gap for some of the most common yet most under-diagnosed and under-researched health conditions.”
*9 While hCG was identified in the 1920s, it wasn’t until the 1960s that scientists turned to immunoassays—tests that combined hCG, hCG antibodies, and urine—and discovered that if a woman was pregnant, the mixture would clump together in certain distinctive ways.
*10 The average age of menopause in the United States is fifty-one.
*11 Initially, the vans typically parked on high-traffic corners and were a marketing tool. Now they’re used in various communities to serve self-pay and privately insured patients, as well as employees of companies that Kindbody has contracted with; employees interested in using their Kindbody employee benefit can pop into the mobile clinic parked at their work campus during their workday to learn more and do initial testing.
*12 Though not the full picture; there is currently no reliable biomarker that tells a woman how many eggs she has left.
*13 A woman’s AFC can vary month to month, and both AMH and FSH levels can fluctuate not just within but also between menstrual cycles. Also, women on hormonal birth control, take note: Hormonal birth control suppresses the ovaries and ovulation, which, according to some studies, can impact AMH and suppress follicle count (not permanently; just while on birth control). For a more accurate AMH result, it’s best to test while not on hormonal birth control.
*14 A peptide hormone that’s associated with the maturation of follicles in the ovaries.
*15 Since lower AMH levels can indicate diminished ovarian reserve, a fertility patient with low AMH might need to undergo multiple cycles of IVF to get pregnant or multiple cycles of egg freezing to get a sufficient number of eggs on ice.
*16 If the eggs Lunny froze don’t result in a viable embryo, she’ll use some of her sister’s frozen eggs; Lunny’s sister also froze her eggs and donated half—ten frozen eggs—to Lunny in case she needs an egg donor down the road.
*17 In addition to AMH tests, Kindbody’s mobile clinics also have the ability to do full initial consultations, pelvic ultrasounds, lab panels, genetic carrier screening, and well-woman exams.
*18 Fertility clinics tend to have their own preferences and policies on this, but know that there are potential suppressive side effects to using oral contraceptive pills directly prior to an egg freezing cycle. The available data is somewhat conflicting, but several studies have concluded that doing so can result in a longer stimulation cycle that requires more medication—and can actually negatively affect the number of eggs that are retrieved.
*19 Name has been changed.
7 Not Our Bodies, Not Ourselves
Shame and Stigma
In 1940, when she was eighteen, the poet and activist Grace Paley tiptoed into her doctor’s office and lied about being married so she could get a diaphragm. “We all knew that birth control existed, but we also knew it was impossible to get,” begins her essay “The Illegal Days,” part of Paley’s collection Just As I Thought. “You had to be older and married. You couldn’t get anything in drugstores, unless you were terribly sick and had to buy a diaphragm because your womb was falling out. The general embarrassment and misery around getting birth control were real.”
When we talk about controlling women’s bodies, abortion typically bookends the conversation. A woman’s right to choose has dominated the reproductive rights discourse for decades. Paley, who died of breast cancer in 2007, spoke openly and famously about the illegal abortion she had in Manhattan at age thirty. Her remarks on how difficult it was to obtain birth control are less well known but, I find, are similarly disturbing. While less drastic than Paley’s, hurdles have persisted for generations of women since. In 1975, my mother waited until she was away at college to visit Planned Parenthood for the first time so as to avoid running into someone she knew at her small town’s clinic. In 2006, a girl I went to high school with exaggerated her period cramps so she’d be put on the Pill without her parents knowing she was sleeping with her boyfriend. As of 2023, twenty-four states restrict minors’ ability to obtain contraception without parental consent—a stark difference from 2006, when no state or federal laws required minors to get parental consent in order to get contraception.
I recalled a conversation I’d had with a woman named Cynthia, a young mother of three who grew up in rural southwest Virginia. Cynthia was raised in a Pentecostal family; James, her husband, is a strict Catholic who doesn’t believe in birth control. When we first spoke, Cynthia had just turned twenty-six. She told me she’d had four miscarriages, and while she and her husband wanted to have more children, she felt overwhelmed by the prospect of trying again. Mostly she was scared about gaining weight again so quickly. Normally she weighs just one hundred pounds, and each of her pregnancies had been difficult and severely stressed her body. Her second baby had been too big to deliver naturally; her doctors said a vaginal birth would have caused her hips to break. And complications with C-section scar tissue after her last pregnancy resulted in her needing surgery to have her bladder repaired. “So I’m not really in a rush to have more kids, like, right now,” she told me.
