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more than six million: Guttmacher Institute, “Contraceptive Use in the United States by Method.”

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hundreds of millions: United Nations, “Contraceptive Use by Method 2019.”

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many women struggle: Lauren N. Lessard, Deborah Karasek, Sandi Ma, Philip Darney, Julianna Deardorff, Maureen Lahiff, Dan Grossman, and Diana Greene Foster, “Contraceptive Features Preferred by Women at High Risk of Unintended Pregnancy,” Perspectives on Sexual and Reproductive Health 44, no. 3 (2012): 194–200, doi.org/​10.1363/​4419412.

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mood disorders: Eveline Mu and Jayashri Kulkarni, “Hormonal Contraception and Mood Disorders,” Australian Prescriber 45, no. 3 (2022): 75–79, doi.org/​10.18773/​austprescr.2022.025.

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serious health risks: “Hormonal Methods of Contraception,” Merck Manual Consumer Version, last modified August 2023, merckmanuals.com/​home/​women-s-health-issues/​family-planning/​hormonal-methods-of-contraception.

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Chapter 5

Portions of this chapter were previously published in The New York Times on May 1, 2020, under the title “Fertility Clinics Stay Open Despite Unclear Guidelines.”

more than 50 percent: According to the (meager) research available. The World Health Organization says the statistic is even higher, up to a worrying 70 percent. Wendy Wolf, Rachel Wattick, Olivia Kinkade, and Melissa Olfert, “Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity,” International Journal of Environmental Research and Public Health 12, no. 11 (2018), doi.org/​10.3390/​ijerph15112589.

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demographics are beginning to shift: Dayna Evans, “ ‘I’ve Just Spent $14,000 on One Egg’: Five People on Their Egg Freezing Experience,” Buzzfeed News, January 26, 2023, buzzfeednews.com/​article/​daynaevans/​egg-freezing-stories-what-to-expect.

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roughly 35 percent: Alisha Haridasani Gupta and Dani Blum, “Hope, Regret, Uncertainty: 7 Women on Freezing Their Eggs,” New York Times, December 28, 2022, nytimes.com/​2022/​12/​23/​well/​family/​egg-freezing-fertility.html.

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more than 80 percent: Marcia Inhorn, Daphna Birenbaum-Carmeli, Ruoxi Yu, and Pasquale Patrizio, “Egg Freezing at the End of Romance: A Technology of Hope, Despair, and Repair,” Science, Technology, & Human Values 47, no. 1 (2021), doi.org/​10.1177/​0162243921995892.

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Inhorn identified: Matilda Hay, “What the Egg-Freezing Process Feels Like: One Woman’s Fertility Journey,” Washington Post, September 25, 2023, washingtonpost.com/​wellness/​2023/​09/​25/​egg-freezing-fertility-motherhood-emotions/.

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“a reproductive backstop”: Marcia C. Inhorn, Motherhood on Ice: The Mating Gap and Why Women Freeze Their Eggs (New York: New York University Press, 2023).

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largest egg freezing ethnographic study to date: The two-year study comprised 150 women who had completed at least one cycle of non-medical egg freezing and volunteered to participate in the study. At the time of egg freezing, 85 percent of the women were single, and of these single women, 35 percent had experienced a breakup. Additionally, 26 percent of the married and partnered women in the study were in the midst of separations.

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“For women whose”: Inhorn, Motherhood on Ice, 57.

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one in six adults: World Health Organization, “Infertility Prevalence Estimates,” 2023, who.int/​publications/​i/item/​978920068315. For a full discussion on male infertility and the plummeting sperm levels among men in Western countries, see Count Down: How Our Modern World Is Threatening Sperm Counts, Altering Male and Female Reproductive Development, and Imperiling the Future of the Human Race by Shanna H. Swan, in which she writes, “…it’s that the chemicals in our environment and unhealthy lifestyle practices in our modern world are disrupting our hormonal balance, causing varying degrees of reproductive havoc that can foil fertility and lead to long-term health problems even after one has left the reproductive years.”

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Chapter 6

the fun really begins: Once past the obstacle of the cervix’s muscular contractions, sperm must then “choose” and swim up one of two fallopian tubes, while the egg only travels down one. Then, the egg can affect which sperm wins the race—the audition, really—with the chemicals it releases in the follicular fluid that surrounds the egg. The sperm that gets there first and is able to penetrate the egg shell—via the very complex biological process that has to occur—gets the starring role in conceiving a baby.

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“Your menstrual cycle is not something”: Toni Weschler, Taking Charge of Your Fertility, 20th Anniversary Edition (New York: William Morrow, 2015).

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Fertilization happens when: The establishment of a pregnancy is a process: first fertilization, then implantation. Between one-third and one-half of all fertilized eggs never fully implant in a woman’s uterine lining. Also worth noting: The term “conception” isn’t actually a medical term, and it’s often mistakenly used synonymously with “fertilization,” when technically it’s equated with implantation.

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they’d use a condom: Although, Will noted, there was something to be said for having to wait. As Weschler writes: “By choosing to postpone sex rather than using a barrier method during the fertile phase, people often feel they’re living in harmony with their fertility, rather than fighting it.” Weschler, Taking Charge of Your Fertility, 164.

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$100 billion by 2030: According to a 2023 report by Precedence Research, a worldwide research and consulting organization. Precedence Research, “Femtech Market Size to Surpass US $108.78 Billion by 2032,” 2023, precedenceresearch.com/​femtech-market.

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the only: The app Natural Cycles, when combined with the wearable Oura ring, is also FDA-approved for fertility tracking.

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with 90 percent accuracy: Brianna Goodale, Mohaned Shilaih, Lisa Falco, Franziska Dammeier, Györgyi Hamvas, and Brigitte Leeners, “Wearable Sensors Reveal Menses-Driven Changes in Physiology and Enable Prediction of the Fertile Window: Observational Study,” Journal of Medical Internet Research 21, no. 4 (2019): e13404, doi.org/​10.2196/​13404.

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users were dissatisfied: Daniel A. Epstein, Nicole B. Lee, Jennifer H. Kang, Elena Agapie, Jessica Schroeder, Laura R. Pina, James Fogarty, Julie A. Kientz, and Sean Munson, “Examining Menstrual Tracking to Inform the Design of Personal Informatics Tools,” CHI ’17: Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems (New York: ACM, 2017), 6876–6888, doi.org/​10.1145/​3025453.3025635.

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an unintended pregnancy: One of the more alarming studies illustrating the unreliability of fertility-tracker apps was a case study in 2018, when thirty-seven women who relied on the European fertility app Natural Cycles as their contraception method reported unwanted pregnancies. Authorities in Sweden investigated the app, which is certified in Europe for birth control and approved for marketing as a contraceptive in the United States by the FDA. Natural Cycles has since further clarified the risk for users.

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