My favorite part of having my fertility assessed was seeing my bladder in the ultrasound; it was so full the technician chuckled and asked if I needed to pee (I did, and laughing about it didn’t help). My least favorite part was learning that, at 29, I am over three years past my “reproductive prime” and less than two years away from my first notable drop-off in fertility. But more memorable than either of those two moments were the conversations I had after the experience, with peers, and what those revealed about my generation’s attitudes around having kids.
My attitude has mostly been assumptive: I’ve always imagined I’d eventually become a parent. I’m sure that’s as much a consequence of my personality as the time I grew up (the optimistic 90s) and my home life (where there were two happy parents who loved Parenting). There were years when my interest waned, when I believed apathy made me edgy—or more delusionally, a stauncher feminist—but I always came back around. Still, I’ve often worried that, in the end, it won’t actually be up to me, at least not biologically. So when the opportunity arose to have my fertility assessed while I was researching the topic for a story, I knew I would say yes, even if it meant facing some bad news. Better to know, right?
My appointment was with Trellis Health, a fertility clinic with a beautiful sun-drenched space in the Flatiron district, and I’d soon learn it’s not in the business of telling cis-women whether they’ll be able to get pregnant. In fact, such an assessment isn’t exactly possible—although there are myriad ways to get close. Trellis is primarily an egg-freezing clinic, and my consultation would be focused on reviewing my candidacy for that process—which, while definitely relevant to my fertility, isn’t the whole story.
The visit started with a small disappointment: the ultrasound would not involve a technician moving a wand around on my stomach like in the movies. It would be transvaginal, which is decidedly less joyous (although seeing my full bladder cheered me up). The point of the ultrasound, technically called an Antral Follicle Count, was to determine the number of mature follicles on my ovaries, which correlates to the number of eggs I have left. Unsettling fact I learned soon after: Female babies are born with all the eggs they’ll ever have; they deplete throughout the course of our lives and finally run out around menopause.
An unusually low follicle count (for your age) can indicate premature ovarian failure; an extremely high one can indicate polycystic ovarian syndrome. My right ovary had six. “Is that right?” I asked the technician. She replied with a neutral hum, which I took to mean I was failing. When she moved to my left ovary and counted 15, she exhaled. “21 follicles!” she said, withholding further analysis “Now you can go pee.”
Next I had my blood drawn, which isn’t worth regaling, but it was done to check my anti-mullerian hormone (AMH), another indicator of egg reserves. Mine was 2.99, a number that meant nothing to me at first, but which I still wanted to be 3, in a competitive sense.
The last part of the assessment involved sitting down with an egg-freezing specialist to learn about the process and then consulting with a doctor to have my numbers analyzed. It was there that I learned about one’s “prime reproductive years” (18-26), the way fertility, on average, takes its first big hit around 32 and its second around 35, and that conception after that is often referred to as a “geriatric pregnancy,” which must be the most dramatic medical term in existence. I’d heard this stuff before, but hearing it in this setting—and recognizing its increasing relevance to my life—stung more than expected.
I was relieved to learn that my numbers all fall within an average, healthy range though: Although sources vary a bit, anywhere between 12 and 35 visible follicles points to normal, good, or excellent ovarian reserves for a woman my age, and a typical AMH level in a fertile woman is between 1.0 and 4.0. I also learned I’m a good candidate for egg-freezing, although I’m not currently interested (the process costs around $10,000—it’s broken down really well on Trellis’ site).
After the appointment I felt palpably weird, and like maybe I should have kids immediately, despite not actually wanting them yet. On some levels, despite feeling well taken care of at Trellis (it really is a lovely place with lovely people), I felt unsatisfied; I’d have preferred the doctor tell me I am so fertile I shouldn’t sneeze in the vicinity of sperm unless I’m ready to parent. But doctors never say things with that level of certainty (sometimes it feels like a field of educated guesses), and fertility is complicated. As I was told multiple times: Pregnancy only takes one egg, so a woman with low ovarian reserves might get naturally pregnant before a woman with high reserves—there are several other contributing factors.
Later that night I mentioned I’d had my fertility assessed on my Instagram Story and my DMs blew up. First came a flurry of questions: What was it like? Would I recommend it? Am I fertile? Should they do it? Then came opinions: We don’t discuss fertility enough; we discuss it too much; the biological clock is overblown. Then came personal anecdotes: women who were struggling with fertility; women who felt pressure to have kids; and most of all—and these messages came in droves—young women with a subtle, haunting fear of being infertile.
I was taken aback by the level of impassioned interest, which stood in contrast to the low volume of conversation on the topic in my day-to-day life. It made me wonder if the chasm between how often women think about fertility and how often they talk about it is growing. As a very vocal generation on the topics of career aspirations and social and political issues, it makes sense that something like the ability to conceive might take a backseat, especially among progressive crowds who want to change the narrative around what women are supposed to do and be. But that doesn’t mean the anxiety doesn’t exist.
One DM pointed me to a feature The Atlantic ran back in 2013. “How Long Can You Wait to Have a Baby?” the headline asks. In the piece, writer and psychological researcher Jean M. Twenge examines the quality of the public discourse around the topic. She knew that scientific findings are often quite different from what the public eventually hears and spreads—was that the case here? “I scoured medical-research databases,” she writes, “and quickly learned that the statistics on women’s age and fertility—used by many to make decisions about relationships, careers, and when to have children—were one of the more spectacular examples of the mainstream media’s failure to correctly report on and interpret scientific research.”
Take the widely circulated statistic that a third of women 35 to 39 won’t be pregnant within a year of trying (and almost as many will never succeed). Apparently this finding is based on a 2004 article in a medical journal, which used French birth records from 1670-1830. Twenge writes: “In other words, millions of women are being told when to get pregnant based on statistics from a time before electricity, antibiotics, or fertility treatment. Most people assume these numbers are based on large, well-conducted studies of modern women, but they are not.”
In fact, only a few of those kinds of studies have been conducted, and according to Twinge, they aren’t quite so ominous. She points to a 2004 study which found that, “with sex at least twice a week, 82 percent of 35-to-39-year-old women conceive within a year, compared with 86 percent of 27-to-34-year-olds. (The fertility of women in their late 20s and early 30s was almost identical—news in and of itself.)” Twenge goes on to lay out the possible biases informing the whole conversation, and it’s worth the read if you think about this stuff a lot.
Fertility will always naturally correlate with age—not even the most thorough study will tell us otherwise. For those who can afford it, egg-freezing is a great way to take the pressure off. But the speed at which our fertility is declining is still somewhat up for debate in the scientific community. And based on the conversations I’ve had and the reading I’ve done over the last month, the language we’re using—prime years, ticking clocks, geriatric pregnancies—seems dramatic at best, fear-mongering at worst. Aside from contributing to an overall lack of nuance in the public discourse, these words have a way of shaming women harboring quiet fears.
Learning more about my reproductive health proved to be a productive kind of curtain-pulling. It startled me as much as it humbled me, and in the end, it encouraged me to finally do some of my own research. It shouldn’t have surprised me that the conversation around fertility has been simplified in favor of making us anxious—as so often happens in matters of women’s health—but it’s comforting to know there are people out there trying to change that.
Do you think about your fertility? Is it something you’re worried about? Do you feel like you have all the information, or like it’s more of a mystery? Would you get your fertility assessed before you wanted to have kids?
Illustrations by Amber Vittoria.