Cynthia doesn’t remember having sex ed in school. She had no idea what a period was when she first got hers. When she was sixteen, the doctor in her small town of two thousand people prescribed the Pill because of her painful periods—but didn’t bother to tell her its primary purpose was to help prevent pregnancy. She didn’t take it regularly. Then, the first time she had sex, on the night of her high school graduation, she became pregnant, though they used a condom. “No one told me you could get pregnant even if you used condoms!” she exclaimed. “I didn’t know they came in different sizes. In my town, they don’t tell you about birth control. They just give you a little bit of knowledge and send you on your way.” I asked Cynthia if she would have made different choices if she had known more. “I think about that a lot,” she said. “My kids are my entire life.” She paused. “But if I could go back, if I had the knowledge I have now, I would’ve waited.”
Only a couple of incidents come to mind when I look back at my major milestones of learning about my body and what goes on inside it. They were all unpleasant. While I had more choices and knowledge than Cynthia did, it still wasn’t smooth sailing.
Periods. I got mine after school one day in eighth grade and taught myself how to insert a tampon. The brownish, sticky blood alarmed me. It was a year after 9/11 and my mother, a colonel in the Army, had recently been deployed overseas. I can’t recall if I bought the tampons myself at the pharmacy a few blocks from my middle school or if I had surreptitiously added them to my father’s grocery store list. But I remember the complicated instructions inside the box, how having to decipher them alone made me feel small and scared—like a young girl who needed her mom. But Mom’s not here, I told myself, so you’re going to have to figure this out on your own.
Going to the gynecologist. The first time I had a pelvic exam, I was so nervous I apologized to the doctor for how much I was sweating. It is a specific kind of unnerving, spreading your legs in a harshly lit room while a stranger peers into your vagina. The speculum and probing fingers are even worse. Most of the OB/GYNs I have seen as a patient have been polite but brisk. I’d usually leave their offices with a few unanswered questions I was too intimidated to ask, but with a vague sense of having been invaded. The OB/GYN I saw when I was twenty-two was a different story. He was in his fifties and from Romania, with a rough accent and rougher hands. In the exam room, I gave my I-only-have-one-ovary spiel and summarized my surgeries. He asked if I was sexually active. My boyfriend and I had been sleeping together for a while, I replied, but I was frustrated: My irregular “periods” were causing regular what-if-I’m-pregnant scares, despite being on the Pill. “So that’s why we use two forms of birth control,” I explained. I felt self-conscious; talking about my sex life with a stranger—even if he was a doctor—was awkward. The OB/GYN raised his eyebrows. “Oh, my dear,” he said, shaking his head. “That’s very unnecessary. Stop using condoms and live your life!” He closed my chart with a flip. “Your boyfriend will thank me,” he chuckled. We didn’t stop using condoms, but fuming about this interaction to my boyfriend did make it a bit easier for the two of us to talk about sex and sex-related things.[*1]
And then there was a more recent kind of milestone that happened as I was listening to the doctors at the EggBanxx event. They were lecturing a roomful of mature, well-educated women about their reproductive systems rather than assuming the women in attendance were well informed already. As I sat there, memories came flooding back of my sex ed days: teachers showing pictures of genitalia on overhead projectors, older high school girls whispering about hand jobs and how boys liked “shaved” girls better. I remembered the swirl of nervous-excited feelings in my stomach as I sat on the classroom floor with other girls, the boys down the hall. I remembered learning about a lot of things but never really talking about any of them. At best, sex ed explains some of what young adolescents have started to experience as they come into their bodies. But for most of us, it also sows seeds of confusion and stigma that grow as we get older. That evening at the EggBanxx party, it was those seeds I saw being watered.
Entire books have been written about the brutal cycles of women’s health through the centuries. In a New York Times book review of Elinor Cleghorn’s Unwell Women, Janice P. Nimura writes, “Taught that their anatomy was a source of shame, women remained in ignorance of their own bodies, unable to identify or articulate their symptoms and therefore powerless to contradict a male medical establishment that wasn’t listening anyway.” Most women find it difficult to get a sense of what’s normal and what isn’t when it comes to their bodies. We swap stories about contraception methods and bemoan uncomfortable visits to the gynecologist. At some point we realize we’ve never quite recovered from the grisly pictures imposed on us in health class all those years ago. Superficial, often poorly taught sex ed and a pervasive cultural shh leave many people in the dark, missing out on or avoiding candid conversations about sex and all it entails.
Cynthia’s story is a powerful illustration of the direct connection between women’s lack of knowledge about fertility and lack of agency regarding reproductive choices. Beyond being poorly educated about their bodies, women continue to face challenges in their efforts to access comprehensive sexual healthcare and resources. Paley’s account about procuring a diaphragm, along with Cynthia’s story and other conversations I’d had with women about sex and fertility, got me thinking: How does a person gain access to the knowledge and resources they’re entitled to?
Not so much in schools, as we’ve established. Not so much from medical providers either, it turns out. A study by Yale researchers found that about 50 percent of reproductive-age women had never discussed their reproductive health with a physician.[*2] OB/GYNs routinely cover contraception but rarely assess their patients’ quantity and quality of eggs; a survey of five thousand U.S. OB/GYNs found that less than one-third of clinicians counsel patients under age thirty-five on reproductive aging and fertility preservation. So why do these discussions rarely take place? Not enough doctors and not enough time is one reason. Nearly half of U.S. counties do not have a single OB/GYN. For patients who do see a gynecologist regularly, appointments are typically brief, with barely enough time for a woman to refill her birth control prescription and ask if she’s up to date with her HPV vaccine shots, much less inquire about the quality of her eggs or check her hormone levels.[*3]
To be sure, teens learn about sex from a range of sources beyond school. But what kids learn in health class doesn’t align with what the internet and popular culture tells them—not that TV, music, and movies are all that illuminating on the subject. It’s also out of sync with what they hear from Mom and Dad. Most American parents, sex educators repeatedly point out, either ignore the subject completely or teach their children myths about where babies come from when they are very young, and leave it at that. In light of the horrid shame of Paley’s generation, my mother giving me the American Girl body book was quite progressive.
And then there’s easy-to-access online porn, which reporter Maggie Jones, in a New York Times Magazine feature, described as the de facto sex educator for American youth, filling the vacuum left by the country’s deficient sex education. “There’s nowhere else to learn about sex,” one boy told Jones. “And porn stars know what they are doing.” The media we consume and watch undoubtedly influences how we act in real life, and the most popular porn sites are among the one hundred most-frequented websites in the world. Jones notes that it’s not easy to discern what’s fake and what’s real in porn; the line between fantasy and exaggeration can be blurry. It’s not a huge deal for an informed adult watching porn for fun, but it’s another matter entirely when we consider that hardcore porn is where a great many teenagers learn what to do to each other, and that porn is a primary influencer in young people’s lives, shaping their early ideas about sex and their sexual behaviors, too.
So. Sex ed teaches girls to be ashamed. Our doctors are very busy and we don’t know what questions to ask them anyway. Porn and pop culture distort our thinking, providing a script for sex that leaves many young people feeling insecure and alienated. It’s not all that surprising, then, that many young women grow up having an aversion to their periods and feeling pressure to shave their pubic hair, entering adulthood all too often having never uttered the word “labia” and without knowing what a clitoris is, where it is, and/or what to do with it. And so I couldn’t blame the doctors at the EggBanxx event for assuming we needed their Fertility 101 talk, nor could I fault the women for not knowing more. It was clear to me now that filling in our knowledge gaps at any age is neither straightforward nor easy, and that young women’s lack of crucial knowledge about their bodies inhibits their ability to make informed choices, as adolescents and when they’re older—especially with regard to their fertility.
—
It was around this time that I talked with a group of ten or so young women gathered at the home of one of them in a suburb of Washington, D.C. We sat around a dining room table, eating chips and hummus. The young women[*4] were between the ages of twenty-two and twenty-nine, represented various ethnicities, belonged to middle- to upper-middle-class families, and had all grown up in northern Virginia, a mostly prosperous and progressive part of the country. When I had invited them, I’d explained I wanted to ask the group a few open-ended questions related to sex and fertility: what they knew and how they’d learned it. Before I turned on my audio recorder and started asking questions, I looked around the table and paused. I told the group about some of the articles I had written, hoping to break the ice before launching into intimate territory.
Then I kicked things off by asking them what they remembered from sex ed classes. They all laughed at once, exchanging knowing smirks. Beyond learning about STIs and the structure of the vagina and the penis, they all agreed they did not recall learning much. “It’s kind of the same as when they were teaching us about drugs in elementary school,” said twenty-three-year-old Taylor. “We were like, ‘What are drugs?’ ” she went on, describing the pattern of young people being told about the inherent danger of something at the same time they were taught what the thing actually was. “So now it was like, ‘Huh? What’s oral sex?’ ”
The conversation turned to another taboo topic: female pleasure. “I didn’t even know that women were supposed to enjoy sex,” said Alexis, a college senior with a slender frame and fiery opinions. None of the women recalled talking about female masturbation in sex ed. “It wasn’t mentioned that girls would touch themselves, or ever do anything like that,” Alexis continued, her tone bristly. “It was like, ‘This is your uterus and that’s all you need to know.’ ”
“This is where you carry babies when you’re thirty,” chimed in Madison, twenty-four.
